Democratic Erosion Predicts Rising Deaths from Drug Poisoning and Infectious Disease

Strong democratic functioning is good for population health. However, democratic functioning eroded in many U.S. states in recent decades. The erosion was especially pronounced for one aspect of democratic functioning—electoral democracy, which refers to free and fair elections. This brief summarizes findings from a study examining how changes in electoral democracy in the 50 states predicted changes in the risk of death among adults ages 25-64 during 2000-2019. Findings demonstrate that democratic erosion strongly predicts rising deaths from drug poisoning, infectious disease, suicide, and homicide

Adverse Effects of Excessive Zinc Intake in Infants and Children Aged 0-3 Years: A Systematic Review and Meta-Analysis

Zinc supplementation reduces morbidity, but evidence suggests that excessive intakes may have negative health consequences. Current guidelines of upper limits (ULs) of zinc intake for young children are extrapolated from adult data. This systematic review (PROSPERO; registration no. CRD42020215187) aimed to determine the levels of zinc intake at which adverse effects are observed in young children. Studies reporting potential adverse effects of zinc intake in children aged 0–3 years were identified (from inception to August 2020) in MEDLINE, EMBASE and the Cochrane Library, with no limits on study design. Adverse clinical and physical effects of zinc intake were synthesized narratively, and meta-analyses of biochemical outcomes were conducted. Random effects models, forest plots were generated to examine the evidence by age category, dose, dose duration, chemical formula of zinc, and zinc vs placebo. The Joanna Briggs Institute Critical Appraisal Checklist, Cochrane Risk of Bias 2, and Grading of Recommendations Assessment, Development and Evaluation guideline (GRADE) were employed to assess risk of bias and to appraise the certainty of evidence. Fifty-eight studies assessed possible adverse effects of zinc doses ranging from 3 to 70 mg/d. Data from 39 studies contributed to meta-analyses. Zinc supplementation had an adverse effect on serum ferritin, plasma/serum copper concentration, sTfR, hemoglobin, hematocrit, and the odds of anemia in at least one of the subgroups investigated. Lactulose: mannitol ratio was improved with zinc supplementation, and no significant effect was observed on CRP, eSOD, ZPP and blood cholesterol and iron deficiency anemia. The certainty of the evidence, as assessed using GRADE, was very low to moderate. Although possible adverse effects of zinc supplementation were observed in some subgroups, it is unclear whether these findings are clinically important. The synthesized data can be used to undertake a dose-response analysis to update current guidelines of ULs of zinc intake for young children

Health effects of saturated and trans-fatty acid intake in children and adolescents: Systematic review and meta-analysis

<div><p>Background</p><p>Elevated cholesterol has been linked to cardiovascular disease in adults and preclinical markers of atherosclerosis in children, thus reducing saturated (SFA) and trans-fatty acids (TFA) intake from an early age may help to reduce cholesterol and the risk of cardiovascular disease later in life. The aim of this review is to examine the evidence for health effects associated with reducing SFA and TFA intake in free-living children, adolescents and young adults between 2 to 19 years of age.</p><p>Design</p><p>Systematic review and meta-analysis of randomised controlled trials (RCTs) and prospective cohort studies. Study selection, assessment, validity, data extraction, and analysis were undertaken as specified by the Cochrane Collaboration and the GRADE working group. Data were pooled using inverse variance models with random effects.</p><p>Data sources</p><p>EMBASE; PubMed; Cochrane Central Register of Controlled Trials; LILACS; and WHO Clinical Trial Registry (up to July 2016).</p><p>Eligibility criteria for selecting trials</p><p>RCTs involving dietary interventions aiming to reduce SFA or TFA intakes and a control group, and cohort studies reporting the effects of SFA or TFA exposures, on outcomes including blood lipids; measures of growth; blood pressure; insulin resistance; and potential adverse effects. Minimum duration was 13 days for RCTs and one year for cohort studies. Trials of weight loss or confounded by additional medical or lifestyle interventions were excluded.</p><p>Results</p><p>Compared with control diets, there was a highly statistically significant effect of reduced SFA intake on total cholesterol (mean difference (MD) -0.16 mmol/l, [95% confidence interval (CI): -0.25 to -0.07]), LDL cholesterol (MD -0.13 mmol/l [95% CI:-0.22 to -0.03]) and diastolic blood pressure (MD -1.45 mmol/l [95% CI:-2.34 to -0.56]). There were no significant effects on any other risk factors and no evidence of adverse effects.</p><p>Conclusions</p><p>Advice to reduce saturated fatty acids intake of children results in a significant reduction in total and LDL-cholesterol levels as well as diastolic blood pressure without evidence of adverse effects on growth and development. Dietary guidelines for children and adolescents should continue to recommend diets low in saturated fat.</p></div

PRISMA flow diagram of trial selection for saturated fatty acid intake in children.

<p>PRISMA flow diagram of trial selection for saturated fatty acid intake in children.</p

Dietary intake data for included trials.

<p>Dietary intake data for included trials.</p

Characteristics of included trials.

<p>Characteristics of included trials.</p

Summary of effect estimates for randomised trials that compared usual diets with reduced saturated fat diets in children.

<p>Summary of effect estimates for randomised trials that compared usual diets with reduced saturated fat diets in children.</p

Risk of bias assessment for included trials + = low risk of bias; ? = unclear risk of bias; - = high risk of bias.

<p>Risk of bias assessment for included trials + = low risk of bias; ? = unclear risk of bias; - = high risk of bias.</p

Meta-analysis of weighted mean (95% CI) differences in effects on systolic blood pressure (mm Hg) in randomised trials that compared usual diets with reduced saturated fat diets in children.

<p>Meta-analysis of weighted mean (95% CI) differences in effects on systolic blood pressure (mm Hg) in randomised trials that compared usual diets with reduced saturated fat diets in children.</p

Meta-analysis of weighted mean (95% CI) differences in effects on total cholesterol (mmol/l) in randomised trials that compared usual diets with reduced saturated fat diets in children.

<p>Meta-analysis of weighted mean (95% CI) differences in effects on total cholesterol (mmol/l) in randomised trials that compared usual diets with reduced saturated fat diets in children.</p