Non-specific effects of measles, mumps, and rubella (MMR) vaccination in high income setting: population based cohort study in the Netherlands.

Objectives To investigate whether measles, mumps, and rubella (MMR) vaccine has positive non-specific effects in a high income setting and to compare rates of hospital admissions for infections between children aged ≤2 years who received live MMR vaccine and those who received an inactivated vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaP-IPV-Hib) as their most recent vaccination.Design Nationwide population based cohort study.Setting In the Netherlands, DTaP-IPV-Hib+pneumococcal vaccination (PCV) is recommended at ages 2, 3, 4, and 11 months and MMR + meningococcal C (MenC) vaccination at age 14 months. Data from the national vaccine register were linked to hospital admission data.Participants 1 096 594 children born in 2005-11 who received the first four DTaP-IPV-Hib+PCV vaccines.Main outcome measures Hazard ratio for admission to hospital for infection in children with MMR+MenC compared with the fourth DTaP-IPV-Hib+PCV as their most recent vaccination. Cox regression was performed with most recent vaccination as time dependent variable, adjusted for potential confounders. Analyses were repeated with admission for injuries or poisoning as a negative control outcome. In addition, rate of admission for infection was compared between the fourth and third DTaP-IPV-Hib+PCVas most recent vaccination.Results Having had MMR+MenC as the most recent vaccination was associated with a hazard ratio of 0.62 (95% confidence interval 0.57 to 0.67) for admission to hospital for infection and 0.84 (0.73 to 0.96) for injuries or poisoning, compared with the fourth DTaP-IPV-Hib+PCV as most recent vaccination. The fourth DTaP-IPV-Hib+PCV as most recent vaccination was associated with a hazard ratio of 0.69 (0.63 to 0.76) for admission to hospital for infection, compared with the third DTaP-IPV-Hib+PCV as most recent vaccination.Conclusions Healthy vaccinee bias could at least partly explain the observed lower rate of admission to hospital with infection after MMR vaccination. The lower rate is associated with receipt of any additional vaccine, not specifically MMR vaccine. This emphasises the caution required in the interpretation of findings from observational studies on non-specific effects of vaccination

Twenty-four hour urinary urea excretion and 9-year risk of hypertension:the PREVEND study

<p>Objectives:It is not yet clear whether dietary protein could help maintaining a healthy blood pressure (BP). We investigated the association between total protein intake, estimated from 24-h urinary urea excretion, and incident hypertension in Dutch men and women.Methods:We analyzed data of 3997 men and women (aged 28-75 years) who participated in the Prevention of Renal and Vascular Endstage Disease (PREVEND) study, a prospective cohort study. Urea excretion was assessed in two consecutive 24-h urine collections at baseline and approximately 4 years later, from which total protein intake was estimated using the Maroni method. Participants were followed for 9 years for hypertension incidence, defined as BP at least 140/90mmHg or initiation of antihypertensive medication. Hazard ratios (HR) were obtained in sex-specific quintiles of protein intake using time-dependent Cox regression, adjusted for age, sex, BMI, smoking, alcohol use, and 24-h urinary excretions of sodium and potassium.Results:Baseline BP was on average 119/70mmHg and 976 participants developed hypertension during follow-up. Mean protein intake (in g/kg ideal body weight) was 1.180.26 for men and 1.12 +/- 0.25 for women. Estimated protein intake was nonlinearly inversely associated with incident hypertension in the fully adjusted model, with nonsignificant HR of 0.77, 0.75, 0.82, and 0.83 in consecutive quintiles compared with the lowest quintile (P-trend: 0.52).Conclusion:Protein intake, as assessed by urinary urea excretion, was not significantly associated with 9-year hypertension incidence in Dutch men and women.</p>

Amino acid metabolism.

<p>Amino acid metabolism.</p

Socio-demographic and medical characteristics in celiac disease patients and matched controls.

<p>Data are presented as n (%) or mean (± SD), or median (Q₁-Q₃), when appropriate. MDD denotes, major depressive disorder; hsCRP, High-sensitivity C-reactive protein; MET, metabolic equivalents of task.</p><p>*: Two sided <i>p</i>-values by chi-squared test for categorical variables and by ANOVA for continuous variables.</p><p>^a Statistically significantly different in post-hoc tests from controls.</p><p>^b Statistically significantly different in post-hoc tests from never MDD.</p><p>Socio-demographic and medical characteristics in celiac disease patients and matched controls.</p

Diet intake in celiac disease patients and matched controls.

<p>Data are (adjusted) means ± standard error (SE). MDD denotes, major depressive disorder.</p><p>*: Two sided <i>p</i>-values by AN(CO)VA, adjusted for age, gender, education, BMI, alcohol intake and smoking.</p><p>^a Statistically significantly different in post-hoc tests from controls.</p><p>Diet intake in celiac disease patients and matched controls.</p

Dietary intake and serum levels of tyrosine, phenylalanine and tryptophan in controls and celiac disease patients with and without depression.

<p>Dietary intake and serum levels of tyrosine, phenylalanine and tryptophan in controls and celiac disease patients with and without depression.</p

Serum amino acid levels in celiac disease patients and matched controls.

<p>Data are (adjusted) means ± standard error (SE). MDD denotes, major depressive disorder.</p><p>*: Two sided <i>p</i>-values by AN(CO)VA, adjusted for age, gender, education, BMI, alcohol intake, smoking and total energy intake.</p><p>^a Statistically significantly different in post-hoc tests from controls.</p><p>^b Statistically significantly different in post-hoc tests from never MDD.</p><p>Serum amino acid levels in celiac disease patients and matched controls.</p