2015 Seychelles global school-based student health survey

Introduction : Risky behaviors in school‐aged children, such as unhealthy dietary patterns, lack of physical activity, cigarette smoking, alcohol and substance use, sexual behavior, can impact their health in the short and long terms. This survey aimed to assess the prevalence of selected risk behaviors and protective factors in students aged 13‐15 years. Methods: The Global School‐based Student Health Survey (GSHS) was conducted in September 2015 in Seychelles. Methods followed the standard methodology of GSHS developed by the World Health Organization, the Centers of Disease Prevention and Control (Atlanta, USA) and other international agencies. A two‐stage cluster sample was used to include a random sample of students in grades S1 to S5, i.e. students aged 11 to 17 years. Students completed a self reported questionnaire, which was anonymous, which included questions from several standard modules of GSHS. In addition, weight and height was measured on the day before the survey and students were asked to report their results in their anonymous response forms

2015 Seychelles Global Youth Tobacco Survey and comparison with GYTS in 2007 and 2002

OBJECTIVES: The Global Youth Tobacco Survey (GYTS) is aimed to assess behaviors, knowledge, beliefs, opinions and other variables related to tobacco use among students of secondary schools aged 13‐15 years in countries worldwide using a standard methodology and questionnaire. METHODS: We present the main findings of GYTS performed in Seychelles in 2015 and compare results with results of two previous GYTS surveys done in Seychelles in 2007 and 2002 in order to identify trends over time. In each GYTS, a two‐stage cluster sample design was used to produce a representative sample of all students in grades S1, S2, S3, S4 and S5 from all public and private schools in Seychelles. Participants completed a standard self‐administered questionnaire in schools on an anonymous and voluntary basis

Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries

Purpose Previously reported associations of protein-rich foods with stroke subtypes have prompted interest in the assessment of individual amino acids. We examined the associations of dietary amino acids with risks of ischaemic and haemorrhagic stroke in the EPIC study. Methods We analysed data from 356,142 participants from seven European countries. Dietary intakes of 19 individual amino acids were assessed using validated country-specific dietary questionnaires, calibrated using additional 24-h dietary recalls. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of ischaemic and haemorrhagic stroke in relation to the intake of each amino acid. The role of blood pressure as a potential mechanism was assessed in 267,642 (75%) participants. Results After a median follow-up of 12.9 years, 4295 participants had an ischaemic stroke and 1375 participants had a haemorrhagic stroke. After correction for multiple testing, a higher intake of proline (as a percent of total protein) was associated with a 12% lower risk of ischaemic stroke (HR per 1 SD higher intake 0.88; 95% CI 0.82, 0.94). The association persisted after mutual adjustment for all other amino acids, systolic and diastolic blood pressure. The inverse associations of isoleucine, leucine, valine, phenylalanine, threonine, tryptophan, glutamic acid, serine and tyrosine with ischaemic stroke were each attenuated with adjustment for proline intake. For haemorrhagic stroke, no statistically significant associations were observed in the continuous analyses after correcting for multiple testing. Conclusion Higher proline intake may be associated with a lower risk of ischaemic stroke, independent of other dietary amino acids and blood pressure

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

SOCIO-ECONOMIC DETERMINANTS OF DIET IN HIGH AND MIDDLE INCOME COUNTRIES: EVIDENCE FROM SWISS, GUATEMALAN AND SEYCHELLES POPULATIONS

The relationship between socioeconomic status (SES) and diet in high-income countries (HICs) has been widely assessed, with low SES individuals generally showing diets high in fatty méats, refîned grains and added fats. However, few studies have assessed the associations between SES and diet in low- and middle-income countries (LMICs). This project airned to assess the associations between SES and diet in countries of différent levels of socioeconomic development and to provide indications on how to address these inequalities. This project also aimed to conduct systematic reviews of the literature in LM ICs on the associations between SES and diet, and on the effect of interventions promoting healthy eating on social inequalities in diet. To achieve these objectives, six studies were conducted: two systematic reviews in LMICs, three separate studies in three lower-middle, higher-middie and HICs (i.e. Guatemala, Seychelles and Switzerland, respectively), and one analyzing the three countries together. One systematic review showed that in LMICs high SES was associated with a healthier diet and greater diet quality and diversity but also to a higher intake of protein, fat and cholesterol. Then, in Guatemala, high SES was associated with a more "westernized" diet but a less traditional diet. In Seychelles, low SES was associated with lower adherence to the "fruit and vegetables" pattern, and with higher adherence to the "fish and rice" pattern across ail éducation levels. In Switzerland, a low educational level was not consistently associated with lower compliance to the Swiss dietary recommendations. Afterwards, the three countries were analyzed together by assessing compliance to the Eatwell plate dietary recommendations. High SES was associated with higher compliance to the fruit and vegetable recommendations but for other foods, compliance might depend on the level of country development such as the fish intake recommendation. Finally, the systematic assessment of interventions promoting healthy eating in LMICs showed interventions focusing on disadvantaged populations were likely to reduce social inequalities in diet. This project contributed to the current knowledge on the associations between SES and diet in several countries, but further research in LMICs is required to formulate evidence based policies and interventions. -- Le lien entre statut socio-économique (SSE) et alimentation dans les pays à haut revenu (HICs) a été largement discuté : il a notamment été démontré que les individus avec un SSE bas avaient un régime alimentaire plus riche en viandes grasses, en produits céréaliers raffinés et en graisses ajoutées. Néanmoins, peu d'études se sont encore intéressées au rapport entre le SSE et l'alimentation dans les pays à revenu faible ou intermédiaire (LMICs). Ce projet vise, d'une part, d'analyser le lien entre le SSE et le régime alimentaire dans trois pays de niveaux socio-économiques différents et, d'autre part, de fournir des indications sur ce qu'il est possible d'entreprendre pour réduire ces inégalités. De plus, ce projet a comme but de conduire des revues systématiques de la littérature portant sur les LMICs et sur les associations entre le SSE et l'alimentation, ainsi que sur les effets des interventions promouvant une alimentation saine sur les inégalités en lien avec les habitudes alimentaire. A cette fin, six études ont été conduites: deux revues systématiques dans les LMICs, trois études dans des pays à revenu intermédiaire inférieur, intermédiaire supérieur et haut (respectivement au Guatemala, aux Seychelles et en Suisse), de même qu'une analyse portant sur les trois pays ensemble. Une revue systématique a montrée que dans les LMICs, un SSE supérieur était associé à une alimentation plus diversifiée et de meilleure qualité, mais également à un apport plus important en protéines, graisses et cholestérol. Ainsi, au Guatemala, un SSE supérieur était associé à un régime alimentaire plus « occidental » et moins traditionnel. Aux Seychelles, un SSE inférieur était lié à une faible adhésion aux régimes du type « fruits et légumes », mais à une adhésion plus forte au régime du type « poisson et riz » et ce, quel que soit le niveau d'éducation. En Suisse, un faible niveau d'éducation n'était pas lié de façon consistante à une faible adhésion aux recommandations alimentaires suisses. Finalement, les trois pays ont été analysés ensemble pour étudier l'adhésion aux recommandations de la « Eatwell plate ». Un SSE supérieur était partout associé à une plus forte adhésion au régime de type «fruits et légumes». En revanche, pour ce qui concerne les autres régimes tels que le régime de type «poisson», l'adhésion semble dépendre du niveau de développement socio-économique du pays. Finalement, l'évaluation systématique des interventions qui visent à promouvoir une alimentation saine dans les LMICs montre que les interventions focalisées sur les populations désavantagées était plus efficaces pour réduire les inégalités sociales en lien avec l'alimentation. Bien que ce projet enrichisse substantiellement nos connaissances sur le lien entre SSE et alimentation dans différents pays, des recherches plus approfondies dans les LMICs sont nécessaires pour mieux formuler des politiques et des interventions en matière de recommandations alimentaires basées sur des preuves scientifiques

Pre-diagnostic circulating resistin concentrations are not associated with colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study

Resistin is a polypeptide implicated in inflammatory processes, and as such could be linked to colorectal carcinogenesis. In case-control studies, higher resistin levels have been found in colorectal cancer (CRC) patients compared to healthy individuals. However, evidence for the association between pre-diagnostic resistin and CRC risk is scarce. We investigated pre-diagnostic resistin concentrations and CRC risk within the European Prospective Investigation into Cancer and Nutrition using a nested case-control study among 1293 incident CRC-diagnosed cases and 1293 incidence density-matched controls. Conditional logistic regression models controlled for matching factors (age, sex, study center, fasting status, and women-related factors in women) and potential confounders (education, dietary and lifestyle factors, body mass index (BMI), BMI-adjusted waist circumference residuals) were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for CRC. Higher circulating resistin concentrations were not associated with CRC (RR per doubling resistin, 1.11; 95% CI 0.94–1.30; p = 0.22). There were also no associations with CRC subgroups defined by tumor subsite or sex. However, resistin was marginally associated with a higher CRC risk among participants followed-up maximally two years, but not among those followed-up after more than two years. We observed no substantial correlation between baseline circulating resistin concentrations and adiposity measures (BMI, waist circumference), adipokines (adiponectin, leptin), or metabolic and inflammatory biomarkers (C-reactive protein, C-peptide, high-density lipoprotein cholesterol, reactive oxygen metabolites) among controls. In this large-scale prospective cohort, there was little evidence of an association between baseline circulating resistin concentrations and CRC risk in European men and women

Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: A pooled analysis of data from two prospective cohort studies

Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (Phomogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences.National Health and Medical Research Council of Australia 1074383 209057 396414 GNT1163120Canadian Institutes of Health Research (CIHR) Cancer Council VictoriaCancer Research UK C570/A16491 C8221/A19170 C864/A14136Catalan Institute of Oncology - ICO (Spain)Danish Cancer SocietyDeutsche KrebshilfeDeutsches Krebsforschungszentrum (Germany)Dutch Ministry of Public Health, Welfare and SportsEuropean Commission European Commission Joint Research CentreFoundation for Alcohol Research and Education (Australia)French Ministry of Health GR-IARC-2003-09-12-01Health Research Fund (FIS) -Instituto de Salud Carlos III (ISCIII)Junta de AndalucíaRegional Government of AsturiasBasque GovernmentRegional Government of MurciaRegional Government of NavarraHellenic Health Foundation (Greece)Hellenic Ministry of Health and Social Solidarity (Greece)Institut National de la Sante et de la Recherche Medicale (Inserm)Consiglio Nazionale delle Ricerche (CNR)Associazione Italiana per la Ricerca sul Cancro (AIRC)Ligue Contre le Cancer (France)LK Research FundsDutch Prevention FundsNetherlands Organization for Scientific Research (NWO)UK Research & Innovation (UKRI) Medical Research Council UK (MRC) MC-UU_12015/1 MR/M012190/1 MR/N003284/Mutuelle Generale de l'Education NationaleNational Institute for Public Health and the Environment (RIVM) (the Netherlands)Netherlands Cancer RegistryStavros Niarchos Foundation (Greece)Stroke Association (UK)British Heart FoundationDepartment of Health (UK)Food Standards Agency (UK)Wellcome TrustSwedish Cancer SocietySwedish Scientific Council (Sweden)Regional Government of Skane (Sweden)Federal Ministry of Education & Research (BMBF)VicHealth (Australia)World Cancer Research Fund and Statistics Netherlands (the Netherlands)Institut Gustave Rouss

Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: A pooled analysis of data from two prospective cohort studies

Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (Phomogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences

Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: A pooled analysis of data from two prospective cohort studies

Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (Phomogeneity =.02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences. © 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC

Dietary intake of advanced glycation end products (AGEs) and changes in body weight in European adults

Purpose: Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5 years of follow-up. Methods: A total of 255,170 participants aged 25–70 years were recruited in ten European countries (1992–2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11 years later depending on the study center. A reference database for AGEs was used containing UPLC–MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects. Results: A one-SD increment in CEL intake was associated with 0.111 kg (95% CI 0.087–0.135) additional weight gain over 5 years. The corresponding additional weight gain for CML and MG-H1 was 0.065 kg (0.041–0.089) and 0.034 kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish. Conclusion: In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5 years of follow-up. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature