Dietary Habits and Risk of Early-Onset Dementia in an Italian Case-Control Study

Risk of early-onset dementia (EOD) might be modified by environmental factors and lifestyles, including diet. The aim of this study is to evaluate the association between dietary habits and EOD risk. We recruited 54 newly-diagnosed EOD patients in Modena (Northern Italy) and 54 caregivers as controls. We investigated dietary habits through a food frequency questionnaire, assessing both food intake and adherence to dietary patterns, namely the Greek-Mediterranean, the Dietary Approaches to Stop Hypertension (DASH), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets. We modeled the relation between dietary factors and risk using the restricted cubic spline regression analysis. Cereal intake showed a U-shaped relation with EOD, with risk increasing above 350 g/day. A high intake (>400 g/day) of dairy products was also associated with excess risk. Although overall fish and seafood consumption showed no association with EOD risk, we found a U-shaped relation with preserved/tinned fish, and an inverse relation with other fish. Similarly, vegetables (especially leafy) showed a strong inverse association above 100 g/day, as did citrus and dry fruits. Overall, sweet consumption was not associated with EOD risk, while dry cake and ice-cream showed a positive relation and chocolate products an inverse one. For beverages, we found no relation with EOD risk apart from a U-shaped relation for coffee consumption. Concerning dietary patterns, EOD risk linearly decreased with the increasing adherence to the MIND pattern. On the other hand, an inverse association for the Greek-Mediterranean and DASH diets emerged only at very high adherence levels. To the best of our knowledge, this is the first study that explores the association between dietary factors and EOD risk, and suggests that adherence to the MIND dietary pattern may decrease such risk

Definitive childlessness in women with multiple sclerosis: a multicenter study

The frequency of definitive childlessness in women with multiple sclerosis (MS) may be higher than in the general population. MS may also affect decisions on the delivery procedure and on breast-feeding issues. Aim of the study was to assess the frequency of childlessness and its possible causes, the proportion of cesarean deliveries (CD), and the frequency of breast-feeding in patients and controls who have reached the end of their reproductive period. Female MS patients (>43 years) and controls (>45 years) filled out a questionnaire. We enrolled 303 patients and 500 controls. MS was associated with a higher frequency of childlessness (22 vs 13%) and less patients were in a stable relationship (83 vs 89%). There was no difference in the reported rates of infertility and miscarriages, while elective abortions were more frequent in patients (20 vs 12%). MS did not significantly affect the frequency of CD or of breast-feeding. MS-related reasons for childlessness, reported by 16% of childless patients, included disability/fear of future disability, fear of genetically transmitting MS, fear of not starting/discontinuing treatments, and discouragement by physician. Definitive childlessness is more frequent in women with MS compared to controls. A portion of voluntary childlessness may be avoided through correct/tailored information to patients

Effect modification of smoking status and menopausal status on the association between die- tary intake of acrylamide and risk of breast cancer

Introduction Acrylamide is a probable human carcinogen 1 that occurs natu- rally in starchy foods during cooking processes at high tempera- tures 2. Aside from occupational exposures and smoking 3, main source of human exposure is diet, particularly consumption of potatoes, grain products, and coffee 4 5. High acrylamide intake has been associated with altered sex-steroid hormone concen- trations and increased risk of hormone-dependent cancers, such breast neoplasm with inconsistent findings 6-9. Since this cancer type represent a major cause of death among both premenopau- sal and postmenopausal women 10, investigating its environmen- tal and life-style risk factors, including for instance acrylamide intake, is of key relevance under a public health perspective. Materials and methods We performed a systematic review of the association between estimated dietary intake of acrylamide and risk of female breast cancer. Using PubMed, we performed a systematic search for non-experimental studies published through October 20, 2019 and we first performed a meta-analysis of the overall measure of association. Subsequently, we carried out a dose-response meta- analysis of these associations using restricted cubic spline models which allow to estimate the summary relative risk (sRR) across a large exposure range of acrylamide intake alongside with their approximate pointwise 95% confidence interval (CI) 11 12. Results We identified 10 papers covering 8 different study populations: 9 cohorts and 1 case-control studies, with a total of 18100 cases of breast cancer. Acrylamide dietary intake ranged from 3.6 μg/ day to 44 μg/day, with both mean and median values of 21 μg/ day (range 6.3 to 29.8 μg/day). In the meta-analysis summarizing the RR in the highest category of exposure versus the lowest, we found no evidence of cancer risk at any levels of acrylamide ex- posure. After restricting the analysis to never smokers, we found similar results, if not a reverse correlation. In analyses stratified by menopausal status, we found no appreciable association be- tween exposure and risk of breast cancer among premenopau- sal women, and an inverse association in postmenopausal par- ticipants. Results among never-smoking premenopausal women was available only for one study, which reported a positive as- sociation between acrylamide intake and breast cancer risk. Con- versely, among postmenopausal women, we found no associa- tion for breast cancer in never-smokers. In the dose-response me- ta-analysis, we found evidence of a null or even inverse relation between exposure to dietary acrylamide and breast cancer risk, particularly in never smokers and in post-menopausal women. Interestingly, in subgroup analysis limited to pre-menopausal women, breast cancer risk linearly increased starting from 20 μg/ day of acrylamide intake. Conclusions In conclusion, there was limited evidence for an association between acrylamide intake and breast cancer risk, with the ex- ception of increased risks at the highest levels of acrylamide exposure among premenopausal women, which warrants further investigation

Dietary intake of acrylamide and risk of breast, endometrial and ovarian cancer: a systematic review and dose-response meta-analysis.

Background: Acrylamide is a probable human carcinogen that occurs naturally in starchy foods during cooking processes at high temperatures. Aside from occupational exposures and smoking, the main source of human exposure is diet, particularly consumption of potatoes, grain products, and coffee. High acrylamide intake has been associated with altered sex-steroid hormone concentrations and increased risk of hormone-dependent gynecologic neoplasms. Objective: We performed a systematic review of the papers investigating the association between acrylamide intake and risk of breast, endometrial and ovarian cancer in humans. We also examined a possible dose-response relation by carrying out a dose-response meta-analysis of these studies. Methods: We searched in PubMed up to September 10, 2019 the non-experimental human studies investigating risk of breast, endometrial, or ovarian cancer in relation to dietary intake of acrylamide. We also carried out a dose-response meta-analysis using a restricted cubic spline model. Results: We retrieved 18 studies: 11 cohort, 5 case-cohort, and 2 case-control studies. Since some studies assessed more than one cancer type, we found a total of ten studies on risk of breast cancer, seven on endometrial cancer, and seven on ovarian cancer. In the dose-response meta-analysis, acrylamide intake was associated with slightly increased risks of endometrial and ovarian cancers, with a stronger and almost linear increased risk among never smokers. Conversely, for breast cancer we found no evidence to support an increased risk following acrylamide exposure, except for a positive association among premenopausal women exposed to at least 20 µg/day of acrylamide. Conclusions: Based on the relatively small number of studies published to date, acrylamide intake was associated with increased risk of endometrial and ovarian cancer in a dose-response fashion, with a slightly stronger association observed among never smokers. Acrylamide intake was associated with an increased risk of breast cancer only among premenopausal women and at intakes greater than 20 µg/day. Keywords: acrylamide; dietary intake; breast cancer; endometrial cancer; ovarian cancer

Risk of early onset dementia (EOD) in relation to fruit and vegetable consumption: a case-control study

Introduction Early onset dementia (EOD) is a condition characterized by the onset of severe cognitive impairment before 65 year 1. There is a general agreement that clinical presentation and conse- quences on daily life are different than late-onset dementia, due to the occurrence when subjects are still involved within occupational activities as well as familiar responsibilities 2. Previous studies have raised the possibility that the risk factors may also differ between the two forms, including the role of environmental and life-style determinants such as diet 3. There is some epidemiologic evidence of an association between dietary habits and protective relations to cognitive decline and incident dementia 4 5. The aim of this study is to evaluate, for the first time to our knowledge, the association between diet and EOD risk. Materials and methods Using a case-control design, we recruited newly-diagnosed EOD cases from 2016 to 2019 in Modena province, Northern Italy. We recruited controls from care-givers of dementia patients referring the Neurology Units of Modena-Baggiovara and Carpi Hospi- tals. We investigated dietary habits through a self-administered semi-quantitative food frequency questionnaire, designed and validated to capture eating behaviors in Italy, and specifically developed as part of the European Prospective Investigation into Cancer and Nutrition (EPIC) study for the Northern Italy pop- ulation 6. Participants were asked to respond to 248 questions about 188 different food items, in order to assess frequency and quantity of daily consumption for each food item. We specifically focused on consumption of fruits and vegetables that were categorized into major and sub-group categories as previously reported 7. We computed the odds ratios (ORs) of EOD risk, and the corresponding 95% confidence intervals (CIs), according to increasing tertile of intake using an unconditional logistic regres- sion model and we also modeled the relation using restricted cu- bic splines with three knots (10, 50 and 90%). We implemented a model adjusted for sex, age (years), educational attainment (years), and total energy intake (kcal/day). Results We recruited 56 (men/women: 22/34) and 53 (men/women: 24/29) controls who agreed to participate and returned study ma- terial. Regarding food intake, cases showed a lower intake than controls of vegetables (119 g/day versus 148 g/day), pulses (19 g/day versus 22 g/day), potatoes (15 g/day versus 23 g/day), and dry fruits (2.6 g/day versus 4.0 g/day). Conversely cases showed a higher intake than controls of fresh fruits (256 g/day versus 240 g/day). In the analysis of EOD risk according to increasing tertile we found an inverse association with all vegetables overall considered and also for individual subgroup, particularly leafy vegetables and other vegetables (e.g. eggplant, zucchini or sweet pepper). Also, an inverse association was found for potatoes and slightly for legumes. Conversely, the higher tertile of intake of fresh fruits was associated with no difference in EOD risk, but in the stratified analysis for non-citrus and citrus fruits we found inverse association for the latter. Interestingly, for non-citrus fruits we found inverse association in the second tertile of consumption, and an opposite positive association in the third tertile. Finally, with increasing tertile of dry fruits intake, we found a strong inverse association with EOD risk. Similarly in the spline analysis, the increasing consumption of vegetables, particularly leafy vegetables showed a strong inverse association, as simi- larly also increased pulse intake. Regarding fruit consumption, fresh fruit overall considered showed ambivalent relation, while higher consumption of citrus fruits only, as well as dry fruits, showed a negative association with EOD risk. Conclusions In this study, we found an association of consumption of vegeta- bles and to some extent fruit with EOD risk in an Italian popula- tion. Despite the study limitations, such as the possible occur- rence of selection bias, our findings suggest that dietary habits may influence EOD etiology and onset

Environmental Risk Factors for Early-Onset Alzheimer’s Dementia and Frontotemporal Dementia: A Case-Control Study in Northern Italy

Background: Early-onset dementia (EOD) is defined as dementia with symptom onset before 65 years. The role of environmental risk factors in the etiology of EOD is still undefined. We aimed at assessing the role of environmental risk factors in EOD etiology, taking into account its different clinical types. Methods: Using a case-control study, we recruited all EOD cases referred to Modena hospitals from 2016 to 2019, while the referent population was drawn from cases’ caregivers. We investigated residential history, occupational and environmental exposures to chemicals and lifestyle behaviors through a self-administered questionnaire. We computed the odds ratios of EOD risk (overall and restricting to the Alzheimer’s dementia (AD) or frontotemporal dementia (FTD) diagnoses) and the corresponding 95% confidence intervals using an unconditional logistic regression model. Results: Fifty-eight EOD patients (19 FTD and 32 AD) and 54 controls agreed to participate. Most of the investigated exposures, such as occupational exposure to aluminum, pesticides, dyes, paints or thinners, were associated with an increased odds ratio (OR) for FTD but not for AD. Long-term use of selenium-containing dietary supplements was associated with increased OR for EOD and, particularly, for FTD. For both EOD forms, smoking and playing football showed an increased odds ratio, while cycling was associated with increased risk only in FTD. Overall sports practice appeared to be a protective factor for both types. Conclusions: Our results suggest a role of environmental and behavioral risk factors such as some chemical exposures and professional sports in EOD etiology, in particular with reference to FTD. Overall sports practice may be associated with a reduced EOD risk

Occupational risk factors for early onset dementia (EOD) in the Modena population: a case-control study

Introduction Dementia is a clinical condition generally affecting subjects in the elderly. However, it may occur also at younger age, yielding a condition called early-onset dementia (EOD) characterized by an onset before 65 years 1 2. Despite the limited epidemiological data and the paucity of information regarding possible risk fac- tors 3 4, there is a general agreement that clinical presentation and consequences on daily life are different than late-onset demen- tia, due to the occurrence when subjects are still involved within occupational activities as well as familiar responsibilities 5. The aim of this work is to assess the epidemiological, clinical and prognostic role of occupational risk factors in EOD. Materials and methods Using a case-control design, we recruited newly-diagnosed EOD cases from the two Centers of Cognitive Disease of the Neurol- ogy Units of Modena-Baggiovara and Carpi Hospitals, as well as from the community health centers and general practitioners, October 1, 2016 to May 31, 2019. Referent population have been recruited from care-givers of EOD and LOD (late onset demen- tia) subjects. We investigated as possible risk factors of the dis- ease the occupational history, by administering a questionnaire collecting information about personal characteristics, family his- tory of diseases, clinical history and comorbidities, occupation activities, hobbies and other leisure activities, residential history, domestic use of pesticides, and dental care. We computed the odds ratios (ORs) of EOD risk, and the corresponding 95% con- fidence intervals (CIs), according to exposure to the investigated risk factors using an unconditional logistic regression model ad- justing for sex, age, and educational attainment. Results Fifty-six cases and fifty-three controls agreed to participate, with generally higher number of women (60% cases and 55% controls) and people over 65 (60% cases compared to 49% con- trols). About occupational factors, working in the agricultural sector seemed to be only slightly associated with risk of EOD (OR 1.31, 95% CI 0.26-6.59), while an increased risk was found for industrial sector (OR 2.23, 95% CI 0.85-5.88). Occupational exposure to contaminants showed positive association for occupational exposure to selenium (OR 2.23, 95% CI 0.11-46.42), aluminum (OR 2.75, 95% CI 0.42-18.11), pesticides (OR 2.10, 95% CI 0.60-7.36), dyes, paints or thinners (OR 2.07, 95% CI 0.70-6.05), while no association was found for exposure to or use of electric and electronic system or electromagnetic fields. Conclusions Results of this study suggest that some occupational factors, namely use of pesticides, dyes/paints, and metalloids such as alu- minum and selenium, could be associated with increased disease risk. Despite study limitations due to case-control design, includ- ing possible occurrence of selection and recall bias, our findings support the hypothesis of an environmental etiology of EOD