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1.
Effect of infant formula supplemented with prebiotics and probiotics on incidence of respiratory tract infections: A systematic review and meta-analysis of randomized clinical trials.
Rashidi, K, Darand, M, Garousi, N, Dehghani, A, Alizadeh, S
Complementary therapies in medicine. 2021;:102795
Abstract
BACKGROUND Previous investigations have proposed that the consumption of infant formula supplemented with prebiotics, probiotics and synbiotics (PRO-formula) may have protective impacts on respiratory tract infections (RTIs). Nevertheless, the findings of studies are contradictory. This meta-analysis aimed to explore the influence of PRO-formula on RTIs in infants by pooling randomized controlled trials (RCTs). METHODS To obtain eligible RCTs, Scopus and PubMed databases were systematically searched from their inception to November 2020. A random-effects model was applied to pool the relative risks (RR) and corresponding 95% confidence intervals (CI) for RTIs following consumption of PRO-formula. RESULTS A total of 15 RCTs, with a total sample size of 3805 participants (1957 for intervention and 1848 for placebo), were included in the present meta-analysis. In the overall analysis, in comparison to placebo, consumption of PRO-formula had a significant protective impact against RTIs (RR = 0.89, 95%CI: 0.82-0.97) in infants, with a remarkable evidence of heterogeneity across studies (I2 = 61.4%, P < 0.001). In the meta-regression analysis, the effect of PRO-formula on RTIs was not modified by the follow-up duration. No evidence for publication bias was detected. CONCLUSIONS Administration of PRO-formula may be a potential approach for the prevention of respiratory tract infections in infants.
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2.
Glycemic index, but not glycemic load, is associated with an increased risk of metabolic syndrome: Meta-analysis of observational studies.
Askari, M, Dehghani, A, Abshirini, M, Raeisi, T, Alizadeh, S
International journal of clinical practice. 2021;(10):e14295
Abstract
BACKGROUND Diets with high glycemic index (GI) or high glycemic load (GL) have been linked to important risk factors associated with the development of metabolic syndrome (MetS), such as dyslipidemia, higher blood glucose, and insulin concentrations. However, the role of GI and GL in relation to Mets is still understudied and controversial. This review, therefore, assessed whether high GI or GL contribute to development of Mets. METHODS A systematic search of four bibliographic databases was conducted (MEDLINE/PubMed, EMBASE, Web of Sciences, and Scopus) from inception to January 2020 for observational studies assessing GI/GL in relation to MetS. Risk estimates were pooled using random-effect models for the highest versus lowest intake categories, and assessed for heterogeneity using subgroup analysis. The dose-response nature of the relationship was also investigated. Sensitivity analysis and Egger test were used to check the robustness of findings and the possibility of publication bias, respectively. RESULTS Data from 12 publications (one cohort study and eleven cross-sectional studies) with a total sample size of 36,295 subjects are included. The pooled effect sizes from the nine studies indicated high versus low dietary GI was associated with increased risk of MetS (OR = 1.05, 95% CI: 1.01 to 1.09) (I2 = 58.1, P = .004). This finding was supported by all subgroup analyses except where studies used 24-h recalls for dietary assessment. Additionally, a linear dose-response investigation revealed that each 5-point increment in GI was associated with 2% increase in the risk of MetS (OR = 1.02, 95% CI: 1.01 to 1.02); non-linear pattern was insignificant, however (p-nonlinearity = 0.63). Moreover, pooled effect sizes from ten studies suggested that no association was found between the GL and MetS with results remaining consistent in all subgroup analyses. CONCLUSION A diet with lower GI may protect against MetS. Nutrition policy and clinical practices should encourage a diet with low GI. Future studies should include both GI and GL and different criteria of MetS to provide a better comparison.
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3.
Quantifying the advantages of conducting a prospective meta-analysis (PMA): a case study of early childhood obesity prevention.
Seidler, AL, Hunter, KE, Espinoza, D, Mihrshahi, S, Askie, LM, ,
Trials. 2021;(1):78
Abstract
BACKGROUND For prospective meta-analyses (PMAs), eligible studies are identified, and the PMA hypotheses, selection criteria, and analysis methods are pre-specified before the results of any of the studies are known. This reduces publication bias and selective outcome reporting and provides a unique opportunity for outcome standardisation/harmonisation. We conducted a world-first PMA of four trials investigating interventions to prevent early childhood obesity. The aims of this study were to quantitatively analyse the effects of prospective planning on variations across trials, outcome harmonisation, and the power to detect intervention effects, and to derive recommendations for future PMA. METHODS We examined intervention design, participant characteristics, and outcomes collected across the four trials included in the EPOCH PMA using their registration records, protocol publications, and variable lists. The outcomes that trials planned to collect prior to inclusion in the PMA were compared to the outcomes that trials collected after PMA inclusion. We analysed the proportion of matching outcome definitions across trials, the number of outcomes per trial, and how collaboration increased the statistical power to detect intervention effects. RESULTS The included trials varied in intervention design and participants, this improved external validity and the ability to perform subgroup analyses for the meta-analysis. While individual trials had limited power to detect the main intervention effect (BMI z-score), synthesising data substantially increased statistical power. Prospective planning led to an increase in the number of collected outcome categories (e.g. weight, child's diet, sleep), and greater outcome harmonisation. Prior to PMA inclusion, only 18% of outcome categories were included in all trials. After PMA inclusion, this increased to 91% of outcome categories. However, while trials mostly collected the same outcome categories after PMA inclusion, some inconsistencies in how the outcomes were measured remained (such as measuring physical activity by hours of outside play versus using an activity monitor). CONCLUSION Prospective planning led to greater outcome harmonisation and greater power to detect intervention effects, while maintaining acceptable variation in trial designs and populations, which improved external validity. Recommendations for future PMA include more detailed harmonisation of outcome measures and careful pre-specification of analyses to avoid research waste by unnecessary over-collection of data.
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4.
An updated meta-analysis showed smoking modify the association of GSTM1 null genotype on the risk of coronary heart disease.
Song, Y, Shan, Z, Liu, X, Chen, X, Luo, C, Chen, L, Wang, Y, Gong, L, Liu, L, Liang, J
Bioscience reports. 2021;(2)
Abstract
Background Oxidative stress is considered to be involved in the pathogenesis of coronary heart disease (CHD). Glutathione-S-transferase (GST) enzymes play important roles in antioxidant defenses and may influence CHD risk. The present meta-analysis was performed to investigate the link between glutathione S-transferase M1 (GSTM1) null genotype and CHD and to get a precise evaluation of interaction between GSTM1 null genotype and smoking by the case-only design. Methods PubMed and EMBASE databases were searched through 15 December 2020 to retrieve articles. Odds ratios (ORs) were pooled using either fixed-effects or random-effects models. Results Thirty-seven studies showed that GSTM1 null genotype was associated with risk of CHD in total population, Caucasians and Asians (for total population, OR = 1.38, 95% confidence interval (CI): 1.15, 1.65; for Caucasians, OR = 1.34, 95% CI: 1.04, 1.72; for Asians, OR = 1.40, 95% CI: 1.11, 1.77). After adjustment for heterogeneity, these relationships were still significant. After adjustment for heterogeneity, case-only analysis of 11 studies showed a positive multiplicative interaction between GSTM1 null genotype and smoking (ever smoking vs. never smoking) (OR = 1.27, 95% CI: 1.08, 1.50; I2 = 0%, P=0.553). Conclusions The overall results indicated that GSTM1 null genotype was associated with a higher risk of CHD, and the association may be affected by smoking status. This is the first meta-analysis to prove a positive effect of the interaction between GSTM1 null genotype and smoking status on the risk of CHD. Well-designed studies are needed to investigate the possible gene-gene or gene-environment interactions.
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5.
Exposure to pesticides and childhood leukemia risk: A systematic review and meta-analysis.
Karalexi, MA, Tagkas, CF, Markozannes, G, Tseretopoulou, X, Hernández, AF, Schüz, J, Halldorsson, TI, Psaltopoulou, T, Petridou, ET, Tzoulaki, I, et al
Environmental pollution (Barking, Essex : 1987). 2021;:117376
Abstract
Despite the abundance of epidemiological evidence concerning the association between pesticide exposure and adverse health outcomes including acute childhood leukemia (AL), evidence remains inconclusive, and is inherently limited by heterogeneous exposure assessment and multiple statistical testing. We performed a literature search of peer-reviewed studies, published until January 2021, without language restrictions. Summary odds ratios (OR) and 95% confidence intervals (CI) were derived from stratified random-effects meta-analyses by type of exposure and outcome, exposed populations and window of exposure to address the large heterogeneity of existing literature. Heterogeneity and small-study effects were also assessed. We identified 55 eligible studies (n = 48 case-control and n = 7 cohorts) from over 30 countries assessing >200 different exposures of pesticides (n = 160,924 participants). The summary OR for maternal environmental exposure to pesticides (broad term) during pregnancy and AL was 1.88 (95%CI: 1.15-3.08), reaching 2.51 for acute lymphoblastic leukemia (ALL; 95%CI: 1.39-4.55). Analysis by pesticide subtype yielded an increased risk for maternal herbicide (OR: 1.41, 95%CI: 1.00-1.99) and insecticide (OR: 1.60, 95%CI: 1.11-2.29) exposure during pregnancy and AL without heterogeneity (p = 0.12-0.34). Meta-analyses of infant leukemia were only feasible for maternal exposure to pesticides during pregnancy. Higher magnitude risks were observed for maternal pesticide exposure and infant ALL (OR: 2.18, 95%CI: 1.44-3.29), and the highest for infant acute myeloid leukemia (OR: 3.42, 95%CI: 1.98-5.91). Overall, the associations were stronger for maternal exposure during pregnancy compared to childhood exposure. For occupational or mixed exposures, parental, and specifically paternal, pesticide exposure was significantly associated with increased risk of AL (ORparental: 1.75, 95%CI: 1.08-2.85; ORpaternal: 1.20, 95%CI: 1.07-1.35). The epidemiological evidence, supported by mechanistic studies, suggests that pesticide exposure, mainly during pregnancy, increases the risk of childhood leukemia, particularly among infants. Sufficiently powered studies using repeated biomarker analyses are needed to confirm whether there is public health merit in reducing prenatal pesticide exposure.
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6.
Comparison of renin-angiotensin-aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes.
Bezabih, YM, Bezabih, A, Alamneh, E, Peterson, GM, Bezabhe, W
BMC infectious diseases. 2021;(1):527
Abstract
BACKGROUND Reports on the effects of renin-angiotensin-aldosterone system (RAAS) inhibitors on the clinical outcomes of coronavirus disease-19 (COVID-19) have been conflicting. We performed this meta-analysis to find conclusive evidence. METHODS We searched published articles through PubMed, EMBASE and medRxiv from 5 January 2020 to 3 August 2020. Studies that reported clinical outcomes of patients with COVID-19, stratified by the class of antihypertensives, were included. Random and fixed-effects models were used to estimate pooled odds ratio (OR). RESULTS A total 36 studies involving 30,795 patients with COVID-19 were included. The overall risk of poor patient outcomes (severe COVID-19 or death) was lower in patients taking RAAS inhibitors (OR = 0.79, 95% CI: [0.67, 0.95]) compared with those receiving non-RAAS inhibitor antihypertensives. However, further sub-meta-analysis showed that specific RAAS inhibitors did not show a reduction of poor COVID-19 outcomes when compared with any class of antihypertensive except beta-blockers (BBs). For example, compared to calcium channel blockers (CCBs), neither angiotensin-I-converting enzyme inhibitors (ACEIs) (OR = 0.91, 95% CI: [0.67, 1.23]) nor angiotensin-II receptor blockers (ARBs) (OR = 0.90, 95% CI: [0.62, 1.33]) showed a reduction of poor COVID-19 outcomes. When compared with BBs, however, both ACEIs (OR = 0.85, 95% CI: [0.73, 0.99) and ARBs (OR = 0.72, 95% CI: [0.55, 0.94]) showed an apparent decrease in poor COVID-19 outcomes. CONCLUSIONS RAAS inhibitors did not increase the risk of mortality or severity of COVID-19. Differences in COVID-19 clinical outcomes between different class of antihypertensive drugs were likely due to the underlying comorbidities for which the antihypertensive drugs were prescribed, although adverse effects of drugs such as BBs could not be excluded.
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7.
Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis.
Mclaughlin, M, Delaney, T, Hall, A, Byaruhanga, J, Mackie, P, Grady, A, Reilly, K, Campbell, E, Sutherland, R, Wiggers, J, et al
Journal of medical Internet research. 2021;(2):e23180
Abstract
BACKGROUND The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users' subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. OBJECTIVE This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). METHODS Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non-digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. RESULTS Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). CONCLUSIONS The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.
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8.
Effect of glucose and sucrose on cognition in healthy humans: a systematic review and meta-analysis of interventional studies.
García, CR, Piernas, C, Martínez-Rodríguez, A, Hernández-Morante, JJ
Nutrition reviews. 2021;(2):171-187
Abstract
CONTEXT Evidence suggests that plasma glucose levels may influence cognitive performance, but this has not been systematically reviewed and quantified. OBJECTIVE The aim of this review was to investigate the potential effects of glucose and sucrose, compared with placebo, on cognition in healthy humans. DATA SOURCES The electronic databases PubMed and Web of Science were searched up to December 2019. Reference lists of selected articles were checked manually. STUDY SELECTION Randomized controlled trials or crossover trials that compared glucose or sucrose with placebo for effects on cognition were eligible. DATA EXTRACTION Potentially eligible articles were selected independently by 2 authors. Risk of bias was assessed through the Cochrane Collaboration tool. Standardized mean differences (SMDs) were obtained from random-effects meta-analyses for a subsample of studies that reported the same outcomes. RESULTS Thirty-seven trials were identified, of which 35 investigated the effect of glucose consumption compared with placebo on cognition. Two studies found no effect of glucose on cognition, while the others found mixed results. Only 3 of the 37 studies investigated the effects of sucrose intake, reporting mixed results. Meta-analyses revealed a significantly positive effect of glucose compared with control, but only when a verbal performance test (immediate word recall) was used in parallel-design studies (SMD = 0.61; 95%CI, 0.20-1.02; I2 = 0%). Twenty-four studies were classified as having high risk of bias for the selection procedure. CONCLUSIONS A limited body of evidence shows a beneficial effect of glucose in individuals performing immediate verbal tasks. High-quality trials with standardized cognitive measurements are needed to better establish the effect of glucose or sucrose on cognition. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019122939.
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9.
Meta-Analysis of Dedicated Heart Failure Trials Evaluating the Effect of Sacubitril/Valsartan on Major Cardiac Rhythm Disorders.
Patoulias, D, Papadopoulos, C, Toumpourleka, M, Tranidou, A, Boulmpou, A, Doumas, M
The American journal of cardiology. 2021;:120-122
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10.
The effect of soy protein containing soy isoflavones on serum concentration of cell adhesion molecules: A systematic review and meta-analysis of randomized controlled trials.
Hariri, M, Baradaran, HR, Gholami, A
Complementary therapies in medicine. 2021;:102764
Abstract
BACKGROUND Soy protein in combination with soy isoflavones might reduce the serum concentration of inflammatory mediators. In this study, we attempted to summarize the effect of soy protein combined with soy isoflavones on circulating E-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) in adults. METHODS Clinicaltrials.gov, Web of Science, Cochrane Library, PubMed, and Scopus were searched for English articles with no time limit regarding publication up to December 2020. Thereafter, the mean changes from baseline and their standard deviations (SDs) for both intervention and comparison groups were used to calculate the effect size. We used DerSimonian and Laird random-effects model if the heterogeneity test was statistically significant. Cochran's Q test and I-squared statistic were also used to calculate the statistical heterogeneity of the intervention effects. RESULTS Eight articles were found as eligible for this study. The treatment duration was between 6 and 24 weeks. Soy isoflavones dose was in a range of 30-112 mg/day and soy protein dose was in a range of 11.25-52 g/day. Overall, taking soy protein supplements containing soy isoflavones was not associated with changes in cell adhesion molecules, E-selectin, ICAM-1, or VCAM-1 (WMD = 0.65, 95 % CI: -2.58, 3.89; p = 0.692; WMD = 2.68, 95 % CI: -0.98, 6.34; p = 0.151; WMD = 2.66, 95 % CI: -6.28, 11.61; p = 0.559, respectively). CONCLUSION The combination of soy protein and soy isoflavones was not significantly associated with changes in levels of E-selectin, ICAM-1, and VCAM-1. However, we need more studies with a large sample size and more participants with different age categories in this regard.