BACKGROUND AND AIMS:Adopting and maintaining a healthy lifestyle-characterized by nutritious dietary patterns and regular physical activity-remains a persistent challenge for many individuals. Social support has been identified as a critical facilitator of successful lifestyle modification and long-term adherence. This study reports 6-month follow-up findings from 980 healthy adults (396 men, 584 women; median age: 43 years) residing in Italy, Spain, and Greece who participated in the Credits4Health (C4H) multicenter randomized controlled trial. We investigated whether social support and social integration moderated the efficacy of a digital health intervention designed to promote physical activity and Mediterranean diet adherence. Participants were randomized to either a dynamic platform (experimental arm: goal-setting, tailored recommendations, personalized pathways, and real-time feedback) or a static platform (control arm: general information and self-monitoring without personalization). METHODS:We employed mixed-effects ordinal and linear regression models to examine the effect of platform assignment (dynamic vs. static) on physical activity levels and Mediterranean Diet Adherence Screener (MEDAS) scores, stratified by social support and social integration subcategories. Likelihood ratio tests were conducted to assess potential interactions between social support/integration variables and platform assignment by comparing models with and without interaction terms. RESULTS:Analysis of data from 980 participants revealed no significant moderating effects of any social support or social integration subcategories on intervention efficacy for either physical activity promotion or Mediterranean diet adherence. CONCLUSION:This study found no evidence that social support or social integration moderate the efficacy of digital interventions targeting physical activity and adherence to Mediterranean diet. These null findings may reflect the study's 6-month duration or participation characteristics. Future investigations employing longer follow-up periods, enhanced participant engagement strategies, and more granular assessment of social support dimensions are warranted to better understand how social factors may influence the efficacy of digital health interventions, particularly as such technologies become increasingly prevalent in public health promotion.
The aim of the study was to assess associations between intake of combined soft drinks (sugar sweetened and artificially sweetened) and fruit and vegetable juices and the risk of hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBC) and biliary tract cancers (GBTC) using data from the European Prospective Investigation into Cancer and Nutrition cohort of 477,206 participants from 10 European countries.After 11.4 years of follow-up, 191 HCC, 66 IHBC and 236 GBTC cases were identified. Hazard ratios and 95% confidence intervals (HR; 95% CI) were estimated with Cox regression models with multivariable adjustment (baseline total energy intake, alcohol consumption and intake pattern, body mass index, physical activity, level of educational attainment and self-reported diabetes status).No risk associations were observed for IHBC or GBTC. Combined soft drinks consumption of >6 servings/week was positively associated with HCC risk: HR 1.83; 95% CI 1.11-3.02, p trend = 0.01 versus non-consumers. In sub-group analyses available for 91% of the cohort artificially sweetened soft drinks increased HCC risk by 6% per 1 serving increment (HR 1.06, 95% CI 1.03-1.09, n cases = 101); for sugar-sweetened soft drinks, this association was null (HR 1.00, 95% CI 0.95-1.06; n cases = 127, p heterogeneity = 0.07). Juice consumption was not associated with HCC risk, except at very low intakes (<1 serving/week: HR 0.60; 95% CI 0.38-0.95; p trend = 0.02 vs. non-consumers).Daily intake of combined soft drinks is positively associated with HCC, but a differential association between sugar and artificially sweetened cannot be discounted. This study provides some insight into possible associations of HCC with sugary drinks intake. Further exploration in other settings is required.
Background Evidence from epidemiological studies on the role of tea drinking in gastric cancer risk remains inconsistent. We aimed to investigate and quantify the relationship between tea consumption and gastric cancer in the Stomach cancer Pooling (StoP) Project consortium. Methods A total of 9438 cases and 20,451 controls from 22 studies worldwide were included. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of gastric cancer for regular versus non-regular tea drinkers were estimated by one and two-stage modelling analyses, including terms for sex, age and the main recognised risk factors for gastric cancer. Results Compared to non-regular drinkers, the estimated adjusted pooled OR for regular tea drinkers was 0.91 (95% CI: 0.85-0.97). When the amount of tea consumed was considered, the OR for consumption of 1-2 cups/day was 1.01 (95% CI: 0.94-1.09) and for >3 cups/day was 0.91 (95% CI: 0.80-1.03). Stronger inverse associations emerged among regular drinkers in China and Japan (OR: 0.67, 95% CI: 0.49-0.91) where green tea is consumed, in subjects with H. pylori infection (OR: 0.68, 95% CI: 0.58-0.80), and for gastric cardia cancer (OR: 0.64, 95% CI: 0.49-0.84). Conclusion Our results indicate a weak inverse association between tea consumption and gastric cancer.
BACKGROUND:Accelerated reproductive aging, in women indicated by early natural menopause, is associated with increased coronary heart disease (CHD) risk in observational studies. Conversely, an adverse CHD risk profile has been suggested to accelerate menopause. OBJECTIVES:To study the direction and evidence for causality of the relationship between reproductive aging and (non-)fatal CHD and CHD risk factors in a bidirectional Mendelian randomization (MR) approach, using age at natural menopause (ANM) genetic variants as a measure for genetically determined reproductive aging in women. We also studied the association of these variants with CHD risk (factors) in men. DESIGN:Two-sample MR, using both cohort data as well as summary statistics, with 4 methods: simple and weighted median-based, standard inverse-variance weighted (IVW) regression, and MR-Egger regression. PARTICIPANTS:Data from EPIC-CVD and summary statistics from UK Biobank and publicly available genome-wide association studies were pooled for the different analyses. MAIN OUTCOME MEASURES:CHD, CHD risk factors, and ANM. RESULTS:Across different methods of MR, no association was found between genetically determined reproductive aging and CHD risk in women (relative risk estimateIVW = 0.99; 95% confidence interval (CI), 0.97-1.01), or any of the CHD risk factors. Similarly, no associations were found in men. Neither did the reversed analyses show evidence for an association between CHD (risk factors) and reproductive aging. CONCLUSION:Genetically determined reproductive aging is not causally associated with CHD risk (factors) in women, nor were the genetic variants associated in men. We found no evidence for a reverse association in a combined sample of women and men.
The role of allium vegetables on gastric cancer (GC) risk remains unclear. We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the "Stomach cancer Pooling (StoP) Project", including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach. Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56–0.90), with substantial heterogeneity across studies (I2 > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55–0.86) for onions and 0.83 (95% CI, 0.75–0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29–0.86) but not European (OR 0.96, 95% CI, 0.81–1.13) and American (OR 0.66, 95% CI, 0.39–1.11) studies. Results were consistent across all other strata. In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.
