Associations between exploratory dietary patterns and incident type 2 diabetes : a federated meta-analysis of individual participant data from 25 cohort studies

Purpose In several studies, exploratory dietary patterns (DP), derived by principal component analysis, were inversely or positively associated with incident type 2 diabetes (T2D). However, fndings remained study-specifc, inconsistent and rarely replicated. This study aimed to investigate the associations between DPs and T2D in multiple cohorts across the world. Methods This federated meta-analysis of individual participant data was based on 25 prospective cohort studies from 5 continents including a total of 390,664 participants with a follow-up for T2D (3.8–25.0 years). After data harmonization across cohorts we evaluated 15 previously identifed T2D-related DPs for association with incident T2D estimating pooled incidence rate ratios (IRR) and confdence intervals (CI) by Piecewise Poisson regression and random-efects meta-analysis. Results 29,386 participants developed T2D during follow-up. Five DPs, characterized by higher intake of red meat, processed meat, French fries and refned grains, were associated with higher incidence of T2D. The strongest association was observed for a DP comprising these food groups besides others (IRRpooled per 1 SD=1.104, 95% CI 1.059–1.151). Although heterogeneity was present (I 2=85%), IRR exceeded 1 in 18 of the 20 meta-analyzed studies. Original DPs associated with lower T2D risk were not confrmed. Instead, a healthy DP (HDP1) was associated with higher T2D risk (IRRpooled per 1 SD=1.057, 95% CI 1.027–1.088). Conclusion Our fndings from various cohorts revealed positive associations for several DPs, characterized by higher intake of red meat, processed meat, French fries and refned grains, adding to the evidence-base that links DPs to higher T2D risk. However, no inverse DP–T2D associations were confrmed

Information Management in Multicenter Studies: the Brazilian Longitudinal Study for Adult Health

Information management in large multicenter studies requires a specialized approach. The Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil - Brazilian Longitudinal Study for Adult Health) has created a Datacenter to enter and manage its data system. The aim of this paper is to describe the steps involved, including the information entry, transmission and management methods. A web system was developed in order to allow, in a safe and confidential way, online data entry, checking and editing, as well as the incorporation of data collected on paper. Additionally, a Picture Archiving and Communication System was implemented and customized for echocardiography and retinography. It stores the images received from the Investigation Centers and makes them available at the Reading Centers. Finally, data extraction and cleaning processes were developed to create databases in formats that enable analyses in multiple statistical packages.A gerência da informação em estudos multicêntricos de grande porte requer uma abordagem especializada. O Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) criou um Centro de Dados para delinear e gerenciar seu sistema de dados. O objetivo do artigo foi descrever os passos envolvidos, incluindo os métodos de entrada, transmissão e gerência de informações. Foi desenvolvido um sistema web que permitiu, de forma segura e confidencial, a entrada online, verificação e edição, bem como incorporação de dados coletados em papel. Além disso, foi implantado e personalizado um sistema de armazenamento e comunicação de imagens (Picture Arquiving and Communication System) para ecocardiografia e retinografia que armazena as imagens recebidas dos Centros de Investigação e as torna acessíveis nos Centros de Leitura. Finalmente, foram desenvolvidos processos de extração e limpeza de dados para criação de bases de dados em formatos que permitam análises em múltiplos pacotes estatísticos

O elevado risco nutricional está associado a desfechos desfavoráveis em pacientes internados na unidade de terapia intensiva

OBJECTIVE: To evaluate possible associations between nutritional risk and the clinical outcomes of critical patients admitted to an intensive care unit. METHODS: A prospective study was carried out with a cohort comprising 200 patients admitted to a university hospital intensive care unit. Nutritional risk was assessed with the NRS-2002 and NUTRIC scores. Patients with scores ≥ 5 were considered at high nutritional risk. Clinical data and outcome measures were obtained from patients'' medical records. Multiple logistic regression analysis was used to calculate odds ratios and their respective 95% confidence intervals (for clinical outcomes). RESULTS: This sample of critical patients had a mean age of 59.4 ± 16.5 years and 53.5% were female. The proportions at high nutritional risk according to NRS-2002 and NUTRIC were 55% and 36.5%, respectively. Multiple logistic regression models adjusted for gender and type of admission indicated that high nutritional risk assessed by the NRS-2002 was positively associated with use of mechanical ventilation (OR = 2.34; 95%CI 1.31 - 4.19; p = 0.004); presence of infection (OR = 2.21; 95%CI 1.24 - 3.94; p = 0.007), and death (OR = 1.86; 95%CI 1.01 - 3.41; p = 0.045). When evaluated by NUTRIC, nutritional risk was associated with renal replacement therapy (OR = 2.10; 95%CI 1.02 - 4.15; p = 0.040) and death (OR = 3.48; 95%CI 1.88 - 6.44; p < 0.001). CONCLUSION: In critically ill patients, high nutritional risk was positively associated with an increased risk of clinical outcomes including hospital death

Validity and reproducibility of retinal arteriole and venule diameter measurements : ELSA-Brasil study : a cross-sectional study

BACKGROUND: Investigation of alterations to retinal microvasculature may contribute towards understanding the role of such changes in the pathophysiology of several chronic non-communicable diseases. The objective here was to evaluate the validity and reproducibility of retinal arteriole and venule diameter measurements made by Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) graders. DESIGN AND SETTING: Cross-sectional study at six teaching and research institutions. METHODS: To evaluate validity, each of 25 retinal images from the University of Wisconsin (gold standard) was measured by five ELSA-Brasil graders. To evaluate reproducibility, 105 images across the spectrum of vessel diameters were selected from 12,257 retinal images that had been obtained between 2010 and 2012, and each image was reexamined by the same grader and by an independent grader. All measurements were made using the Interactive Vessel Analysis (IVAN) software. Bland-Altman plots, paired t tests and intraclass correlation coefficients (ICCs) were analyzed. RESULTS: Mean differences between ELSA-Brasil and gold-standard readings were 0.16 μm (95% CI -0.17‑0.50; P = 0.31) for central retinal artery equivalent (CRAE), -0.21 μm (95% CI -0.56-0.14; P = 0.22) for central retinal vein equivalent (CRVE) and 0.0005 (95% CI -0.008-0.009; P = 0.55) for arteriole/venule ratio (AVR). Intragrader ICCs were 0.77 (95% CI 0.67-0.86) for CRAE, 0.90 (95% CI 0.780.96) for CRVE and 0.70 (0.55‑0.83) for AVR. Intergrader ICCs were 0.75 (95% CI 0.64-0.85) for CRAE, 0.90 (95% CI 0.79-0.96) for CRVE and 0.68 (95% CI 0.55‑0.82) for AVR. CONCLUSIONS: Retinal microvascular diameter measurements are valid and present moderate to high intra and intergrader reproducibility in ELSA-Brasil