A LATENT VARIABLE APPROACH TO DIETARY PATTERNS RESEARCH

INTRODUCTION The dietary pattern approach is useful to study the effect of the overall diet on health outcomes, through considering the network of complex interactions between foods or nutrients. The main methods traditionally used to identify dietary patterns are principal components analysis, factor analysis, principal components factor analysis and cluster analysis. Latent class analysis (LCA) is a latent variable approach, that has some advantages in comparison to the previous methods. Unlike principal component, factor and principal component factor analysis, it can be used to classify individuals into mutually exclusive groups conceived as dietary patterns and differently from cluster analysis, which has the same aim of grouping subjects, it permits quantification of the uncertainty of class membership, and assessment of goodness of fit. Moreover, it allows for adjustment for covariates directly in the pattern identification. OBJECTIVES As latent class analysis has rarely been applied in dietary pattern studies, the aim of this research is to apply the recent developments of the techniques to this area of research. We targeted to address the issue of dietary pattern identification in the case-control setting using latent class analysis and latent class trees. We provided estimation of pattern sizes and their characterization, taking into account correlations between dietary variables (local dependencies), and covariate adjustment. We also evaluated the robustness of the identified dietary patterns to total non-alcoholic energy intake adjustment, for different types of correction. Finally, we illustrated the method\u2019s properties in the assessment of the relation between the identified dietary patterns and selected health outcomes, given the all the above. DIETARY PATTERNS AND THE RISK OF ORAL AND PHARYNGEAL CANCER We analyzed data from a multicentric case-control study on oral and pharyngeal cancer (OPC) carried out between 1992 and 2009, including 946 cases and 2492 hospital controls. Information on diet was collected through a food frequency questionnaire (FFQ). Using LCA, we identified 4 dietary patterns, conceived as mutually exclusive groups of people who shared a common dietary behaviour within groups. The first pattern, labelled \u2018Prudent pattern\u2019, showed higher probability of consuming more leafy and fruiting vegetables, citrus fruit and all other kinds of fruits, tea while showing lower probability of consuming red meat. The second pattern, that we named \u2018Western pattern\u2019, reported higher consumption of red meat and lower consumption of fruits, cruciferous and fruiting vegetables. We termed the third pattern \u2018Lower consumers-combination pattern\u2019 as people in it were less likely to eat fruits, leafy and fruiting vegetables, pulses, potatoes, fish, white and red meat, bread and tea/decaffeinated coffee. The last pattern had higher probability to eating fruiting, leafy and other vegetables, white and red meat and bread, while showed a lower probability to consume coffee, tea, processed meat, cheese, fish, sugary drinks and desserts. We called this last pattern \u2018Higher consumers-combination pattern\u2019. Dietary patterns were adjusted for total non-alcoholic energy intake and correlation between certain foods item (sugar-coffee, soups-pulses) was allowed during classes identification. 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 \u2013 3.45 and OR=2.23, 95% CI: 1.64 \u2013 3.02). Higher consumers-combination pattern didn\u2019t differ significantly from the Prudent pattern (OR=1.28, 95% CI: 0.92 \u2013 1.77). ENERGY INTAKE ADJUSTMENT IN DIETARY PATTERN RESEARCH USING LATENT CLASS ANALYSIS Using data from the multicentric case-control study on OPC (Italy, 1992-2009), we identified and compared dietary patterns adjusting or not for total non-alcoholic energy intake in the classes identification phase of the analysis. Three possible ways to correct for total energy intake in class identification were presented, corresponding to different hypothesis on the effect of this variable. In general unadjusted and adjusted solutions were comparable. The main difference was related to the patterns that showed highest/lowest non-alcoholic energy intake, that resulted in a variation of number of classes (4/5/7 patterns for the different adjusted solutions and 5 patterns for the unadjusted one). Then, to determine the effect of adjustment in predicting an health outcome, we compared the effect of unadjusted dietary patterns, unadjusted dietary patterns with non-alcoholic energy intake variable also included in the model as a confounder, and adjusted dietary patterns on the risk of OPC . Differences in the estimations for the distinct solutions were found when Odds Ratios (ORs) were not corrected for known/potential risk factors. In general, adjustments for non-alcoholic energy intake results in a mitigation of the effects, thus remaining in the same order. When adjusting for known/potential risk factors, estimations of ORs and related confidence intervals (CIs) remained consistent in all the models we fitted. In the end, specific suggestions on how to perform energy correction in dietary patterns research using LCA were delivered, basing on the results of the current analysis. DIETARY PATTERNS INSPECTION THROUGH LATENT CLASS TREE We analyzed data from two Italian case\u2013control studies, the first included 946 cases with OPC and 2492 hospital controls, and the second included 304 cases with squamous cell carcinoma of the esophagus (ESCC) and 743 hospital controls. In our application of latent class analysis on the combined dataset of the two case-control studies (Italy, 1992-2009), we found the best fit for a solution that was difficult to interpret and included minor differences between clusters. To address these issues, the Latent Class Tree method was proposed. Three fit statistics (AIC, AIC3, BIC) were used for their different level of penalty that resulted in different lengths of the tree and consequently, different granularity in the analysis. For the first split we allowed for a 4-class solution which identified a pattern characterized by high intake of leafy and fruiting vegetable and fruits (\u2018Prudent pattern\u2019), a pattern with a high intake of red meat and low intake of certain fruits and vegetables (\u2018Western pattern\u2019) and two patterns which showed a combination-type of diet. The first \u2018combination\u2019 pattern showed a low intake of the majority of foods (\u2018Lower consumers-combination pattern\u2019), and the other one high intake of various foods (\u2018Higher consumers-combination pattern\u2019). Compared to the Prudent pattern, the Western one was positively related to OPC (OR=1.91, 95% CI: 1.41-2.58) and to ESCC (OR=3.22, 95% CI: 1.78 \u2013 5.82). The Lower consumers-combination pattern was positively associated to OPC (OR=2.14, 95% CI: 1.58-2.91) and to ESCC (OR=2.85, 95% CI: 1.47-5.55). No significant association was found between the Higher consumers-combination pattern and OPC (1.04, 95% CI: 0.74-1.46) and ESCC (OR=0.89, 95% CI: 0.39-1.99). In the \u2018Prudent pattern\u2019 branch of the tree, at the third level, we found two classes that differed in the risk of both cancer types. These two classes differed mainly for the intake of citrus fruit, showing respectively, OR=1.85, 95% CI:1.07-3.19 for OPC and OR=5.37, 95% CI: 1.48-19.44 for ESCC for the class that reported low intake of citrus fruit with respect to the class which exhibit a high intake of citrus fruit. No other significant differences were found between the other pairs of classes at any other level of the tree. CONCLUSION We presented latent class methods as powerful tools to determine dietary patterns conceived as mutually exclusive homogeneous groups of subjects which shared common dietary habits. These methods exhibit some advantages, with respect to classical approaches, that can address important issues in dietary pattern research. For example, it is possible to obtain estimation for pattern prevalence in the population, and to perform energy intake adjustment in the pattern identification phase of the analysis. Moreover, class formation inspection, comparison between different solutions and the analysis of subgroups that may be relevant for the research at hand are features offered by the newly developed latent class tree approach

Dietary Patterns in Italy and the Risk of Renal Cell Carcinoma

Background: Conclusive evidence on foods, nutrients, or dietary patterns and the risk of renal cell carcinoma (RCC) is lacking in the literature. Methods: We considered data from an Italian hospital-based case\u2013control study (1992\u20132004) on 767 incident RCC cases and 1534 controls. A posteriori dietary patterns were identified by applying principal component factor analysis on 28 nutrients derived from a 78-item food-frequency questionnaire. We estimated the odds ratios (ORs) of RCC and corresponding 95% confidence intervals (CIs) for each quartile category (compared to the lowest one) using conditional multiple logistic regression models providing adjustment for major confounding factors. Results: We identified four dietary patterns, named \u201cAnimal products\u201d, \u201cStarch-rich\u201d, \u201cVitamins and fiber\u201d, and \u201cCooking oils and dressings\u201d. Higher intakes of the \u201cStarch-rich\u201d pattern were positively associated with RCC risk (OR = 1.38, 95% CI: 1.04\u20131.82 for the highest quartile, p = 0.018). The association was inverse with the \u201cCooking oils and dressings\u201d pattern (OR = 0.61, 95% CI: 0.47\u20130.80, p < 0.001), whereas no association was found with \u201cAnimal products\u201d and \u201cVitamins and fiber\u201d patterns. Conclusions: Higher intakes of starch-related foods may increase RCC risk, whereas consumption of olive and seed oils may favorably influence RCC risk

Frequency of Pregnancy‐Associated Cancer: A Systematic Review of Population‐Based Studies

Despite numerous available resources of evidence, the results about the frequency of pregnancy\u2010associated cancer (PAC) still show poor comparability due to dissimilarities in the study design and methodology, inclusion criteria, incoherent duration of follow\u2010up and a heterogeneous reference population. We conducted a systematic review of population\u2010based studies on PAC published up to December 2019, to provide updated research on this topic, highlighting strengths and limitations. Of the 24 papers included, 11 considered all types of tumors and 13 dealt with specific types of cancer. Differences in the procedures for estimating the frequency of PAC emerged even among population studies. However, we found consistent results for overall frequency of PAC\u2014 around 1/1000 pregnancies. Our review suggests that about 25% of PAC cases are diagnosed during pregnancy, confirming the hypothesis of an excess of diagnosis in the postpregnancy period. Sparse and inconsistent results were found regarding a potential increase in the frequency of PAC over calendar years. Alignments in the strategy to identify PAC are needed to overcome methodological weaknesses

Coverage and outcomes of antenatal tests for infections: a population based survey in the Province of Trento, Italy

BACKGROUND: Rubella, syphilis, toxoplasmosis, cytomegalovirus (CMV), hepatitis B (HBV) and C (HCV), HIV, and Group B Streptococcus (GBS) infections may have very severe outcomes during pregnancy, and for this reason, monitoring of infections in pregnant women is a requirement of prenatal assistance. AIMS: To describe coverage and outcome of the screening for rubella, syphilis, toxoplasmosis, CMV, HBV, HCV, HIV, and Group B Streptococcus in pregnancy in the Autonomous Province of Trento, Northern Italy (538,600 inhabitants). METHODS: We analysed the coverage and outcome of the above-mentioned screenings among women who delivered in the hospitals of the Province of Trento between 2007 and 2014 (N\u2009=\u200938,712). Screenings were grouped according to characteristics such as recommendation by national and local guidelines, scheduling of the tests, operating methods, and charge. We also estimated odds ratios (ORs) for missing screening for selected infections through multiple logistic regression. RESULTS: Estimated uptake of antenatal screening was 99.7% for rubella, 99.3% for syphilis, 99.7% for toxoplasmosis, 98.1% for HIV infection, 99.0% for HBV, 98.9% for HCV, 94.0% for GBS infection, and 75.4% for CMV infection. The overall prevalence of immunity was 94.1% for rubella, 24.2% for toxoplasmosis, and 64.2% for CMV. The rate of seroconversion in pregnant women was 0.02% for rubella, 0.29% for toxoplasmosis, and 0.75% for CMV. The overall prevalence of infection was 0.94% for HBV, 0.53% for HCV, 22.3% for GBS, 0.29% for syphilis, and 0.13% for HIV. We found a significant positive association for all screening tests, between lack of testing and late first medical examination in pregnancy (ORs ranging from 1.20 to 1.66 for the first medical visit in the second trimester and ORs ranging from 1.60 to 5.88 for the first medical visit in third trimester, compared to early medical visit in the first trimester). Compared to Italian citizenship, foreign citizenship of the mother was also positively associated with absence of screening (ORs ranging from 1.30 to 1.53). A significant inverse association was observed for calendar year of delivery (ORs ranging from 0.71 to 0.97, for 1 year increment). Less educated mothers and pluriparae were also at higher risks of not being tested. Analysis of the association with mother age showed different heterogeneous effects. CONCLUSIONS: Our study indicates that the attention to screening and detecting infected cases is growing over the time. In addition, care delivered during pregnancy has a leading role in determining coverage of the examinations. Immigrant, pluriparous and less educated women need particular attention

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

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. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.This study was supported by the Fondazione AIRC per la Ricerca sul Cancro, Project no. 21378 (Investigator Grant). The Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da Universidade do Porto (EPIUnit; UIDB/04750/2020) and the Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR; LA/P/0064/2020) were funded by the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education). SM was supported by the project “NEON‐PC—Neuro‐oncological complications of prostate cancer: longitudinal study of cognitive decline” (POCI‐01‐0145‐FEDER‐032358; ref. PTDC/SAU‐EPI/32358/2017), which is funded by FEDER through the Operational Programme competitiveness and Internationalization, and national funding from FCT and the EPIUnit—Junior Research—Prog Financing (UIDP/04750/2020). The authors thank the European Cancer Prevention (ECP) Organization for providing support for the StoP Project meetings and all MCC‐Spain study collaborators (CIBERESP, ISCIII, ISGlobal, ICO, University of Huelva, University of Oviedo, University of Cantabria, ibs.Granada, Instituto Salud Pública de Navarra, FISABIO, Murcia Regional Health Authority and cols)

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

La gestione condivisa dei dati sanitari nei servizi di telemedicina: l’esperienza del progetto NATHCARE

Nell\u2019ambito di un approccio che vede il paziente sempre pi\uf9 al centro dei processi curativi che lo riguardano, la predisposizione di piattaforme informatiche di telemedicina atte a gestire i flussi informativi che dal paziente vanno al medico (e viceversa) costituisce un\u2019ottima occasione per testare la fattibilit\ue0 dell\u2019implementazione di innovative modalit\ue0 di prestazione del servizio sanitario alla luce delle stringenti regole volte a garantire la tutela dei dati personali dei soggetti coinvolti.. Nell\u2019ambito del progetto europeo NATHCARE, la Provincia Autonoma di Trento ha guidato l\u2019individuazione di tutte le misure a garanzia di un corretto svolgimento della sperimentazione di una piattaforma di telemedicina, nel rispetto della normativa vigente in materia di privacy e sicurezza