Background:Folate has been examined extensively in relation to carcinogenesis due to its role in one-carbon metabolism impacting the synthesis of DNA and RNA, methylation processes, and genomic integrity. Current evidence on the relationship between folate status and the risk of cancer is equivocal: low or deficient folate status may contribute to an increased risk of cancers, while high-dose folic acid supplementation may have adverse effects on carcinogenesis. Methods:We searched MEDLINE, Embase, CINAHL, the Cochrane Library, and the Database of Abstracts of Reviews of Effects up to February 2024 for systematic reviews and meta-analyses investigating the associations of folate (measured as dietary intake, supplementation, or blood concentrations) with any specific cancer outcome. Screening, data extraction, and risk of bias assessment were performed in duplicate. We assessed the credibility of the evidence using predefined criteria. Results:We found 67 syntheses, of which 57 provided meta-analyses. Over half of the syntheses had a high risk of bias. We identified 168 unique associations (unique exposure - unique outcome - unique setting) across 10 cancer types, 3 system cancers, and total cancer. Of these, we assessed 15 directional associations (colorectal, oesophageal, and total cancers) to be at a highly suggestive level of credibility, and 17 directional and 10 null associations to be at a suggestive level of credibility. Conclusions:The available evidence for each category of unique association was generally limited. Highly suggestive associations were found for oesophageal, colorectal, childhood brain and spinal tumours and total cancers. More robust primary studies are warranted to follow-up the signal of a positive relationship reported for prostate cancer warranting further research. Evidence was weak for all but colorectal and oesophageal cancers, or the central nervous system cancers in children. Registration:PROSPERO: CRD42021265041.
Objectives Current evidence is unclear due to methodological limitations. We bridge critical knowledge gaps by quantifying the longitudinal changes in movement behaviours and their correlates from early childhood through adolescence.Design Longitudinal observational cohort study.Setting General healthy child and adolescent sample in Singapore.Participants Growing Up in Singapore Towards healthy Outcomes study participants.Primary and secondary outcome measures We used wrist-worn accelerometry and proxy-reported data to examine movement behaviours (sleep, inactivity, light physical activity (PA; LPA) and moderate-to-vigorous PA (MVPA) and screen-viewing) at ages 5.5, 8, 10 and 12 years and the sociodemographic and maternal lifestyle-related correlates using linear regression models with generalised estimating equations.Results Among 837 children, sleep, LPA and MVPA declined by 3% (from 9.1 to 8.8 hours/day), 24% (from 5.8 to 4.4 hours/day) and 44% (from 71.3 to 40.1 min/day), respectively, while inactivity and screen viewing increased by 26% (from 8.0 to 10.1 hours/day) and 155% (from 1.8 to 4.6 hours/day), respectively, from ages 5.5 to 12 years. The greatest annual increase in inactivity (0.6 hour/annum) and screen-viewing (0.8 hour/annum) and decrease in LPA (0.3 hour/annum) and MVPA (10.4 min/annum) occurred from ages 8 to 10 years. Girls of Malay ethnicity and lower socioeconomic status, and whose mothers had less favourable movement behaviours, had significantly less sleep, higher inactivity and screen-viewing and/or lower PA. Maternal PA levels and/or sitting time were associated with children’s sleep, inactivity and MVPA up to age 8 years, while maternal sitting and screen-viewing behaviours were associated with children’s screen-viewing at all ages.Conclusions Using contemporaneous datasets relevant to the present day, we confirmed that children become less physically active and have longer screen-viewing as they transition into adolescence and highlighted characteristics to be prioritised in future interventions.
Recent research suggests that maternal mood entropy, a novel measure of mood dysfunction, is associated with child outcomes. However, the link between maternal mood entropy and children's structural brain development, and how this association may change across childhood, remains unclear. In a longitudinal study with neuroimaging data collected at ages 4.5, 6, 7.5, and 10.5 years (n = 1,498; n = 674 with neuroimaging), we examined whether maternal mood entropy is associated with children's hippocampal and amygdala volumes over time. Mothers reported on negative mood symptoms at several assessments between ages 3 months and 4.5 years. We calculated maternal mood levels as the sum of mood symptoms and computed maternal mood entropy by applying Shannon's entropy to the distributions of mood questionnaire responses. Maternal mood measures were not associated with amygdala volumes; however, mood entropy was directly associated with smaller hippocampal volumes at age 4.5 years and indirectly associated with smaller hippocampal volumes at 10.5 years through rank-order stability over time. These effects were present beyond the effects of socioeconomic status and intracranial volume and were specific to mood entropy, not mood levels. Our findings indicate that patterns of maternal mood are embedded in early childhood brain structure, setting the stage for subsequent neurodevelopment.
Abstract Introduction Women with OSA are at high risk of being missed or misdiagnosed due to gender-specific differences in symptoms and disease presentation. Compared to men, women with OSA more often report fatigue, insomnia, anxiety, depression, and morning headaches. They commonly have milder OSA characterized by fewer respiratory events, less oxygen desaturation, and a higher prevalence of REM-predominant OSA. These variations reflect complex interactions among OSA pathophysiological traits, anatomical, hormonal, ventilatory, and cardiovascular factors, as well as changes across life stages such as pregnancy and menopause. Existing screening questionnaires used in clinical practice may lack sensitivity for detecting women with OSA. To address this gap, we aimed to develop and validate an OSA screening questionnaire to improve early identification and referral of women at risk. Methods Development followed a multi-step approach. Initially, we analyzed data from Resmed’s online sleep assessment linked with home sleep test (HST) results to identify symptoms most predictive of OSA amongst women. Second, a targeted literature review identified studies describing gender differences in language and symptom descriptors used by OSA patients. Third, we reviewed evidence on gender-specific comorbidities associated with OSA. Finally, consultation with expert sleep clinicians and researchers to enhance the clinical interpretability and patient usability. The resulting questionnaire is being prospectively tested among a clinical population of adults undergoing diagnostic sleep studies. To evaluate predictive validity in women, correlations and multivariable regression analyses are being conducted between questionnaire responses and AHI values obtained from HST. Results To date, data from n = 437 (39% women (34% post-menopausal); mean age: 48±14yrs; age range 18-86yrs) participants have been analyzed from Australia and the US. Preliminary descriptive statistics indicate that women with OSA report a higher symptom burden than males. Women more frequently described poor sleep quality, insomnia symptoms, sleep disturbances due to pain, and daytime fatigue/low energy. Males were more likely to report waking with a dry mouth, whereas women more often reported waking with headaches or jaw discomfort. Comorbidity patterns also differed: diabetes was most common among males, while anxiety/depression and mood disorders were most frequent among women. Conclusions Our preliminary findings suggest clear differences in symptoms burden and comorbidities between women and men in a group of newly diagnosed OSA patients. Further development of the screening questionnaire in a larger more geographically and ethnically diverse population will strengthen its clinical utility and offer healthcare providers a simple tool for screening OSA risk in women. This abstract is funded by: Resmed
Background Despite Singapore’s top-ranked healthcare system, the country’s low birth weight (LBW) rates exceed the Organisation for Economic Co-operation and Development average. Singapore also has one of the highest proportions of female marriage migrants in Asia, many of whom originate from lower-income neighbouring countries. These marriage migrants often face socioeconomic disadvantages and social integration challenges, and their children tend to exhibit more behavioural problems and lower achievement scores at a young age, raising concerns about potential higher LBW risk in this population. Given the increasing global migration population, this study examines whether foreign-born mothers have higher LBW prevalences than native-born mothers, assesses whether their presence contributes to Singapore’s high LBW rates, and explores the contributing factors underlying any observed differences.Methods Using data from the Singapore Longitudinal Early Development Study, a nationally representative sample of 5005 children born between 2011 and 2019, four family types were identified based on parental nativity: native families; cross-national families with a foreign-born mother; cross-national families with a foreign-born father; and families with both foreign-born parents. Logistic regression was used to measure group differences in LBW prevalence. Fairlie decomposition was applied to quantify the contributions of observed covariates to these differences.Results Cross-national families with a foreign-born mother had a lower LBW prevalence (OR 0.56, 95% CI 0.37 to 0.86) than native families, even after adjusting for risk factors. Fairlie decomposition showed that 75% of the immigrant health advantage in LBW was explained by observed covariates, driven primarily by mismatches in the quality of healthcare systems between the countries of origin and Singapore, followed by group differences in biological and socioeconomic factors.Conclusions The findings reveal an epidemiological paradox in Singapore, echoing immigrant health advantages observed in other developed countries: socioeconomically disadvantaged foreign-born mothers had lower LBW rates than native-born mothers. However, this advantage is not uniform and varies by family type and migration background, highlighting the importance of considering immigrant-family heterogeneity in perinatal health research.
