In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival.

IntroductionAdults with end-stage kidney disease (ESKD) treated with haemodialysis experience mortality of between 15% and 20% each year. Effective interventions that improve health outcomes for long-term dialysis patients remain unproven. Novel and testable determinants of health in dialysis are needed. Nutrition and dietary patterns are potential factors influencing health in other health settings that warrant exploration in multinational studies in men and women treated with dialysis. We report the protocol of the “DIETary intake, death and hospitalisation in adults with end-stage kidney disease treated with HaemoDialysis (DIET-HD) study,” a multinational prospective cohort study. DIET-HD will describe associations of nutrition and dietary patterns with major health outcomes for adults treated with dialysis in several countries.Methods and analysisDIET-HD will recruit approximately 10 000 adults who have ESKD treated by clinics administered by a single dialysis provider in Argentina, France, Germany, Hungary, Italy, Poland, Portugal, Romania, Spain, Sweden and Turkey. Recruitment will take place between March 2014 and June 2015. The study has currently recruited 8000 participants who have completed baseline data. Nutritional intake and dietary patterns will be measured using the Global Allergy and Asthma European Network (GA2LEN) food frequency questionnaire. The primary dietary exposures will be n-3 and n-6 polyunsaturated fatty acid consumption. The primary outcome will be cardiovascular mortality and secondary outcomes will be all-cause mortality, infection-related mortality and hospitalisation.Ethics and disseminationThe study is approved by the relevant Ethics Committees in participating countries. All participants will provide written informed consent and be free to withdraw their data at any time. The findings of the study will be disseminated through peer-reviewed journals, conference presentations and to participants via regular newsletters. We expect that the DIET-HD study will inform large pragmatic trials of nutrition or dietary interventions in the setting of advanced kidney disease.

Background Diet is a modifiable risk factor for cardiovascular disease; however, dietary patterns are historically difficult to capture in the clinical setting. Healthcare providers need assessment tools that can quickly summarize dietary patterns. Research should evaluate the effectiveness of these tools, such as Rate Your Plate (RYP), in the clinical setting. Hypothesis RYP diet quality scores are associated with measures of body adiposity in patients referred for coronary angiography. Methods Patients without a history of coronary revascularization (n = 400) were prospectively approached at a tertiary medical center in New York City prior to coronary angiography. Height, weight, and waist circumference (WC) were measured; body mass index (BMI) and waist‐to‐height ratio (WHtR) were calculated. Participants completed a 24‐question RYP diet survey. An overall score was computed, and participants were divided into high (≥58) and low (≤57) diet quality groups. Results Participants in the high diet quality group (n = 98) had significantly lower measures of body adiposity than did those in the low diet quality group (n = 302): BMI (P < 0.001), WC (P = 0.001), WHtR (P = 0.001). There were small but significant inverse correlations between diet score and BMI, WC, and WHtR (P < 0.001). These associations remained significant after adjustment for demographics, tobacco use, and socioeconomic factors. Conclusions Higher diet quality scores are associated with lower measures of body adiposity. RYP is a potential instrument to capture diet quality in a high‐volume clinical setting. Further research should evaluate the utility of RYP in cardiovascular risk‐factor control.

INTRODUCTION: Tumor size has long been recognized as the strongest predictor of the outcome of patients with breast cancer. While screening programs are increasing the proportion of non-palpable breast cancer cases, it is important to know its relevance in the outcome. Our purpose was to evaluate various prognostic factors, including tumor palpability, in a multivariate fashion. METHODS: A Kaplan-Meier survival analysis was carried out for a retrospective cohort of 758 women with early stages of invasive breast carcinomas who were treated at the Breast Unit of the CECLINES (Caracas-Venezuela), Clinica el Viñedo y Centro Medico Dr. Rafael Guerra Mendez and University of Carabobo (Valencia-Venezuela), between 1987-2010. Endpoints were 10 years disease free survival (10 yrs-DFS) and 10 years overall survival (10 yrs-OS). Using a multivariate analysis, Hazard ratios (HR) were calculated in order to identify independent prognostic factors for 10 yrs-DFS and 10 yrs-OS. RESULTS: The median age for the entire cohort was 55yo; 293 (38.7%) tumors were not palpable and 465 (61.3%) were palpable; 42.2% (318 cases) were in pathological stage (PS) I and 57.8% (436 cases) in PS II. Tumor size was &lt;1cm in 26% of cases; was between 1 - 3cm in 24.9% and &gt;3cm in 49.1%; 23.2% had nodal involvement. In regard to immunohistochemistry markers, 633 were evaluable for estrogen receptor (ER); 599 for progesterone receptor (PR) and 578 for HER2. In regard to the status for these markers, 76.9% were ER+; 68.4% PR+ and 28.4% HER2+. Patients more likely to have non palpable tumors were ≥45yo (p = 0.001); smaller tumors (p&lt;0.001); negative lymph nodes (p = 0.008); HER2 negative tumors (p = 0.001) and pathological stage I (p&lt;0.001). The median of follow up was 42.6 months. The 10yrs-DFS was 78.7% and the 10yrs-OS was 91%. There were significant differences in 10yrs-DFS according to tumor palpability (non-palpable 81.1% vs palpable 73.3%, p = 0.002); tumor size (&lt;1cm 81.7% vs 1-3cm 78.3% vs &gt;3cm 77.3%, p = 0.017); nodal involvement (negative 81.9% vs positive 67.2%, p = 0.054); PS (I-IIA: 89.4% vs IIB, 74.9%, p&lt;0.001); treatment with radiotherapy (yes 79% vs no 65.9%) and hormonotherapy (yes 78.9% vs no 70.1%). For 10yrs-OS, there were significant differences in palpability (palpable 78.2% vs non palpable 86.9%, p&lt;0.001); tumor size (&lt;1cm 96% vs 1-3cm 87.6% vs &gt;3cm 75.3%, p = 0.027); HER2 (positive 95.9% vs negative 87.4%, p = 0.052); PS (I-IIA: 95.4% vs IIB, 86.5%, p&lt;0.016) and radiotherapy (yes 92.7% vs no 79.1%, p = 0.001). In the multivariate analysis for 10 yrs-DFS, significant variables were: palpability (HR = 0.43 for non-palpable tumors, CI 95%: 0.242-0.781; p = 0.005) and radiotherapy (HR = 2.5 for patients that did not undergo radiotherapy, CI 95% 1.44 - 4.23). For 10 yrs-OS significant variables were HER2 (HR = 3.6 for HER2+, CI 95%: 1.18 - 10.86, p = 0.024). There was a statistical trend with palpability (HR = 0.23 for non-palpable tumors, CI 95%: 0.05-1.06; p = 0.06). CONCLUSIONS Women with early stage breast cancers with non-palpable tumors were less likely to present disease recurrence, independently of other factors. In the era of genomic profiling, a variable easily assessed in routine could be a surrogate factor for disease free survival. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-41.

Introduction: Dietary patterns play a significant role in the development of obesity and atherosclerotic heart disease. Healthcare providers need tools to quickly and easily assess diet quality. Hypothesis: The objective of this study was to examine the association between self-reported diet quality and measures of body adiposity in adults presenting for coronary angiography. We assessed the hypothesis that there is an association between diet quality and measures of body adiposity including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Methods: This prospective study enrolled subjects (n=185) who presented for coronary angiography at a tertiary medical center in New York City between February and September 2015. Potential subjects were approached in the waiting room prior to their scheduled procedure. Subjects who had previously undergone coronary revascularization, presented for emergent revascularization, or spoke languages other than English or Spanish as their primary language were excluded. Enrolled subjects completed an interview-administered Rate Your Plate - Heart survey, a 24-question tool designed to capture qualitative information related to fat intake, animal protein/dairy, servings of fruit, vegetables, whole grains, snacks, and sweets in 10 minutes. Scores range from 24 to 72, and higher scores indicated better diet quality. Height, weight, and waist circumference were measured by trained personnel to calculate BMI and WHtR. Participants were divided into two groups based on their survey scores (≥58 or ≤57): high (n=47) and low (n=138) diet quality. Measures of adiposity were compared using independent sample t test and correlations between diet score and measures of adiposity were examined using Pearson correlation test. Level of significance was set at p<0.05. Results: Of the 185 subjects, 114 were men (62%) and average age was 60.6 ± 11.8 years, BMI 29.2 ± 6.6 kg/m2, WC 103.9 ± 15.8 cm, and WHtR 0.61 ± 0.09. Subjects in the high diet quality group had significantly lower markers of body adiposity than participants in the low diet quality group. (BMI: 26.6 ± 4.0 kg/m2 vs 30.2 ± 7.1 kg/m2, p<0.001; WC: 97.9 ± 11.5 cm vs 105.9 ± 16.6 cm, p<0.001; WHtR: 0.58 ± 0.07 vs 0.63 ± 0.09, p<0.001). There were significant negative correlations between diet score and measures of body adiposity (BMI: r= -0.30, p<0.001; WC: r= -0.29, p<0.001; WHtR r= -0.24, p=0.001). Conclusions: Higher diet quality scores correlate with lower measures of body adiposity. Rate Your Plate - Heart survey is an appropriate instrument to capture diet quality prior to coronary angiography in a high-volume clinical setting. Further research to test the validity of this tool as a marker of atherosclerotic heart disease is warranted.