Use of folic acid during periconceptional period to prevent some birth defects is universally recognized. Major scientific organizations involved in prevention and public health are engaged in detailed assessment of the risk-benefit and effectiveness of various strategies implemented in order to improve the use of folic acid in the general population and in women of childbearing age. These assessments are essential points for the decisions to be taken by the government to ensure an adequate intake of folic acid by women during very early pregnancy. The 2009 edition of the Conference of the Italian Network for the Promotion of Folic Acid has been an important moment to promote a productive discussion between the main stakeholders and leaders of numerous research projects and initiatives on the protection of maternal-child health and promotion of healthy lifestyles. The objective is to create opportunities for collaboration and integration of the activities undertaken in each projects and to implement a common evaluation strategy. The Conference was also an opportunity to learn about new findings of scientific research relating to the folic acid issue.
Atmospheric particulate matter (PM) has multiple adverse effects on human health, high temperatures are also associated with adverse health outcomes, and the frequency of cardiovascular events (CVEs) varies with season. We investigated a hypothesized increase in PM-related accident and emergency (A&E) presentations for CVE with high temperature, warm season, days of high influenza incidence, and in people with a cancer diagnosis, using a time-stratified case-crossover study design. Outcomes were associations of A&E presentation for CVE with atmospheric PM ≤ 10 μm (PM(10)), season, and air temperature. PM(10) levels in the municipality of residence (exposure variable) were estimated by modeling data from local monitoring stations. Conditional logistic regression models estimated odds ratios (OR) with 95% confidence intervals (CI) for presentations in relation to supposed influencers, adjusting for confounders. Study participants were all who presented at the A&E of a large hospital near Milan, Italy, for a CVE (ICD-9: 390–459) from 1st January 2014 to 31st December 2015. There were 1349 A&E presentations for CVE in 2014–2015 and 5390 control days. Risk of A&E presentation was significantly increased on hot days with OR 1.34 (95%CI 1.05–1.71) per 10 μg/m(3) PM(10) increment (as mean PM(10) on day of presentation, and 1 and 2 days before (lags 0–2)), and (for lag 0) in autumn (OR 1.23, 95%CI 1.09–1.37) and winter (OR 1.18, 95%CI 1.01–1.38). Risks were also significantly increased when PM(10) was on lag 1, in people with a cancer diagnosis in the spring and summer months (1.88, 95%CI 1.05–3.37), and on days (lags 0–2) of high influenza incidence (OR 2.34, 95%CI 1.01–5.43). PM(10) levels exceeded the 50 μg/m(3) "safe" threshold recommended by the WHO and Italian legislation for only 3.8% of days during the warm periods of 2014–2015. Greater risk of A&E presentation for CVE in periods of high PM(10) and high temperature suggests that "safe" thresholds for PM(10) should be temperature-dependent ...
In: Kengne , A P , Beulens , J W J , Peelen , L M , Moons , K G M , van der Schouw , Y T , Schulze , M B , Spijkerman , A M W , Griffin , S J , Grobbee , D E , Palla , L , Tormo , M J , Arriola , L , Barengo , N C , Barricarte , A , Boeing , H , Bonet , C , Clavel-Chapelon , F , Dartois , L , Fagherazzi , G , Franks , P W , Huerta , J M , Kaaks , R , Key , T J , Khaw , K T , Li , K , Mühlenbruch , K , Nilsson , P M , Overvad , K , Overvad , T F , Palli , D , Panico , S , Quirós , J R , Rolandsson , O , Roswall , N , Sacerdote , C , Sánchez , M J , Slimani , N , Tagliabue , G , Tjønneland , A , Tumino , R , van der A , D L , Forouhi , N G , Sharp , S J , Langenberg , C , Riboli , E & Wareham , N J 2014 , ' Non-invasive risk scores for prediction of type 2 diabetes (EPIC-InterAct) : A validation of existing models ' , The Lancet Diabetes and Endocrinology , vol. 2 , no. 1 , pp. 19-29 . https://doi.org/10.1016/S2213-8587(13)70103-7
Background: The comparative performance of existing models for prediction of type 2 diabetes across populations has not been investigated. We validated existing non-laboratory-based models and assessed variability in predictive performance in European populations. Methods: We selected non-invasive prediction models for incident diabetes developed in populations of European ancestry and validated them using data from the EPIC-InterAct case-cohort sample (27 779 individuals from eight European countries, of whom 12 403 had incident diabetes). We assessed model discrimination and calibration for the first 10 years of follow-up. The models were first adjusted to the country-specific diabetes incidence. We did the main analyses for each country and for subgroups defined by sex, age (0·05) except for three models. However, two models overestimated risk, DPoRT by 34% (95% CI 29-39%) and Cambridge by 40% (28-52%). Discrimination was always better in individuals younger than 60 years or with a low waist circumference than in those aged at least 60 years or with a large waist circumference. Patterns were inconsistent for BMI. All models overestimated risks for individuals with a BMI of <25 kg/m 2 . Calibration patterns were inconsistent for age and waist-circumference subgroups. Interpretation: Existing diabetes prediction models can be used to identify individuals at high risk of type 2 diabetes in the general population. However, the performance of each model varies with country, age, sex, and adiposity. Funding: The European Union.
BACKGROUND: The comparative performance of existing models for prediction of type 2 diabetes across populations has not been investigated. We validated existing non-laboratory-based models and assessed variability in predictive performance in European populations. METHODS: We selected non-invasive prediction models for incident diabetes developed in populations of European ancestry and validated them using data from the EPIC-InterAct case-cohort sample (27,779 individuals from eight European countries, of whom 12,403 had incident diabetes). We assessed model discrimination and calibration for the first 10 years of follow-up. The models were first adjusted to the country-specific diabetes incidence. We did the main analyses for each country and for subgroups defined by sex, age (0·05) except for three models. However, two models overestimated risk, DPoRT by 34% (95% CI 29-39%) and Cambridge by 40% (28-52%). Discrimination was always better in individuals younger than 60 years or with a low waist circumference than in those aged at least 60 years or with a large waist circumference. Patterns were inconsistent for BMI. All models overestimated risks for individuals with a BMI of <25 kg/m(2). Calibration patterns were inconsistent for age and waist-circumference subgroups. INTERPRETATION: Existing diabetes prediction models can be used to identify individuals at high risk of type 2 diabetes in the general population. However, the performance of each model varies with country, age, sex, and adiposity. FUNDING: The European Union.