HR and 95% CI for lung cancer according to serum bilirubin levels^{^a}.

a<p>Adjusted for age, body mass index, white blood cell count, hemoglobin, and alcohol intake.</p>b<p>Additionally adjusted for smoking status.</p><p>Abbreviation: PY, person year; SD, standard deviation; T3, highest tertile; T2, middle tertile; T1, lowest tertile.</p

Hazard ratio(HR) for lung cancer according to serum bilirubin levels and smoking status in men.

<p>Cox proportional hazard models were examined after adjusting for age, body mass index, white blood cell count, hemoglobin, and alcohol intake. *represents 95% confidence interval of hazard ratio estimate excluded 1.</p

Combined Effects of Smoking and Bilirubin Levels on the Risk of Lung Cancer in Korea: The Severance Cohort Study

<div><p>Background</p><p>Smoking is a major risk factor for lung cancer. Bilirubin, an antioxidant, is inversely associated with the risk of diseases related to oxidative stress. This study was conducted to determine the influence of smoking and bilirubin levels on the risk of lung cancer in the Severance cohort study.</p><p>Methods</p><p>This study included 68,676 Korean who received a health examination at Severance Health Promotion Center from 1994 to 2004. Serum bilirubin measurements within normal range were divided into tertiles whereas smoking states were divided as never-smokers, former smokers and current smokers. A diagnosis of lung cancer was coded as occurring based on the report from the National Cancer Registry. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards model.</p><p>Results</p><p>At the end of the study period, 240 patients (men: 181, women: 59) developed lung cancer. Compared to those with bilirubin levels ≥1.0 mg/dL, HRs (95% CI) for lung cancer were 2.8 (1.8–4.2) for subjects having bilirubin levels from 0.2 to 0.7 mg/dL in men. When we stratified our analysis by smoking status, bilirubin consistently showed a protective effect on the risk of lung cancer on both never- and current smokers. Current smokers having bilirubin levels from 0.2 to 0.7 mg/dL had a risk of lung cancer by 6.0-fold higher than never-smokers with bilirubin levels ≥1.0 mg/dL in men.</p><p>Conclusion</p><p>In this large prospective study, higher baseline bilirubin level in the normal range was associated with low risk of lung cancer. Smoking and low bilirubin levels were cumulatively associated with a higher risk of lung cancer.</p></div

Baseline characteristics of the study population (N = 68,676), 1994–2004^{^a,^b}.

a<p>Data are expressed as mean (standard error) unless otherwise indicated.</p>b<p>Except for age, all mean values were age-adjusted.</p><p>Abbreviation: HDL, high-density lipoprotein.</p

Serum bilirubin levels according to the amount of smoking.

<p>Serum bilirubin levels according to the amount of smoking.</p

The association between serum total bilirubin level and the risk of lung cancer according to smoking status among Korean men^{^a}.

a<p>Adjusted for age, body mass index, white blood cell count, hemoglobin, and alcohol intake.</p>b<p>Additionally adjusted for amount of smoking(per sig/day). 706 were excluded because of missing variable on amount of smoking.</p

Association of various variables according to serum bilirubin levels, 1994–2004^{^a}.

a<p>All mean values were age-adjusted.</p><p>Abbreviation: HDL, high-density lipoprotein.</p><p>T3: highest tertile, T2: middle tertile, T1: lowest tertile.</p

Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium

OBJECTIVE:To evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality. DESIGN:Individual participant data meta-analysis. SETTING:Cohorts from 40 countries with data collected between 1970 and 2017. PARTICIPANTS:Adults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607). MAIN OUTCOME MEASURES:GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m2) and all cause mortality. RESULTS:Over a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index. CONCLUSIONS:Elevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR