2 Minute Medicine Rewind March 4, 2024

Use of tobacco products and suicide attempts among elementary school-aged children

1. In a cohort of US children aged 9-10, those who used tobacco products had a greater risk of suicide attempts (SAs) but not nonsuicidal self-injury (NSSI), or suicidal ideation (SI).

Evidence Rating Level: 2 (Good)

Tobacco use has been on the rise in adolescents and children, and it has become an increasing public health concern. Smoking has negative effects on the health of individuals, especially on mental health outcomes such as diminished neurocognition and increased risk of poor social behaviours. Specifically, previous studies have found that there is a 2-5 greater risk of self-injurious thoughts and behaviours (SITBs) activity in adolescent smokers than in adult smokers, although this association is poorly characterized. In this cohort study, researchers included data from September 1, 2022 to Septermber 5, 2023, from the Adolescent Brain Cognitive Development study to further assess this link. Bivariate analyses along with multivariate logistic regressions were performed to understand the data. Included in the study were 8988 youths, with the median age being 9.8 years (8.9-11.0) and 4301 girls (47.9%). Of these individuals, 101 (1.1%) reported ever using tobacco at baseline, while the other 8887 (98.9%; 4259 girls [47.9%]; median age, 9.8 years [range, 8.9-11.0]) did not report using any tobacco products at baseline. The prevalence of SITBs at baseline was: Nonsuicidal self-injury (NSSI), 4.8% (n=428); suicidal ideation (SI), 12.8% (n=1151); and suicidal attempts (SAs), 1.7% (n=227), whereas the values at year 1 were: NSSI, 5.7% (n=508); SI, 16.2 (n=1454), and SAs, 2.5% (n=227), and the values at year 2 were: NSSI, 6.2% (n=560); SI, 20.6% (n=1853); and SAs 3.6% (n=321). Significant associations were found between tobacco use and SAs and SI at all times. Youth that used tobacco products had an increased risk of SAs by 3-5 times (baseline: n=153 [adjusted odds ratio (OR), 4.67; 95% CI, 2.35-9.28; false discovery rate (FDR)-corrected P<.001]; year 1: n=227 [adjusted OR, 4.25; 95% CI, 2.33-7.74; FDR-corrected P<.001]; and year 2: n=321 [adjusted OR, 2.85; 95% CI, 1.58-5.13; FDR-corrected P=.001]). Overall, tobacco use was associated with an increased risk of SAs among elementary school-aged children. Although further research will be required to characterize this association, this serves as another warning on the possible deleterious effects of smoking and vaping.

Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study

1. In Ontario Canada, only 50% of home care clients received at least 1 or more palliative home care visits during their last 6 months of life.

2. The Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) served as a valuable prognostic model to provide early identification of palliative care needs.

 Evidence Rating Level: 2 (Good)

Palliative care is as essential service in the provision of holistic and patient-centred care for those diagnosed with life-limiting illnesses. Earlier initiation of palliative care has been linked with better outcomes such as improved quality of life and reduced distress. Despite this however, there is evidence that in Canada, as little as 15% of eligible individuals receive palliative care in their last year of life. This retrospective cohort study involved individuals 50 years or older (median age 80.1 [SD 11.0) years, mostly female [61.9%]) and examined their use of health care in Ontario. Within the first 6 months of the study, 29420 (11.9%) of the participants died. The median survival ranged from 30 days to 1576 days, and 98.1% in RESPECT risk bin 1 to 1.6% in risk bin 61. Only a few participants (2.6%) that were receiving home care, received a diagnosis of end-stage disease. The median survival was 58 (Interquartile range [IQR] 19-181) days for individuals with a median survival of less than 3 months, whereas the median survival for those predicted to live between 3 to 6 months was 144 (IQR 47-466) days, and 268 (IQR 79-826) days for those with a predicted median survival between 6 to 12 months. In all, this study corroborates prior literature that there is a poor utilization rate of palliative care resources in Canada.

Plant-based diets and risk of hip fracture in postmenopausal women

1. Long-term adherence to a plant-based diet was not associated with an increased risk of hip fractures in a cohort of US adult women.

2. Consumption of healthier plant-based options (whole fruits, vegetables) was associated with a 21% lower risk of fracture.

3. Consumption of more unhealthy plant-based options (fruit juices, processed foods, refined grains) was associated with a 28% higher risk of fracture.

Evidence Rating Level: 1 (Excellent)

As the aging process ensues, fractures become a public health concern as older adults have decreasing bone mass, especially postmenopausal women. Despite a large push for plant-based diets for health-related reasons, there has been concern in the past that adherence to these diets may result in poor effects on bone health. Even less characterized, is the relationship between the quality of plant based diets to bone health. In this prospective cohort study, researchers included data from 70,285 postmenopausal women that were included in the US Nurses’ Health Study from 1984 to 2014. Researchers scored the quality of diets via the healthful Plant-Based Diet Index (hPDI) and unhealth Plant-Based Index (uPDI), validated tools that effectively grade diets according to the proportion of healthy foods (ex., whole fruits, vegetables) compared to less healthy foods (sweets, fruit juices, processed foods), respectively.  A total of 7285 individuals participated in the study, with 2038 cases of hip fractures amongst them during the follow-up period of 30 years. The mean (SD) age of participants was 54.92 (4.48) years at baseline, with everyone being white. The mean (SD) hPDI was 54.33 (7.33) points while the mean uPDI was 54.38 (7.70) points. Energy consumption was analyzed, and the mean (SD) was 1743.64 (521.07) kcal while the mean BMI was 25.69 (4.85), which is classified as overweight. Individuals with a higher hPDI had healthier diets that included more calcium along with plant-based foods and were more physically active compared to participants with a lower hPDI. Individuals with a higher uPDI had lower levels of physical activity and lower calcium intake along with less healthy plant food consumption. The adjusted hazard ratio (HR) was 0.97 (95% CI, 0.83-1.14) for the highest quintile (Q5) vs the lowest quintile (Q1) for the hPDI and 1.2 (95% CI, 0.87-1.20) for the uPDI. In more recent tests, there was a 21% decreased risk of hip fracture associated with the hPDI (HR, 0.79 [95% CI, 0.68-0.92]; P=.02 for trend) while there was a 28% increased risk associated with the uPDI (HR, 1.28 [95% CI, 1.09-1.51]; P=.008 for trend). Overall, study findings indicated that longterm adherence to plant-based diets were not associated with hip fracture risk. Furthermore, greater consumption of healthier plant-based foods compared to less healthy options provided additional protection against hip fractures.

Metabolic-dysfunction associated steatotic liver disease related diseases, cognition and dementia: a two-sample mendelian randomization study

1. Vascular dementia may be increased by metabolic dysfunction associated steatotic liver disease (MASLD), liver fibrosis, and cirrhosis.

Evidence Rating Level: 1 (Excellent)

Metabolic dysfunction associated steatotic liver disease (MASLD) which is replacing the term non-alcoholic fatty liver disease is characterized by an abnormal accumulation of fat in the liver tissue not due to excessive alcohol use. MASLD is associated with the presence of obesity, and abnormal metabolism of blood lipids along with glucose thus also being a strong risk factor for diabetes, and cardiovascular diseases. Given the association of other metabolic conditions such as diabetes being associated with dementia, it has been hypothesized that MASLD may be additionally associated with dementia risk. In this study, researchers utilized from the Genome wide association study (GWAS) to understand the connection between MASLD-related diseases and cognitive performance.  A causal relationship was found between MASLD and vascular dementia (VD) (p of IVW=0.020, OR=1.660, 95% CI = 1.082-2.546) via mendelian randomization analysis. The results also suggested a positive causal relationship between liver fibrosis and cirrhosis (p of IVW = 0.009, OR=1.849, 95% CI = 1.169-2.922) with VD. Study findings suggest that MASLD-associated diseases were correlated with VD only and no other dementia types, though it was not possible to determine if there was a causal relationship between MASLD-related diseases and cognitive function. Overall, genetically predicted MASLD, liver fibrosis, and cirrhosis may lead to an increased risk of VD.

Mid- and long-term risk of atrial fibrillation among breast cancer surgery survivors

1. In a Korean cohort of breast cancer survivors, younger survivors had an increased risk of incident atrial fibrillation compared to older breast cancer survivors, regardless of length of follow-up.

Evidence Rating Level: 2 (Good)

Individuals previously treated with breast cancer may be at increased risk of developing atrial fibrillation (AF). Several mechanisms, such as the sharing of common risk factors between AF and cancer, cardiotoxicity of treatments, and health effects of cancer itself have been proposed to explain this association. Less known however, is the association between age of diagnosis and subsequent risk of developing AF. In this nationwide population-based cohort study, data from the Korean National Health Insurance Service (NHIS) database was used to evaluate the AF risk in breast cancer survivors of different ages at diagnosis. The mean age of the population was 51.6 years with 10.8% of participants being less than 40 years old. Of breast cancer survivors, 61.0% used chemotherapy, 15.0% used target therapy, 61.8% used endocrine treatment and 69.8% used radiation therapy. Survivors of breast cancer had an increased risk of developing AF compared to cancer-free individuals (sHR 1.06; 95% CI 1.00-1.13) however, the association began decreasing over time. Survivors aged < 40 years had a greater than 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98-3.94) however, there was not an increased risk in older breast cancer survivors (>65 years). In all breast cancer survivors, the use of anthracyclines was associated with higher AF risk (sHR 1.57; 95% CI 1.28-1.92), especially in younger survivors (sHR 1.94; 95% CI 1.40-2.69 in those aged ≤50 years). When compared to the general population, breast cancer survivors had an increased risk of developing AF among those without CV or CVD at baseline. The use of anthracyclines was associated with a higher risk of AF when accounting for cancer treatments. Overall, younger breast cancer survivors or survivors who were treated with anthracyclines may be associated with a higher risk of mid- to long-term risk of AF.

Image: PD

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