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Headache Associated with Coeliac Disease: A Systematic Review and Meta-Analysis.
Zis, P, Julian, T, Hadjivassiliou, M
Nutrients. 2018;10(10)
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Plain language summary
Coeliac disease (CD) is the best-recognised gluten-related disorder (GRD), and it is characterized by a small bowel enteropathy occurring in genetically susceptible individuals whilst exposed to the protein gliadin. The aim of this study was to systematically review the current literature in order to establish the relationship between headache and CD. This study is a systematic review of 40 articles, studying a total of 42,388 individuals with either headache or GRD. Results show that: - There is an increased prevalence of headache amongst patients with CD. - There is an increased prevalence of CD amongst patients with idiopathic headache. - Headaches associated with CD are mainly migraines. - Gluten-free diet is a very effective treatment for headaches associated with CD. Authors conclude that further studies on the prevalence of gluten sensitivity in patients with idiopathic headache are needed, including further research on the pathogenetic mechanisms.
Abstract
OBJECTIVE The aim of this systematic review was to explore the relationship between coeliac disease (CD) and headache. The objectives were to establish the prevalence of each entity amongst the other, to explore the role of gluten free diet (GFD), and to describe the imaging findings in those affected by headaches associated with CD. METHODOLOGY A systematic computer-based literature search was conducted on the PubMed database. Information regarding study type, population size, the age group included, prevalence of CD amongst those with headache and vice versa, imaging results, the nature of headache, and response to GFD. RESULTS In total, 40 articles published between 1987 and 2017 qualified for inclusion in this review. The mean pooled prevalence of headache amongst those with CD was 26% (95% CI 19.5⁻33.9%) in adult populations and 18.3% (95% CI 10.4⁻30.2%) in paediatric populations. The headaches are most often migraine-like. In children with idiopathic headache, the prevalence of CD is 2.4% (95% CI 1.5⁻3.7%), whereas data for adult populations is presently unavailable. Brain imaging can be normal, although, cerebral calcifications on CT, white matter abnormalities on MRI and deranged regional cerebral blood flow on SPECT can be present. GFD appears to be an effective management for headache in the context of CD, leading to total resolution of headaches in up to 75% of patients. CONCLUSIONS There is an increased prevalence of CD amongst idiopathic headache and vice versa. Therefore, patients with headache of unknown origin should be screened for CD, as such patients may symptomatically benefit from a GFD.
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Body composition status and the risk of migraine: A meta-analysis.
Gelaye, B, Sacco, S, Brown, WJ, Nitchie, HL, Ornello, R, Peterlin, BL
Neurology. 2017;88(19):1795-1804
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Both migraine and obesity are conditions associated with substantial personal and societal burdens. The aim of this study was to evaluate the pooled risk of migraine by body composition status as characterized by the WHO physical status categories and the influence of age and sex on this relationship. This study is a meta-analysis of twelve studies with data from 288,981 unique participants. The age of the participants ranged between 18 and 98 years. Results indicate that obesity and underweight status are associated with an increased risk of migraine, and that age and sex are important covariates for the increased risk. Authors conclude that further research to better understand the mechanisms underlying the association between body composition and migraine, has the potential to advance the understanding of migraine and lead to the development of targeted therapeutic strategies based on obesity status.
Abstract
OBJECTIVE To evaluate the association between migraine and body composition status as estimated based on body mass index and WHO physical status categories. METHODS Systematic electronic database searches were conducted for relevant studies. Two independent reviewers performed data extraction and quality appraisal. Odds ratios (OR) and confidence intervals (CI) were pooled using a random effects model. Significant values, weighted effect sizes, and tests of homogeneity of variance were calculated. RESULTS A total of 12 studies, encompassing data from 288,981 unique participants, were included. The age- and sex-adjusted pooled risk of migraine in those with obesity was increased by 27% compared with those of normal weight (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.16-1.37, p < 0.001) and remained increased after multivariate adjustments. Although the age- and sex-adjusted pooled migraine risk was increased in overweight individuals (OR 1.08; 95% CI 1.04, 1.12, p < 0.001), significance was lost after multivariate adjustments. The age- and sex-adjusted pooled risk of migraine in underweight individuals was marginally increased by 13% compared with those of normal weight (OR 1.13; 95% CI 1.02, 1.24, p < 0.001) and remained increased after multivariate adjustments. CONCLUSIONS The current body of evidence shows that the risk of migraine is increased in obese and underweight individuals. Studies are needed to confirm whether interventions that modify obesity status decrease the risk of migraine.
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Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies.
Dinu, M, Abbate, R, Gensini, GF, Casini, A, Sofi, F
Critical reviews in food science and nutrition. 2017;57(17):3640-3649
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Vegetarian diet is experiencing a considerable popularity in the general population. The aim of this study was to obtain an estimate of the association between vegetarian, vegan diets, and multiple health outcomes, including risk factors for chronic diseases, risk of all-cause mortality, incidence and mortality from cardio-cerebrovascular diseases, total cancer and specific types of cancer. This study is a comprehensive systematic review with meta-analysis of all cross-sectional and cohort studies. A total of 108 articles were included in the meta-analysis with a total population of over 130,000 vegetarians and 15,000 vegans. Results indicate that: - vegetarians and vegans show significantly lower levels of the most relevant risk factor for chronic disease such as body mass index, lipid variables and fasting glucose, when compared to non-vegetarians and nonvegans. - a significant protection versus ischemic heart disease and cancer is present in vegetarian subjects, however this protection is not significant for overall mortality, cardio and cerebrovascular diseases. - vegan diet seems to be associated with a lower rate of cancer incidence (interpreted with caution due to the small sample size of the study). Authors conclude that their findings may be useful for helping to give correct information to subjects who want to adopt vegetarian or vegan dietary patterns.
Abstract
BACKGROUND Beneficial effects of vegetarian and vegan diets on health outcomes have been supposed in previous studies. OBJECTIVES Aim of this study was to clarify the association between vegetarian, vegan diets, risk factors for chronic diseases, risk of all-cause mortality, incidence, and mortality from cardio-cerebrovascular diseases, total cancer and specific type of cancer (colorectal, breast, prostate and lung), through meta-analysis. METHODS A comprehensive search of Medline, EMBASE, Scopus, The Cochrane Library, and Google Scholar was conducted. RESULTS Eighty-six cross-sectional and 10 cohort prospective studies were included. The overall analysis among cross-sectional studies reported significant reduced levels of body mass index, total cholesterol, LDL-cholesterol, and glucose levels in vegetarians and vegans versus omnivores. With regard to prospective cohort studies, the analysis showed a significant reduced risk of incidence and/or mortality from ischemic heart disease (RR 0.75; 95% CI, 0.68 to 0.82) and incidence of total cancer (RR 0.92; 95% CI 0.87 to 0.98) but not of total cardiovascular and cerebrovascular diseases, all-cause mortality and mortality from cancer. No significant association was evidenced when specific types of cancer were analyzed. The analysis conducted among vegans reported significant association with the risk of incidence from total cancer (RR 0.85; 95% CI, 0.75 to 0.95), despite obtained only in a limited number of studies. CONCLUSIONS This comprehensive meta-analysis reports a significant protective effect of a vegetarian diet versus the incidence and/or mortality from ischemic heart disease (-25%) and incidence from total cancer (-8%). Vegan diet conferred a significant reduced risk (-15%) of incidence from total cancer.