A Functional NQO1 609C>T Polymorphism and Risk of Gastrointestinal Cancers: A Meta-Analysis

Background: The functional polymorphism (rs1800566) in the NQO1 gene, a 609C.T substitution, leading to proline-toserine amino-acid and enzyme activity changes, has been implicated in cancer risk, but individually published studies showed inconclusive results. Methodology/Principal Findings: We performed a meta-analysis of 20 publications with a total of 5,491 cases and 5,917 controls, mainly on gastrointestinal (GI) cancers. We summarized the data on the association between the NQO1 609C.T polymorphism and risk of GI cancers and performed subgroup analyses by ethnicity, cancer site, and study quality. We found that the variant CT heterozygous and CT/TT genotypes of the NQO1 609 C.T polymorphism were associated with a modestly increased risk of GI cancers (CT vs. CC: OR = 1.10, 95 % CI = 1.01 – 1.19, P heterogeneity = 0.27, I 2 = 0.15; CT/TT vs. CC: OR = 1.11, 95%CI = 1.02 – 1.20, Pheterogeneity = 0.14; I 2 = 0.27). Following further stratified analyses, the increased risk was only observed in subgroups of Caucasians, colorectal cancer in Caucasians, and high quality studies. Conclusions: This meta-analysis suggests that the NQO1 609T allele is a low-penetrance risk factor for GI cancers. Although the effect on GI cancers may be modified by ethnicity and cancer sites, small sample seizes of the subgroup analyse

Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team

A review of the distribution of particulate trace elements in urban terrestrial environments and its application to considerations of risk

We review the evolution, state of the art and future lines of research on the sources, transport pathways, and sinks of particulate trace elements in urban terrestrial environments to include the atmosphere, soils, and street and indoor dusts. Such studies reveal reductions in the emissions of some elements of historical concern such as Pb, with interest consequently focusing on other toxic trace elements such as As, Cd, Hg, Zn, and Cu. While establishment of levels of these elements is important in assessing the potential impacts of human society on the urban environment, it is also necessary to apply this knowledge in conjunction with information on the toxicity of those trace elements and the degree of exposure of human receptors to an assessment of whether such contamination represents a real risk to the city’s inhabitants and therefore how this risk can be addressed

Het afwegen van positieve en negatieve gezondheidseffecten van voedingsmiddelen. Casestudie: toegevoegd suiker versus zoetstoffen in koolzuurhoudende frisdrank

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Het verband tussen jojo-en en coronaire hartziekten in de CAREMA-studie. Toelichting bij een wetenschappelijk conceptartikel

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Evaluation of the Dutch legislation on food fortification with folic acid and vitamin D; focus on young children

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Vervanging van vlees en zuivel door duurzamere eiwitbronnen in Nederland : Kwaliteit van de voeding

Een voeding die minder vlees en zuivel bevat en meer duurzame plantaardige voedingsmiddelen kan voldoende eiwitten, mineralen en vitaminen leveren. Daarvoor is het wel nodig gevarieerd te kiezen uit plantaardige producten. De belangrijkste bronnen van plantaardige eiwitbronnen zijn noten, peulvruchten en volkoren graanproducten. Peulvruchten en noten worden nu echter nauwelijks gegeten als vervanger van dierlijke producten. Voor bepaalde vitaminen en mineralen (ijzer, calcium, vitaminen B2 en B12) kunnen ook verrijkte vlees- en zuivelvervangers een goede bron zijn. Dit geldt vooral voor B12, aangezien deze vitamine niet in plantaardige voedingsmiddelen zit. Dit blijkt uit verkennend onderzoek van het RIVM. Hierin is onderzocht wat een verschuiving in een menu van de traditionele, dierlijke eiwitbronnen naar meer duurzamere plantaardige betekent voor de inname van eiwitten, en een selectie van vitaminen en mineralen. Vlees en zuivel leveren in Nederland ongeveer de helft van de eiwitconsumptie. Mensen die geen vlees consumeren, eten meestal wel zuivelproducten. Voor hen zijn zuivel- en graanproducten momenteel de belangrijkste bronnen van eiwit. Daarnaast dragen vlees en zuivel in belangrijke mate bij aan de inname van de vitamines A, B1, B2, en B12 en de mineralen calcium, ijzer, fosfor, selenium en zink. Aanvullend onderzoek is nodig om de inname van voedingsstoffen bij verschillende consumptiepatronen met minder vlees en zuivel, verder te kwantificeren.Diets with less meat and dairy and more sustainable plant based foods can provide enough protein, minerals and vitamins, provided that a varied choice of plant foods is consumed. Main sources of plant proteins are nuts, pulses, and whole grain cereals. Current consumption of pulses and nuts as a replacer of meat is low. Fortified meat and dairy substitutes can also be a source of certain vitamins and minerals (iron, calcium, vitamins B2 en B12). This is especially true for vitamin B12, since it cannot be supplied by plant sources. RIVM carried out an exploratory study on the nutritional consequences of a shift from conventional animal to (more) sustainable protein rich plant foods. The focus was on protein, amino acids and selected micronutrients. In the Netherlands, meat and dairy deliver half of the daily protein intake. People consuming no meat typically do consume dairy products. In addition to dairy, grains are the main source of protein for them. Meat and dairy are major sources of vitamins A, B1, B2, en B12 and minerals calcium, iron, phosphorus, selenium en zinc. Further studies are needed to quantify the effects of different dietary patterns in which meat and dairy intake is reduced.Dutch Food and Consumer Product Safety Authorit

The genetics of overweight: the step towards policy-making and society. Results of an expert meeting

Op dit moment is er te weinig concrete kennis over de erfelijke factoren van overgewicht beschikbaar om daar overheidsbeleid op te kunnen baseren. Dit blijkt uit een bijeenkomst georganiseerd door het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) met experts afkomstig uit verschillende disciplines. Om hier meer inzicht in te krijgen zijn omvangrijke studies nodig met duizenden deelnemers van wie het voedings- en beweeggedrag nauwkeurig wordt gemeten. Hierin moeten ook de hoeveelheid lichaamsvet en de verdeling daarvan over het lichaam worden gemeten. Volgens de experts is het met deze verkregen inzichten in de toekomst mogelijk om nieuwe medicijnen te ontwikkelen die overgewicht voorkomen en behandelen. Verder zal het mogelijk zijn om te dikke mensen met een hoog risico op complicaties, zoals hart- en vaatziekten en diabetes mellitus, op basis van genetische informatie vroegtijdig te identificeren. Deze groep mensen kan vervolgens preventief worden behandeld met medicijnen en voedings- en beweegadviezen, afgestemd op hun genetisch profiel. Of deze toekomstverwachtingen werkelijkheid worden en zo ja wanneer is onbekend. De overheid kan nu wel alvast op deze toekomstige ontwikkelingen inspelen door algemene kennis over genetica onder burgers en medische professionals te vermeerderen. Voor burgers is deze kennis nodig om te kunnen omgaan met keuzes die deze ontwikkelingen met zich meebrengen. Medische professionals kunnen er vragen van hun patienten mee beantwoorden. De overheid kan ook al intern een discussie opzetten over de mogelijke gevolgen voor het beleid en over haar verantwoordelijkheden in deze.The amount of concrete data on heritable factors contributing to overweight is inadequate and, as such, there is currently no solid basis for (changes in) government policies. This is the consensus conclusion of experts in several associated disciplines who participated in an expert meeting organized by the National Institute for Public Health and the Environment (RIVM). To obtain more insight into the genetics of overweight, it will be necessary to carry out large-scale studies in which the diet and physical activity of thousands of participants are accurately measured. The amount of body fat and its distribution throughout the body should also be determined. According to the participants of the expert meeting, the insights gained from such studies will facilitate the development of new medicines that will be able to prevent and treat overweight. The acquired knowledge will also enable for example healthcare providers to identify overweight individuals with a high risk of complications, such as cardiovascular diseases and diabetes mellitus, at an early stage based on their genetic background. It would then be possible to treat this group of people with medicines and dietary and physical activity recommendations that have been determined on the basis of their genetic profile. Whether these expectations will ever become a reality - and if so, when - is unknown. However, in anticipation that such future developments are put into practice, the government can take steps now to improve the level of general knowledge of genetics among the general public and medical professionals. The general public will require this knowledge to be able to deal appropriately with the choices that will emerge from the application of these medical developments. Medical professionals will also be better able to answer questions from their patients. The government could also start internal discussions on the possible consequences of such developments on their policies as well as their own responsibility in this area.VW