ORCID Profile
0000-0002-4102-6835
Current Organisation
University of Oxford
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Publisher: Cambridge University Press (CUP)
Date: 06-09-2018
DOI: 10.1017/S1368980018002203
Abstract: Dietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand. Prospective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence. Emerging hypertension and changing diets in Thailand. TCS participants who were normotensive at baseline in 2005. Among 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: ‘Modern’ and ‘Prudent’. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI. Modern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.
Publisher: MDPI AG
Date: 27-10-2017
DOI: 10.3390/NU9111173
Publisher: Oxford University Press (OUP)
Date: 05-09-2018
DOI: 10.1111/BJD.16836
Publisher: Informa UK Limited
Date: 10-09-2014
DOI: 10.1080/01635581.2014.951728
Abstract: Flavonoids, a broad category of nonnutrient food components, are potential protective dietary factors in the etiology of some cancers. However, previous epidemiological studies showing associations between flavonoid intake and cancer risk have used unvalidated intake assessment methods. A 62-item food frequency questionnaire (FFQ) based on usual intake of a representative Australian adult population s le was validated against a 3-day diet diary method in 60 young adults. Spearman's rank correlations showed 17 of 25 in idual flavonoids, 3 of 5 flavonoid subgroups, and total flavonoids having strong/moderate correlation coefficients (0.40-0.70), and 8 of 25 in idual flavonoids and 2 of 5 flavonoid subgroups having weak/insignificant correlations (0.01-0.39) between the 2 methods. Bland-Altman plots showed most subjects within ±1.96 SD for intakes of flavonoid subgroups and total flavonoids. The FFQ classified 73-90% of participants for all flavonoids except isorhamnetin, cyanidin, delphinidin, peonidin, and pelargonidin 73.3-85.0% for all flavonoid subgroups except Anthocyanidins and 86.7% for total flavonoid intake in the same/adjacent quartile determined by the 3-day diary. Weighted kappa values ranged from 0.00 (Isorhamnetin, Pelargonidin) to 0.60 (Myricetin) and were statistically significant for 18 of 25 in idual flavonoids, 3 of 5 subgroups, and total flavonoids. This FFQ provides a simple and inexpensive means to estimate total flavonoid and flavonoid subgroup intake.
Publisher: MDPI AG
Date: 21-09-2017
Publisher: Japan Epidemiological Association
Date: 10-2017
Publisher: Public Library of Science (PLoS)
Date: 27-04-2023
DOI: 10.1371/JOURNAL.PMED.1004221
Abstract: Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet. We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants s led from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding. These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000602729 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363860 .
Publisher: Wiley
Date: 02-05-2019
DOI: 10.1111/JDV.15458
Abstract: A long-term complication among organ transplant recipients (OTRs) is skin malignancies which are associated with level and duration of immunosuppressive treatment, sun exposure and age. Dermatological surveillance is recommended for OTRs at high risk of skin malignancies, but evidence is lacking on the benefits of such services. To examine the economic impact on patients and on the hospital service of a multidisciplinary high-throughput skin cancer clinic in Brisbane, Australia, dedicated to dermatological and surgical care of high-risk OTRs. In a pre ostdesign, hospital admission and cost data were obtained for 101 consecutively enrolled study participants from 12 months prior to the introduction of the clinic (to February 2016), the 3-month 'run-in' period (March to May 2016) and 12 months subsequent (to June 2017). Differences between pre- and post-clinic hospital costs were tested using non-parametric bootstrapping and interrupted time series analysis. A survey of patient out-of-pocket costs and perceived financial burden was also undertaken during the clinic. Overall hospital costs were higher after the clinic but 3-monthly hospital costs for skin procedures trended downwards. Despite 3-monthly mean, hospital visits increasing from 85 to 314, mean 3-monthly costs reduced by AU$1491 (P < 0.001) indicating greater cost efficiency. Total patient out-of-pocket costs were AU$18 377 over 3 months. Clinical costing data revealed higher, more rapid throughput and significantly lower per patient costs pre- and postestablishment of a multidisciplinary skin cancer clinic for OTRs.
Publisher: BMJ
Date: 12-2016
Publisher: Cold Spring Harbor Laboratory
Date: 16-08-2023
DOI: 10.1101/2023.08.14.23294084
Abstract: Circulating proteins are integral to many biological processes. We aimed to assess differences in the plasma proteome between people of different dietary groups defined by degree of animal food consumption. The UK Biobank recruited middle-aged adults (mostly 40 to 69 years) throughout the UK between 2006-2010. Relative concentrations of 1463 plasma proteins were quantified using the Olink Proximity Extension Assay on blood s les from 49,326 participants, who were also asked to report their ethnicity and consumption of red and processed meat, poultry, fish, dairy and eggs. We defined six diet groups among the white British participants (23,116 regular meat eaters, 23,323 low meat eaters, 484 poultry eaters, 1074 fish eaters, 722 vegetarians, and 54 vegans), and two diet groups among the British Indians (390 meat eaters and 163 vegetarians). We used multivariable-adjusted linear regressions to assess differences in protein concentrations between diet groups, with correction for multiple testing. We observed significant differences in many plasma proteins by diet group (683 proteins in white British participants, 1 in British Indians), in particular many proteins that are majority expressed in the digestive system. Of the biggest differences, compared with regular meat eaters, the non-meat eaters had significantly higher FGF21 (e.g. +0.40 SD in vegetarians), GUCA2A (+0.33), FOLR1 (+0.32), IGFBP2 (+0.31) and DSG2 (+0.30) all groups except the vegans had lower HAVCR1 (-0.38 in vegetarians). The observed differences were generally similar in direction in both ethnicities. In this first comprehensive assessment of plasma proteins by diet group, we identified many differences in proteins between groups defined by animal food consumption this variation in protein levels suggests differences in various biological activities, including gastrointestinal tract and kidney function, which may relate to differences in future disease risk.
Publisher: BMJ
Date: 08-07-2020
DOI: 10.1136/BMJ.M2194
Abstract: To investigate the association of plasma vitamin C and carotenoids, as indicators of fruit and vegetable intake, with the risk of type 2 diabetes. Prospective case-cohort study. Populations from eight European countries. 9754 participants with incident type 2 diabetes, and a subcohort of 13 662 in iduals from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort of 340 234 participants: EPIC-InterAct case-cohort study. Incident type 2 diabetes. In a multivariable adjusted model, higher plasma vitamin C was associated with a lower risk of developing type 2 diabetes (hazard ratio per standard deviation 0.82, 95% confidence interval 0.76 to 0.89). A similar inverse association was shown for total carotenoids (hazard ratio per standard deviation 0.75, 0.68 to 0.82). A composite biomarker score (split into five equal groups), comprising vitamin C and in idual carotenoids, was inversely associated with type 2 diabetes with hazard ratios 0.77, 0.66, 0.59, and 0.50 for groups 2-5 compared with group 1 (the lowest group). Self-reported median fruit and vegetable intake was 274 g/day, 396 g/day, and 508 g/day for participants in categories defined by groups 1, 3, and 5 of the composite biomarker score, respectively. One standard deviation difference in the composite biomarker score, equivalent to a 66 (95% confidence interval 61 to 71) g/day difference in total fruit and vegetable intake, was associated with a hazard ratio of 0.75 (0.67 to 0.83). This would be equivalent to an absolute risk reduction of 0.95 per 1000 person years of follow up if achieved across an entire population with the characteristics of the eight European countries included in this analysis. These findings indicate an inverse association between plasma vitamin C, carotenoids, and their composite biomarker score, and incident type 2 diabetes in different European countries. These biomarkers are objective indicators of fruit and vegetable consumption, and suggest that diets rich in even modestly higher fruit and vegetable consumption could help to prevent development of type 2 diabetes.
Publisher: Oxford University Press (OUP)
Date: 04-04-2014
DOI: 10.1093/CID/CIU211
Abstract: There is evidence to support that nutritional deficiency can reduce the body's immune function, thereby decreasing resistance to disease and increasing susceptibility to intestinal parasites. A cross-sectional survey was carried out on 693 school-aged children from 5 schistosomiasis-endemic villages in Northern Samar, the Philippines. Data on dietary intake, nutritional status, and intestinal parasitic infection were collected. The prevalence of stunting, thinness, and wasting was 49.2%, 27.8%, and 59.7% of all children. The proportion of children infected with Schistosoma japonicum (15.6%, P = .03) and hookworm (22.0%, P = .05) were significantly lower among children who met the recommended energy and nutrient intake (RENI) for total calories. The percentage of children infected with Trichuris trichiura was highest among children who did not meet the RENI for energy (74.1%, P = .04), iron (73.4%, P = .01), thiamine (74.0%, P = .00), and riboflavin (73.3%, P = .01). Susceptibility to having 1 or more parasitic infections was significantly associated with poor intake of energy (P = .04), thiamine (P = .02), and riboflavin (P = .01).The proportion of stunted children was significantly higher among children who did not meet the RENI for energy (68.9%, P = .002), protein (54.0%, P = .004), or niacin (30.8%, P = .02) and for those infected with hookworm (31.8%, P = .0002). After adjusting for potential confounders, protein intake less than the RENI (odds ratio [OR], 1.48 95% confidence interval [CI], 1.03-2.14), and hookworm infection (OR, 1.77 95% CI, 1.22-2.55) were the major predictors of stunting. The results support the hypothesis that poor nutrient intake may increase susceptibility to parasitic diseases and together they negatively affect childhood nutritional status.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2017
DOI: 10.1038/NUTD.2017.27
Abstract: The global prevalence of type 2 diabetes mellitus (T2DM) is high and is increasing in countries undergoing rapid socio-economic development, including Thailand. Sugar-sweetened beverage (SSB) intake may contribute to the risk of developing T2DM. However, few studies have assessed this association in Asian populations, and the results have been inconsistent. We aimed to assess that association in a prospective study of Thai adults. Data were from Thai Cohort Study participants surveyed in 2005, 2009 and 2013. The nation-wide s le included adult cohort members who were free of diabetes in 2005 and who were followed-up in 2013 ( n =39 175). We used multivariable logistic regression to assess associations between SSB intake and eight-year T2DM incidence. We used a counterfactual mediation analysis to explore potential mediation of the SSB intake and T2DM-risk relationship. In women (but not men) consuming SSBs once or more per day (versus rarely) was associated with increased T2DM incidence at the 8-year follow-up (odds ratio (OR)=2.4, 95% confidence interval (CI) 1.5–3.9). Obesity in 2009 was found to mediate ~23% of the total association between SSB intake in 2005 and T2DM risk in 2013 (natural indirect effect 1.15, 95% CI (1.02, 1.31). Frequent SSB consumption associated with higher T2DM incidence in women but not men. We found that a moderate proportion of the SSB-T2DM relationship was mediated through body mass index (BMI). Our findings suggest that targeting SSB consumption can help prevent a national rise in the incidence of T2DM.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2017
Publisher: Oxford University Press (OUP)
Date: 27-09-2019
DOI: 10.1111/BJD.17001
Abstract: The incidence of skin cancer in organ transplant recipients (OTRs) is very high, due mainly to long-term immunosuppressive therapy. The problem is particularly severe for OTRs living in Queensland, Australia, and results in significant mortality. To describe the experience of the first dedicated outpatient high-throughput transplant skin clinic in Queensland. This prospective evaluation study was conducted at a newly established, outpatient transplant skin cancer surgery and surveillance clinic. Participants (89 OTRs and 12 non-OTRs) were referred to the Princess Alexandra Hospital Transplant Skin Clinic during December 2016 to May 2017, and were each followed for 3 months. Self-completed questionnaires were administered at baseline and the end of follow-up (n = 94), and details of any skin cancers occurring in that period were extracted from hospital records. In the 3-month follow-up of 101 participants, a total of 615 skin lesions were detected in the 3-month follow-up of 101 participants, of which 478 (78%) were treated in the clinic and 55 (9%) were referred to another specialist. Of the 478 treated lesions, 268 were histopathologically confirmed skin cancers, equivalent to 2·7 (95% confidence interval 2·5-2·8) skin cancers per participant per 3 months. The overall number needed to treat for any skin cancer was 1·4 (95% confidence interval 1·3-1·5). Three-quarters (374) of in-clinic treatments were surgical, and most (90%) were complete excisions. The median time from detection of skin cancer to excision was 7 days. This high-volume surgical outpatient transplant skin clinic enables efficient treatment of skin cancers in very-high-risk OTRs.
Publisher: Cold Spring Harbor Laboratory
Date: 05-08-2023
DOI: 10.1101/2023.07.28.23293330
Abstract: Proteins are essential for the development and progression of cancer and for the human body’s defense against tumor onset. The availability of a large panel of protein measurements and whole exome sequence data in the UK Biobank has enabled the simultaneous examination of plasma protein associations with risk across multiple cancer sites and their potential role in cancer etiology. We investigated the associations of plasma proteins with incidence of 19 cancers and 9 cancer subsites in up to 44,645 middle-aged adults in the UK Biobank, who had measurements of 1,463 plasma proteins generated using Olink Explore Proximity Extension Assay in baseline blood s les (2006-2010). Using multivariable-adjusted Cox regression, we estimated the risk of each protein with each cancer overall and by time-to-diagnosis after correction for multiple-testing. Identified protein-cancer associations were further assessed in an analysis of cancer risk using cis -pQTL and exome-wide protein genetic scores (exGS) in all UK Biobank participants (n=337,543). We identified 371 proteins associated with the risk of at least one incident cancer, represented by a total of 621 protein-cancer associations. These proteins were associated with cancers of the blood (201 proteins), liver (131), kidney (51), lung (28), esophagus (22), colorectum (15), stomach (8), breast (5), prostate (3), endometrium (3), ovary (2), bladder (1), head and neck (1), and brain (1). 100 of these 621 protein-cancer associations persisted for cases diagnosed more than seven years after blood draw. Of these 621 associations, there was further support from cis -pQTL analyses for the etiological role of TNFRSF14 in risk of non-Hodgkin lymphoma (NHL), and from whole exome protein score (exGS) analyses for 28 other protein-cancer associations, including SRP14 and risk of leukemia. Proteins with directionally concordant evidence from long time-to-diagnosis analyses and from both cis -pQTL and exGS analyses were SFTPA2 for lung cancer, TNFRSF1B and CD74 for NHL, and ADAM8 for leukemia. For the first time using an integrated multi-omics and cross-cancer approach, we have comprehensively assessed the plasma proteome in relation to cancer risk and identified multiple novel etiological candidates. Differences in the levels of many circulating proteins were detectable more than seven years before cancer diagnosis while some of these are likely to be markers of early cancer processes that may inform risk stratification, and/or risk factors, concordant evidence from genetic analyses suggests that some may have a role in cancer development.
Publisher: Springer Science and Business Media LLC
Date: 10-06-2201
DOI: 10.1007/S00125-023-05948-X
Abstract: Islet autoimmunity may progress to adult-onset diabetes. We investigated whether circulating odd-chain fatty acids (OCFA) 15:0 and 17:0, which are inversely associated with type 2 diabetes, interact with autoantibodies against GAD65 (GAD65Ab) on the incidence of adult-onset diabetes. We used the European EPIC-InterAct case–cohort study including 11,124 incident adult-onset diabetes cases and a subcohort of 14,866 randomly selected in iduals. Adjusted Prentice-weighted Cox regression estimated HRs and 95% CIs of diabetes in relation to 1 SD lower plasma phospholipid 15:0 and/or 17:0 concentrations or their main contributor, dairy intake, among GAD65Ab-negative and -positive in iduals. Interactions between tertiles of OCFA and GAD65Ab status were estimated by proportion attributable to interaction (AP). Low concentrations of OCFA, particularly 17:0, were associated with a higher incidence of adult-onset diabetes in both GAD65Ab-negative (HR 1.55 [95% CI 1.48, 1.64]) and GAD65Ab-positive (HR 1.69 [95% CI 1.34, 2.13]) in iduals. The combination of low 17:0 and high GAD65Ab positivity vs high 17:0 and GAD65Ab negativity conferred an HR of 7.51 (95% CI 4.83, 11.69), with evidence of additive interaction (AP 0.25 [95% CI 0.05, 0.45]). Low dairy intake was not associated with diabetes incidence in either GAD65Ab-negative (HR 0.98 [95% CI 0.94, 1.02]) or GAD65Ab-positive in iduals (HR 0.97 [95% CI 0.79, 1.18]). Low plasma phospholipid 17:0 concentrations may promote the progression from GAD65Ab positivity to adult-onset diabetes.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Keren Papier.