Код Парфюмерия Цена*, Р Заказ 12 parfumeurs francais 12 PARFUMEURS INTRIGUE DE L'AMOUR lady ml EdP ref. EP , • Этот блок питания можно использовать только с которая может пролиться и попасть в. «Зная, что такое уголовный процесс в наших условиях, можно предсказать. 26/06/ · ABSTRACT. Background: The association between fruit and vegetable (FV) consumption and overall mortality has seldom been investigated in large cohort sap.детекторлжиекатеринбург.рф by: 2 assistance, providing for additional assistance to families with two or more children with disabilities and to single parents who care for disabled.
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Background: The association between fruit and vegetable FV consumption and overall mortality has seldom been investigated in large cohort studies. Findings from the few available studies are inconsistent.
Objective: The objective was to examine the dose-response relation between FV consumption and mortality, in terms of both time and rate, in a large prospective cohort of Swedish men and women. Design: FV consumption was assessed through a self-administrated questionnaire in a population-based cohort of 71, participants 38, men and 33, women aged 45—83 y. We performed a dose-response analysis to evaluate 10th survival percentile differences PDs by using Laplace regression and estimated HRs by using Cox regression.
Results: During 13 y of follow-up, 11, deaths men and women occurred in the cohort. Major focus has been given to the effect of FV consumption on specific chronic diseases such as cardiovascular disease CVD 2 , 3 and cancer 4.
Few cohort studies have investigated FV consumption in relation to risk of overall mortality as a primary outcome 5 — 9 , and most of the available information comes from smaller studies that examined total serum carotenoids as a marker of FV intake 10 — The association was mainly evaluated by categorizing the main variable in quintiles or tertiles of daily consumption 6 — 9 , 11 — 14 , despite the recognized limitations of the use of categories 15 , Findings from those studies are inconsistent.
To the best of our knowledge, no previous studies have evaluated FV consumption as a continuous variable to investigate the shape of the association between FV consumption and mortality in a population-based cohort study. Therefore, our aim was to examine the dose-response relation between FV consumption and mortality, in terms of both time to death and mortality rate, in a large cohort of Swedish men and women. Participants from the population-based Cohort of Swedish Men and the Swedish Mammography Cohort were combined in this study.
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A self-administrated questionnaire was used to collect information on diet, alcohol consumption, education, body weight, height, physical activity, smoking habits, and other lifestyle factors. A total of 48, men returned the questionnaire. Participants completed a questionnaire with questions regarding diet, alcohol consumption, education, body weight, and height. In the late fall of , women who were still alive and residing in the study area received a second questionnaire that was expanded to include information regarding smoking status, physical activity, and other lifestyle factors.
A total of 39, women returned this second questionnaire and were considered in the current analysis. This study was approved by the Regional Research Ethics Board at Karolinska Institutet, and all participants gave their informed consent. After these exclusions, a total of 71, participants 38, men and 33, women were included in the current analysis. Usual dietary intake over the previous year was assessed through a self-administered item food-frequency questionnaire. In our validation study, the Spearman correlation coefficients between the average of four 1-wk dietary records and the dietary questionnaire ranged from 0.
Information on FV consumption was collected by using 14 questions on vegetables carrot, beetroot, lettuce, cabbage, cauliflower, broccoli, tomato, pepper, spinach, peas, onion, garlic, pea soap, and other vegetables , 5 on fruit orange, apple, banana, berry, and other fruit , and 1 on orange juice. Participants were asked to indicate how often on average in the previous year they had consumed each food. Our main variables for FV, fruit, and vegetable consumption were calculated as the average servings per day and were obtained by converting the questionnaire responses to average daily intake of each item and adding the intake of all items.
When aggregating items, we assumed that missing values for an individual food meant no intake for that particular item From 1 January through 31 December , during 13 y of follow-up, we documented 11, deaths in the cohort men and women.
We used multivariable Laplace regression to model percentiles of survival 19 , The evaluation of other percentiles between 1 and 16 provided similar results. The main measure of exposure-disease association was defined as the 10th percentile difference PD. Mortality rates were modeled by using multivariable Cox regression, and HRs are reported.
We found no evidence of departure from the assumption. Age-adjusted P -trend values of potential confounders across exposures categories were obtained from a linear regression for continuous variables, logistic regression for binary variables, and ordinal logistic regression for categorical variables.
The shape of the dose-response relation was fairly insensitive to the location of the knots Linearity was evaluated by testing the null hypothesis that the coefficients of the unrestricted spline transformations are jointly equal to zero We also evaluated the dose-response relation for fruit and vegetable consumption as separate exposures in a single model. A second sensitivity analysis was performed by further adjusting our models for the nonrecommended food score as previously described In our last sensitivity analysis, we evaluated whether there was any difference excluding information on orange juice.
Statistical interactions were assessed by testing the product terms in the model with a Wald test. Statistical analyses were performed with Stata version 12; StataCorp.
The characteristics of the study population by categories of FV consumption are shown in Table 1. On average, women tended to consume more FV than did men.
Participants with a low FV intake were more likely to be current smokers, to have a lower educational level, and to have a higher consumption of nonrecommended foods. An increase in FV consumption corresponded to a higher total energy intake.
Age, BMI, physical activity, and alcohol consumption were similar, overall, across categories of FV consumption. Age-standardized baseline characteristics by categories of fruit and vegetable consumption in 45—y-old Swedish men and 48—y-old Swedish women.
Age-adjusted P -trend values were obtained from a linear regression for continuous variables, logistic regression for binary variables, and ordinal logistic regression for categorical variables. The dose-response association between FV consumption and mortality is shown in Figure 1. We flexibly modeled the association by using splines and estimating 10th survival PDs and HRs.
The point and interval estimates of the dose-response analysis at specific levels of the distribution of FV consumption are shown in Table 2. Data were fitted by using Laplace regression A and Cox proportional hazard regression B.
Models were adjusted for age at baseline, sex, BMI, total physical activity, alcohol consumption, smoking status and pack-years, education level, and total energy intake. Tabular presentation of estimates for specific values of fruit and vegetable consumption from the spline dose-response model.
We next considered the consumption of fruit and vegetables separately in a mutually adjusted model. The 10th survival PDs, according to levels of fruit consumption and vegetables consumption, are presented in Figure 2. Data were fitted by using multivariable Laplace regression.
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The histograms show the distribution of fruit and vegetable consumption in the cohort. In our first sensitivity analysis, we excluded participants who died during the first 3 y of follow-up. Finally, no changes were observed when we omitted orange juice from total FV or fruit consumption.
We next evaluated possible interactions between FV and sex, smoking status, BMI, and education level in predicting mortality. We found that daily consumption of FV was associated with a substantially longer survival and lower rate of overall mortality. The shape of the association was nonlinear.
Association between FV consumption and overall mortality has seldom been investigated in large cohort studies. Research has mainly focused on the association between FV consumption and specific major chronic diseases such as CVD and different cancers. However, the study of the association of daily FV consumption with overall mortality represents a primary and basic tool to explore its effects on health as a whole and needs to be kept in consideration while providing dietary recommendations.
Results from the few previous studies of the association between FV and risk of overall mortality are not consistent. Some studies found that regular FV consumption is associated with a strong reduction in the risk of overall mortality 8 , On the other hand, other studies have found that this decrease in mortality risk was not substantial 6 , 7. A possible explanation for the discrepancy in the previous findings is the choice to perform analyses only by categories of the quantitative exposure obtained by using study-specific cutoffs quintiles or tertiles.
This approach had some limitations that have been widely identified 15 , 16 , The major limitations of a categorical approach are the assumption of a step dose-response function, the subjective choice of cutoff, the loss of statistical power, and the loss of within-category information.
Categorization by necessity leads to pooling groups with different risks so that any difference between individuals in the same category cannot be detected.
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We observed a strong increase in mortality among those with low levels of consumption. This decrease could not be observed if all participants with low consumption were considered together in the same category. Moreover, trying to characterize the shape of the dose-response association from a categorical approach may not be straightforward in the presence of strong nonlinearity, as we observed in our data.
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Although one study on serum carotenoid intake has already suggested that the shape of the relation could be nonlinear 13 , a linear trend was often assumed and positively tested 6 — 9.
To the best of our knowledge this was the first cohort study that evaluated the dose-response relation between FV consumption and mortality with the use of flexible tools such as splines. The strengths of this study were the population-based and prospective design, large sample size, completeness of ascertainment of deaths through the National Register, and detailed information on diet. The small fraction of missing data reported on single items, which were treated with the zero-consumption approach, is unlikely to represent a source of bias for the observed findings Another major strength of this work was that we characterized the association both in terms of time and in terms of rate—an approach that makes it easier to interpret results and communicate them to the general public.
Information on time to event is obtained by the estimation of survival percentiles, which express the time period within which a specified proportion of people die. Laplace regression, the main statistical model that we used for analyses, directly estimates differences in survival percentiles according to levels of the exposure 19 , This approach provided many advantages, such as modeling continuous exposures, adjusting for potential confounders, and assessing interactions in predicting survival.
The estimation of differences in survival percentiles the regression coefficients obtained from Laplace regression provides an intuitive measure of the observed association between the exposure of interest and mortality directly in the unit of the time scale eg, months, years.
In our closed cohort, all censored observations occurred at the end of the study period, and estimable survival percentiles depended on the length of follow-up. Inference on higher percentiles, for example median survival time, would require extrapolation beyond the range of observed follow-up time. No other statistical methods, Cox regression included, could overcome this limitation, which is inherent in this type of data.
The main limitation of this study was that information on FV consumption was self-reported, which can lead to a potential misclassification of the exposure. Classification errors in our prospective study, however, were nondifferential with respect to the occurrence of death and most likely led to an attenuation of the results. All authors reviewed and approved the final manuscript and participated in the study design and in the writing of the manuscript.
None of the authors had any personal or financial conflicts of interest. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.
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