Energy drinks can cause cardiovascular, gastrointestinal, and other health disorders. These effects are particularly pronounced in youth. The aim of this study was to systematically review the literature on the consumption of energy drinks in European countries.

A systematic bibliographic search was performed in November 2024 in EMBASE, MEDLINE (Ovid), Scopus and Cochrane databases with no restrictions on country, study period, study design and language.

Energy drinks are beverages high in caffeine, sugar, and other stimulants.

A total of 2008 studies were identified and reviewed by four researchers. Ninety-four met the inclusion criteria and were extracted in a table designed ad hoc.

The included studies showed differences regarding their design, definition of consumption, and time frame under study. The most studied frequency of energy drink consumption was weekly consumption, and the most studied population was school students. An increase in prevalence of consumption was observed when tracking energy drink consumption over time. Variables most related to consumption were low socioeconomic status, alcohol and tobacco consumption, physical activity, age, and sex.

It is difficult to have a clear picture of the extent of energy drink consumption in Europe, mainly due to differences in the design of the studies and the lack of periodicity of the estimates in different countries. However, given the health problems that have been associated with energy drink consumption, regulation of these beverages is essential, especially in youth.

Children who have undergone an oncological process and have received treatment with chemotherapy or radiotherapy on the central nervous system may have significant neurocognitive sequelae. Some video games have shown neurocognitive benefits in people with impairments in different areas, such as attention or memory.

This work aims to demonstrate the benefit of a video game-based training program to improve the neurocognitive profile in a child survivor of cancer.

The patient is a 9-year-old female who was diagnosed with acute lymphoblastic leukemia at the age of 4 years. She received routine treatment of this disease by chemotherapy, including high-dose chemotherapy (with blood-brain barrier crossing) and intrathecal chemotherapy. She is currently 3 years after the end of treatment.

The Continuous Performance Test 3 (CPT-3) (sustained attention/vigilance) was administered before and after a multifaceted training program consisting of playing 3 video games for 12 weeks, as follows: a brain-training game (4 days per week, 7-12 minutes per day), a skill-training game (2 days per week, 10 minutes per day) and an exergaming game (2 days per week, 10 minutes per day).

Prior to intervention, the patient had 3 atypical z-scores on the CPT-3 (z scores: mean = 0, S.D. = 1), with a pattern compatible with ADHD (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2). After intervention, she had only an atypical z-score (hit reaction time z = 3.6), with a pattern compatible with slowing, without ADHD.

The neuropsychological evaluation of this patient showed an improvement in his attentional pattern on the CPT-3 after the video game-based training.

None Declared

Childhood cancer survivors have neurocognitive sequelae that in most survivor follow-up programs are underdiagnosed and for which there is usually no treatment plan.

Video games have demonstrated various psychological and neurocognitive benefits in different subpopulations, such as patients with organic neurological deficits or children with ADHD. However, few studies have been carried out using video games-based interventions in the paediatric oncology population.

The aim of this work is to present the WINNERS study protocol, the objectives of which are to diagnose the neurological and cognitive sequelae in child cancer survivors, and to demonstrate the benefit in these areas of a training program based on video games.

A randomized controlled and unblinded trial is presented. Fifty-six patients aged 8 to 17 years stratified into two age groups (8-12 and 13-17) who had received any of the following treatments 1 to 6 years before the enrolment will be selected: high-dose chemotherapy with blood-brain barrier crossing, intrathecal or intraventricular chemotherapy, CNS radiotherapy or hematopoietic stem cell transplantation.

A neuropsychological evaluation will be performed consisting of a battery of neuropsychological tests to assess parameters such as attention, memory, visuospatial ability or speed of response, as well as a neuroimaging evaluation by structural and functional magnetic resonance imaging. The evaluation will be repeated 3 months and 6 months after the enrolment. Patients will be randomized to a treatment group or to a recycled waiting group. Intervention will consist on a 12-week training at home using 3 video games: a brain training game, an exergaming game and a skill training game.

According to the hypotheses of this study, it is expected that the proposed program of videogame-based interventions will improve neurocognitive and other wellbeing parameters in the intervention group.

This study aims to improve the quality of care for patients who have survived a cancer disease by detecting sequelae that have so far been poorly attended, and by proposing a gamification-based intervention program that is effective and attractive for this population.

None Declared

Suicide attempts (SA) leading to highly lethal consequences have been associated with heightened suicide planning (Barker et al., 2022), along with deficits in social cognition (Levi-Belz et al., 2022). Hypomentalizing, characterized by excessive uncertainty regarding mental states, may contribute to heightened social withdrawal and an increased risk of SA (Nestor & Sutherland, 2022). Although certain studies have identified a connection between hypomentalizing profiles and self-harm (Badoud et al., 2015), research into the lethality of SA remains limited.

This study aimed to explore the association between hypomentalizing and SA lethality.

Our study encompassed a cohort of 1,371 patients who committed a SA. We conducted assessments of mentalizing using the RFQ-8 instrument, and evaluations of suicidal ideation and behavior employing the CSRSS questionnaire. Demographic and clinical characteristics were compared using the T-student and Chi-square tests. To investigate the relationship between hypomentalizing and the SA lethality, we employed logistic regression models.

Descriptive date are presented in Table 1. Our results show that hypomentalizing do not predict a higher SA lethality. Additionally, hypomentalizing increased the risk of SA planning (p≤0.001, B=-0.182), and SA planning predicted a higher SA lethality (see Table 2).Table 1.

Means Comparison for low and high lethality (N=1371)

While the association between hypomentalizing and high SA lethality was not significant, a discernible trend toward such relationship can be noted. Further studies examining the moderating effects of planning in the association between hypomentalizing and SA lethality are required.

None Declared

Suicide is a serious public health problem. Each year it is estimated that it causes almost one million deaths worldwide, much more than those caused by war or homicide. These deaths are also devastating, affecting not only the person who commits them, but also his or her environment (family, friends, professionals involved, etc.) and society as a whole. The risk and protective factors for suicide are well known in the literature, which gives rise to the estimation of possible high-risk groups according to their characteristics, especially when risk factors are added, protective factors are reduced, and unfavorable life circumstances are present. Among these groups with greater vulnerability to suicidal behavior are homeless people with severe mental disorders, who are unfortunately little visible in society and in the investigation.

The aim of this paper is to review the current state of the question of suicide in homeless people with severe mental disorders.

Review of the international scientific literature on the issue published in the last twenty years.

The few studies available conclude the higher prevalence of suicidal behavior in homeless people with severe mental disorders compared to the general population, which has not been translated into the development of specific care and prevention plans and programs.

It is considered essential to expand investigation in this field, which will be very useful to lay the foundations for the development of guidelines, plans and specific programs, and to know the evidence about them.

None Declared

Migration has been present in the evolution of human beings throughout history. Economic inequalities give rise to a permanent flow of people trying to improve their lives. In addition, there are people who are forced to seek asylum or refuge due to wars or political violence. Therefore, the migratory flow, gives rise to a clinical scenario in which, the arrival of immigrant people demands an adaptation of the psychiatric paradigm.

The objective of this paper is to review the international scientific literature published on the impact of the migration process on mental health.

We propose a review of the international scientific literature published in recent years on psychiatry and migration.

We present the case of a 27-year-old male, diagnosed with paranoid schizophrenia, who arrived in the Canary Islands after a 2-year migration process from his country of origin (Senegal).

The limits between normality and pathology of certain types of behavior vary from one culture to another.

In the case of a patient with a mental disorder who has undergone a migration process, an approach based on the cultural formulation of the case should be made, taking into account the process of adaptation to the culture of the host country, as well as the impact of the culture of origin on the patient’s interpretation of his or her psychopathology.

Culture can influence the acceptance or rejection of a diagnosis and treatment, affecting the course of the disease and recovery.

Therefore, understanding the cultural context in which the disease is experienced is essential for a good diagnostic evaluation and effective clinical management.

N. Molina Pérez: None Declared, J. Pereira López: None Declared, M. I. Santana Ortiz: None Declared, P. Rivero Rodríguez: None Declared, A. R. Del Rosario Grant / Research support from: Jansen Pharmaceuticals, Inc., Consultant of: Jansen Pharmaceuticals, Inc.; Lundbeck, Inc., Employee of: Universidad de Las Palmas de Gran Canaria, Speakers bureau of: Jansen Pharmaceuticals, Inc.; Lundbeck, Inc.; Otsuka Pharmaceutical Co.; Pfizer Inc.; Esteve Pharmaceuticals, S.A.; AstraZeneca Pharmaceuticals LP.; Angelini Pharma S.L.U.; Laboratorios Farmacéuticos ROVI SA., M. Grimal: None Declared, V. Acosta Pérez: None Declared

Paediatric cancer survivors have a risk for neuropsychological impairment due to the disease and the treatment received. These affections have been neglected in the follow-up of these patients. It is important to identify the most valid outcomes in the evaluation of neurocognitive sequelae in childhood cancer survivors.

This work aims to compare the results obtained between subjective perception of caregivers and objective cognitive performance based on validated attention tests.

In a randomized controlled and unblinded trial to demonstrate the benefit of video games on different neurocognitive areas in cancer survivors, we studied attention functioning before and after the intervention program. The attention deficit subscale from the Behavior Assessment System for Children 3rd edition (BASC-3), self- and parent-reported versions, and the Continuous Performance Test, 3rd edition (CPT 3) will be used as outcomes (z scores: mean = 0, S.D. = 1).

We observed an improvement in attention after intervention using the CPT-3 (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2 versus hit reaction time z = 3.6 without other atipycal z scores after intervention), changing the attentional pattern from “ADHD” to “slowed”. However, in the parent-reported version of the BASC-3, a worsening in the attention subscale is observed (z = 0.3 pre-intervention vs z = 1.0 post-intervention) while the self-reported version of the patient didn’t show any significant changes (z = 1.4 pre-intervention vs z = 1.1 post-intervention).

It is essential to use objective tests to measure neurocognitive sequelae in these patients. Subjective surveys can provide additional information, but not substitute the above.

None Declared

Transcranial Magnetic Stimulation is a non invasive brain stimulation technique used for several neuropsychiatric conditions. The treatment of Acute Lymphoblastic Leukaemia (ALL) involves many cytotoxic drugs that inhibit the rapid growth of cancer cells, but also damage healthy cells, resulting in a wide range of adverse effects (Śliwa-Tytko et al., 2022). Studies have shown that approximately 10-30% of paediatric ALL patients suffer from psychiatric disorders. Therefore, new therapeutic tools are needed, and repetitive transcranial magnetic stimulation (rTMS) has demonstrated tolerability, effectiveness and safety in children (Allen et al., 2017).

We discuss the first case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in who underwent Continuous Theta-Burst Stimulation

Case Presentation. In this study, we describe a case of a 9-year-old girl diagnosed with acute lymphoblastic leukaemia B in November 2016 who completed treatment in July 2019. Since April 2018 she presented symptoms of intracranial hypertension and encephalopathy with behavioural alterations, attention deficit secondary to toxicity. Psychotic outbreaks after toxicity from different treatments was also present. Since starting pericyazine (July 2022) there has been a slight improvement, but her symptoms continue to have a severe impact in her daily functioning. Baseline developmental profile assessed with the Battelle Inventory was significantly below the expected level in all developmental areas except for gross motor skills. Treatment. The TMS intervention consisted of the application on right DLPFC (F4), inhibitory cTBS protocol (5Hz bursts and 3 pulses of 50 Hz each). The protocol consisted in delivering 2 sessions per day for 15 days (separated by 55 minutes), 4 minutes per session (3600 pulses/session), 30 sessions in total. An intensity of 100% of resting motor threshold (C4). TMS was performed with the Magventure Magpro X100 MagOption equipment, Cool DB-80 double cone coil. The Child Behaviour Checklist (CBCL) for parents was used to assess intervention effects.

CBCL results reflect improvements in both internalising and externalising total scores after treatment. Specifically, the patient presents clinically significant decreases in several dimensions such as anxious/depressed symptoms, somatic complaints, and social problems. No adverse effects have been reported since the beginning of the intervention.

Internalising and externalising behaviours severity were reduced after 30 TMS sessions. In accordance with the latest systematic reviews on the safety of TMS in the paediatric patient (Zewdie et al, 2020) we propose the development of paediatric guidelines to offer this technique to patients with a history of intolerability or poor drug response.

None Declared

Adverse childhood experiences (ACEs), defined as abuse, neglect, or a dysfunctional household in childhood, have been associated with suicidality (Fjeldsted et al., 2020). Every type of ACE has a direct impact on suicide ideation, self-harm and/or suicide attempt (Angelakis et al., 2019).

We aim to quantify the association between types of ACEs (including emotional, physical, sexual abuse, and emotional and physical neglect) and the number of suicide attempts in lifetime.

We included 748 patients who attempted suicide at least once. They were asked to complete the Columbia-Suicide Severity Rating Scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Logistic regression models were run to assess the association between each ACE type and the number of suicide attempts.

Poisson univariate regression analyses show a linear trend in the relationship between having a higher number of suicide attempts and having suffered every ACE type in childhood (p<0.05). Our results show a lower percentage of previous suicide attempts among participants without ACEs, and an increasing tendency among patients with various types of ACEs. The rate of ACEs types is significantly higher in the group with previous suicide attempts than in the first-attempt group (p=0.000).

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This study contributes to clarify the role of childhood trauma in the number of suicide attempts in lifetime. This has important implications for reducing suicide rates, and preventing future re-attempts. Further studies analysing every construct of childhood trauma may contribute to the detection of suicidal behaviour.

This work was supported by the Instituto de Salud Carlos III (grant number: PI19/00941 SURVIVE) and co-funded by the European Union (grant numbers: COV20/00988, PI17/00768), the European Union’s Horizon 2020 research and innovation programme Societal Challenges (grant number: 101016127), and the Fundación Española de Psiquiatría y Salud Mental

SURVIVE project (PI19/00941)

Suicide attempt, Adverse Childhood Experiences

Angelakis, I., Gillespie, E. L., & Panagioti, M. (2019). Childhood maltreatment and adult suicidality: A comprehensive systematic review with meta-analysis. Psychological Medicine, 49(7), 1057-1078. https://doi.org/10.1017/S0033291718003823

Fjeldsted, R., Teasdale, T. W., & Bach, B. (2020). Childhood trauma, stressful life events, and suicidality in Danish psychiatric outpatients. Nordic Journal of Psychiatry, 74(4), 280-286. https://doi.org/10.1080/08039488.2019.1702096

None Declared

Resistant schizophrenia is a schizophrenia subtype characterized by a non-ability to respond to an appropriate antipsychotic treatment in dosage and duration by the patients. These patients show a lower prognostic and symptomatology. The unique drug which has shown efficacy for resistant schizophrenia treatment is clozapine, which is effective in suicide and aggressive behaviour prevention too. Whereas clozapine has numerous and serious adverse effects such as agranulocytosis risk. Because of this, and for guaranteeing an accurate diagnosis of resistant schizophrenia, distinguishing this from pseudo-resistance due to a poor tracing of schizophrenia, clozapine’s plasmatic levels monitoring is recommended in Spain by many clinical practise-guidelines.

This studio has the objective of determining if altered clozapine’s plasmatic levels have predictive potential of therapeutical response and answering what clinical and sociodemographic variables are associated to these anormal plasmatic levels.

In this work, a cross-sectional observational study was carried out in which clinical and sociodemographic data obtained by the Mental Health Unit of the Jerez de la Frontera University Hospital were collected within the research project entitled: "Role of social cognition as a factor psychosocial functioning of the schizophrenic patient” (ECOFUN), of all the participating patients (in total the sample was 141 patients, of which 40 are in treatment with clozapine).

The sample of patients has a mean age of 44 years and medium-high educational levels. The vast majority are men and do not currently consume substances of abuse, and when this consumption occurs, tobacco and alcohol are the most consumed substances. Their total scores on the PANSS and Markova Barrios scales are generally very disparate, but with average values of 55 and 16. It has been obtained as results that there is no significant statistical correlation between the plasma levels of clozapine and the values of the PANSS scale and its subscales in the patients. On the other hand, patients treated with clozapine would present clinical and sociodemographic characteristics practically identical to those of patients treated with other antipsychotics, especially their values on the PANSS scale. In addition, plasma levels of clozapine are correlated, although not significantly, with an improvement in the positive symptomatology of schizophrenia.

As a conclusion, unusually higher values of clozapine are correlated significantly with lower values in positive symptomatology in schizophrenia, but plasmatic levels are not correlated significantly with values of PANSS scale.

None Declared

Transition between adolescence and adulthood represents the most important challenge for personal development and involves several transformations: physical, psychological and social. It is a complex age bracket, concurring the transition from youth psychiatric units to adult ones, with an increased risk for the appearance of mental disorders and risky behaviours. TRANVIA program, developed in Avilés, provides psychiatric assistance to patients between 15 and 25 years old, diagnosed with a severe psychiatric disorder or with an increased risk of having one.

Our objectives are: ensuring clinical continuity assistance, promoting communication among professionals and the empowerment of our patients to improve their functionality and quality of life.

Descriptive study including patients involved in TRANVIA program from November 2019 to November 2021.

During this two-years period there have been 44 referrals to the program, 11 of them were rejected for failure to comply with diagnostic criteria. In November 2021 there were 33 patients included in the TRANVIA program with an average age of 17 years old (range: 15-22). 70% of them were men and 30% women. All of them had psychiatric assistance from different sources: youth mental health units, neuropediatrics… About 75% of the patients were diagnosed with autistic spectrum disorder and approximately three-quarters of the sample needed pharmacological treatment. Risperidone was the most prescribed drug. We have also developed other assistance alternatives as home-based care, relaxation sessions, social worker interventions and coordination with schools.

TRANVIA program has allowed us to provide continual attention to vulnerable patients that shift from youth psychiatric units to adult ones. Patients that meet inclusion criteria were enrolled independently the type of assistance they have previously received. Accessibility and flexibility were our priority. During the described period there was only one dropout, three patients required psychiatric hospitalization and two others visited the emergency department. There have been no cases of completed suicide.

None Declared

Mutism is the inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output. Mutism is a common manifestation of psychiatric, neurological, and drug-related illnesses. Psychiatric disorders associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurological disorders causing mutism affect the basal ganglia, frontal lobes, or the limbic system.

Outline the importance of setting a differential diagnosis of mutism in the Emergency Room.

Review of scientific literature based on a relevant clinical case.

Male, 58 years old. He has lived in a residence for 3 months due to voluntary refusal to ingest. Diagnosed with paranoid personality disorder. He is refered to the Emergency Service due to sudden mutism. During this day, he has been stable and suitable with a good functionality. For 3 hours he is mutist, oppositional attitude and stiff limbs, refusing to obey simple orders. Hyperalert and hyperproxia. Not staring. After ruling out organic pathology: normal blood tests, negative urine toxins and cranial CT without alterations, he was admitted to Psychiatry for observation and, finally, he was diagnosed with Psychotic Disorder NOS.

Mutism most often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. The most common disorder of behavior occurring with mutism is catatonia. The differential diagnosis of mutism is complex. In some cases the diagnosis will be clarified only by careful observation and after a neurological evaluation. Published studies show neurological disorders presenting with mutism can be misdiagnosed as psychiatric.

No significant relationships.

Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.

8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.

4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.

Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565

Day care programs have been extensively used to treat people with acute psychiatric disorders. Day hospitals (DH) can act as an alternative to admission in patients with acute symptoms, shorten the duration of admission, be useful for rehabilitation and maintenance care or enhance treatment in patients with poor adherence to outpatient care. Few research has been conducted in delusional disorder (DD).

To investigate whether DH care increases adherence with psychiatric appointments in patients with DD. To describe functions of partial hospitalization in DD.

Comparative study including DD patients who attended a DH (Group 1:n=12) versus patients who did not receive DH care (Group 2;n=7). Patients attending DH were classified into 3 groups according to the program function at referral. Adherence with outpatient follow-up appointments (primary outcome) and pharmacy refill data (secondary outcome) were assessed after discharge over a 6-month period (DH) and compared with group 2. For statistical analyses, non-parametric tests were performed.

Program function (DH): alternative to admission (n=4); shortening of admission (n=5) and enhancing outpatient treatment (n=3). Patients receiving DH care were more frequently referred from the inpatient unit or emergency department compared to those who did not attend DH (commonly referred from primary care services). No statistically significant differences were found between both groups in adherence to psychiatric appointments. Patients who attended DH showed higher compliance with antipsychotics (89.29% vs.72.62, p<0.05).

DH care may be a useful alternative to increase adherence with antipsychotics in DD patients with poor awareness of illness.

AGR has received honoraria, registration for congresses and/or travel costs from Janssen, Lundbeck-Otsuka and Angelini.

It has been speculated that vegetarians or vegans may have higher risks of fractures than meat eaters, but there is limited evidence from prospective cohorts. We aimed to assess the risks of total and site-specific fractures in people of different diet groups, in a prospective cohort with a large proportion of non-meat eaters.

In EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up around 14 years later (≈2010). Participants were categorised into five diet groups (≈20,106 regular meat eaters: ≥ 50 g of meat per day, ≈9,274 low meat eaters: < 50 g of meat per day, ≈8,037 fish eaters, ≈15,499 vegetarians and ≈1,982 vegans, with minor variations in numbers for each outcome after pre-specified exclusions) at both time points. Using multivariable Cox regression adjusted for socio-demographic, lifestyle, and physiological confounders, we estimated the risks of total and site-specific fractures (arm, wrist, hip, leg, ankle, and other main sites i.e. clavicle, rib and vertebra) in the different diet groups, with outcomes identified through record linkage.

Over an average of 17.6 years of follow-up, we observed 3,941 cases of total fractures, 566 arm fractures, 889 wrist fractures, 945 hip fractures, 366 leg fractures, 520 ankle fractures, and 467 other main site fractures. Compared with meat eaters, vegetarians had marginally higher risks of total fractures (hazard ratios and 95% confidence intervals: 1.10; 1.00–1.20) and arm fractures (1.28; 1.01–1.63), while vegans had significantly higher risks of total fractures (1.44; 1.21–1.72) and leg fractures (2.06; 1.22–3.47), and marginally higher risks of arm fractures (1.60, 1.01–2.54). For hip fractures, the risks were higher in fish eaters (1.28; 1.03–1.59), vegetarians (1.27; 1.05–1.55) and vegans (2.35; 1.67–3.30, p-heterogeneity < 0.0001) than regular meat eaters. There were no significant differences in risks of wrist, ankle or other main site fractures by diet groups. Overall, the significant associations appeared stronger without adjustment for body mass index (e.g. 1.52; 1.27–1.81 in vegans for total fractures), and were slightly attenuated with additional adjustment for total protein (1.41; 1.17–1.69) or dietary calcium (1.32; 1.10–1.59).

In conclusion, non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. The higher risks might be partly explained by the lower body mass index in these diet groups, but differences in dietary intakes of protein and calcium are likely relevant as well. Given the observational design of this study, causality and potential mechanisms should be further investigated.

Meat intake is thought to play a role in the risk of cancer. The Third Expert Report of the World Cancer Research Fund/American Institute for Cancer Research concluded that red meat was a probable cause and processed meat a convincing cause of colorectal cancer. However, evidence for associations between red and processed meat intake and other cancer sites is limited. Furthermore, few studies have investigated the association between poultry intake and cancer risk. Therefore, this study aimed to examine the associations between red, processed meat and poultry intake and incidence for 20 common cancer sites.

We analysed data from 475,264 participants (54 % women) in UK Biobank. Participants were aged 37–73 years and cancer free at baseline. Cancer diagnosis and death due to cancer without prior diagnosis during follow-up were determined using data-linkage with cancer and death registries (with follow-up until 31 March 2016 for England and Wales and until 31 October 2015 for Scotland, respectively). Information on meat consumption was based on a touchscreen questionnaire completed at baseline covering type and frequency of meat intake. We used multivariable-adjusted Cox proportional hazards models to determine the association between baseline meat intake and cancer incidence. Analyses of lung cancer risk were restricted to never smokers. All analyses were adjusted for socio-demographic, lifestyle and women-specific factors.

Over a mean 6.9 (SD 1.3) years of follow-up, 28,431 participants were diagnosed with any type of cancer. Red meat intake was positively associated with risk for colorectal cancer (n cases = 3,164; Hazard ratio (HR) per 50 g/day higher intake 1.22, 95% Confidence Interval (CI) 1.05–1.41), breast cancer (n cases = 5,536; 1.12, 1.01–1.24) and prostate cancer (n cases = 5,807; 1.16, 1.03–1.30). Processed meat intake was positively associated with risk for colorectal cancer (n cases = 3,189; HR per 20 g/day higher intake 1.17, 95% CI 1.06–1.30). Poultry intake was positively associated with risk for cancers of the lymphatic and hematopoietic tissues (n cases = 2,431; HR per 30g/day increment in intake 1.16, 95%-CI 1.03, 1.32).

In summary, higher intakes of red and processed meat were associated with a higher risk of colorectal cancer. Red meat consumption was also positively associated with risk of breast and prostate cancer, but these associations are not supported by most previous prospective studies. The positive association of poultry intake with cancers of the lymphatic and hematopoietic tissues requires further investigation.