Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey

Chronic kidney disease (CKD) is highly prevalent in the elderly and negatively impacts survival and health status. Thus, nephrological competence is mandatory for a skilled geriatrician. The present study aimed to assess nephrological competence in a sample of geriatricians recruited through a web survey. To this aim, a 12-items questionnaire was produced by an expert panel of nephrologists and geriatricians and was available online for members of the Italian Society of Gerontology and Geriatrics (SIGG). Two-hundred-eighty-seven geriatricians volunteered to fill in the questionnaire. The majority of them indirectly estimated the glomerular filtration rate (GFR) using mainly the Cockroft-Gault (C-G) formula. Selected nephrological exams, such as urinary Na and serum D-vitamin measurements, did not qualify as routine exams although the majority of geriatricians supplemented their patients with fat-soluble secosteroids. Ten percent of geriatricians asked for nephrological consultation only for stage 5 CKD patients and 30,9% only for stage 4 or 5. Erythropoietin supplementation was common practice for the majority of geriatricians, while only one third of them systematically used a procedure intended to prevent the contrast induced nephropathy (CIN). Finally, an alleged 50% adherence to the international guidelines for the management of CKD patients emerged from the questionnaire. Overall, results from this survey strongly recommend promoting nephrological education among geriatricians. Didactic standards for in training geriatricians need to be updated and the cooperation between geriatrics and nephrological societies promoted

Trend of change of sperm count and concentration over the last two decades: A systematic review and meta‐regression analysis

Background: Since the 1970s, several studies found that sperm concentration (SC) and total sperm count (TSC) constantly worsened over time, mainly in high-income countries. Objectives: To evaluate whether the decreasing trend in sperm count is continuing in Western European countries and USA, we performed a systematic review and meta-regression analysis. Materials and methods: Embase and Pubmed/Medline were searched papers published in English in the 2000-2020 period limiting the search to data collected in the USA and Western European countries. Results: We identified 62 articles and pooled information on 24,196 men (range 10-2,523), collected from 1993 to 2018. Considering all the studies, random-effects meta-regression analyses showed no significant trend for SC (slope per year -0.07 mil/mL, p-value = 0.86). Negative trends of SC were detected in Scandinavian countries (slope per year -1.11 mil/mL, 95% CI: -2.40 to +0.19; p-value = 0.09), but the findings were statistically not significant. No significant trends of SC were detected in Central Europe (slope per year +0.23, 95% CI -2.51 to +2.96; p-value = 0.87), the USA (slope per year +1.08, 95% CI -0.42 to +2.57; p-value = 0.16), and Southern Europe (slope per year +0.19, 95% CI -0.99 to +1.37; p-value = 0.75). We have analyzed separately findings from studies including sperm donors, fertile men, young unselected men (unselected men, study mean age < 25 years) and unselected men (unselected men, study mean age ≥ 25 years). No significant trends of SC were observed among sperm donors (slope per year -2.80, 95% CI -6.76 to +1.17; p-value 0.16), unselected men (slope per year -0.23, 95% CI -1.58 to +1.12; p-value 0.73), young unselected men (slope per year -0.49, 95% CI -1.76 to +0.79; p-value 0.45), fertile men (slope per year +0.29, 95% CI -1.09 to +1.67; p-value 0.68). Discussion and conclusion: The results of this analysis show no significant trends in SC, in USA, and selected Western European countries

Dietary patterns and oral and pharyngeal cancer using latent class analysis

The methods traditionally used to identify a posteriori dietary patterns are principal components, factor and cluster analysis. The aim of our study is to assess the relationship between dietary patterns derived with latent class analysis (LCA) and oral/pharyngeal cancer risk (OPC), highlighting the strengths of this method compared to traditional ones. We analyzed data from an Italian multicentric case-control study on OPC including 946 cases and 2,492 hospital controls. Dietary patterns were derived using LCA on 25 food groups. A multiple logistic regression model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for OPC according to the dietary patterns identified. We identified four dietary patterns. The first one was characterized by a high intake of leafy and fruiting vegetable and fruits (Prudent pattern), the second one showed a high intake of red meat and low intake of selected fruits and vegetables (Western pattern). The last two patterns showed a combination-type of diet. We labeled "Lower consumers-combination pattern" the cluster that showed a low intake of the majority of foods, and "Higher consumers-combination pattern" the one characterized by a high intake of various foods. Compared to the "Prudent pattern", the "Western" and the "Lower consumers-combination" ones were positively related to the risk of OPC (OR = 2.56, 95% CI: 1.90-3.45 and OR = 2.23, 95% CI: 1.64-3.02). No difference in risk emerged for the "Higher consumers-combination pattern" (OR = 1.28, 95% CI: 0.92-1.77)

Inverse Association between Dietary Iron Intake and Gastric Cancer: A Pooled Analysis of Case-Control Studies of the Stop Consortium

Background: Inconsistent findings have been reported regarding the relationship between dietary iron intake and the risk of gastric cancer (GC). Methods: We pooled data from 11 case-control studies from the Stomach Cancer Pooling (StoP) Project. Total dietary iron intake was derived from food frequency questionnaires combined with national nutritional tables. We derived the odds ratios (ORs) and 95% confidence intervals (CIs) for quartiles of dietary iron through multivariable unconditional logistic regression models. Secondary analyses stratified by sex, smoking status, caloric intake, anatomical subsite and histological type were performed. Results: Among 4658 cases and 12247 controls, dietary iron intake was inversely associated with GC (per quartile OR 0.88; 95% CI: 0.83-0.93). Results were similar between cardia (OR = 0.85, 95% CI = 0.77-0.94) and non-cardia GC (OR = 0.87, 95% CI = 0.81-0.94), and for diffuse (OR = 0.79, 95% CI = 0.69-0.89) and intestinal type (OR = 0.88, 95% CI = 0.79-0.98). Iron intake exerted an independent effect from that of smoking and salt intake. Additional adjustment by meat and fruit/vegetable intake did not alter the results. Conclusions: Dietary iron is inversely related to GC, with no difference by subsite or histological type. While the results should be interpreted with caution, they provide evidence against a direct effect of iron in gastric carcinogenesis

Tea consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling (StoP) Project consortium

Background Evidence from epidemiological studies on the role of tea drinking in gastric cancer risk remains inconsistent. We aimed to investigate and quantify the relationship between tea consumption and gastric cancer in the Stomach cancer Pooling (StoP) Project consortium. Methods A total of 9438 cases and 20,451 controls from 22 studies worldwide were included. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of gastric cancer for regular versus non-regular tea drinkers were estimated by one and two-stage modelling analyses, including terms for sex, age and the main recognised risk factors for gastric cancer. Results Compared to non-regular drinkers, the estimated adjusted pooled OR for regular tea drinkers was 0.91 (95% CI: 0.85-0.97). When the amount of tea consumed was considered, the OR for consumption of 1-2 cups/day was 1.01 (95% CI: 0.94-1.09) and for >3 cups/day was 0.91 (95% CI: 0.80-1.03). Stronger inverse associations emerged among regular drinkers in China and Japan (OR: 0.67, 95% CI: 0.49-0.91) where green tea is consumed, in subjects with H. pylori infection (OR: 0.68, 95% CI: 0.58-0.80), and for gastric cardia cancer (OR: 0.64, 95% CI: 0.49-0.84). Conclusion Our results indicate a weak inverse association between tea consumption and gastric cancer

Adult lifetime body mass index trajectories and endometrial cancer risk

Objective:  To identify body mass index (BMI) trajectories in adult life and to examine their association with endometrial cancer (EC) risk, also exploring whether relations differ by hormonal replacement therapy use.  Design:  Pooled analysis of two case–control studies.  Setting:  Italy and Switzerland.  Population:  A total of 458 EC cases and 782 controls.  Methods:  We performed a latent class growth model to identify homogeneous BMI trajectories over six decades of age, with a polynomial function of age. Odds ratios (ORs) and the corresponding 95% CI for EC risk were derived through a multiple logistic regression model, correcting for classification error.  Main outcome measures:  The relation of BMI trajectories with endometrial cancer.  Results:  We identified five BMI trajectories. Compared with women in the ‘Normal weight-stable’ trajectory, a reduction by about 50% in the risk of EC emerged for those in the ‘Underweight increasing to normal weight’ (95% CI 0.28–0.99). The ‘Normal weight increasing to overweight’ and the ‘Overweight-stable’ trajectories were associated with, respectively, an excess of 3% (95% CI 0.66–1.60) and of 71% (95% CI 1.12–2.59) in cancer risk. The OR associated to the trajectory ‘Overweight increasing to obese’ was 2.03 (95% CI 1.31–3.13). Stronger effects emerged among hormonal replacement therapy never users (OR 2.19 for the ‘Overweight-stable’ trajectory and OR 2.49 for the ‘Overweight increasing to obese’ trajectory).  Conclusions:  Our study suggests that longer exposure to overweight and obesity across a lifetime is associated with an increased risk of endometrial cancer. Weight during adulthood also appears to play an important role.  Tweetable abstract:  Longer exposure to overweight and obesity across a lifetime is associated with an increased risk of endometrial cancer

Adult lifetime body mass index trajectories and endometrial cancer risk

Objective:  To identify body mass index (BMI) trajectories in adult life and to examine their association with endometrial cancer (EC) risk, also exploring whether relations differ by hormonal replacement therapy use.  Design:  Pooled analysis of two case–control studies.  Setting:  Italy and Switzerland.  Population:  A total of 458 EC cases and 782 controls.  Methods:  We performed a latent class growth model to identify homogeneous BMI trajectories over six decades of age, with a polynomial function of age. Odds ratios (ORs) and the corresponding 95% CI for EC risk were derived through a multiple logistic regression model, correcting for classification error.  Main outcome measures:  The relation of BMI trajectories with endometrial cancer.  Results:  We identified five BMI trajectories. Compared with women in the ‘Normal weight-stable’ trajectory, a reduction by about 50% in the risk of EC emerged for those in the ‘Underweight increasing to normal weight’ (95% CI 0.28–0.99). The ‘Normal weight increasing to overweight’ and the ‘Overweight-stable’ trajectories were associated with, respectively, an excess of 3% (95% CI 0.66–1.60) and of 71% (95% CI 1.12–2.59) in cancer risk. The OR associated to the trajectory ‘Overweight increasing to obese’ was 2.03 (95% CI 1.31–3.13). Stronger effects emerged among hormonal replacement therapy never users (OR 2.19 for the ‘Overweight-stable’ trajectory and OR 2.49 for the ‘Overweight increasing to obese’ trajectory).  Conclusions:  Our study suggests that longer exposure to overweight and obesity across a lifetime is associated with an increased risk of endometrial cancer. Weight during adulthood also appears to play an important role.  Tweetable abstract:  Longer exposure to overweight and obesity across a lifetime is associated with an increased risk of endometrial cancer

Assessment of the geriatric competence and perceived needs of Italian nephrologists: an internet survey

An internet survey was set up to assess the geriatric competence and perceived needs of 337 members of the Italian society of nephrology (SIN). The survey assessed how well aware nephrologists are of the typical geriatric conditions and needs of their elderly chronic kidney disease (CKD) patients. SIN associates were also questioned about their current use of comprehensive geriatric assessment, prescription of potentially nephrotoxic drugs, and screening for osteoporosis. The main finding is that CKD and dialysis are almost unanimously perceived as typically geriatric conditions, but knowledge and use of geriatric tools are scanty. While use of potentially inappropriate drugs is rare, almost half of the patients are not screened for osteoporosis. The significant clinical gaps observed could greatly impair the management of older CKD patients, and call for an urgent educational intervention