INTRODUCTION:Dementia is a neurodegenerative disease in which environmental and lifestyle factors, including dietary habits, appear to play an important etiologic role. In particular, the effects of tea and coffee consumption are still under debate, having shown both protective and risk effects. This review aimed to assess the dose-response relation between coffee and tea consumption and risk of dementia. METHODS:We performed a systematic literature search to identify relevant studies using the electronic databases PubMed and EMBASE until December 9, 2025. Inclusion criteria were: population free of chronic diseases and without previous diagnosis of dementia, assessment of tea or coffee intake and of the risk of developing dementia, and cohort or cohort-nested case-control design. We assessed the quality of the studies with the ROBINS-E tool. We performed nonlinear dose-response modeling of dementia for increasing tea and coffee consumption. RESULTS:Ten studies were included in the analysis, with more than 450,000 participants at baseline and mean follow-up duration of 11.5 years. We found a progressive and linear decrease in all-cause dementia risk with increasing tea consumption, with comparable results for all tea types and for green tea only. Coffee demonstrated a U-shaped relation with the lowest risk between 2-3 cups/day (about 300/450 mL/day). The relation with Alzheimer's dementia showed no difference in risk until 3 cups of coffee per day when risk started to increase. CONCLUSIONS:This study shows that moderate coffee consumption does not seem to affect dementia risk, while high coffee consumption (≥3 cups/day) could increase risk of all-cause dementia and Alzheimer's dementia. Conversely, tea consumption appears to linearly decrease all-cause dementia risk, while for Alzheimer's dementia there seems to be no further decrease in risk with consumption above one cup/day.

Exposure to metalloids and metals has been associated with childhood cancer, specifically acute leukemia, though studies are limited. During 2020-2023, we conducted a hospital-based case-control study in Italy to evaluate the association between trace element status and childhood leukemia. We enrolled 77 cases with newly-diagnosed acute childhood leukemia and 74 controls referred to the hospital for minor medical procedures. In blood samples collected at hospital admission, we used inductively-coupled plasma mass spectrometry to measure serum concentrations of selenium (and its species), copper, iron, manganese, and cadmium. We estimated odds ratios and 95% confidence intervals using restricted cubic spline regression. Dose-response, confounder-adjusted analyses showed positive monotonic associations of selenium, copper and iron, above a certain level of exposure, with childhood leukemia. Two selenium species, selenoprotein P-bound selenium and selenomethionine, showed similar results to total selenium. Zinc showed an inverse association with leukemia, while there was no appreciable relation with manganese. Copper concentrations in the top tertile were associated with the highest odds ratio of leukemia, though the association was imprecise. These findings indicate the need for further investigation of the potential adverse role of some selenium species and copper in childhood leukemia. However, reverse causation bias and residual confounding could not be ruled out as possible explanations for our findings.

BACKGROUND:The contribution of environmental determinants in the etiology of amyotrophic lateral sclerosis (ALS) is still unclear. Among the various environmental factors, exposure to green spaces, also known as greenness, is attracting considerable interest as many studies have reported its beneficial associations to health outcomes, particularly to neurodegenerative diseases. METHODS:To investigate the relation between greenness and ALS risk, we conducted a population-based case-control study in a Northern Italy population (from Modena, Reggio Emilia and Parma provinces), including 499 cases of ALS newly-diagnosed from 1998 to 2011 and 1,935 sex-, age-, and province-matched controls randomly selected from study provinces residents. We evaluated the association between greenness in the proximity of residence and ALS risk, assessing exposure through multiple satellite-based and land-use derived indices, both conventional and novel devised, for a total of six indices, each providing specific information, including annual and seasonal Normalized Difference Vegetation Index (NDVI), NDVI-weighted to green areas, green cover ratio, accessibility index, and their combined Green Exposure Index (GEI). We used conditional logistic regression models to evaluate disease risk for increasing exposure through both fixed-categories and non-linear restricted cubic splines. RESULTS:We observed a non-linear U-shaped association between greenness and ALS risk with increased odds ratios at both low and high levels. Results were more defined when using NDVI-based indices, while the associations were smoother when considering GEI. The higher risk at low levels may be related to lower accessibility to green spaces with lower physical activity and higher exposure to outdoor air pollutants, whilst elevated greenness may reflect higher exposure to neurotoxic pesticides. These results were confirmed also after adjustment for potential confounders, namely magnetic fields and light at night. Sex stratified analysis yielded similar results, except for more distinct associations in females for GEI. CONCLUSIONS:Despite the limitations due to possible unmeasured confounding and exposure misclassification related to the use of residential data, our results provide evidence of an inverse association between intermediate residential greenness and ALS risk, and may have public health implications including disease prevention and urban planning.

BACKGROUND:Consistent evidence from randomized controlled trials has shown that overexposure to selenium induces type 2 diabetes. However, uncertainties remain about the specific species and doses of selenium that trigger such diabetogenic effect. METHODS:We investigated the long-term effects of selenium exposure on diabetes risk using data from a natural experiment in Northern Italy. During 1974-1985, a small cohort of residents had been consuming drinking water with an unusually high content of inorganic hexavalent selenium, selenate (8-10 μg/L), close to the standard of the European Union and other countries of 10 μg/L. Using data from a population-based registry, we compared the prevalence of type 2 diabetes in 2013 in selenate-exposed (n = 1310) and unexposed residents (n = 56,251). RESULTS:In December 2013, the prevalence of diabetes in exposed and unexposed cohorts was 9.85 % and 10.29 %, respectively, with a multivariable-adjusted prevalence ratio of 0.95 (95 % confidence interval 0.81-1.12). Results were similar after stratifying by sex, age, and country of birth. CONCLUSIONS:Overall, these results do not support the hypothesis that consumption of water with inorganic hexavalent selenium levels close to the European limit increases the risk of type 2 diabetes. Null results could be due to non-differential outcome misclassification, other sources of bias, or the fact that selenate is a non-diabetogenic selenium species or that the dose of exposure was too low to elicit an adverse effect.

Environmental epidemiology is currently facing significant challenges, particularly the need for exposure assessment methods that are not only accurate and precise but also accessible and cost-effective. In this context, the implementation of real-time measurements and predictive modelling represents a key opportunity to improve exposure assessment and to manage increasingly large datasets. These approaches may expand populations, reduce selection bias, and enable analyses at broader spatial and temporal scales. This commentary aims to discuss emerging methodologies that address the evolving needs of modern environmental epidemiology, highlighting their advantages and limitations. The focus is placed on methods applied to air pollution, land use and light pollution analyses. Among these, dispersion models remain reliable tools, although their precision may decrease over large geographical areas. In contrast, satellite-based data provide high spatial and temporal resolution, offering greater exposure assessment capabilities. Additionally, remote sensing techniques are increasingly used to evaluate human mobility, enabling access to data that were previously difficult or impossible to obtain. Despite these advantages, several challenges remain, including data privacy concerns, the integration of real-time mobility data, the assessment of multi-exposure scenarios, and the need for standardized, robust and analytical methodologies. Addressing these issues requires strong interdisciplinary collaboration among public health professionals, physicists, mathematicians, engineers, biologists, biotechnologists and architects. Overall, emerging methodologies offer remarkable opportunities to advance environmental epidemiology, provided their limitations are carefully addressed.

Although plant-rich dietary patterns like the Mediterranean and Mediterranean-DASH Intervention for Neurodegenerative Delay diets have been linked to cognitive benefits, the role of predominantly plant-based diets is less understood. This systematic review aimed to evaluate the association between plant-based diets and cognitive outcomes. A literature search was conducted in Medline and Embase using keywords related to plant-based diets (e.g., "vegetarian diet") and cognitive outcomes (e.g., "dementia"). Studies of any design were eligible. Reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Meta-analyses were conducted on prospective studies that examined the same dietary exposure and cognitive outcome, using fixed-effects regression models. Twenty-two studies were included, with considerable variability in methodologies and outcomes. Plant-based diets were defined either categorically (e.g., vegetarian compared with nonvegetarian), or using indices of adherence, such as the healthful plant-based diet index (hPDI), with higher scores reflecting higher adherence. Two meta-analyses, each based on 2 high-quality prospective cohort studies, examined associations between plant-based diet indices and cognitive outcomes. For cognitive impairment, pooled odds ratios (95% confidence interval) for highest compared with lowest quartiles were 0.61 (0.55, 0.68; I2 = 97.1%) for plant-based diet index (PDI) and 0.68 (0.62, 0.75; I2 = 84.3%) for hPDI. For dementia, pooled hazard ratios were 1.03 (0.91, 1.17; I2 = 0%) for PDI, 0.85 (0.75, 0.97; I2 = 0%) for hPDI, and 1.17 (1.03, 1.33; I2 = 60.3%) for unhealthful PDI. These findings suggest that dietary patterns emphasizing healthful plant-based foods and limiting less healthful plant foods and animal products are associated with lower odds of cognitive impairment and risk of dementia. However, findings across individual studies were inconsistent, highlighting the need for further high-quality research. This review was registered at PROSPERO as CRD42022380055.

Type 2 diabetes (T2D) incidence has been steadily increasing over the past few decades. Several studies have evaluated the effect of plant-based, vegetarian or vegan diets on the risk of T2D, although their potential benefits need to be confirmed and characterised. We performed a literature search up to 10 July 2025, using the terms/keywords related to plant-based index (PDI), vegetarian/vegan diets and T2D. We included observational non-experimental studies evaluating adherence to such diets in adult subjects assessing T2D risk. We specifically considered overall PDI and related healthy PDI (hPDI) and unhealthy PDI (uPDI), assessing intake of different food groups. We included 36 studies published between 1999 and 2025. We found an inverse association between adherence to vegetarian/plant-based dietary patterns and T2D risk. This association was stronger, though statistically imprecise, for the vegan diet (RR = 0·65, 95 % CI 0·42, 1·00) and for lacto-ovo-vegetarian diet (RR = 0·68, 0·57, 0·82). For studies using plant-based indices, the RR were 0·82 (0·69, 0·82), 0·76 (0·69, 0·82) and 1·13 (0·98, 1·30) for overall PDI, hPDI and uPDI, respectively. In the dose-response meta-analysis, overall PDI and hPDI showed an inverse and almost linear association with T2D risk. Conversely, adherence to uPDI directly correlated with T2D risk. Overall, adherence to vegan/vegetarian diets may reduce T2D risk, while an unhealthy plant-based diet appears to linearly increase disease risk, indicating caution in the consumption of such unhealthy foods even if of plant origin. The beneficial association between vegetarian and healthy plant-based diets may have major public health implications.

BACKGROUND:The validity of biomarkers to estimate exposure to selenium (Se) species and selenoproteins in the central nervous system (CNS) is not well studied. METHODS:Among 83 Italian participants with mild cognitive impairment, we estimated total Se and single Se species concentrations in paired serum and cerebrospinal fluid (CSF) samples using anion exchange chromatography-inductively coupled plasma-dynamic reaction cell-mass spectrometry. In each matrix (serum and CSF), we assessed associations between: 1) paired Se species and 2) total Se and Se species. RESULTS:The distribution of Se exposure was comparable to that generally found in European populations. We found few consistent patterns for most biomarkers, including total Se and some Se species. An exception was a positive association between the two matrices for selenoprotein-P-bound Se and the inorganic Se form selenate, and an unexpected inverse association for glutathione-peroxidase-bound Se. Total Se was positively associated with some Se species but inversely associated with other Se species in serum, while in CSF the positive association was stronger and more consistent across various Se species. CONCLUSIONS:Concentrations of total Se and single Se species in serum were not strongly correlated with their respective concentrations in CSF, the gold standard to estimate CNS exposure. Furthermore, total Se and selected Se species showed consistent positive correlations within CSF but not serum. Our results suggest that relying on serum Se concentrations to assess CNS exposure can introduce error in human studies.

Selenium is a trace element found in many chemical forms. Selenium and its species have nutritional and toxicologic properties, some of which may play a role in the etiology of neurological disease. We hypothesized that adherence to the Mediterranean-Dietary Approach to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet could influence intake and endogenous concentrations of selenium and selenium species, thus contributing to the beneficial effects of this dietary pattern. We carried out a cross-sectional study of 137 non-smoking blood donors (75 females and 62 males) from the Reggio Emilia province, Northern Italy. We assessed MIND diet adherence using a semiquantitative food frequency questionnaire. We assessed selenium exposure through dietary intake and measurement of urinary and serum concentrations, including speciation of selenium compound in serum. We fitted non-linear spline-based regression models to investigate the association between MIND diet adherence and selenium exposure concentrations. Adherence to the MIND diet was positively associated with dietary selenium intake and urinary selenium excretion, whereas it was inversely associated with serum concentrations of overall selenium and organic selenium, including serum selenoprotein P-bound selenium, the most abundant circulating chemical form of the metalloid. MIND diet adherence also showed an inverted U-shaped relation with inorganic selenium and particularly with its hexavalent form, selenate. Our results suggest that greater adherence to the MIND diet is non-linearly associated with lower circulating concentrations of selenium and of 2 potentially neurotoxic species of this element, selenoprotein P and selenate. This may explain why adherence to the MIND dietary pattern may reduce cognitive decline.

Background: A limited number of studies have investigated the role of environmental chemicals in the etiology of mild cognitive impairment (MCI). We performed a cross-sectional study of the association between exposure to selected trace elements and the biomarkers of cognitive decline. Methods: During 2019–2021, we recruited 128 newly diagnosed patients with MCI from two Neurology Clinics in Northern Italy, i.e., Modena and Reggio Emilia. At baseline, we measured serum and cerebrospinal fluid (CSF) concentrations of cadmium, copper, iron, manganese, and zinc using inductively coupled plasma mass spectrometry. With immuno-enzymatic assays, we estimated concentrations of β-amyloid 1-40, β-amyloid 1-42, Total Tau and phosphorylated Tau181 proteins, neurofilament light chain (NfL), and the mini-mental state examination (MMSE) to assess cognitive status. We used spline regression to explore the shape of the association between exposure and each endpoint, adjusted for age at diagnosis, educational attainment, MMSE, and sex. Results: In analyses between the serum and CSF concentrations of trace metals, we found monotonic positive correlations between copper and zinc, while an inverse association was observed for cadmium. Serum cadmium concentrations were inversely associated with amyloid ratio and positively associated with Tau proteins. Serum iron concentrations showed the opposite trend, while copper, manganese, and zinc displayed heterogeneous non-linear associations with amyloid ratio and Tau biomarkers. Regarding CSF exposure biomarkers, only cadmium consistently showed an inverse association with amyloid ratio, while iron was positively associated with Tau. Cadmium concentrations in CSF were not appreciably associated with serum NfL levels, while we observed an inverted U-shaped association with CSF NfL, similar to that observed for copper. In CSF, zinc was the only trace element positively associated with NfL at high concentrations. Conclusions: In this cross-sectional study, high serum cadmium concentrations were associated with selected biomarkers of cognitive impairment. Findings for the other trace elements were difficult to interpret, showing complex and inconsistent associations with the neurodegenerative endpoints examined.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Cardiac rehabilitation (CR) is an evidence-based systematic, medically supervised program that helps patients with cardiovascular disease to recuperate from their cardiac event; adopt and adhere to healthy lifestyle habits; address co-morbid conditions; monitor for safety issues, including new or recurrent signs or symptoms; and adhere to medical therapies. The core strategies to improve physical and psychological health are focused on patient education on healthy behaviors including smoking cessation, healthy eating (e.g., Mediterranean diet, Dietary Approaches to Stop Hypertension diet along with lowering caloric and sodium intake), physical activities, stress management, and medication adherence. 1 Taylor RS Dalal HM McDonagh STJ The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol. 2022; 19: 180-194 Crossref PubMed Scopus (104) Google Scholar Despite the evidence of its beneficial effects, disparities in patient referral, access and participation in CR are still of concern, in particular for older patients, women, ethnic/racial minorities, and subjects from rural communities. 2 Thomas RJ Balady G Banka G Beckie TM Chiu J Gokak S Ho PM Keteyian SJ King M Lui K Pack Q Sanderson BK Wang TY 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2018; 11e000037 Crossref Scopus (62) Google Scholar ,3 Ritchey MD Maresh S McNeely J Shaffer T Jackson SL Keteyian SJ Brawner CA Whooley MA Chang T Stolp H Schieb L Wright J Tracking cardiac rehabilitation participation and completion among medicare beneficiaries to inform the efforts of a national initiative. Circ Cardiovasc Qual Outcomes. 2020; 13e005902 Crossref PubMed Scopus (166) Google Scholar A very important aspect not to be underestimated is also represented by social determinants of health, including educational attainment because it could impact the long-term maintenance of practices encouraged in CR. Educational Attainment and Cardiovascular Risk Among Patients in Cardiac RehabilitationAmerican Journal of CardiologyVol. 207PreviewCardiac rehabilitation (CR) has a class I indication after major cardiovascular events and includes supervised exercise, dietary instruction, and psychosocial education. Patients are encouraged to follow the Mediterranean dietary pattern to prevent cardiovascular events.1,2 CR has been associated with decreased cardiovascular risk factors, higher exercise tolerance, better nutrition, and lower mortality.3 Social determinants of health (SDOH), including educational attainment, can impact the long-term maintenance of practices encouraged in CR. Full-Text PDF

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

BACKGROUND:Several studies have documented an increased risk of leukemia among children exposed to magnetic fields from high-voltage power lines, with some evidence of dose-response relation. However, findings in some studies have been inconsistent, and data on the effects of different sources of exposure are lacking. In this study, we evaluated the relation of childhood leukemia risk to exposure to magnetic fields from transformer stations. METHODS:We conducted a population-based case-control study in a pediatric population of two Northern Italian provinces of Modena and Reggio Emilia. We included 182 registry-identified childhood leukemia cases diagnosed during 1998-2019 and 726 population controls matched on sex, year of birth, and province of residence. We assessed exposure by calculating distance from childhood residence to the nearest transformer station within a geographical information system, computing disease odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression, adjusting for potential confounders. We evaluated exposure using two buffers (15 m and 25 m radius) and assessed two case groups: leukemia (all subtypes) and acute lymphoblastic leukemia (ALL). RESULTS:Residing within 15 m of a transformer station (vs. ≥15 m) was not appreciably associated with risk of leukemia (all subtypes) or ALL. We found similar results using a less stringent exposure buffer (25 m). Among children aged ≥5 years, the adjusted ORs were 1.3 (95% CI 0.1-12.8) for leukemia and 1.3 (95% CI 0.1-12.4) for ALL using the 15 m buffer, while they were 1.7 (95% CI 0.4-7.0) for leukemia and 0.6 (95% CI 0.1-4.8) for ALL using the 25 m buffer. CONCLUSIONS:While we found no overall association between residential proximity to transformer stations and childhood leukemia, there was some evidence for elevated risk of childhood leukemia among children aged ≥5 years. Precision was limited by the low numbers of exposed children.

BACKGROUND:Several studies have suggested an excess risk of leukemia among children living close to high-voltage power lines and exposed to magnetic fields. However, not all studies have yielded consistent results, and many studies may have been susceptible to confounding and exposure misclassification. METHODS:We conducted a case-control study to investigate the risk of leukemia associated with magnetic field exposure from high-voltage power lines. Eligible participants were children aged 0-15 years residing in the Northern Italian provinces of Modena and Reggio Emilia. We included all 182 registry-identified childhood leukemia cases diagnosed in 1998-2019, and 726 age-, sex- and province-matched population controls. We assessed exposure by calculating distance from house to nearest power line and magnetic field intensity modelling at the subjects' residence. We used conditional logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for potential confounders (distance from nearest petrol station and fuel supply within the 1000 m-buffer, traffic-related particulate and benzene concentrations, presence of indoor transformers, percentage of urban area and arable crops). RESULTS:In multivariable analyses, the OR comparing children living <100 m from high-voltage power-lines with children living ≥400 m from power-lines was 2.0 (95% CI 0.8-5.0). Results did not differ substantially by age at disease diagnosis, disease subtype, or when exposure was based on modeled magnetic field intensity, though estimates were imprecise. Spline regression analysis showed an excess risk for both overall leukemia and acute lymphoblastic leukemia among children with residential distances <100 m from power lines, with a monotonic inverse association below this cutpoint. CONCLUSIONS:In this Italian population, close proximity to high-voltage power lines was associated with an excess risk of childhood leukemia.

Selenium is an element present in trace amounts and different chemical forms. It may exert both beneficial and adverse effects on cellular redox status and on the generation of reactive oxygen species. 8-oxo-7,8-dihydro-2'deoxyguanosine (8-oxodG) is an oxidized derivative of deoxyguanosine, and a sensitive biomarker of oxidative stress and genotoxicity. The present study assessed the extent to which selenium status was associated with urinary 8-oxodG concentrations in a Northern Italian population. We recruited healthy, non-smoking blood donors living in the Reggio Emilia province during 2017-2019. We measured urinary 8-oxodG concentrations and used restricted cubic spline regression analyses to investigate the association between selenium status (estimated using food frequency questionnaires, urinary concentrations, and serum concentrations of selenium and selenium species) and 8-oxodG/g creatinine. Among 137 participants aged 30-60 years, median urinary selenium and 8-oxodG concentrations were 22.02 μg/L and 3.21 μg/g creatinine, respectively. Serum samples and selenium speciation analyses were available for 104 participants. Median total serum selenium levels and dietary intake were 116.5 μg/L and 78.7 μg/day, respectively. In spline regression analysis, there was little association between dietary, serum, or urinary selenium with 8-oxodG concentrations. In sex-specific analyses, urinary selenium showed a positive association with the endpoint among males. For single selenium species, we observed positive associations with urinary 8-oxodG for serum organic selenium species, and negative associations for inorganic selenium forms. In the most adjusted analysis, urinary 8-oxodG concentrations showed a strong positive association with selenomethione-bound selenium (Se-Met) and a negative association with inorganic tetravalent selenium, selenite. In sex-specific analyses, these associations were considerably stronger in males than in females. Overall, study findings indicate that selenium species exhibited very different patterns of associations with the biomarker of oxidative stress, and that these associations also depended on sex. Background exposure to Se-Met appears to be strongly and positively associated with oxidative stress.

Sulfur is an essential nutrient but data about its intake are scarce. We aimed to measure sulfur content in food samples and assess its habitual intake in relation to adherence to healthy dietary patterns in 719 Italian adults. Using a food frequency questionnaire, we estimated overall sulfur intake, and its relation with adherence to healthy dietary patterns. The highest sulfur content was found in preserved/canned fish (3.0 g/kg), seafood (2.8 g/kg), white meat (2.8 g/kg) and dairy products, particularly aged cheeses (2.1 g/kg) and lowest in fresh fruit (87 mg/kg), oils and fats (157 mg/kg), and beverages (141 mg/kg), with the exception of onion and garlic (1.3 g/kg). The mean sulfur intake in the study population was 1.1 g/day, slightly higher in men than women. The foods contributing most to sulfur intake were meat (29%) and cereals (19%), with also substantial contribution (>10%) from beverages and dairy products. Adherence to dietary patterns had little influence on sulfur intake, except for adherence to MIND diet positively and linearly associated with sulfur intake. Our study provides an updated overview of sulfur content in foods composing the Italian diet, as well as of sulfur intake in an Italian community of Northern Italy.

Introduction: Cadmium is a toxic heavy metal with detrimental effects on human health. Apart from smoking and occupational factors, diet is the main source of cadmium. However, the relation between adherence to so-called "healthy" dietary patterns and cadmium exposure has not been investigated in detail. In this study, we aimed at assessing such association in a Northern Italian population.Methods: Using a cross-sectional study design, we investigated a population of non-smokers aged 30-60 years in the period 2017-2019. Each subject completed a validated food frequency questionnaire (FFQ) in order to estimate adherence to four dietary patterns, namely the Dietary Approach to Stopping Hypertension-DASH diet, Greek Mediterranean Index-GMI, the Italian Mediterranean Index-IMI, and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. We collected a fasting morning urinary sample to measure urinary levels of cadmium and cotinine. The association between increasing adherence to dietary patterns and cadmium exposure was evaluated using a cubic spline regression non-linear model and adjusting for relevant confounders (age, sex, body mass index, urinary cotinine levels, intake of fiber, and alcohol).Results: We recruited 137 participants (males/females: 62/75) with median (interquartile range-IQR) age of 47 (IQR: 43-53) years. Median scores for the investigated dietary patterns were 24 (IQR: 21-28), 4 (IQR: 3-6), 4 (IQR: 3-5), and 7.5 (IQR: 6.5-8.5) for DASH, GMI, IMI and MIND diets, respectively. The median urinary cadmium level was 0.21 mu g/L (IQR: 0.11-0.34 mu g/L). Spline regression analysis showed an inverse linear association between increasing adherence to the DASH and MIND diets and urinary cadmium levels, reaching a plateau at high adherence scores, approximately > 25 and > 9 for DASH and MIND diets, respectively. An increase of cadmium exposure with increasing MIND score also emerged. Conversely, the association was almost null for IMI, and slightly positive for GMI.Conclusions: The present findings suggest that increasing adherence to the DASH and MIND diets are associated with decreased cadmium levels only at moderate level. Overall, these results indicate that public health strategies, including the decrease of cadmium contamination in healthy foods should be implemented.

Petrol stations emit benzene and other contaminants that have been associated with an increased risk of childhood leukemia. We carried out a population-based case-control study in two provinces in Northern Italy. We enrolled 182 cases of childhood leukemia diagnosed during 1998-2019 and 726 age- and sex-matched population controls. We geocoded the addresses of child residences and 790 petrol stations located in the study area. We estimated leukemia risk according to distance from petrol stations within a 1000 m buffer and amount of supplied fuel within a buffer of 250 m from the child's residence. We used conditional logistic regression models to approximate risk ratios (RRs) and 95% confidence intervals (CIs) for associations of interest, adjusted for potential confounders. We also modeled non-linear associations using restricted cubic splines. In secondary analyses, we restricted to acute lymphoblastic leukemia (ALL) cases and stratifed by age (<5 and ≥5 years). Compared with children who lived≥1000 m from a petrol station, the RR was 2.2 (95% CI 0.5-9.4) for children living<50 m from nearest petrol station. Associations were stronger for the ALL subtype (RR=2.9, 95% CI 0.6-13.4) and among older children (age≥5 years: RR=4.4, 95% CI 0.6-34.1; age<5 years: RR=1.6, 95% CI 0.1-19.4). Risk of leukemia was also greater (RR=1.6, 95% CI 0.7-3.3) among the most exposed participants when assigning exposure categories based on petrol stations located within 250 m of the child's residence and total amount of gasoline delivered by the stations. Overall, residence within close proximity to a petrol station, especially one with more intense refueling activity, was associated with an increased risk of childhood leukemia, though associations were imprecise.

BACKGROUND AND AIM:The term early-onset dementia (EOD) encompasses several forms of neurodegenerative diseases characterized by symptom onset before 65 years and leading to severe impact on subjects already in working activities, as well as on their family and caregivers. Despite the increasing incidence, the etiology is still unknown, with possible association of environmental factors, although the evidence is still scarce. In this review, we aimed to assess how several environmental and lifestyle factors may be associated with the onset of this disease.METHODS:We conducted a literature search in PubMed and EMBASE databases up to May 6, 2022, to retrieve epidemiological studies evaluating the effect of environmental and lifestyle factors on EOD risk.RESULTS:We eventually included 22 studies, ten with cohort and twelve with case-control design. Traumatic injury, especially on the head/brain, some cardiovascular diseases such as atrial fibrillation and stroke, metabolic diseases including diabetes and hypercholesterolemia, and alcohol consumption have been identified as potential risk factors for EOD. Conversely, playing leisure activities including sports (without trauma), higher educational attainment and higher adherence to Mediterranean DASH-Intervention for Neurodegenerative Delay (MIND) diet appeared to be protective for EOD.CONCLUSIONS:The literature on environmental risk factors for EOD has been considerably growing in recent years. Overall, it supports an association between some environmental and lifestyle factors with disease risk. However, additional high-quality research is required to confirm these relations and its causal nature (www.actabiomedica.it).