Nutritional advice

Objectives:
The influence of dietary fat upon breast cancer mortality remains largely understudied despite extensive investigation into its influence upon breast cancer risk. Therefore, this review article has been conducted.

Does higher total fat or saturated fat dietary intake increase risk of breast-cancer-specific death (breast cancer mortality) among women?

Study design:
This review article included 15 prospective cohort studies investigating total fat and/or saturated fat intake (g/day) and breast cancer mortality.

Results and conclusions:
The investigators found there was no difference in risk of breast-cancer-specific death [HR = 1.14, 95% CI = 0.86 to 1.52, p = 0.34, n = 6] or all-cause death [HR = 1.73, 95% CI = 0.82 to 3.66, p = 0.15, n = 4] for women in the highest versus lowest category of total fat dietary intake.
No difference because HR of 1 was found in the 95% CI of 0.82 to 3.66. HR of 1 means no risk/association.

The investigators found for the highest versus lowest category of saturated fat dietary intake, a significantly increased risk of 51% for breast-cancer-specific death among women [HR = 1.51, 95% CI = 1.09 to 2.09, p 0.01 n = 4].
Significant because HR of 1 was not found in the 95% CI of 1.09 to 2.09. HR of 1 means no risk/association.

The investigators concluded that higher saturated fat dietary intake increases risk of breast-cancer-specific death among women.

Original title:
Dietary fat and breast cancer mortality: A systematic review and meta-analysis by Brennan SF, Woodside JV, […], Cantwell MM.

Link:
https://pubmed.ncbi.nlm.nih.gov/25692500/

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A diet high in saturated fat is a diet with more than 10 En% saturated fat.
The most easy way to follow a diet with more than 10 En% saturated fat is to choose only meals/products with more than 10 En% saturated fat. Check here which products contain more than 10 En% saturated fat.

However, the most practical way to follow a diet with more than 10 En% saturated fat is, all meals/products that you eat on a daily basis should contain on average more than 10 En% saturated fat.

To do this, use the 7-points nutritional profile app to see whether your daily diet contains more than 10 En% saturated fat.

However, a diet with more than 10 En% saturated fat is an unhealthy diet.

A diet low in saturated fat is a diet with maximum 7 En% saturated fat.
 

Objectives:
Approximately 600 million children of preschool and school age are anaemic worldwide. It is estimated that at least half of the cases are due to iron deficiency. Point-of-use fortification of foods with micronutrient powders (MNP) has been proposed as a feasible intervention to prevent and treat anaemia. It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form, to energy-containing foods (excluding beverages) at home or in any other place where meals are to be consumed. MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to assess the effects of point-of-use fortification of foods with iron-containing MNP alone, or in combination with other vitamins and minerals on nutrition, health and development among children at preschool (24 to 59 months) and school (5 to 12 years) age, compared with no intervention, a placebo or iron-containing supplements.

Study design:
This review article included 13 trials (RCTs and quasi-RCTs) involving 5,810 participants from Latin America, Africa and Asia, of which 6 ongoing/unpublished trials.
All trials compared the provision of MNP for point-of-use fortification with no intervention or placebo. No trials compared the effects of MNP versus iron-containing supplements (as drops, tablets or syrup).
The sample sizes in the included trials ranged from 90 to 2193 participants. 6 trials included participants younger than 59 months of age only, 4 included only children aged 60 months or older and 3 trials included children both younger and older than 59 months of age.

The iron doses varied from 2.5 mg to 30 mg of elemental iron. 4 trials reported giving 10 mg of elemental iron as sodium iron ethylenediaminetetraacetic acid (NaFeEDTA), chelated ferrous sulphate or microencapsulated ferrous fumarate. 3 trials gave 12.5 mg of elemental iron as microencapsulated ferrous fumarate. 3 trials gave 2.5 mg or 2.86 mg of elemental iron as NaFeEDTA. 1 trial gave 30 mg and 1 trial provided 14 mg of elemental iron as microencapsulated ferrous fumarate, while 1 trial gave 28 mg of iron as ferrous glycine phosphate.

Micronutrient powders contained from 2 to 18 vitamins and minerals

Results and conclusions:
The investigators found in comparison with receiving no intervention or a placebo, children receiving iron-containing micronutrient powders for point-of-use fortification of foods had a significantly lower risk of 34% for anaemia prevalence [prevalence ratio = 0.66, 95% CI = 0.49 to 0.88, 10 trials, 2,448 children; moderate-quality evidence].

The investigators found in comparison with receiving no intervention or a placebo, children receiving iron-containing micronutrient powders for point-of-use fortification of foods had a significantly lower risk of 65% for iron deficiency [prevalence ratio = 0.35, 95% CI = 0.27 to 0.47, 5 trials, 1,364 children; moderate-quality evidence].

The investigators found in comparison with receiving no intervention or a placebo, children receiving iron-containing micronutrient powders for point-of-use fortification of foods had higher haemoglobin levels [mean difference MD = 3.37 g/L, 95% CI = 0.94 to 5.80, 11 trials, 2,746 children; low-quality evidence].

The investigators found in comparison with receiving no intervention or a placebo, no effect on diarrhoea among children receiving iron-containing micronutrient powders for point-of-use fortification of foods was observed [risk ratio = 0.97, 95% CI = 0.53 to 1.78, 2 trials, 366 children; low-quality evidence].

The investigators concluded point-of-use fortification of foods with micronutrient powders containing iron (2.5 mg to 30 mg of elemental iron) reduces anaemia and iron deficiency in preschool- and school-age children. However, information on mortality, morbidity, developmental outcomes and adverse effects is still scarce.

Original title:
Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age by De-Regil LM, Jefferds MED and Peña-Rosas JP.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29168569

Additional information of El Mondo:
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Objectives:
Artemisinin combination therapies (ACTs), the most efficacious antimalarials available, are the recommended first-line treatment for Plasmodium falciparum malaria except in the first trimester of pregnancy. Animal embryotoxicity data and the scarcity of safety data in human pregnancies, have prevented artemisinin derivatives from being recommended for malaria treatment in the first trimester except in lifesaving circumstances. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to compare the risk of miscarriage, stillbirth and major congenital anomaly (primary outcomes) among first-trimester pregnancies treated with artemisinin derivatives versus quinine or no antimalarial treatment.

Study design:
This review article included 5 prospective observational studies involving 30,618 pregnancies; 4 from sub-Saharan Africa (n = 6,666 pregnancies, 6 sites) and 1 from Thailand (n = 23,952).

Results and conclusions:
The investigators found no difference in the risk of miscarriage associated with the use of artemisinins anytime during the first trimester (n = 37/671) compared with quinine [adjusted hazard ratio = 0.73, 95% CI = 0.44 to 1.21, I2 = 0%, p = 0.228, n = 96/945].

The investigators found pregnancies treated with quinine during the first trimester were associated with significantly increased risk of 48% of miscarriage compared with pregnancies not treated with an antimalarial [adjusted hazard ratio = 1.48, 95% CI = 1.18 to 1.86]. However, in the sensitivity analysis the association between miscarriage and first-trimester quinine treatment compared with no antimalarial treatment was no longer significant when data from Thailand were omitted [adjusted hazard ratio = 2.12, 95% CI = 0.76 to 5.94, p = 0.153].
Significant because RR of 1 was not found in the 95% CI of 1.18 to 1.86. RR of 1 means no risk/association.

The investigators found pregnancies treated with artemisinins during the first trimester were not associated with an increased risk of miscarriage compared with pregnancies not treated with an antimalarial [adjusted hazard ratio = 1.16, 95% CI = 0.81 to 1.66].
Not associated because adjusted hazard ratio of 1 was found in the 95% CI of 0.81 to 1.66. Adjusted hazard ratio of 1 means no risk/association.

The investigators found no difference in the risk of stillbirth associated with the use of artemisinins anytime during the first trimester (n = 10/654) compared with quinine [adjusted hazard ratio = 0.29, 95% CI = 0.08 to 1.02, p = 0.053, n = 11/615].

The investigators found neither treatment with an artemisinin nor quinine was associated with an increased risk of stillbirths compared to pregnancies without any antimalarial treatment in the first trimester [adjusted hazard ratio = 0.65, 95% CI = 0.34 to 1.23 and adjusted hazard ratio = 1.35, 95% CI = 0.69 to 2.65, respectively].

The investigators found no difference in the risk of miscarriage and stillbirth combined (pregnancy loss) associated with the use of artemisinins anytime during the first trimester (n = 10/654) compared with quinine [adjusted hazard ratio = 0.58, 95% CI = 0.36 to 1.02, p = 0.099]. 

The investigators found the prevalence of major congenital anomalies was similar for first-trimester artemisinin [1.5%, 95% CI = 0.6% to 3.5%] and quinine exposures [1.2%, 95% CI = 0.6% to 2.4%].

The investigators concluded that first-trimester use of artemisinin derivatives is not associated with an increased risk of miscarriage or stillbirth compared to quinine. The data to date also indicate no difference in the prevalence of major anomalies between treatment groups in early pregnancy, although the numbers of major anomalies were small. Three-day artemisinin combination therapy (ACT) regimens are currently recommended to treat malaria in the second and third trimester. Expanding ACT recommendations to include the first trimester may outweigh the adverse outcomes of partially treated malaria due to poor adherence to 7 days oral quinine regimens in early pregnancy.

Original title:
First-trimester artemisinin derivatives and quinine treatments and the risk of adverse pregnancy outcomes in Africa and Asia: A meta-analysis of observational studies by Dellicour S, Sevene E, […], Stergachis A.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412992/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, pregnancy and study design/meta-analysis/significant right here.

Objectives:
There is no agreed standard method to assess the efficacy of antimalarial drugs for uncomplicated falciparum in pregnancy despite an increased risk of adverse outcomes for the mother and the fetus. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to update the currently available efficacy data of artemisinin-based treatments (ABT) and quinine-based treatments (QBT) from both observational and interventional cohort studies in all trimesters with uncomplicated falciparum malaria.  

Study design:
This review article included 48 studies with 7,279 treated Plasmodium falciparum episodes, of which 22 RCTs comparing two or more treatment regimens.
14 studies included women treated with QBT, 40 studies included ABT and 6 studies included both. Altogether, 6244 and 1035 episodes were treated with ABT or QBT, respectively.

First trimester women were included in 12 studies none of which were, however, RCTs of ABT treated.

Results and conclusions:
The investigators found that while polymerase chain reaction (PCR) was used in 24 studies for differentiating recurrence, the assessment and reporting of treatment efficacy was heterogeneous.

The investigators found when the same definition could be applied, PCR-corrected treatment failure of ≥ 10% at any time points was observed in 3/30 ABT and 3/7 QBT arms.

The investigators found in 5 RCTs compared ABT and QBT that the risk of treatment failure was significantly lower in ABT than in QBT [risk ratio = 0.22, 95% CI = 0.07-0.63], although the actual drug combinations and outcome endpoints were different. There was no evidence for asymmetry of the funnel plot suggesting publication bias [p = 0.7].
However, none of these 5 RCTs included pregnant women in the first trimester.

The investigators concluded that efficacy studies in pregnancy are not only limited in number but use varied methodological assessments. In 5 RCTs with comparable methodology, ABT resulted in higher efficacy than QBT in the second and third trimester of pregnancy. Individual patient data meta-analysis can include data from observational cohort studies and could overcome some of the limitations of the current assessment given the paucity of data in this vulnerable group.

Original title:
Systematic literature review and meta-analysis of the efficacy of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy: methodological challenges by Saito M, Gilder ME, […], Guérin PJ.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729448/

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Objectives:
Atovaquone/proguanil, registered as Malarone®, is a fixed-dose combination recommended for first-line treatment of uncomplicated Plasmodium falciparum malaria in non-endemic countries and its prevention in travellers. Mutations in the cytochrome bc1 complex are causally associated with atovaquone resistance. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to assess the clinical efficacy of atovaquone/proguanil treatment of uncomplicated malaria and examines the extent to which codon 268 mutation in cytochrome b influences treatment failure and recrudescence based on published information.

Study design:
This review article included 27 P. falciparum studies with 1960 patients, of whom 1695 were treated and followed up to 28 days (86.5%). A total of 1640 patients were successfully treated up to 28 days, 83.7% of the 1960 original patients and 96.8% of the 1695 treated and followed-up patients. Most of the 27 studies were of low methodological quality, being small and having between 18 and 253 participants receiving atovaquone/proguanil.

14 of the 27 studies were RCT designed to test the efficacy of atovaquone/proguanil or used atovaquone/proguanil as a control treatment and participants of these made up only 55% of the total participants.

Results and conclusions:
The investigators found that atovaquone/proguanil treatment efficacy was 89%-98% for P. falciparum malaria (from 27 studies including between 18 and 253 patients in each case) and 20%-26% for Plasmodium vivax malaria (from 1 study including 25 patients).

The investigators found that the in vitro P. falciparum phenotype of atovaquone resistance was an IC50 value >28 nM.

The investigators found in case report analyses that recrudescence in a patient presenting with parasites carrying cytochrome b codon 268 mutation would occur on average at day 29 [95% CI = 22-35], 19 [95% CI = 7-30] days longer than if the mutation is absent.

The investigators concluded that atovaquone/proguanil therapy is comparable in efficacy to ACT used in treating uncomplicated malaria. Late treatment failure is likely to be associated with a codon 268 mutation in cytochrome b, though recent evidence from animal models suggests these mutations may not spread within the population. However, early treatment failure is likely to arise through alternative mechanisms, requiring further investigation.

Original title:
Clinical implications of Plasmodium resistance to atovaquone/proguanil: a systematic review and meta-analysis by Staines HM, Burrow R, […], Krishna S.

Link:
https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkx431/4693708

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Objectives:
What is the relationship between serum, dietary and urinary potassium and the risk of type 2 diabetes mellitus (T2DM)?  

Study design:
This review article included 8 prospective cohort studies involved 5,053 type 2 diabetes mellitus cases among 119,993 individuals.
The follow-up durations were from 5 to 18.1 years with a baseline age range from 18 to 95 years.
Serum potassium was measured using the ion-selective electrode method. Dietary potassium was estimated from food frequency questionnaire (FFQ). Urinary potassium samples were analyzed by potentiometric methods.
Most of the included studies provided risk estimates adjusted for age, sex, race, BMI and family history of diabetes.

Results and conclusions:
The investigators found in 5 studies involving 28,944 individuals and 3,849 type 2 diabetes mellitus cases, a non-significantly reduced risk of 21% [summary RR = 0.79, 95% CI = 0.60-1.04, I2 = 76.7%] for type 2 diabetes mellitus, when comparing the highest versus lowest serum potassium levels.
However, the sensitivity analysis did show a significant inverse association between serum potassium and type 2 diabetes mellitus risk [RR = 0.63, 95% CI = 0.52-0.73, I2 = 0%].

The investigators found in random dose-response meta-regression analysis a significantly reduced risk of 17% for type 2 diabetes mellitus [RR = 0.83, 95% CI = 0.73-0.95] per 1 mmol/L increase in serum potassium.

The investigators found in 6 studies involving 112,125 individuals and 4,573 type 2 diabetes mellitus cases, a non-significantly reduced risk of 7% [RR = 0.93, 95% CI = 0.81-1.06, I2 = 0.0%, p = 0.52] for type 2 diabetes mellitus, when comparing the highest versus lowest dietary potassium intake.
The sensitivity analysis did not significantly alter the association between dietary potassium and type 2 diabetes mellitus risk.

The investigators found there was no significant dose-response relationship between dietary potassium and type 2 diabetes mellitus risk [RR for every 1000mg increase dietary potassium per day = 1.00, 95% CI = 0.96-1.05].

The investigators found in 3 studies involving 4,376 individuals and 455 type 2 diabetes mellitus cases, a non-significantly reduced risk of 17% [RR = 0.83, 95% CI = 0.39-1.75, I2 = 73.9%, p = 0.02] for type 2 diabetes mellitus, when comparing the highest versus lowest urinary potassium levels.

The investigators found there was no significant dose-response relationship between urinary potassium levels and type 2 diabetes mellitus risk [RR for 10 mmol increase in urinary potassium per 24 hours = 1.00, 95% CI = 0.95-1.05].

The investigators concluded that serum potassium levels are linearly associated with the risk of type 2 diabetes mellitus, with each 1 mmol/L increase in serum potassium lowering the risk by 17%. However, neither dietary potassium nor urinary potassium shows any association with the risk of type 2 diabetes mellitus.

Original title:
Potassium measurements and risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies by Peng Y, Zhong GC, […], Yang G.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725047/

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Objectives:
The World Health Organization recommends participatory learning and action (PLA) in women’s groups to improve maternal and newborn health, particularly in rural settings with low access to health services. There have been calls to understand the pathways through which this community intervention may affect neonatal mortality. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to examine the effect of women’s groups on key antenatal, delivery and postnatal behaviours in order to understand pathways to mortality reduction.

Study design:
This review article included data from 7 cluster-randomised controlled trials that took place between 2001 and 2012 in rural India (2 trials), urban India (1 trial), rural Bangladesh (2 trials), rural Nepal (1 trial) and rural Malawi (1 trial), with the number of participants ranging between 6,125 and 29,901 live births.

There is a high degree of heterogeneity for effects on most behaviours, possibly due to the limited number of trials involving women’s groups and context-specific effects.

Results and conclusions:
The investigators found overall, women’s groups practising participatory learning and action significantly improved behaviours during and after home deliveries, including: 
-the use of safe delivery kits [during: OR = 2.92, 95% CI = 2.02-4.22, I2 = 63.7% and after: 95% CI = 4.4%-86.2%];
-the use of a sterile blade to cut the umbilical cord [during: OR = 1.88, 95% CI = 1.25-2.82, I2 = 67.6% and after 95% CI = 16.1%-87.5%];
-birth attendant washing hands prior to delivery [during: OR = 1.87, 95% CI = 1.19-2.95, I2 = 79% and after: 95% CI = 53.8%-90.4%];
-delayed bathing of the newborn for at least 24 hours [during: OR = 1.47, 95% CI = 1.09-1.99, I2 =  68.0% and after 29.2%-85.6%] and;
-wrapping the newborn within 10 minutes of delivery [during: OR = 1.27, 95% CI = 1.02-1.60, I2 =  0.0% and after: 95% CI = 0%-79.2%]. Significant because RR of 1 was not found in the 95% CI of 1.02 to 1.60. RR of 1 means no risk/association.
Effects were partly dependent on the proportion of pregnant women attending groups.

The investigators found overall, women’s groups practising participatory learning and action non-significantly improved behaviours during and after home deliveries, for:  
-uptake of antenatal care [during: OR = 1.03, 95% CI = 0.77-1.38, I2 = 86.3% and after: 95% CI = 73.8%-92.8%];
-facility delivery [during: OR = 1.02, 95% CI = 0.93-1.12, I2 = 21.4% and after: 95% CI = 0%-65.8%];
-initiating breastfeeding within 1 hour [during OR = 1.08, 95% CI = 0.85-1.39, I2 = 76.6% and after: 95% CI = 50.9%-88.8%] or;
-exclusive breastfeeding for 6 weeks after delivery [during OR = 1.18, 95% CI = 0.93-1.48, I2 = 72.9% and after: 95% CI = 37.8%-88.2%]. Non-significantly because RR of 1 was found in the 95% CI of 0.93 to 1.48. RR of 1 means no risk/association.

The investigators concluded that women’s groups practising participatory learning and action improve key behaviours on the pathway to neonatal mortality, with the strongest evidence for home care behaviours and practices during home deliveries. A lack of consistency in improved behaviours across all trials may reflect differences in local priorities, capabilities and the responsiveness of health services. Future research could address the mechanisms behind how participatory learning and action improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children and adolescents.  

Original title:
Effects of women’s groups practising participatory learning and action on preventive and care-seeking behaviours to reduce neonatal mortality: A meta-analysis of cluster-randomised trials by Seward N, Neuman M, […], Prost A.

Link:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002467

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Objectives:
Several studies have been conducted on the relationship between tea intake and the risk of osteoporosis. The results from these studies are, however, inconsistent. Therefore, this review article (meta-analysis) has been conducted.

Does tea intake reduce risk of osteoporosis?

Study design:
This review article included 2 prospective cohort studies, 4 cross-sectional studies and 11 case-control studies with 107,819 cases (people with osteoporosis). In the present study, the main symptom of osteoporosis was hip fracture.
10 studies - case-control and cohort studies were all of high quality - were in relative high quality (over 6 stars) with an average NOS score of 7.23.

The heterogeneity in the present review article mainly came from Asia group, female group, prospective cohort study group and case-control study group.

There was no publication bias of the meta-analysis about tea consumption and osteoporosis.

Results and conclusions:
The investigators found for the highest versus the lowest categories of tea consumption a significantly reduced risk of 38% [total OR = 0.62, 95% CI = 0.46-0.83, I2  =  94%, p   0 .01] for osteoporosis. However, when reducing heterogeneity, the overall OR [95% CI = 0.57-0.74, I2 = 30%] was still significant.
Subgroup analysis showed that tea consumption significantly reduced the risk of osteoporosis in all examined subgroups.

The investigators found stratified by categories of osteoporosis, a significantly reduced risk of 26% [OR  =  0.74, 95% BI = 0.63-0.88] for hip fracture.

The investigators found among women a significantly reduced risk of 27% [OR  =  0.73, 95% CI = 0.54-0.99] for osteoporosis.

The investigators concluded that high tea consumption reduces risk of osteoporosis, particularly hip fracture and particularly among women. However, the exact mechanism of the relationship between tea consumption and osteoporosis still needs further research.

Original title:
Association between tea consumption and osteoporosis: A meta-analysis by Sun K, Wang L, [...], Li X.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728912/

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Objectives:
Fish oil supplementation has been shown to be associated with a lower risk of metabolic syndrome and benefit a wide range of chronic diseases, such as cardiovascular disease, type 2 diabetes and several types of cancers. However, the evidence of fish oil supplementation on glucose metabolism and insulin sensitivity is still controversial. Therefore, this review article (meta-analysis) has been conducted.

Does fish oil supplementation improve insulin sensitivity in humans?

Study design:
This review article included a total of 17 RCTs with 672 participants. One of the 17 studies was crossover design and others were parallel design.
The doses of active ingredients of fish oil (n-3 fatty acids) ranged from 1 g/d to 4 g/d. Duration of the interventions was ranged from 4 weeks to 24 weeks.
There was no suggestion of small study effect based on visual inspection of the funnel plot. Results of the Egger’s (p = 0.78) and Begg’s (p = 0.43) tests showed that there was no potential publication bias.

Results and conclusions:
The investigators found pooled analysis showed that fish oil supplementation had no effects on insulin sensitivity overall [SMD = 0.17, 95% CI = -0.15 to 0.48, p = 0.292, I2 = 58.1%, p = 0.001].

The investigators found subgroup analysis showed that fish oil supplementation significantly improved insulin sensitivity among people who were experiencing at least one symptom of metabolic disorders [SMD = 0.53, 95% CI = 0.17 to 0.88, p 0.001].

The investigators found subgroup analysis showed a positive effect of fish oil on insulin sensitivity among the short-term intervention group (12 weeks) rather than the long-term intervention group [SMD = 0.31, 95% CI = 0.01-0.61, p = 0.04].

The investigators found subgroup analysis showed that fish oil had no effects on insulin sensitivity among the healthy people or people with T2DM.

The investigators found there were no significant differences between subgroups of methods of insulin sensitivity and doses of omega-3 polyunsaturated fatty acids (n-3 PUFA) of fish oil supplementation.

The investigators found in sensitivity analysis that summary results did not differ significantly when omitting studies one at a time.

The investigators concluded that fish oil supplementation during 12 weeks improves insulin sensitivity among people who were experiencing at least one symptom of metabolic disorders.

Original title:
Fish oil supplementation and insulin sensitivity: a systematic review and meta-analysis by Gao H, Geng T, [...], Zhao Q.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496233/

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Objectives:
Intermittent preventive treatment (IPT) for malaria is used in infants, children, adults and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to assess the efficacy, safety and tolerability of repeated dosing of dihydroartemisinin-piperaquine when used for case management, intermittent preventive treatment, mass drug administration or seasonal malaria chemoprevention?

Study design:
This review article included 1 cohort study in pregnant women (n = 5,288), 1 RCT of repeated treatments in children younger than 5 years (n = 312) and 9 RCTs with IPT/SMC.
Of the 9 RCTs, 5 were in children younger than 5 years (n = 5,481), 1 in schoolchildren (n = 740), 1 in adult men at occupational risk of malaria (n = 961) and 2 in pregnant women (n = 1,846).
In total, there were 14,628 participants; 4,883 in dihydroartemisinin-piperaquine (DP) groups, of whom 4,511 were exposed to DP and 3,935 received at least two courses of DP, including 762 pregnant women and 1,913 children aged less than 5 years. The remaining 9,745 were exposed to placebo or other comparator therapy (including 990 exposed to SP–piperaquine).
The 4,511 participants exposed to dihydroartemisinin-piperaquine (DP) received a total of 18,873 courses, with 18,297 courses taken by the 3,935 participants who received at least two doses, some of whom received as many as 18 monthly doses.

All studies were conducted in areas with no or low parasite resistance to piperaquine or the artemisinins.

Results and conclusions:
The investigators found monthly dihydroartemisinin-piperaquine for intermittent preventive treatment for malaria was associated with an 84% [IRR = 0.16, 95% CI = 0.06-0.26, I2 = 99.4%, p = 0.000] reduction in the incidence of malaria parasitaemia measured by microscopy compared with placebo.

The investigators found monthly dihydroartemisinin-piperaquine for intermittent preventive treatment was associated with fewer serious adverse events than placebo, daily co-trimoxazole or monthly SP.

The investigators found among 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP.

The investigators concluded that monthly dihydroartemisinin-piperaquine appears well tolerated and effective for intermittent preventive treatment for malaria. However, additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing.

Original title:
Safety, tolerability, and efficacy of repeated doses of dihydroartemisinin-piperaquine for prevention and treatment of malaria: a systematic review and meta-analysis by Gutman J, Kovacs S, [...], ter Kuile FO.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266794/

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Intermittent preventive treatment (IPT) or intermittent preventive therapy is a public health intervention aimed at treating and preventing malaria episodes in infants, children, schoolchildren and pregnant women.

Objectives:
Women have a 50% risk of urinary tract infection (UTI) over their lifetime and 20-30% experience a subsequent urinary tract infection recurrence. Cranberry (Vaccinium spp.) has been advocated for treatment of urinary tract infection; however, its efficacy is controversial. Therefore, this review article (meta-analysis) has been conducted.

Does cranberry reduce the risk of urinary tract infection recurrence in healthy women?

Study design:
This review article included 7 RCTs conducted in healthy nonpregnant women aged ≥18 years with a history of urinary tract infection (n = 1498 participants).
Risk of bias indicated that 2 studies had high loss to follow-up or selective outcome reporting. Overall, the studies were relatively small, with only 2 having >300 participants.

Results and conclusions:
The investigators found that cranberry significantly reduced the risk of urinary tract infection by 26% [pooled risk ratio = 0.74, 95% CI = 0.55-0.98, I2 = 54%].

The investigators concluded that cranberry may be effective in preventing urinary tract infection recurrence in generally healthy women. May be effective because the studies were relatively small, with only 2 having >300 participants. Therefore, larger high-quality studies are needed to confirm these findings.

Original title:
Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis by Zhuxuan Fu, DeAnn Liska, […], Mei Chung.

Link:
http://jn.nutrition.org/content/147/12/2282.abstract

Additional information of El Mondo:
Find more information/studies on chronic disease and fruit right here.
 

Objectives:
Previous studies have shown that fish consumption and dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFAs) are associated with hip fracture; however, findings were conflicting. Therefore, this review article (meta-analysis) has been conducted.

Do both dietary intake of fish and n-3 polyunsaturated fatty acids decrease hip fracture risk?

Study design:
This review article included 7 prospective cohort studies and 3 case-control studies with a total sample size of 29,2657 participants. The age of participants was 20 years or older.

Results and conclusions:
The investigators found combining 8 effect sizes from 4 prospective cohort studies and 2 case-control studies revealed a significant inverse association between fish consumption and risk of hip fracture [pooled effect size = 0.88, 95% CI = 0.79-0.98, p = 0.02].
Although this relationship became non-significant in prospective cohort studies, a significant inverse association was found in prospective cohort studies with sample size of 10,000 individuals or more and studies that considered body mass index as a covariate.

The investigators also found dietary intake of n-3 PUFAs significantly reduced risk of hip fracture with 12% [pooled effect size = 0.88, 95% CI = 0.80-0.98, p = 0.02].

The investigators concluded that both fish consumption and dietary intake of n-3 PUFAs have protective effects on bone health and decline the risk of hip fracture.

Original title:
Dietary intake of fish, n-3 polyunsaturated fatty acids and risk of hip fracture: A systematic review and meta-analysis on observational studies by Sadeghi O, Djafarian K, […], Shab-Bidar S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29244536

Additional information of El Mondo:
Find more information/studies on fish consumption, n-3 PUFAs and elderly right here.

Fatty acids in fish are all n-3 PUFAs.
 

Objectives:
Although there is an overall reduction in underfive mortality rate, the progress in reducing neonatal mortality rate has been very slow. Over the last 20 years, preterm births have steadily increased in low-income and medium-income countries (LMICs) particularly in sub-Saharan Africa and South Asia. Preterm birth is associated with increased mortality and morbidity, particularly in LMICs. Based on systematic reviews of randomised controlled trials (RCTs), many neonatal units in high-income countries have adopted probiotics as standard of care for preterm neonates. Therefore, this review article (meta-analysis) has been conducted.

Do probiotics reduce mortality and morbidity in preterm neonates (born 37 weeks) in low-income and medium-income countries?

Study design:
This review article included 23 RCTs (n = 4783) conducted in 10 different low-income and medium-income countries in 4 continents with preterm neonates born at a gestational age (GA) 37 weeks or LBW (2500 g) or both.

Out of the 23 included studies, single-strain probiotics were used in 11 studies, whereas 12 used multiple strains. Lactobacillus was part of the supplementation in 13 studies; Bifidobacterium was part of the supplementation in 11 studies and Saccharomyces in 3 studies.

The results were significant on random effects model analysis and after excluding studies with high risk of bias. No significant adverse effects were reported.

Results and conclusions:
The investigators found in 20 trials (n = 4022), a significantly reduced risk of 54% [risk ratio = 0.46, 95% CI = 0.34 to 0.61, p 0.00001, I2 = 19%, p = 0.22] for the risk of necrotising enterocolitis (NEC greater than or equal to stage II) for probiotic supplemented neonates.
The numbers needed to treat (NNT) with probiotics to prevent one case of necrotising enterocolitis was 25 [95% CI = 20 to 50].

The investigators found in 18 trials (n = 4062), a significantly reduced risk of 20% [risk ratio = 0.80, 95% CI= 0.71 to 0.91, p = 0.0009, I2 = 25%, p = 0.16] for the risk of late-onset sepsis (LOS) for probiotic supplemented neonates.
The numbers needed to treat (NNT) with probiotics to prevent one case of late-onset sepsis was 25 [95% CI = 17 to 50].

The investigators found in 19 trials (n = 4196), a significantly reduced risk of 27% [risk ratio = 0.73, 95% CI = 0.59 to 0.90, p = 0.003, I2 = 0%, p = 0.67] for the risk of all-cause mortality for probiotic supplemented neonates.
The numbers needed to treat (NNT) to prevent one death by probiotic supplement was 50 [95% CI = 25 to 100].

The investigators concluded that probiotics have significant potential to reduce mortality and morbidity (eg, NEC, LOS) in preterm neonates (born 37 weeks) in low-income and medium-income countries. Considering the burden of death, disease (NEC, LOS) and suboptimal nutrition in preterm neonates in LMICs, cooperation between various stake holders (eg, industry, scientists, regulatory agencies) is warranted to either develop or to improve access to high-quality safe and effective probiotics in such set-ups. Support from organisations such as the WHO is important in providing access to probiotics for the countries (eg, sub-Saharan Africa) where most prematurity related deaths occur. Whether probiotics could be used for research and/or routine use in preterm neonates in LMICs will depend on the national health priorities, resources and ethics.

Original title:
Benefits of probiotics in preterm neonates in low-income and medium-income countries: a systematic review of randomised controlled trials by Deshpande G, Jape G, […],Patole S.

Link:
http://bmjopen.bmj.com/content/7/12/e017638

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, probiotics and study design/meta-analysis/significant right here.

Objectives:
Randomised controlled trials comparing low- versus high-fat diets on cardiometabolic risk factors in people with overweight or obesity have shown inconsistent results, which may be due to the mixed metabolic status of people with excess adiposity. The role of dietary fat manipulation in modifying cardiometabolic indicators in people with overweight or obese without metabolic disturbance is unclear. Therefore, this review article (meta-analysis) has been conducted.

Does a low-fat diet modify cardiometabolic indicators in people who are overweight (BMI>25) or obese (BMI>30) without metabolic disturbance?

Study design:
This review article included 20 RCTs with 2,106 participants.

Results and conclusions:
The investigators found total cholesterol levels in people who are overweight or obese without metabolic disturbance were significantly lower following low-fat diet compared with high-fat diet [WMD = -7.05 mg/dL, 95% CI = -11.30 to -2.80, p = 0.001].  

The investigators found LDL-cholesterol levels (bad cholesterol) in people who are overweight or obese without metabolic disturbance were significantly lower following low-fat diet compared with high-fat diet [WMD = -4.41 mg/dL, 95% CI = -7.81 to -1.00, p = 0.011].  

The investigators found HDL-cholesterol levels (good cholesterol) in people who are overweight or obese without metabolic disturbance were significantly lower following low-fat diet compared with high-fat diet [WMD = -2.57 mg/dL, 95% CI = -3.85 to -1.28, p 0.001].  

The investigators found TAG levels (blood fat levels) in people who are overweight or obese without metabolic disturbance were significantly higher following low-fat diet compared with high-fat diet [WMD = -11.68 mg/dL, 95% CI = 5.90 to 17.45, p 0.001].  

The investigators concluded a low-fat diet reduces cholesterol and TAG levels in people with overweight or obesity without metabolic disturbances.

Original title:
Effects of low-fat compared with high-fat diet on cardiometabolic indicators in people with overweight and obesity without overt metabolic disturbance: a systematic review and meta-analysis of randomised controlled trials by Lu M, Wan Y, [...], Li D.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29212558

Additional information of El Mondo:
Find more information/studies on fat, cholesterol and overweight right here.

A triglyceride (TG, triacylglycerol, TAG or triacylglyceride) is an ester derived from glycerol and three fatty acids. Triglycerides are the main constituents of body fat in humans.

Those with overweight or obesity are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Objectives:
There is considerable evidence of the favourable role of more physical activity (PA) in fighting against dementia. However, the shape of the dose-response relationship is still unclear. Therefore, this review article (meta-analysis) has been conducted.

Does leisure time physical activity reduce risk of all-cause dementia (ACD), Alzheimer’s disease (AD) and vascular dementia (VD) in dose-response manner?

Study design:
This review article included 15 cohort studies with 37,436 participants for all-cause dementia, with 25,031 participants for Alzheimer’s disease and with 16,797 participants for vascular dementia.
During follow-up (3-31.6 years for all-cause dementia, 3.9-31.6 years for Alzheimer’s disease and 4-11.9 years for vascular dementia), at least 2,665, 1,337 and 343 participants who were not suffering from dementia at baseline (=at the beginning of the study) were diagnosed with all-cause dementia, Alzheimer’s disease and vascular dementia, respectively.

There was no publication bias.

Results and conclusions:
The investigators found in the dose-response analysis, either all-cause dementia [p trend 0.005 and p non-linearity = 0.87] or Alzheimer’s disease [p trend 0.005 and p non-linearity = 0.10] exhibited a linear relationship with leisure time physical activity over the observed range (0-2000 kcal/week or 0-45 metabolic equivalent of task hours per week (MET-h/week)).

The investigators found for every 500 kcal or 10 MET-h increase per week, a significantly 10% [95% CI = 0.85-0.97] and 13% [95% CI = 0.79-0.96] decrease in the risk of all-cause dementia and Alzheimer’s disease, respectively.

The investigators concluded leisure time physical activity over a specific range (0-2000 kcal/week or 0-45 MET-h/week) is associated with a risk of dementia and Alzheimer’s disease in an inverse linear dose-response manner; with for every 500 kcal (calories) or 10 MET-h increase per week, a 10% and 13% decrease in the risk of all-cause dementia and Alzheimer’s disease, respectively.

Original title:
Leisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies by Xu W, Wang HF, [...], Tan L.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5665289/

Additional information of El Mondo:
Find more information/studies on physical activities and dementia here.

If you do a 4 MET activity for 30 minutes, you have done 4 x 30 = 120 MET-minutes or 2.0 MET-hours of physical activity.
 

Objectives:
The aim of this meta-analysis (review article) is to evaluate the influence of dietary intake and blood level of vitamin A (total vitamin A, retinol or β-carotene) on total and hip fracture risk?

Study design:
This review article included 11 prospective cohort studies and 2 nested case-control studies, involving a total of 319,077 participants over the age of 20 years (109,056 post-menopausal women).

Results and conclusions:
The investigators found higher dietary intake of retinol significantly decreased total fracture risk with 5% [RR = 0.95, 95% CI = 0.91 to 1.00, I2 = 64.64%, p = 0.04].

The investigators found higher dietary intake of retinol significantly increased hip fracture risk with 40% [RR = 1.40, 95% CI = 1.02 to 1.91, I2 = 30.01%, p = 0.40].

The investigators found higher dietary intake of vitamin A significantly decreased total fracture risk with 6% [RR = 0.94, 95% CI = 0.88 to 0.99, I2 = 35.18%, p = 0.20].

The investigators found higher dietary intake of vitamin A significantly increased hip fracture risk with 29% [RR = 1.29, 95% CI = 1.06 to 1.57, I2 = 0.00%, p = 0.60].

The investigators found lower blood level of retinol significantly increased hip fracture risk with 27% [RR = 1.27, 95% CI = 1.05 to 1.53, I2 = 0.00%, p = 0.62].

The investigators concluded that higher dietary intake of total vitamin A or retinol increases the risk of hip fracture but decreases total fracture risk. Clinical trials are warranted to confirm these results and assess the clinical applicability.

Original title:
The Effect of Vitamin A on Fracture Risk: A Meta-Analysis of Cohort Studies by Zhang X, Zhang R, [...], Chen G.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615580/

Additional information of El Mondo:
Find more information/studies on vitamin A and elderly right here.

Vitamin A is a generic term for compounds with the biological activity of retinol. Preformed vitamin A (mainly retinol and retinyl esters) is usually found in foods derived from animal products and provitamin A (mainly β-carotene and carotenoids) is usually found in foods derived from plant products.
 

Objectives:
Vitamin A deficiency (VAD), a leading cause of preventable childhood blindness, has been recognized as an important public health problem in many developing countries. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to identify all population-based studies of vitamin A deficiency and marginal vitamin A deficiency (MVAD) in Chinese children published from 1990 onwards.

Study design:
This review article included 54 studies.

Results and conclusions:
The investigators found the prevalence of vitamin A deficiency and marginal vitamin A deficiency both decreased with increasing age and rural children had a higher prevalence of vitamin A deficiency and marginal vitamin A deficiency than urban children.

The investigators found in 2015, the prevalence of vitamin A deficiency was 5.16% [95% credible interval = 1.95-12.64] and that of marginal vitamin A deficiency was 24.29% [95% credible interval = 12.69-41.27] in Chinese children aged 12 years and under.

The investigators concluded that vitamin A deficiency remains a public health problem in China. Efforts to reduce vitamin A deficiency in younger children are needed, especially for those in rural areas.

Original title:
The Prevalence of Vitamin A Deficiency in Chinese Children: A Systematic Review and Bayesian Meta-Analysis by Song P, Wang J, […], An L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29186832

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, vitamin A and study design/meta-analysis/significant right here.

Objectives:
Epidemiological studies have provided controversial evidence between beverage consumption and the risk of ulcerative colitis (UC). Therefore, this review article (meta-analysis) has been conducted.

Is there a relationship between beverage consumption and risk of ulcerative colitis?

Study design:
This review article included 13 case-control studies and 3 prospective cohort studies, with a total of 3,689 cases (subjects with ulcerative colitis) and 335,339 controls (subjects without ulcerative colitis).

Egger test detected no significant publication bias.

Results and conclusions:
The investigators found high intake of soft drinks versus low intake, significantly increased risk of ulcerative colitis with 69% [pooled RR = 1.69, 95% CI = 1.24-2.30, I2  =  12.9%, p  = 0 .332].
In subgroup analysis, no substantial changes of the primary result were found between subgroups.

The investigators found high tea consumption versus low consumption, significantly decreased risk of ulcerative colitis with 31% [pooled RR = 0.69, 95% CI = 0.58-0.83, I2  =  0.0%, p  = 0 .697].
In subgroup analysis, no substantial changes of the primary result were found between subgroups.

The investigators found no significant association between alcohol [pooled RR = 1.08, 95% CI = 0.66-1.51] or coffee consumption [pooled RR = 0.58, 95% CI = 0.33-1.05, I2  =  87.5%, p    0.001] and risk of ulcerative colitis. No significant association because RR of 1 was found in the 95% CI of 0.66 to 1.51. RR of 1 means no risk/association.

The investigators concluded high consumption of soft drinks increases the risk of ulcerative colitis, while high tea consumption decreases the risk.

Original title:
Beverage consumption and risk of ulcerative colitis. Systematic review and meta-analysis of epidemiological studies by Nie JY and Zhao Q.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728934/

Additional information of El Mondo:
Find more information/studies on chronic disease, alcohol and tea consumption right here.
 

Objectives:
Over the last 7 years there has been intense debate about the advice to reduce saturated fat and increase polyunsaturated fat to reduce cardiovascular (CVD) risk. Therefore, this review article (meta-analysis) has been conducted.

Does replacement of saturated fat with carbohydrate, polyunsaturated fatty acid (PUFA) or monounsaturated fatty acid (MUFA) reduce cardiovascular risk?

Study design:
This review article included cohort studies and intervention studies.

Results and conclusions:
The investigators found replacement of saturated fat with any carbohydrate, polyunsaturated fatty acid (PUFA) and monounsaturated fatty acid (MUFA) is associated with lower mortality with PUFA being more effective than MUFA [19% reduction versus 11%].

The investigators found per 5% of energy (5 En%) replacement of saturated fat with polyunsaturated fatty acid and fish oil significantly lowered risk of cardiovascular mortality with 28%.  

The investigators found replacing saturated fat with PUFA or MUFA was equally effective at reducing coronary heart disease (CHD) events

The investigators found replacement of saturated fat with whole grains significantly lowered coronary heart disease events while replacement with sugar and starch significantly increased coronary heart disease events.

The investigators found replacement of saturated fat with carbohydrate had no effect on coronary heart disease events or death.

The investigators found only PUFA replacement of saturated fat significantly lowered coronary heart disease events and cardiovascular and total mortality.

The investigators concluded reducing saturated fat and replacing it with carbohydrate will not lower coronary heart disease events or cardiovascular mortality although it will reduce total mortality. Replacing saturated fat with PUFA, MUFA or high-quality carbohydrate will lower coronary heart disease events.

Original title:
A systematic review of the effect of dietary saturated and polyunsaturated fat on heart disease by Clifton PM and Keogh JB.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29174025

Additional information of El Mondo:
Find more information/studies on fat, carbohydrates and cardiovascular diseases right here.

Objectives:
Dietary fiber intake may provide beneficial effects on the components of metabolic syndrome (MetS); however, observational studies reported inconsistent results for the relationship between dietary fiber intake and metabolic syndrome risk. Therefore, this review article (meta-analysis) has been conducted.

Does dietary fiber intake reduce risk of metabolic syndrome?

Study design:
This review article included 11 cross-sectional studies and 3 cohort studies.
There was evidence of publication bias in cross-sectional studies.

Results and conclusions:
The investigators found in cross-sectional studies when comparing the highest with lowest categories of dietary fiber intake, a significantly reduced risk of 33% [OR = 0.67, 95% CI = 0.58-0.78, I2 = 32.4%, p = 0.181] for metabolic syndrome. However, this reduced risk was not significant in cohort studies [pooled RR = 0.86, 95% CI = 0.70-1.06]. Not significant because RR of 1 was found in the 95% CI of 0.70 to 1.06. RR of 1 means no risk/association.

The investigators concluded that a high dietary intake of fiber may reduce risk of metabolic syndrome. May reduce because there was evidence of publication bias in cross-sectional studies and the reduced risk was not significant in cohort studies. Therefore, more prospective cohort studies are needed to further verify the association between dietary fiber intake and the risk of metabolic syndrome.

Original title:
Fruit and vegetable consumption and risk of the metabolic syndrome: a meta-analysis by Tian Y, Su L, [...], Jiang X.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29151369

Additional information of El Mondo:
Find more information/studies on publication bias/cohort studies/significant, fiber consumption and overweight right here.  

Find out whether you are overweight or not right here.

Those with metabolic syndrome are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Objectives:
Several epidemiological studies have been performed to evaluate the association of fruit and vegetable consumption with risk of the metabolic syndrome (MetS), but the results remain controversial. Therefore, this review article (meta-analysis) has been conducted.

Does consumption of vegetables or fruit reduce risk of metabolic syndrome?

Study design:
This review article included a total of 9 studies for fruit consumption, 9 studies for vegetable consumption and 7 studies for fruit and vegetable consumption.

There was no evidence of small-study effect (publication bias)

Results and conclusions:
The investigators found a significantly reduced risk of 13% [pooled RR = 0.87, 95% CI = 0.82-0.92, I2 = 46.7%] for metabolic syndrome when comparing the highest fruit consumption versus the lowest consumption.

The investigators found a significantly reduced risk of 15% [pooled RR = 0.85, 95% CI = 0.80-0.91, I2 = 0.0%] for metabolic syndrome when comparing the highest vegetable consumption versus the lowest consumption.

The investigators found a significantly reduced risk of 24% [pooled RR = 0.76, 95% CI = 0.62-0.93, I2 = 83.5%] for metabolic syndrome when comparing the highest fruit and vegetable consumption versus the lowest consumption.

The investigators found in subgroup analyses stratified by continent, the inverse association of fruit consumption [RR = 0.86, 95% CI = 0.77-0.96] and vegetable consumption [RR = 0.86, 95% CI = 0.80-0.92] with risk of metabolic syndrome remained significant in Asia.

The investigators concluded that a high fruit or/and vegetable consumption reduce risk of metabolic syndrome, particularly among Asian. Therefore, people should consume more fruits and vegetables to reduce risk of metabolic syndrome.

Original title:
Fruit and vegetable consumption and risk of the metabolic syndrome: a meta-analysis by Tian Y, Su L, [...], Jiang X.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29151369

Additional information of El Mondo:
Find more information/studies on fruit and vegetables consumption and overweight right here.  

Find out whether you are overweight or not right here.

Those with metabolic syndrome are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Objectives:
The role of omega-3 polyunsaturated fatty acids (omega-3 or n-3 PUFAs) in the pathogenesis and treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD) is unclear. Therefore, this review article (meta-analysis) has been conducted.

Do children and adolescents with attention deficit hyperactivity disorder (ADHD) benefit from n-3 PUFA supplementation?

Study design:
This review article included 7 RCTs and 7 case-control studies.

Results and conclusions:
The investigators found in 7 RCTs (n = 534 randomised youth with ADHD) n-3 PUFAs supplementation significantly improved ADHD clinical symptom scores [g = 0.38, p 0.0001].

The investigators found in 3 RCTs (n = 214 randomised youth with ADHD) n-3 PUFAs supplementation significantly improved cognitive measures associated with attention [g = 1.09, p = 0.001].

The investigators found children and adolescents with ADHD had lower levels of DHA [7 case-control studies, n = 412, g = -0.76, p = 0.0002], EPA (7 case-control studies, n = 468, g = -0.38, p = 0.0008] and total n-3 PUFAs [6 case-control studies, n = 396, g = -0.58, p = 0.0001].

The investigators concluded there is evidence that n-3 PUFAs supplementation monotherapy improves clinical symptoms and cognitive performances in children and adolescents with ADHD and that these youth have a deficiency in n-3 PUFAs levels. These findings provide further support to the rationale for using n-3 PUFAs as a treatment option for ADHD.

Original title:
Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies by Chang JC, Su KP, [...], Pariante CM.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28741625

Additional information of El Mondo:
Find more information/studies on chronic disease, n-3 PUFA right here.
EPA and DHA are n-3 PUFA.

Objectives:
What are the cardiovascular benefits of indiscriminate supplementation of omega-3 supplementation?

Study design:
This review article included 8 RCTs.

Results and conclusions:
The investigators found omega-3 supplementation significantly resulted in a 8% decrease of the risk of cardiac death, unless the patients are treated by statins.

The investigators found omega-3 supplementation prolonged quality adjusted life years by about a month. Old people gained less, whereas diabetes mellitus type 2 patients and people with history of cardiovascular events gained more.

The investigators concluded omega-3 supplementation decreases risk of cardiac death, unless the patients are treated by statins.

Original title:
The cardiovascular benefits of indiscriminate supplementation of omega-3 fatty acids; meta-analysis and decision-making approach by Leshno M, Goldbourt U, [...], Lichtenberg D.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29171335

Additional information of El Mondo:
Find more information/studies on omega-3 fatty acids and cardiovascular diseases right here.

Objectives:
What is the relationship between dietary intake of 12 major food groups, including whole grains, refined grains, vegetables, fruit, nuts, legumes, eggs, dairy, fish, red meat, processed meat and sugar-sweetened beverages and colorectal cancer (CRC) risk?

Study design:
This review article included cohort studies.

Results and conclusions:
The investigators found in the linear dose-response meta-analysis, that every 30 g/d whole grains significantly reduced risk of colorectal cancer with 5% [RR = 0.95, 95% CI = 0.93 to 0.97, n = 9 cohort studies].

The investigators found in the linear dose-response meta-analysis, that every 100 g/d vegetables significantly reduced risk of colorectal cancer with 3% [RR = 0.97, 95% CI = 0.96 to 0.98, n = 15 cohort studies].

The investigators found in the linear dose-response meta-analysis, that every 100 g/d fruit significantly reduced risk of colorectal cancer with 3% [RR = 0.97, 95% CI = 0.95 to 0.99, n = 16 cohort studies]. 

The investigators found in the linear dose-response meta-analysis, that every 200 g/d dairy products significantly reduced risk of colorectal cancer with 7% [RR = 0.93, 95% CI = 0.91 to 0.94, n = 15 cohort studies]. 

The investigators found in the linear dose-response meta-analysis, that every 100 g/d red meat significantly increased risk of colorectal cancer with 12% [RR = 1.12, 95% CI = 1.06 to 1.19, n = 21 cohort studies].

The investigators found in the linear dose-response meta-analysis, that every 50 g/d processed meat significantly increased risk of colorectal cancer with 17% [RR = 1.17, 95% CI = 1.10 to 1.23, n = 16 cohort studies].

The investigators found some evidence for a nonlinear relationship between dietary intake of vegetables, fruit and dairy products and risk of colorectal cancer.

The investigators concluded that daily dietary intake of 30g whole grains, 100g vegetables,100g fruit and 200g dairy products reduce risk of colorectal cancer, while daily dietary intake of 100g red meat and 50g processed meat increase risk of colorectal cancer.

Original title:
Food groups and risk of colorectal cancer by Schwingshackl L, Schwedhelm C, [...], Schlesinger S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29210053

Additional information of El Mondo:
Find more information/studies on different food groups and colorectal cancer right here.

Objectives:
Undernutrition is the outcome of insufficient food intake and recurrent infectious diseases. The baseline levels of undernutrition remain so high that Ethiopia still needs to continue substantial investment in nutrition. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to obtain estimates of over-time trends in the prevalence of undernutrition in Ethiopia and to determine risk factors for undernutrition among children of under five years of age.

Study design:
This review article included 18 cross-sectional studies published in English from 1997 to 2015 focusing the prevalence of stunting, wasting and underweight in children aged 0-5 years (n = 39,585) in Ethiopia.
Sample size ranged from 100 to 10,449 participants. The majority (14/18) of the studies were conducted in rural and urban areas.

There was no publication bias.

Results and conclusions:
The investigators found the overall pooled prevalence estimate of stunting, underweight and wasting in Ethiopia was 42.0% [95% CI = 37.0 to 46.0], 33.0% [95% CI = 27.0 to 39.0] and 15.0% [95% CI = 12.0 to 19.0], respectively. The heterogeneity between studies was very high [I2 = 98.5% and p = 0.433].

The investigators found the highest prevalence of stunting was reported in East Ethiopia 67.8% and the least was in North Ethiopia 14.6%. The highest prevalence of underweight was reported in country level studies (DHS) (47.2%) and the least was in South Ethiopian studies (12%). Similarly, the highest prevalence of wasting was reported in country level studies (DHS) 42% and the least was reported in North Ethiopian studies (4.5%).

The investigators found that sensitivity analyses showed a prevalence of stunting of 40% [95% CI = 32.0 to 48.0, I2 = 99.19%], a prevalence of underweight of 33% [95% CI = 24.0 to 42.0, I2 = 99.34%] and wasting rate equal to 19% [95% CI = 14.0 to 24.0, I2 = 99.19%].

The investigators found cumulative analysis revealed a stabilization trend of stunting and underweight (1996-2010) followed by an upward trend (2010-2014).

The investigators found child age, child sex, complementary food, poor dietary diversity, diarrheal diseases, maternal education, maternal height, residential area and socio- economic status were significant risk factors for undernutrition in Ethiopia.

The investigators concluded that the trend of undernutrition in Ethiopia indicates that there is an increment of chronic malnutrition cases in recent years and the prevalence of undernutrition remains extremely high. Thus, the implementation of policies to reverse child undernutrition should get maximum emphasis.

Original title:
Nutritional Status of Under Five Children in Ethiopia: A Systematic Review and Meta-Analysis by Abdulahi A, Shab-Bidar S, […], Djafarian K.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440832/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and study design/meta-analysis/significant right here.