Lihchyun Joseph Su

Background: Metabolic dysfunction has been linked to prostate cancer (PCa) development and progression. This study sought to assess whether metabolic risk factors influence PCa death or simply reflect overall mortality risk among men with PCa. Methods: We analyzed data from 1497 men enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Pre-diagnosis dietary and metabolic factors were summarized into a standardized metabolic health-related (MHD) index reflecting higher intake of added sugars, glycemic load, saturated fat, and sodium intake, and lower intake of fiber, fruit, vegetable, and whole grain. Adjusting for demographic, clinical and lifestyle factors, we used multinomial logistic regression to examine associations between the metabolic index and outcomes: PCa death, non-PCa death, and alive at follow-up. Results: Among 1497 men, 95 and 311 died from PCa and non-PCa causes, respectively, and 1091 were alive at follow-up. The MHD index differed across mortality-status groups (p < 0.001) and was higher among men with aggressive PCa (p < 0.001) but did not differ significantly by race (p = 0.187). In adjusted multinomial logistic models, higher MHD index, which represents a less favorable metabolic health–related dietary profile, was significantly associated with increased odds of PCa-specific death adjusted odds ratio [aOR] = 1.38 (95% CI, 1.10–1.73; p = 0.006), but not non-PCa death [aOR] = 1.03 (95% CI, 0.89–1.19; p = 0.687). Conclusions: Less favorable pre-diagnosis metabolic health–related dietary profiles were significantly associated with PCa-specific mortality but not non-PCa mortality, suggesting a potentially distinct role of dietary pattern in PCa progression. The association was not observed for non-PCa death and was attenuated after adjustment for anthropometric and tumor characteristics. These findings support further investigation of overall dietary-metabolic profiles as potentially relevant factors in PCa-specific mortality.

Background: Doxorubicin (DOX)-based chemotherapy has improved survival outcomes in breast cancer patients but is often limited by doxorubicin-induced cardiotoxicity (DIC). Currently, no validated biomarkers can predict early DIC. Identifying novel biomarkers is essential for detecting patients at higher risk and enable timely interventions before irreversible cardiac injury occurs. Methods: Twenty-seven breast cancer patients treated with DOX-containing chemotherapy were stratified by change in left ventricular ejection fraction (LVEF): 19 patients who maintained normal cardiac function (normal, decline < 10%) and 8 who developed cardiotoxicity (abnormal, decline > 10%). Plasma samples were collected at baseline and after chemotherapy for untargeted metabolomic profiling. Both baseline and pre–post designs were employed to capture static and dynamic metabolic alterations associated with DIC. Stepwise logistic regression was used to filter non-informative metabolites, and predictive performance was further validated using Random Forest modeling. Results: A well-marked separation of plasma metabolomic profiles was observed between normal and abnormal cardiotoxicity groups at baseline (T0). Statistical analysis identified 100 significant metabolites at baseline (T0) and 78 metabolites after the first cycle of chemotherapy (T0-T1), with 10 metabolites common to both time-points: 3-phosphoglycerate, 2-hydroxyphenylacetate, inosine, taurine, suberate (C8-DC), sebacate (C10-DC), sphingadienine, oxindolylalanine. Machine learning models identified key metabolites (e.g., sebacate [C10-DC], 2-hydroxyhippurate, orotate, picolinate, and suberate [C8-DC]) as candidate predictors of cardiotoxicity, achieving moderate discriminatory performance in cross-validation, with higher specificity than sensitivity, indicating limited detection of abnormal cases. Conclusions: Metabolomic profiling shows potential for early detection of DIC in breast cancer patients, supporting personalized interventions to prevent irreversible cardiac damage.

Background: Despite the confirmed beneficial effects on preventing neural tube defects, concerns about high intakes of synthetic folate, or folic acid, in promoting cancer progression have been raised. This study evaluated the association between folate intake and prostate cancer (PCa) aggressiveness among African-American (AA) and European-American (EA) males. Methods: This study included 722 AA and 775 EA men with prostate cancer. Folate intake (dietary folate equivalent (DFE), synthetic folate, natural folate) was estimated using the National Cancer Institute Dietary History Questionnaire and detailed dietary supplement use questionnaire. Analyses included univariable comparisons of demographic and clinical characteristics of the two racial groups using the t-test or its non-parametric counterpart, the Wilcoxon test for continuous variables, and the Chi-square test for categorical variables. Logistic regression analysis was performed to evaluate the associations of each source of folate intake with PCa aggressiveness. Interaction effects between folate intake levels and racial groups were tested to evaluate if the association between folate intake and PCa differed by racial groups. Results: A greater proportion of AA subjects were diagnosed with high PCa aggressiveness compared to EAs (31.6% vs. 21.7%; p < 0.001). Both AAs and EAs had associations between decreased DFE intake and PCa aggressiveness after adjusting for covariates. Among AAs, men with the highest quartile levels of synthetic folate intake had higher odds of high-aggressive PCa compared to those with the lowest levels of intake (adj. OR = 1.39; p = 0.27), while the reversed association became stronger among EAs (adj. OR = 0.62; p = 0.14). Conclusions: The association between folate intake and prostate cancer aggressiveness appears to be source-specific and modified by race. These findings highlight the need for population-informed nutritional guidance and further investigation into nutrient–gene and dietary pattern interactions in prostate cancer progression.

Objective: To evaluate the impact of replacing a traditional midterm exam with a collaborative project-based assessment on student performance and engagement in an introductory graduate-level biostatistics course for public health students using R programming. Methods: We conducted a retrospective study comparing 2 semesters of the same course at a US school of public health. In Fall 2023, students completed traditional midterm and final exams. In Fall 2024, the midterm exam was replaced with a structured project-based assessment, while the final exam format remained unchanged. Student performance was compared using midterm scores, final exam scores, overall course grades, and course evaluations. Additionally, we used the results of a postproject survey that students in the project-based cohort had completed to assess engagement, confidence, and satisfaction. Results: Students in the project-based cohort (Fall 2024) had significantly higher and more consistent midterm scores (median 94.0 vs 91.1; P = . 01) and final exam scores (median 93.7 vs 86.0; P = . 03) than the exam-based cohort (Fall 2023). Final course grades were also higher and more consistent in the project- based cohort. Survey responses indicated high student satisfaction, improved confidence in data analysis and R programming, and increased appreciation for real-world applications. Students also identified challenges related to group dynamics and time management. Conclusion: Replacing a traditional exam with a collaborative project-based assessment in biostatistics significantly improved student performance, engagement, and satisfaction. These findings support project-based learning as a valuable pedagogical strategy in public health education, particularly for developing applied data analysis skills with R.

Background/Objectives: The incidence of colorectal cancer (CRC) is rising, and Western diets high in red and processed meats may be contributing. It is important to identify dietary nutrients that increase CRC risk and perhaps interventions that may modulate such risk. The relationship between dietary choline intake and CRC is still unclear. We hypothesize that high dietary choline intake is associated with greater CRC risk, and B vitamin supplementation may modify this risk. Methods: In this case-control study, we collected demographic and dietary data using the validated National Cancer Institute CRC Risk Assessment Tool and Dietary Health Questionnaire III and analyzed colonoscopy outcomes. Logistic regression and stratified analyses were performed to calculate adjusted odds ratios and evaluate for effect modification. Results: Of 52 total patients, 21 had a normal colonoscopy result, and 31 were found to either have benign polyps or CRC. The average dietary choline intake was 207 mg/day in the normal group and 297 mg/day in the abnormal outcome group. A doubling in dietary choline intake was significantly associated with increased odds of polyps or CRC (OR 25.32, 95% CI 1.95–327.94). When stratified by vitamin B levels, the effect modification was difficult to confidently quantify due to the limited sample size. Conclusions: Our findings suggest that higher dietary choline intake may be associated with an increased risk of CRC and its precursors, such as polyps. Although the potential modifying role of B vitamins was inconclusive, this study underscores the need for larger-scale research to further explore these associations and to assess the potential of dietary interventions in reducing CRC risk.

(1) Background: History of TB is a known risk factor for long-term respiratory impairment affecting lung functions in both restrictive and obstructive lung disease. (2) Methods: We analyzed data from the NHANES I Epidemiologic Follow-up Study (NHEFS), a longitudinal study conducted on a noninstitutionalized adult US population aged 25–74 years. Approximately 93 percent of the original NHANES I cohort was successfully traced by the end of the survey period and was available for analysis. The final adjusted model included age groups, gender, family income, lifetime smoking, body mass index (BMI), and frequency of alcohol consumption as potential confounders. (3) Results: The estimated hazards ratio of developing emphysema during follow-up for individuals with a past diagnosis of TB was 54% lower (95% CI = 0.35, 0.61) that that in individuals with no past TB, after controlling for potential confounders and using proportional hazards regression appropriate to the complex sample design. The association, however, was not statistically significant (HR = 0.86, p-value = 0.38) when only a self-reported history of TB was considered as the exposure in an unadjusted model. (4) Conclusions: Tuberculosis (self-reported or LTBI) was strongly (but inversely) associated with emphysema incidence. The association was not statistically significant with only a self-reported history of TB as exposure.

(1) Background: A history of TB is a known risk factor for long-term respiratory impairment affecting lung functions in both restrictive and obstructive lung disease. (2) Methods: We analyzed data from the NHANES 1 Epidemiologic Follow-up Study (NHEFS), a longitudinal study conducted on non-institutionalized adult US population, ages 25-74 years. Approximately 93 percent (n=13,383) of the cohort was successfully traced by the end of the survey period and was available for analysis. The final adjusted model included age groups, gender, family income, lifetime smoking, BMI, and frequency of alcohol consumption as potential confounders. (3) Results: Estimated hazards ratio of developing Emphysema during follow-up in individuals that had a past diagnosis of TB was 54% lower (95% CI = 0.35, 0.61) as compared to individuals with no past TB, after controlling for potential confounders and using proportional hazards regression appropriate to the complex sample design. The association, however, was not statistically significant (HR = 0.862, p-value = 0.38) when only self-reported history of TB was considered as the exposure. (4) Conclusion: Tuberculosis (self-reported or LTBI) was strongly (but inversely) associated with Emphysema incidence. The association was not statistically significant with only self-reported history of TB as exposure.

Marked reductions in mean annual rainfall associated with climate change in Eswatini in Southern Africa have encouraged the recycling of irrigation water and the increased use of pesticides in agricultural production, raising concerns about potential ecological and health risks due to long-term exposure to pesticide residues in soil and irrigation water. This probabilistic integrated risk assessment used liquid chromatography with tandem mass spectrometry to analyze the concentrations of four commonly used agricultural pesticides (ametryn, atrazine, pendimethalin, and 2,4-dichlorophenoxyacetic acid (2,4-D)) in irrigation water and topsoil samples from farmlands in Eswatini to assess potential ecological and health risks due to exposure. The concentrations of these pesticides ranged from undetectable to 0.104 µg/L in irrigation water and from undetectable to 2.70 µg/g in soil. The probabilistic multi-pathway and multi-route risk assessments conducted revealed hazard indices exceeding 1.0 for all age groups for ametryn and atrazine, suggesting that the daily consumption of recycled irrigation water and produce from the fields in this area may pose considerable health risks. The indices pertaining to ecological risks had values less than 0.1. Adaptation measures are recommended to efficiently manage pesticide use in agriculture, and further research will ensure that agriculture can adapt to climate change and that the general public and ecosystem are protected.