141 results found
Scarpone R, Kimkool P, Ierodiakonou D, et al., 2023, Timing of allergenic food introduction and risk of IgE-mediated food allergy: systematic review and meta-analysis, JAMA Pediatrics, Vol: 177, Pages: 489-497, ISSN: 1072-4710
Importance Earlier egg and peanut introduction probably reduces risk of egg and peanut allergy, respectively, but it is uncertain whether food allergy as a whole can be prevented using earlier allergenic food introduction.Objective To investigate associations between timing of allergenic food introduction to the infant diet and risk of food allergy.Data Sources In this systematic review and meta-analysis, Medline, Embase, and CENTRAL databases were searched for articles from database inception to December 29, 2022. Search terms included infant, randomized controlled trial, and terms for common allergenic foods and allergic outcomes.Study Selection Randomized clinical trials evaluating age at allergenic food introduction (milk, egg, fish, shellfish, tree nuts, wheat, peanuts, and soya) during infancy and immunoglobulin E (IgE)–mediated food allergy from 1 to 5 years of age were included. Screening was conducted independently by multiple authors.Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was used. Data were extracted in duplicate and synthesized using a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess certainty of evidence.Main Outcomes and Measures Primary outcomes were risk of IgE-mediated allergy to any food from 1 to 5 years of age and withdrawal from the intervention. Secondary outcomes included allergy to specific foods.Results Of 9283 titles screened, data were extracted from 23 eligible trials (56 articles, 13 794 randomized participants). There was moderate-certainty evidence from 4 trials (3295 participants) that introduction of multiple allergenic foods from 2 to 12 months of age (median age, 3-4 months) was associated with reduced risk of food allergy (risk ratio [RR], 0.49; 95% CI, 0.33-0.74; I2 = 49%). Absolute risk difference for a population with 5% incidence of food allergy was −
Portoghese I, Siddi M, Chessa L, et al., 2023, COVID-19 Vaccine Hesitancy among Italian Healthcare Workers: Latent Profiles and Their Relationships to Predictors and Outcome., Vaccines (Basel), Vol: 11, ISSN: 2076-393X
Vaccine hesitancy and conspiracy beliefs among healthcare workers (HCWs) represent operational priorities that require urgent attention. Identifying and classifying specific subpopulation of hesitancy is crucial to customize educational and intervention strategies to enhance the acceptance and uptake rate of vaccination. Thus, the main purpose of our study was to empirically identify latent profiles of vaccine hesitancy among Italian HCWs adopting a person-centered approach and investigating their relationships with antecedents and intention to get a fourth dose of COVID-19 vaccine. We conducted latent profile analyses (LPA) to identify different configurations of vaccine hesitancy based on five antecedents of vaccination: confidence, complacency, constraints, calculation, and collective responsibility among a sample of Italian HCWs (n = 573). LPA revealed four distinct profiles: believer (61.5%), middler (24.7%), hesitant (9.00%), and rejecter (4.7%). Having conspiracy beliefs was associated with a greater likelihood of membership in all but believer. Finally, the likelihood of intention to get a fourth dose of COVID-19 vaccine was lowest in the rejector and hesitant profiles. Theoretical contributions and implications for practice are discussed.
Carrillo Larco R, Guzman-Vilca WC, Castillo-Cara M, et al., 2022, Phenotypes of non-alcoholic fatty liver disease (NAFLD) and all-cause mortality: Unsupervised machine learning analysis of NHANES III, BMJ Open, Vol: 12, ISSN: 2044-6055
Objectives: Non-alcoholic fatty liver disease (NAFLD) is a non-communicable disease with a rising prevalence worldwide and with large burden for patients and health systems. To date, the presence of unique phenotypes in patients with NAFLD has not been studied, and their identification could inform precision medicine and public health with pragmatic implications in personalised management and care for patients with NAFLD.Design: Cross-sectional and prospective (up to 31 December 2019) analysis of National Health and Nutrition Examination Survey III (1988–1994).Primary and secondary outcomes measures: NAFLD diagnosis was based on liver ultrasound. The following predictors informed an unsupervised machine learning algorithm (k-means): body mass index, waist circumference, systolic blood pressure (SBP), plasma glucose, total cholesterol, triglycerides, liver enzymes alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transferase. We summarised (means) and compared the predictors across clusters. We used Cox proportional hazard models to quantify the all-cause mortality risk associated with each cluster.Results: 1652 patients with NAFLD (mean age 47.2 years and 51.5% women) were grouped into 3 clusters: anthro-SBP-glucose (6.36%; highest levels of anthropometrics, SBP and glucose), lipid-liver (10.35%; highest levels of lipid and liver enzymes) and average (83.29%; predictors at average levels). Compared with the average phenotype, the anthro-SBP-glucose phenotype had higher all-cause mortality risk (aHR=2.88; 95% CI: 2.26 to 3.67); the lipid-liver phenotype was not associated with higher all-cause mortality risk (aHR=1.11; 95% CI: 0.86 to 1.42).Conclusions: There is heterogeneity in patients with NAFLD, whom can be divided into three phenotypes with different mortality risk. These phenotypes could guide specific interventions and management plans, thus advancing precision medicine and public health for patients with NAFLD.
Vukovic V, Hantikainen E, Raftopoulou A, et al., 2022, Association of dietary proteins with serum creatinine and estimated glomerular filtration rate in a general population sample: the CHRIS study, JOURNAL OF NEPHROLOGY, Vol: 36, Pages: 103-114, ISSN: 1121-8428
Poudyal A, Karki KB, Shrestha N, et al., 2022, Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study., BMJ Open, Vol: 12, Pages: e057509-e057509, ISSN: 2044-6055
OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to
Hernandes VV, Dordevic N, Hantikainen EM, et al., 2022, Age, Sex, Body Mass Index, Diet and Menopause Related Metabolites in a Large Homogeneous Alpine Cohort, METABOLITES, Vol: 12
Guzman-Vilca WC, Yovera Juarez EA, Tarazona-Meza C, et al., 2022, Sugar-sweetened beverages consumption in adults: evidence from a National Health Survey in Peru, Nutrients, Vol: 14, ISSN: 2072-6643
High consumption of sugar-sweetened beverages (SSB) is associated with a high risk of non-communicable diseases. Evidence of SSB consumption is needed to inform SSB-related policies, especially in countries with a high consumption, such as Peru. Using data from Peru’s National Health Survey conducted in 2017–2018, the consumption of homemade and ready-to-drink SSB was estimated from a single 24 h dietary recall, accounting for socio-demographic and health-related variables. Regression models were fitted to assess which variables were linked to a high/low SSB consumption. There were 913 people and mean age was 37.7 years (95% confidence interval (CI): 36.9–38.6). Mean consumption (8 oz servings/day) of homemade SSB (1.2) doubled that of ready-to-drink SSB (0.5). The intake of homemade and ready-to-drink SSB was higher in men (1.3 and 0.7) than women (1.1 and 0.3). The intake of ready-to-drink SSB was higher in urban (0.6) compared to rural (0.2) populations. People aware of having diabetes had a lower consumption of both ready-to-drink (0.9 vs. 0.4) and homemade SSB (1.3 vs. 0.8) than those unaware of having diabetes. Male sex and living in urban locations were associated with higher ready-to-drink SSB intake. Older age was associated with a higher intake of homemade SSB. Amongst Peruvian adults, the consumption of SSB products (particularly homemade) remains high. Population-wide interventions should also aim to improve awareness of the nutritional components of homemade beverages.
Paudyal N, Parajuli KR, Garcia Larsen V, et al., 2022, A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges, Maternal and Child Nutrition, Vol: 18, ISSN: 1740-8695
In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community-based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12-fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.
Peckmezian T, Garcia-Larsen V, Wilkins K, et al., 2022, Microbiome-Targeted Therapies as an Adjunct to Traditional Weight Loss Interventions: A Systematic Review and Meta-Analysis, DIABETES METABOLIC SYNDROME AND OBESITY-TARGETS AND THERAPY, Vol: 15, Pages: 3777-3798, ISSN: 1178-7007
Ducharme-Smith K, Brady TM, Vizthum D, et al., 2021, Diet quality scores associated with improved cardiometabolic measures among African American adolescents, PEDIATRIC RESEARCH, Vol: 92, Pages: 853-861, ISSN: 0031-3998
Bernier-Jean A, Wong G, Saglimbene V, et al., 2021, Dietary potassium intake and all-cause mortality in adults treated with hemodialysis, Clinical Journal of the American Society of Nephrology, Vol: 16, Pages: 1851-1861, ISSN: 1555-9041
Background and objectives Dietary potassium restriction in people receiving maintenance hemodialysis is standard practice and is recommended in guidelines, despite a lack of evidence. We aimed to assess the association between dietary potassium intake and mortality and whether hyperkalemia mediates this association.Design, setting, participants, & measurements A total of 8043 adults undergoing maintenance hemodialysis in Europe and South America were included in the DIETary intake, death and hospitalization in adults with end-stage kidney disease treated with HemoDialysis (DIET-HD) study. We measured baseline potassium intake from the Global Allergy and Asthma European Network food frequency questionnaire and performed time-to-event and mediation analyses.Results The median potassium intake at baseline was 3.5 (interquartile range, 2.5–5.0) g/d. During a median follow-up of 4.0 years (25,890 person-years), we observed 2921 (36%) deaths. After adjusting for baseline characteristics, including cardiac disease and food groups, dietary potassium intake was not associated with all-cause mortality (per 1 g/d higher dietary potassium intake: hazard ratio, 1.00; 95% confidence interval [95% CI], 0.95 to 1.05). A mediation analysis showed no association of potassium intake with mortality, either through or independent of serum potassium (hazard ratio, 1.00; 95% CI, 1.00 to 1.00 and hazard ratio, 1.01; 95% CI, 0.96 to 1.06, respectively). Potassium intake was not significantly associated with serum levels (0.03; 95% CI, −0.01 to 0.07 mEq/L per 1 g/d higher dietary potassium intake) or the prevalence of hyperkalemia (≥6.0 mEq/L) at baseline (odds ratio, 1.11; 95% CI, 0.89 to 1.37 per 1 g/d higher dietary potassium intake). Hyperkalemia was associated with cardiovascular death (hazard ratio, 1.23; 95% CI, 1.03 to 1.48).Conclusions Higher dietary intake of potassium is not associated with hyperkalemia or death in patients treated with hemodialysis.
Bernier-Jean A, Wong G, Saglimbene V, et al., 2021, Self-Reported Physical Activity and Survival in Adults Treated With Hemodialysis: A DIET-HD Cohort Study, KIDNEY INTERNATIONAL REPORTS, Vol: 6, Pages: 3014-3025, ISSN: 2468-0249
Helfer B, Leonardi-Bee J, Mundell A, et al., 2021, Conduct and reporting of formula milk trials: systematic review (vol 375, n2202, 2021), BMJ: British Medical Journal, Vol: 375, Pages: 1-1, ISSN: 0959-535X
Helfer B, Leonardi-Bee J, Mundell A, et al., 2021, Conduct and reporting of formula milk trials: systematic review, BMJ: British Medical Journal, Vol: 375, Pages: 1-9, ISSN: 0959-535X
Objective To systematically review the conduct and reporting of formula trials.Design Systematic review.Data sources Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 January 2006 to 31 December 2020.Review methods Intervention trials comparing at least two formula products in children less than three years of age were included, but not trials of human breast milk or fortifiers of breast milk. Data were extracted in duplicate and primary outcome data were synthesised for meta-analysis with a random effects model weighted by the inverse variance method. Risk of bias was evaluated with Cochrane risk of bias version 2.0, and risk of undermining breastfeeding was evaluated according to published consensus guidance. Primary outcomes of the trials included in the systematic review were identified from clinical trial registries, protocols, or trial publications.Results 22 201 titles were screened and 307 trials were identified that were published between 2006 and 2020, of which 73 (24%) trials in 13 197 children were prospectively registered. Another 111 unpublished but registered trials in 17 411 children were identified. Detailed analysis was undertaken for 125 trials (23 757 children) published since 2015. Seventeen (14%) of these recently published trials were conducted independently of formula companies, 26 (21%) were prospectively registered with a clear aim and primary outcome, and authors or sponsors shared prospective protocols for 11 (9%) trials. Risk of bias was low in five (4%) and high in 100 (80%) recently published trials, mainly because of inappropriate exclusions from analysis and selective reporting. For 68 recently published superiority trials, a pooled standardised mean difference of 0.51 (range −0.43 to 3.29) was calculated with an asymmetrical funnel plot (Egger’s test P<0.001), which reduced to 0.19 after correction for asymmetry. Primary outcomes were reporte
Ducharme-Smith K, Mora-Garcia G, Mendes FDC, et al., 2021, Lung function, COPD and alternative healthy eating index in US adults, ERJ Open Research, Vol: 7, Pages: 1-12, ISSN: 2312-0541
Background There is a large burden of COPD in the US. The purpose of this study was to investigate the association between diet quality with lung function, spirometric restriction and spirometrically defined COPD in a nationally representative sample of US adults.Methods Adults (19–70 years of age) from the National Health and Nutrition Examination Survey 2007–2012 cycles were included (n=10 428). Diet quality was determined using the Alternative Healthy Eating Index (AHEI-2010). Pre-bronchodilator measurements of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and the FEV1/FVC were described. Calibrated lower limit of normal (LLN) estimates were derived to determine prevalence of spirometric restriction (FVC<LLN) and COPD (FEV1/FVC ratio<LLN). Population-weighted linear and logistic regression models were used to investigate the association of AHEI-2010 and respiratory outcomes.Results The mean±SD AHEI was 45.3±12.2, equivalent to meeting 41% of the daily recommendations for optimal diet quality. Those in the highest quartile of AHEI had better FEV1 (adjusted (a)β 47.92, 95% CI 2.27–93.57) and FVC (aβ 80.23, 95% CI 34.03–126.42; p-value interaction (*) of AHEI and smoking >0.05) compared to those in quartile 1. Higher AHEI was also associated with lower odds of spirometric restriction (OR 0.23, 95% CI 0.08–0.67; p-value AHEI*ethnicity >0.05).Conclusions Diet quality was independently associated with better FEV1 and FVC and with lower odds of spirometric restriction. These findings highlight the need for research to further elucidate the possible beneficial role of diet in the preservation of lung function.
Garcia-Larsen V, 2021, Omega-3 polyunsaturated fatty acids and FADS genotype: is personalised prevention of asthma on the horizon?, EUROPEAN RESPIRATORY JOURNAL, Vol: 58, ISSN: 0903-1936
Benslimane A, Garcia-Larsen V, El Kinany K, et al., 2021, Association between obesity and chronic obstructive pulmonary disease in Moroccan adults: Evidence from the BOLD study, SAGE OPEN MEDICINE, Vol: 9, ISSN: 2050-3121
Ducharme-Smith K, Chambers R, Garcia-Larsen V, et al., 2021, Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control, JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS, Vol: 121, Pages: 1125-1135, ISSN: 2212-2672
Mendes FDC, Ducharme-Smith K, Mora-Garcia G, et al., 2021, Household Food Insecurity, Lung Function, and COPD in US Adults, NUTRIENTS, Vol: 13
de Castro Mendes F, Paciencia I, Rufo JC, et al., 2021, Increasing Vegetable Diversity Consumption Impacts the Sympathetic Nervous System Activity in School-Aged Children, NUTRIENTS, Vol: 13
Ducharme-Smith K, Caulfield LE, Brady TM, et al., 2021, Higher Diet Quality in African-American Adolescents Is Associated with Lower Odds of Metabolic Syndrome: Evidence from the NHANES, JOURNAL OF NUTRITION, Vol: 151, Pages: 1609-1617, ISSN: 0022-3166
Russell MA, Dharmage S, Fuertes E, et al., 2021, The effect of physical activity on asthma incidence over 10 years: population-based study, ERJ Open Research, Vol: 7, ISSN: 2312-0541
Mendes FDC, Paciencia I, Cavaleiro Rufo J, et al., 2021, Higher diversity of vegetable consumption is associated with less airway inflammation and prevalence of asthma in school-aged children, PEDIATRIC ALLERGY AND IMMUNOLOGY, Vol: 32, Pages: 925-936, ISSN: 0905-6157
Charles D, Gethings LA, Potts JF, et al., 2021, Mass spectrometry-based metabolomics for the discovery of candidate markers of flavonoid and polyphenolic intake in adults, Scientific Reports, Vol: 11, ISSN: 2045-2322
Robust biological markers of dietary exposure are essential in improving the understanding of the link between diet and health outcomes. Polyphenolic compounds, including flavonoids, have been proposed to mitigate the risk of chronic diseases where oxidative stress and inflammation play a central role. Biomarkers can provide objective measurement of the levels of polyphenolic compounds. In this study, we provide methodology to identify potential candidate markers of polyphenol intake in human serum. Seventeen participants from the UK arm of the Global Allergy and Asthma Network of Excellence (GA2LEN) had their dietary intake estimated using a validated food frequency questionnaire, and serum samples were assessed using mass spectrometry to identify potential candidate markers. 144 features were assigned identities, of these we identified four biologically relevant compounds (rhamnazin 3-rutinoside, 2-galloyl-1,4-galactarolactone methyl ester, 2″,32″-di-O-p-coumaroylafzelin and cyclocommunin), which were significantly increased in the serum of participants with high predicted level of fruit and vegetable intake. 2-galloyl-1,4-galactarolactone methyl ester was strongly correlated with total flavonoids (r = 0.62; P = 0.005), flavan-3-ols (r = 0.67; P = 0.002) as well as with other four subclasses. Rhamnazin 3-rutinoside showed strong correlation with pro-anthocyanidins (r = 0.68; P = 0.001), flavones (r = 0.62; P = 0.005). Our results suggest that serum profiling for these compounds might be an effective way of establishing the relative intake of flavonoids and could contribute to improve the accuracy of epidemiological methods to ascertain flavonoid intake.
Triebner K, Bifulco E, Barrera-Gomez J, et al., 2021, Ultraviolet radiation as a predictor of sex hormone levels in postmenopausal women: A European multi-center study (ECRHS), MATURITAS, Vol: 145, Pages: 49-55, ISSN: 0378-5122
Bernier-Jean A, Wong G, Saglimbene V, et al., 2020, PHYSICAL ACTIVITY AND MORTALITY IN ADULTS UNDERGOING HAEMODIALYSIS: A DIET-HD COHORT STUDY, Publisher: WILEY, Pages: 32-33, ISSN: 1320-5358
Bernier-Jean A, Wong G, Saglimbene V, et al., 2020, DIETARY POTASSIUM INTAKE AND ALL-CAUSE MORTALITY IN ADULTS UNDERGOING HEMODIALYSIS: THE DIET-HD COHORT STUDY, Publisher: WILEY, Pages: 10-10, ISSN: 1320-5358
Mattioli V, Zanolin ME, Cazzoletti L, et al., 2020, Dietary flavonoids and respiratory diseases: a population-based multi-case-control study in Italian adults, Public Health Nutrition, Vol: 23, Pages: 2548-2556, ISSN: 1368-9800
OBJECTIVE: To analyse the associations between chronic respiratory diseases and intakes of total flavonoids and their major subclasses (flavanones, anthocyanins, flavan-3-ols, flavonols, flavones, polymers and proanthocyanidins). DESIGN: Multi-case-control study. SETTING: The analysis was conducted in the frame of the Genes Environment Interaction in Respiratory Diseases (GEIRD) study. The European Prospective Investigation into Cancer and Nutrition FFQ was used to ascertain dietary intake. Multinomial regression models adjusting for age, sex, centre, BMI, smoking habit, alcohol intake, education, total energy intake, vitamin C intake and total fruit intake were used to examine the associations between dietary exposures and the relative risk ratio (RRR) of being a case. PARTICIPANTS: Individuals (n 990) hierarchically defined as follows: cases with asthma (current, n 159; past, n 78), chronic bronchitis (n 47), rhinitis (allergic rhinitis, n 167; non-allergic rhinitis, n 142) and controls (n 97). RESULTS: An increase of 1 sd in flavanones was associated with a reduced risk of non-allergic rhinitis (adjusted RRR = 0·68, 95 % CI 0·47, 0·97); a similar result was found comparing the highest v. lowest quartile of flavanones intake (adjusted RRR = 0·24, 95 % CI 0·10, 0·59). CONCLUSIONS: Flavonoids contained in fruits and vegetables, especially flavanones, might reduce the risk of non-allergic rhinitis. No associations were found between other flavonoids and the considered outcomes.
Ducharme-Smith K, De Castro Mendes F, Villegas R, et al., 2020, Late Breaking Abstract - Ventilatory function and diet quality in US adults - Evidence from the National Health and Nutrition Examination Survey (NHANES), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Bédard A, Carsin A-E, Fuertes E, et al., 2020, Physical activity and lung function - cause or consequence?, PLoS One, Vol: 15, ISSN: 1932-6203
Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991–1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999–2003, and ECRHS III in 2010–2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean β (95% CI), comparing active versus non-active individuals: 58 mL (21–95) for forced expiratory volume in one second and 83 mL (36–130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.
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