Genetically predicted vegetable intake and cardiovascular diseases and risk factors: an investigation with Mendelian randomization

Background: The associations between vegetable intake and cardiovascular diseases have been demonstrated in observational studies, but less sufficiently in randomized trials. Mendelian randomization has been considered a promising alternative in causal inference. The separate effects of cooked and raw vegetable intake remain unclear. This study aimed to investigate the associations between cooked and raw vegetable intake with cardiovascular outcomes using MR. Methods: We identified 15 and 28 genetic variants statistically and biologically associated with cooked and raw vegetable intake, respectively, from previous genome-wide association studies, which were used as instrumental variables to estimate associations with coronary heart disease (CHD), stroke, heart failure (HF), and atrial fibrillation (AF). The independent effects of genetically predicted cooked and raw vegetable intake were examined using multivariable MR analysis. We performed one-sample and two-sample MR analyses and combined their results using meta-analysis. Bonferroni correction was applied for multiple comparisons. We performed two-sample MR analysis for cardiometabolic risk factors (serum lipids, blood pressure, body mass index, and glycemic traits) to explore the potential mechanisms. Results: In the MR meta-analysis of 1.2 million participants, we found null evidence for associations between genetically predicted cooked and raw vegetable intake with CHD, HF, or AF. Raw vegetable intake was nominally associated with stroke (odds ratio [95% confidence interval] 0.82 [0.69–0.98] per 1 daily serving increase, p = 0.03), but this association did not pass the corrected significance level. We found consistently null evidence for associations with serum lipids, blood pressure, body mass index, or glycemic traits. Conclusions: We found null evidence for associations between genetically predicted vegetable intake with CHD, AF, HF, or cardiometabolic risk factors in this MR study. Raw vegetable intake may reduce risk of stroke, but this warrants more research. True associations between vegetable intake and CVDs cannot be completely ruled out, and future investigations are required for causal inference in nutritional research

Milk Consumption and Cardiovascular Risk Factors in Older Chinese: The Guangzhou Biobank Cohort Study

BackgroundDairy products consumption is increasingly common globally. Most of the evidence concerning dairy products comes from observational studies in western populations which are inevitably open to confounding. To triangulate the evidence concerning dairy products, we examined the associations of whole cow’s milk consumption with cardiovascular risk factors in a non-Western setting with a different pattern of milk consumption and cardiovascular diseases from Western populations. MethodsWe used multivariable censored linear or logistic regression to examine cross-sectionally the adjusted associations of whole cow’s milk consumption (none (n = 14892), 1–3/week (n = 2689) and 3+/week (n = 2754)) with cardiovascular risk factors in Chinese ($50 years) in the Guangzhou Biobank Cohort Study. ResultsWhole cow’s milk consumption was negatively associated with systolic blood pressure (3+/week compared to none 22.56 mmHg, 95% confidence interval (CI) 23.63 to 21.49), diastolic blood pressure (21.32 mmHg, 95% CI 21.87 to 20.77) and triglycerides (20.06 mmol/L, 95% CI 20.11 to 20.002), but was positively associated with HDL-cholesterol (0.02 mmol/L,95% CI 0.01 to 0.04) and fasting glucose (0.08 mmol/L, 95% CI 0.01 to 0.16) adjusted for age, sex, phase of study, socio-economic position, lifestyle (smoking, alcohol use and physical activity) and adiposity, but had no obvious association with LDL-cholesterol or the presence of diabetes. ConclusionsWhole cow’s milk consumption had heterogeneous associations with cardiovascular risk factors. Higher whole cow’s milk consumption was associated with lower levels of specific cardiovascular risk factors which might suggest risk factor specific biological pathways with different relations to blood pressure and lipids than glucose

Educational relationships : a study in midwifery

At its inception in 1902, formal midwifery training developed within hospital midwifery services. With the development of a theoretical base, training became education during the 1980s. During a period of economic and societal changes in the 1990s, midwifery education was incorporated into higher education, separating education from health service practice. There were consequences for midwifery education especially the structure of pedagogical relationships. This thesis looks at key sets of relationships in midwifery education between the three main groups of actors: academics, clinicians and students. In so doing, the inquiry utilises a grounded theory approach and embraces disciplines of education, social sciences, social psychology, management and philosophy. The study confirms the importance of relationships between the key actors as part of a student's learning experiences. However, these relationships have become more problematic as a result of the organisational separation between the academic and professional components. A framework is proposed to describe educational relationships in midwifery. The framework has six dimensions; (i) a core component of personal traits, (ii) a secondary component of social and communication abilities and four subsidiary components of (iii) professional expertise, (iv) personal knowledge, (v) education knowledge and skills and (vi) a vision for practice. Realisation of the components by one person of another within the three groups aids mutuality in understanding. General principles are offered that include notions of encounter, exchange, rules, boundaries, reciprocity and reinforcement that aid in constructions of relationships. Though these conditions, in themselves, aid the formation of learning relationships, two processes occur in these relationships through encounters, that is, complementation (a unity of meanings between actors) and complementarity (a matching of understandings). These require a forum for encounters. A model of education is proposed that offers just such a forum aiding positive encounters to promote learning between the three groups of actors. Features of this model are the development of teachers within clinical practice, accreditation of practitioners as educators and the education of students primarily in clinical situations with interactive learning

Blood n-3 fatty acid levels and total and cause-specific mortality from 17 prospective studies.

The health effects of omega-3 fatty acids have been controversial. Here we report the results of a de novo pooled analysis conducted with data from 17 prospective cohort studies examining the associations between blood omega-3 fatty acid levels and risk for all-cause mortality. Over a median of 16 years of follow-up, 15,720 deaths occurred among 42,466 individuals. We found that, after multivariable adjustment for relevant risk factors, risk for death from all causes was significantly lower (by 15-18%, at least p < 0.003) in the highest vs the lowest quintile for circulating long chain (20-22 carbon) omega-3 fatty acids (eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids). Similar relationships were seen for death from cardiovascular disease, cancer and other causes. No associations were seen with the 18-carbon omega-3, alpha-linolenic acid. These findings suggest that higher circulating levels of marine n-3 PUFA are associated with a lower risk of premature death.The EPIC Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136). NJW, NGF, and FI were supported by the Medical Research Council Epidemiology Unit core funding [MC_UU_12015/1 and MC_UU_12015/5]. NJW and NGF acknowledge support from the National Institute for Health Research Cambridge Biomedical Research Centre [IS-BRC-1215-20014] and NJW is an NIHR Senior Investigator

Heihe river basin water resources decision support system

Water is a basic necessity for maintaining life and development of society, it is a vital resource for human survival and economic development. However, water shortages will engender water use conflicts, both in terms of quantity and quality. River Basin Water Resources Management is the integrating concept for a number of water users such as hydropower, water supply, irrigation and drainage. An integrated water resources perspective ensures that social, economic, environmental and technical dimensions are taken into account in the management and development of water resources. Decision Support System (DSS) is a combination of tools and approaches that are generally attributed to hydroinformatics, and that can help to understand and simulate a variety of management and hydrological aspects. These range from broad scale river basin issues to detailed hydrological and hydrodynamic investigations in relation to water supply and development with respect to quantity and quality in river basins. China Heihe River basin is the study area for this research. The main problem is, given the available water resources and their natural variations, to identify to what extent can the river basin be sustainable. The following issues are to be considered: irrigation schemes, water supply scheme, reservoirs, avoiding unacceptable shortages for water users, especially the damage to the fragile ecological system; when and where will conflicts between water users occur; what combination of infrastructure and management measures will provide an optimum use of the available resources. The main objective of this research is to establish a River Basin Water Resources Decision Support System. RlBASIM modelling tool developed by Delft Hydraulics is the core part of the decision support system, it is a comprehensive and flexible tool to link the hydrologic inputs of water to the various water using activities in the basin and to evaluate a variety of measures related to infrastructure and operational management. RIBAS1M is used to build the water resources model, schematizing the river network, surface water and ground water and water users, especially focused on the irrigation water shortage management in the Middle basin. Then, based on the basic model simulation and calibration of the year 1999, various scenarios can be modelled in order to analyse the impact on the water supply-demand balance in the year 2010, combining both technical and management measures. Besides, optimization techniques, Geographic Information System and an Internet-based information system for the stakeholders to share the hydrologic and socio-economic information are also included in the Decision Support System. The conclusion is that the availability of various hydroinformatics tools, such as simulation models, optimization techniques, database management systems, Internet and GIS, provide an excellent basis for building a DSS. The experiments with the components of DSS built in the framework oft his study, especially with RlBASIM, give the possibility to say that DSS can considerably facilitate the integrated water resources management in the river basin

Diet and cardiovascular disease risk in Chinese

An unhealthy diet is a risk factor for cardiovascular disease (CVD). Most evidence concerning the cardiovascular effect of diet is from observational studies in Western settings, where dietary reporting is open to under-reporting. Bias caused by residual confounding is also possible as higher socio-economic position is often associated with a different diet and a lower CVD risk. Furthermore, people may adjust their diet in response to poor health. Evidence from non-Western settings with potentially different dietary reporting and patterns of confounding may help identify whether these observed associations in the West are biologically based targets of intervention or contextually specific results stemming from information bias and unmeasured confounding. This thesis took advantage of a large study of older adults (50+ years) from the developing non-Western setting of Guangzhou in Southern China to examine the associations of key aspects of diet that feature heavily in dietary guidelines (milk, fruit, vegetable and nut consumption) with CVD risk. In the Guangzhou Biobank Cohort Study (GBCS), first from a food frequency questionnaire (FFQ), I assessed the proportion of dietary under- and over-reporters based on the ratio of reported energy intake to basal metabolic rate. Then I examined the adjusted associations of milk, fruit, vegetable and nut consumption with CVD risk and risk factors cross-sectionally and prospectively. CVD risk was proxied by Framingham score, calculated from sex, age, LDL-cholesterol, HDL-cholesterol, blood pressure, and history of diabetes. CVD risk factors considered were components of the Framingham score. Multivariable linear regression was used to assess the adjusted associations of dietary items with Framingham score. Multivariable censored linear regression was used to assess adjusted associations with CVD risk factors. Given eating habits may change in response to ill-health, I also considered whether associations varied by health status. Only 10.9% of GBCS participants were classified as under-reporters, and 9.1% as over-reporters. Cross-sectionally: (1) whole cow’s milk consumption was associated with lower Framingham score among all participants, (2) fruit consumption was associated with lower Framingham score among participants in poor health, while associated with higher Framingham score among participants in good health, (3) vegetable consumption was associated with higher Framingham score among all participants and (4) nut consumption was associated with slightly lower Framingham score among participants in good health. Prospectively, adjusted for baseline CVD risk or risk factors, milk, fruit, vegetable or nut consumption was barely associated with Framingham score or its components. In this recently developed Chinese population, few were obviously under- or over-reporting energy intake assessed from a FFQ, which might make this setting a particularly suitable setting to assess the association of diet with health. Milk, fruit, vegetable and nut consumption were not consistently associated with lower CVD risk, cross-sectionally or prospectively, in contrast to findings from most observational studies from the West, which might indicate that the associations observed in the West may be contextually specific, and that contextually specific recommendations, based preferably on experimental evidence, are required.published_or_final_versionPublic HealthDoctoralDoctor of Philosoph