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The effect of body mass index (BMI) on esophageal and gastric carcinogenesis might be heterogeneous, depending on subtype or subsite. However, findings from prospective evaluations of BMI associated with these cancers among Asian populations have been inconsistent and limited, especially for esophageal adenocarcinoma and gastric cardia cancer. We performed a pooled analysis of 10 population‐based cohort studies to examine this association in 394,247 Japanese individuals. We used Cox proportional hazards regression to estimate study‐specific hazard ratios (HRs) and 95% confidence intervals (CIs), then pooled these estimates to calculate summary HRs with a random effects model. During 5,750,107 person‐years of follow‐up, 1569 esophageal cancer (1038 squamous cell carcinoma and 86 adenocarcinoma) and 11,095 gastric (728 cardia and 5620 noncardia) cancer incident cases were identified. An inverse association was observed between BMI and esophageal squamous cell carcinoma (HR per 5‐kg/m2 increase 0.57, 95% CI 0.50–0.65), whereas a positive association was seen in gastric cardia cancer (HR 1.15, 95% CI 1.00–1.32). A nonsignificant and significant positive association for overweight or obese (BMI ≥25 kg/m2) relative to BMI <25 kg/m2 was observed with esophageal adenocarcinoma (HR 1.32, 95% CI 0.80–2.17) and gastric cardia cancer (HR 1.24, 95% CI 1.05–1.46), respectively. No clear association with BMI was found for gastric noncardia cancer. This prospective study—the largest in an Asian country—provides a comprehensive quantitative estimate of the association of BMI with upper gastrointestinal cancer and confirms the subtype‐ or subsite‐specific carcinogenic impact of BMI in a Japanese population. The impact of BMI on upper gastrointestinal cancer by subtype or subsite among Asians is inconclusive. Using data from 10 large‐scale population‐based cohort studies, we evaluated the association between BMI and upper gastrointestinal cancers for 394,247 Japanese individuals. With 1038 esophageal squamous cell carcinoma, 86 esophageal adenocarcinoma, 728 gastric cardia cancer, and 5620 gastric noncardia cancer cases, we confirmed the subtype‐ or subsite‐specific carcinogenic impact of BMI in an Asian population.

Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control. During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.

The antibiotic resistance crisis underlies globally increasing failures in treating deadly bacterial infections, largely due to the selection of antibiotic resistance genes (ARG) collection, known as the resistome, in human gut microbiota. So far, little is known about the relationship between gut antibiotic resistome and host metabolic disorders such as type 2 diabetes (T2D). Here, metagenomic landscape of gut antibiotic resistome is profiled in a large multiomics human cohort (n = 1210). There is a significant overall shift in gut antibiotic resistome structure among healthy, prediabetes, and T2D groups. It is found that larger ARG diversity is associated with a higher risk of T2D. The novel diabetes ARG score is positively associated with glycemic traits. Longitudinal validation analysis confirms that the ARG score is associated with T2D progression, characterized by the change of insulin resistance. Collectively, the data describe the profiles of gut antibiotic resistome and support its close relationship with T2D progression. Little is known about the relationship between gut antibiotic resistance genes (ARG) and diabetes. This study profiles the gut antibiotic resistome in a large human cohort (n=1210). There is a significant overall shift in the ARG composition across healthy, prediabetes, and diabetes individuals. A novel diabetes‐ARG score is associated with diabetes progression, characterized by the alteration of insulin resistance.

Time‐based diets have gained popularity for their health benefits, but their effects on human longevity remain unclear, with most evidence from short‐term human trials and animal studies. We determined the associations between eating window and mortality among U.S. adults. We conducted a prospective cohort study using NHANES 2003–2018 data linked to mortality records through December 2019. The analytic sample included 33,052 adults (aged 20 and above) with two complete 24‐h dietary recalls collected at baseline. Eating window was defined as the time between first and last consumption of any food/beverage containing > 0 kcal within 24 h. We used survey‐weighted Cox regression with Restricted Cubic Splines (RCS) to model nonlinear associations, treating eating window as both a continuous and categorical variable (< 8.0–≥ 15.0 h/day). Models were adjusted for sociodemographic, lifestyle, health, and dietary factors. Subgroup analyses were conducted by age, sex, and race/ethnicity. Over a median follow‐up of 8 years, there were 4158 all‐cause, 1277 cardiovascular, and 989 cancer deaths. RCS models showed a U‐shaped association between eating window and mortality, with the lowest risk at ~11–12 h/day (p = 0.004). Shorter windows (≤ 8 h) were linked to ≥ 30% higher all‐cause mortality, especially in older adults, and > 50% higher cardiovascular mortality in older adults, men, and Whites. Longer eating window categories (≥ 15 h/day) were associated with 25% higher all‐cause mortality (95% CI: 1.01–1.55). Moderate eating windows (~11–12 h/day) are linked to the lowest mortality risk, with deviations associated with higher risk. Differences across demographic groups highlight the need for personalized guidance. We examined eating window and mortality among 33,052 U.S. adults from NHANES 2003–2018 with mortality linkage. A U‐shaped association was observed: moderate eating windows of ~11–12 h/day were linked to the lowest risk, while shorter windows (< 8 h/day) and longer windows (≥ 15 h/day) were associated with 30% and 25% higher all‐cause mortality, respectively. Risks were especially pronounced for cardiovascular mortality in older adults and White participants.

Background Type 2 diabetes mellitus (T2DM) and dementia cause heavy health burden in mainland China, where few studies have investigated the association between glucose‐lowering agents and dementia risk. We aimed to assess the association between use of thiazolidinediones (TZDs) and dementia incidence in a mainland Chinese population with T2DM. Methods A retrospective cohort of T2DM patients who were new users of TZDs or alpha glucosidase inhibitors (AGIs) was assembled using the Yinzhou Regional Health Care Database. A Cox model with inverse probability of treatment weighting (IPTW) for controlling potential founding was applied to estimate the hazard ratio (HR) of the association between use of TZDs and dementia risk. Results A total of 49 823 new users of AGIs and 12 752 new users of TZDs were included in the final cohort. In the primary analysis, the incidence of dementia was 195.7 and 78.2 per 100 000 person‐years in users of AGIs and TZDs respectively. TZD use was associated with a reduced risk of incident dementia after adjusting for potential confounding using IPTW, with a HR of 0.51 (95% CI, 0.38–0.67). The results in various subgroup analyses and sensitivity analyses were consistent with the findings of the primary analysis. Conclusions Use of TZDs is associated with a decreased risk of dementia incidence in a mainland Chinese population with T2DM. 摘要 背景:2型糖尿病(T2DM)和痴呆给患者带来严重的健康负担，但目前很少有研究探讨降糖药物与痴呆风险之间的关系。我们旨在评估T2DM人群中噻唑烷二酮类药物的使用与痴呆发病率之间的关系。 研究设计和方法:利用鄞州地区卫生保健数据库，对新使用噻唑烷二酮(TZDs)或α‐糖苷酶抑制剂(AGIs)的2型糖尿病患者进行回顾性队列研究。采用治疗加权逆概率(IPTW)控制潜在发病的Cox模型来估计TZD使用与痴呆风险之间的关联的风险比(HR)。 结果:最终队列共纳入49823名AGIs新用户和12752名TZDs新用户。在初步分析中，AGIs和TZDs使用者的痴呆发病率分别为每10万人195.7/年和78.2/年。在使用IPTW进行潜在混杂调整后，TZDs的使用与痴呆事件风险降低相关，HR为0.51(95%CI,0.38‐0.67)。不同亚组分析和敏感性分析的结果与初步分析的结果一致。 结论:在2型糖尿病人群中，使用TZDs与痴呆发病率降低相关。 Highlights Type 2 diabetes mellitus (T2DM) and dementia cause heavy health burden in China. This was the first cohort study investigating the association between TZD use and dementia incidence in a mainland Chinese population. We found that TZD use was associated with a 49% reduction in incidence of dementia. Our results could provide some insights into developing effective prevention and control measures to reduce the future disease burden of dementia.

The Copenhagen General Practice Laboratory (CGPL) was founded in 1922 to provide paraclinical analyses to the primary health-care sector in Copenhagen. At the end of 2015, CGPL was closed and the CopLab database was established to make CGPL data available for research. We isolated tests performed at the CGPL with clinically relevant test results. The database was linked to national registers containing health, social, and demographic information. Results are presented with descriptive statistics showing counts, percentages, medians, and interquartile ranges (IQR). The CopLab database includes 1,373,643 unique individuals from primary care with test results from laboratory analyses of blood/urine/semen as well as cardiac and lung function tests collected by CGPL from greater Copenhagen from 2000 to 2015. The CopLab database holds nearly all test results requested by general practitioners throughout years 2000 to 2015 for residents in the greater Copenhagen area. The median age of the individuals was 51 years and 59.7% were females. Each individual has a median of 4 requisitions. More than 1 million participants are currently alive and living in Denmark and may be followed in national registries such as the Danish National Patient Registry, Laboratory Database, National Prescription Database etc.

Upper gastrointestinal endoscopy for gastric cancer screening has been implemented in Japan. However, its effectiveness for gastric cancer prevention has not been fully studied. We aimed to investigate the effectiveness of endoscopic screening to reduce mortality from gastric cancer. In a large prospective population‐based cohort study including 80,272 participants, we compared the risk of mortality and incidence of gastric cancer among participants who underwent endoscopic or radiographic screening compared with those who did not undergo any screening using multivariable Cox proportional hazards models. In the 1,023,364 person‐year observation period (median; 13.0 years), 1977 cases of gastric cancer were diagnosed, and 783 patients with gastric cancer died. In the endoscopic screening group, the mortality from gastric cancer and incidence of advanced gastric cancer were reduced by 61% (hazard ratio [HR] = 0.39 [95% CI: 0.30–0.51]) and 22% (HR = 0.78 [95% CI: 0.67–0.90]), respectively. The radiographic screening reduced the mortality from gastric cancer (HR = 0.63 [95% CI: 0.54–0.73]), but its effectiveness was lower than that of endoscopic screening. In conclusion, endoscopic screening reduced the incidence of advanced gastric cancer and mortality from gastric cancer in the Japanese population. In this Japanese prospective population‐based cohort study, endoscopic screening reduced the incidence of advanced gastric cancer by 22% and mortality from gastric cancer by 61% compared with no screening. The effectiveness of endoscopic screening on reducing gastric cancer mortality was greater than that of radiographic screening. The results provide a rationale for promoting endoscopic screening for gastric cancer, which has a high mortality rate and significant public health impact in Japan.

Background We previously observed decreasing resection rates of non‐metastatic gastric adenocarcinoma (GaC) in the US and some European countries. If and to what extent these trends affect the trends in overall survival (OS) of patients with non‐metastatic GaC at the population level remain unclear. This large international population‐based cohort study aimed to assess the impact of the previously observed decreasing resection rates on multivariable‐adjusted trends in the long‐term OS of patients with non‐metastatic GaC. Methods Individual‐level data of patients with non‐metastatic GaC were obtained from the national cancer registries of the Netherlands, Belgium, Sweden, Norway, and Slovenia, and the US Surveillance, Epidemiology, and End Results database. We analyzed data for each country separately. Associations between year of diagnosis and OS were assessed using Cox proportional hazards regression model with adjustment for multiple prognostic variables, with and without including resection and chemotherapy as potential explanatory variables. Results A total of 66,398 non‐metastatic GaC patients diagnosed in 2003‐2016 were analyzed, with an accumulated follow‐up of 172,357 person‐years. Without adjustment for resection, OS was improved only slightly in the US [hazard ratio (HR)per year = 0.99; HR≥ vs. <2010 = 0.96], and no improvement was observed in the investigated European countries, with OS even worsening in Sweden (HRper year = 1.03; HR≥ vs. <2010 = 1.17). After adjusting for resection, the increasing OS trend became stronger in the US (HRper year = 0.98; HR≥ vs. <2010 = 0.88), and the temporal trend became insignificant in Sweden. In Slovenia (HRper year = 0.99; HR≥ vs. <2010 = 0.92) and Norway (HRper year = 0.97; HR≥ vs. <2010 = 0.86), improved OS over time emerged after resection adjustment. Improved OS in patients undergoing resection was observed in the US, the Netherlands, and Norway. Adjustment for chemotherapy did not alter the observed associations. Stratified analyses by tumor location showed mostly similar results with the findings in all patients with non‐metastatic GaCs regarding the associations between year of diagnosis and survival. Conclusions OS of patients with non‐metastatic GaC mostly did not improve in selected European countries and was even worsened in Sweden, while it was slightly increased in the US in the early 21st century. Progress in OS of patients with non‐metastatic GaC seems to have been impeded to a large extent by decreasing rates of resection.

Frailty refers to a decline in the physiological functioning of one or more organ systems. It remained unclear whether variations in the trajectory of frailty over time were associated with subsequent cognitive change. The aim of the current study was to investigate the association between frailty trajectories and subsequent cognitive decline based on the Health and Retirement Study (HRS). A total of 15,454 participants were included. The frailty trajectory was assessed using the Paulson–Lichtenberg Frailty Index, while the cognitive function was evaluated using the Langa–Weir Classification. Results showed that severe frailty was significantly associated with the subsequent decline in cognitive function (β [95% CI] = −0.21 [−0.40, −0.03], p = 0.03). In the five identified frailty trajectories, participants with mild frailty (inverted U‐shaped, β [95% CI] = −0.22 [−0.43, −0.02], p = 0.04), mild frailty (U‐shaped, β [95% CI] = −0.22 [−0.39, −0.06], p = 0.01), and frailty (β [95% CI] = −0.34 [−0.62, −0.07], p = 0.01) were all significantly associated with the subsequent cognition decline in the elderly. The current study suggested that monitoring and addressing frailty trajectories in older adults may be a critical approach in preventing or mitigating cognitive decline, which had significant implications for healthcare. The study investigated the association between frailty trajectories and cognition using a multilevel model on a large cohort of older adults from Health and Retirement Study (HRS). Results revealed that mild frailty (inverted U‐shaped and U‐shaped) and frailty were significantly associated with subsequent cognitive decline, indicating that frailty trajectories may be used to identify people at high risk of age‐related cognitive deterioration.