Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study

Prevalence of behavioral risk factors of cardiovascular diseases and associated socio-economic factors among pregnant women in a rural area in Southern Nepal

BACKGROUND

Cardiovascular diseases (CVDs) have dramatically infiltrated populations living in abject poverty in Low- and Middle-income Countries (LMICs), and poor maternal and child health outcomes have been frequently reported for those with CVD risk factors. However, few studies have explored the behavioral risk factors of CVDs among pregnant women in rural settings. This study aimed at determining the prevalence and identifying the socio-economic predictors of behavioral risk factors of CVDs among pregnant women in rural area in Southern Nepal.

METHODS

A Community-based cross-sectional study was conducted in 52 clusters of Dhanusha District of Nepal in a total of 426 pregnant women in their second trimester using multistage cluster sampling method. Multivariable logistic regression model was used to assess independent associations between behavioral risk factors during pregnancy and maternal socio-economic characteristics.

RESULTS

Of the 426 study participants, 86.9, 53.9, 21.3 and 13.3%, respectively, reported insufficient fruits and vegetables consumption, insufficient physical activity, tobacco use, and harmful alcohol drinking. Socio-economic factors significantly associated with more than one behavioral risk factors in expectant mothers with a primary level education (adjusted odds ratio (AOR) 2.78; 95% Confidence Interval (CI) (1.35-5.72)), 20-34 years age group (Adjusted Odds Ratio (AOR) 0.27; 95% CI (0.13-0.56)), and those with the highest wealth index (AOR 0.36; 95% CI (0.16-0.84)).

CONCLUSION

Higher prevalence of behavioral risk factors for CVDs and their socio-economic factors prevailing among pregnant women living in rural Nepal call for immediate health promotion interventions such as community awareness and appropriate antenatal counseling.

Socioeconomic gradients in chronic disease risk behaviors in a population-based study of older adults in rural South Africa

OBJECTIVES

To investigate the associations between household wealth, household consumption, and chronic disease risk behaviors among older adults in rural South Africa.

METHODS

Data were from baseline assessments of 5059 adults aged ≥ 40 in the population-based "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" in 2015. Confounder-adjusted prevalence ratios were estimated for the associations between each of household wealth and household consumption quintiles with low moderate-to-vigorous physical activity (MVPA), current smoking, frequent alcohol intake, and overweight/obese body mass index (BMI).

RESULTS

Low MVPA and overweight/obese BMI were common (57% and 58%, respectively), and linearly increased in prevalence across household wealth quintiles. Low MVPA decreased and overweight/obese BMI increased in prevalence across household consumption quintiles. Smoking and frequent alcohol intake were rare (9% and 6%, respectively); they decreased in prevalence across wealth quintiles, but did not vary by consumption quintile.

CONCLUSIONS

Chronic disease risk behaviors are socioeconomically graded among older, rural South African adults. The high prevalence of overweight and obesity in rural South Africa is a public health concern requiring urgent attention.

Sedentary Behavior in Patients With Knee Osteoarthritis Before and After Total Knee Arthroplasty: A Systematic Review

Objective:The objective of this systematic review is to integrate the available evidence on changes in sedentary behavior (SB) in patients with knee osteoarthritis after total knee arthroplasty (TKA).Methods:A systematic literature search from January 2002 to October 31, 2017, was performed for studies assessing objectively and/or subjectively measured SB following TKA. The Scottish Intercollegiate Guidelines Network Methodology appraisal tool was used to critically appraise the methodological quality of the included studies.Results:Ten studies reporting on SB with a total of 1,028 participants were included in the review. Three studies reported changes in SB with two showing a reduction in SB and one (with high risk of bias) an increase in SB after TKA. Seven studies showed no change in SB following TKA.Conclusion:Currently, there is insufficient evidence which suggests that SB time improves following TKA. Detailed assessments of SB after TKA are needed.

Composite health behaviour classifier as the basis for targeted interventions and global comparisons in men's health

INTRODUCTION

Lifestyle-related diseases are the leading cause of death among North American men. We evaluated health behaviours and their predictors that contribute to morbidity and mortality among Canadian men as a means to making recommendations for targeted interventions.

METHODS

A cross-sectional analysis of Canadian men drawn from 5362 visitors to our online survey page was conducted. The current study sample of 2000 men (inclusion: male and >18 years; exclusion: incomplete surveys) were stratified to the 2016 Canadian census. The primary outcome was the number of unhealthy men classified using our Canadian Composite Classification of Health Behaviour (CCCHB) score. Secondary outcomes included the number of men with unhealthy exercise, diet, smoking, sleep, and alcohol intake, as well as socioeconomic and demographic factors associated with unhealthy behaviours to be used for targeting future interventions.

RESULTS

Only 118/2000 (5.9%) men demonstrated 5/5 healthy behaviours, and 829 (41.5%) had 3/5 unhealthy behaviours; 391 (19.6%) men currently smoked, 773 (38.7%) demonstrated alcohol overuse, 1077 (53.9%) did not get optimal sleep (<7 or >9 hours per night), 977 (48.9%) failed to exercise >150 minutes/week, and 1235 (61.8%) had an unhealthy diet. Multivariate analysis indicated that men with high school education were at increased risk of unhealthy behaviours (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.15-2.18; p=0.005), as were men living with relatives (OR 2.10; 95% CI1.04-4.26; p=0.039), or with their partner and children (OR 1.34; 95% CI 1.02-1.76; p=0.034).

CONCLUSIONS

An overwhelming 41.5% of Canadian men had 3/5 unhealthy behaviours, affirming the need for targeted lifestyle interventions. Significant health inequities within vulnerable subgroups of Canadian men were identified and may guide the content and delivery of future interventions.

Comparison of Serum Cytokine Levels in Men Who are Obese or Men Who are Lean: Effects of Nonlinear Periodized Resistance Training and Obesity

Nikseresht, M. Comparison of serum cytokine levels in men who are obese or men who are lean: effects of nonlinear periodized resistance training and obesity. J Strength Cond Res 32(6): 1787-1795, 2018-This study examined the capacity of nonlinear resistance training (NRT) to alter some cytokines and markers of insulin resistance in men who are obese. An additional aim was to compare these variables between men who are obese and men who are lean. Age- and fitness-matched men who are obese were randomly allocated to NRT (n = 12) and control (CON, n = 10) groups. An age- and fitness-matched control group of lean men (n = 11) were also recruited for baseline comparison. The NRT (12 weeks, 3 d·wk, 5-11 exercises) performed at different intensities (40-95% of 1 repetition maximum) with flexible periodization. Serum insulin, glucose, interleukin (IL)-6, IL-10, IL-17A, and IL-20 levels were measured at baseline and after training. Men who were obese had significantly lower IL-20 and higher glucose, insulin, insulin resistance (homeostasis model assessment, HOMA-IR), IL-10, and IL-6 than lean participants at baseline (all, p ≤ 0.05). There were significant negative correlations between IL-10 with anthropometric markers and HOMA-IR at baseline, whereas these variables were inversely correlated with IL-20. After training, V[Combining Dot Above]O2peak and 1 repetition maximum for bench press and knee extension of the NRT increased significantly compared with CON, which was accompanied by significant reductions in anthropometric markers, insulin and HOMA-IR. IL-6 and IL-17A did not change significantly in response to training, but IL-10 and IL-20 increased significantly compared with baseline. An inverse relationship between the percent IL-20 increase and the percent waist circumference decrease suggests that adipocytes, or other metabolic factors such as glucose, may exert a lowering-effect on IL-20.

A Co-Designed, Culturally-Tailored mHealth Tool to Support Healthy Lifestyles in Māori and Pasifika Communities in New Zealand: Protocol for a Cluster Randomized Controlled Trial

Background

New Zealand urgently requires scalable, effective, behavior change programs to support healthy lifestyles that are tailored to the needs and lived contexts of Māori and Pasifika communities.

Objective

The primary objective of this study is to determine the effects of a co-designed, culturally tailored, lifestyle support mHealth tool (the OL@-OR@ mobile phone app and website) on key risk factors and behaviors associated with an increased risk of noncommunicable disease (diet, physical activity, smoking, and alcohol consumption) compared with a control condition.

Methods

A 12-week, community-based, two-arm, cluster-randomized controlled trial will be conducted across New Zealand from January to December 2018. Participants (target N=1280; 64 clusters: 32 Māori, 32 Pasifika; 32 clusters per arm; 20 participants per cluster) will be individuals aged ≥18 years who identify with either Māori or Pasifika ethnicity, live in New Zealand, are interested in improving their health and wellbeing or making lifestyle changes, and have regular access to a mobile phone, tablet, laptop, or computer and to the internet. Clusters will be identified by community coordinators and randomly assigned (1:1 ratio) to either the full OL@-OR@ tool or a control version of the app (data collection only plus a weekly notification), stratified by geographic location (Auckland or Waikato) for Pasifika clusters and by region (rural, urban, or provincial) for Māori clusters. All participants will provide self-reported data at baseline and at 4- and 12-weeks postrandomization. The primary outcome is adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score at 12 weeks that assesses smoking behavior, fruit and vegetable intake, alcohol intake, and physical activity. Secondary outcomes include self-reported body weight, holistic health and wellbeing status, medication use, and recorded engagement with the OL@-OR@ tool.

Results

Trial recruitment opened in January 2018 and will close in July 2018. Trial findings are expected to be available early in 2019.

Conclusions

Currently, there are no scalable, evidence-based tools to support Māori or Pasifika individuals who want to improve their eating habits, lose weight, or be more active. This wait-list controlled, cluster-randomized trial will assess the effectiveness of a co-designed, culturally tailored mHealth tool in supporting healthy lifestyles.

Trial Registration

Australia New Zealand Clinical Trials Register ACTRN12617001484336; http://www.ANZCTR.org.au/ACTRN12617001484336.aspx (Archived by WebCite at http://www.webcitation.org/71DX9BsJb)

Registered Report Identifier

RR1-10.2196/10789

Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population

BACKGROUND

Americans have a shorter life expectancy compared with residents of almost all other high-income countries. We aim to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population.

METHODS

Using data from the Nurses' Health Study (1980-2014; n=78 865) and the Health Professionals Follow-up Study (1986-2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m2, ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0-5 scale) with mortality. We used data from the NHANES (National Health and Nutrition Examination Surveys; 2013-2014) to estimate the distribution of the lifestyle score and the US Centers for Disease Control and Prevention WONDER database to derive the age-specific death rates of Americans. We applied the life table method to estimate life expectancy by levels of the lifestyle score.

RESULTS

During up to 34 years of follow-up, we documented 42 167 deaths. The multivariable-adjusted hazard ratios for mortality in adults with 5 compared with zero low-risk factors were 0.26 (95% confidence interval [CI], 0.22-0.31) for all-cause mortality, 0.35 (95% CI, 0.27-0.45) for cancer mortality, and 0.18 (95% CI, 0.12-0.26) for cardiovascular disease mortality. The population-attributable risk of nonadherence to 5 low-risk factors was 60.7% (95% CI, 53.6-66.7) for all-cause mortality, 51.7% (95% CI, 37.1-62.9) for cancer mortality, and 71.7% (95% CI, 58.1-81.0) for cardiovascular disease mortality. We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3-29.8) for women and 25.5 years (95% CI, 24.7-26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3-44.9) for women and 37.6 years (95% CI, 35.8-39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8-16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1-14.2).

CONCLUSIONS

Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.

The Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Heart Rate Variability in Physically Inactive Adults

Physically inactive adults are prevalent worldwide. This study compared the effects of short-term high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on heart rate variability (HRV) in physically inactive adults as a preliminary study. Thirteen physically inactive male adults (27.5 ± 3.80 years) were randomly assigned to HIIT (N = 7) or MICT (N = 6). The HIIT program consisted of 20 min of interval training with cycling to rest ratio of 10/50 s at ≥90% HR_peak, while the MICT program consisted of 40 min of continuous cycling at 60–75% HR_peak. Both groups completed eight sessions of training within two weeks. Time and frequency domains of HRV were measured for 20 min with Actiwave-Cardio monitor (CamNtech, UK). The number of R-R interval and inter-beat interval (IBI) were significantly improved (p < 0.05) in both HIIT and MICT programs following eight sessions of training. A significant interaction effect for group by time was found in the lnLF/HF ratio (p < 0.05) where it was only improved in the HIIT group from pre- to post-test. The HIIT program is superior to MICT in improving HRV in physically inactive adults. The HIIT program can be applied as a time-efficient program for improving cardiac-autoregulation.

Finally, a Regimen to Extend Human Life Expectancy

The United States has the most expensive healthcare system worldwide. Yet measures of health span and life expectancy are well below the major industrialized nations. With the U.S. population aged 65 years and older projected to double by mid-century, a healthcare crisis is looming. Within this context, huge interest and investment have emerged in technologies and drugs to address aging with an expected benefit to health span. The thesis being that such basic interventions will reduce morbidity caused by many chronic diseases wherein biological age itself is the major risk factor. In the light of limited progress to date, a recent study out of the Harvard School of Public Health is quite refreshing: less than half dozen lifestyle interventions can greatly increase health span. Perhaps these are familiar: cessation of smoking, ≥30 minutes of moderate daily exercise, high-quality diet (limited processed food), modest alcohol intake, and maintenance of an optimal body mass index of 18.5-24.9 kg/m². From age 50 years, women engaging in all of these behaviors versus those who do zero can expect to have a life expectancy of 43.1 additional years (an extra 14 years) with men gaining 37.6 years (an extra 12.2 years). A regimen to extend life expectancy is at hand. However, there is room for optimization by including the effects of sleep, intermittent fasting, and/or caloric restriction. Moreover, the extension of life expectancy by adherence to a healthy lifestyle revises the health span threshold for antiaging treatments under development and should provide a better set of controls for clinical trials investigating novel treatments of aging.

Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: A cohort study

BACKGROUND

Multimorbidity is increasingly common and is associated with adverse health outcomes, highlighting the need to broaden the single-disease framework that dominates medical research. We examined the role of midlife clinical characteristics, socioeconomic position, and behavioural factors in the development of cardiometabolic multimorbidity (at least 2 of diabetes, coronary heart disease, and stroke), along with how these factors modify risk of mortality.

METHODS AND FINDINGS

Data on 8,270 men and women were drawn from the Whitehall II cohort study, with mean follow-up of 23.7 years (1985 to 2017). Three sets of risk factors were assessed at age 50 years, each on a 5-point scale: clinical profile (hypertension, hypercholesterolemia, overweight/obesity, family history of cardiometabolic disease), occupational position, and behavioural factors (smoking, alcohol consumption, diet, physical activity). The outcomes examined were cardiometabolic disease (diabetes, coronary heart disease, stroke), cardiometabolic multimorbidity, and mortality. We used multi-state models to examine the role of risk factors in 5 components of the cardiometabolic disease trajectory: from healthy state to first cardiometabolic disease, from first cardiometabolic disease to cardiometabolic multimorbidity, from healthy state to death, from first cardiometabolic disease to death, and from cardiometabolic multimorbidity to death. A total of 2,501 participants developed 1 of the 3 cardiometabolic diseases, 511 developed cardiometabolic multimorbidity, and 1,406 died. When behavioural and clinical risk factors were considered individually, only smoking was associated with all five transitions. In a model containing all 3 risk factor scales, midlife clinical profile was the strongest predictor of first cardiometabolic disease (hazard ratio for the least versus most favourable profile: 3.74; 95% CI: 3.14-4.45) among disease-free participants. Among participants with 1 cardiometabolic disease, adverse midlife socioeconomic (1.54; 95% CI: 1.10-2.15) and behavioural factors (2.00; 95% CI: 1.40-2.85), but not clinical characteristics, were associated with progression to cardiometabolic multimorbidity. Only midlife behavioural factors predicted mortality among participants with cardiometabolic disease (2.12; 95% CI: 1.41-3.18) or cardiometabolic multimorbidity (3.47; 95% CI: 1.81-6.66). A limitation is that the study was not large enough to estimate transitions between each disease and subsequent outcomes and between all possible pairs of diseases.

CONCLUSIONS

The importance of specific midlife factors in disease progression, from disease-free state to single disease, multimorbidity, and death, varies depending on the disease stage. While clinical risk factors at age 50 determine the risk of incident cardiometabolic disease in a disease-free population, midlife socioeconomic and behavioural factors are stronger predictors of progression to multimorbidity and mortality in people with cardiometabolic disease.

Smartphone app uses loyalty point incentives and push notifications to encourage influenza vaccine uptake

PURPOSE

Carrot Rewards is a free, incentive-based, smartphone health app available in participating provinces in Canada. One feature of Carrot was designed to incentivize influenza vaccine education messages and encourage vaccine uptake for users in the province of British Columbia. This study aimed to evaluate the uptake of the Carrot Flu Campaign educational quiz and to determine if mobile "push" notifications, plus loyalty point incentives, resulted in users visiting a sponsored pharmacy to discuss and receive the influenza vaccine.

METHODS

The Carrot Flu Campaign delivered an in-app quiz, educating users on the importance of the influenza vaccine. Push notifications were then sent to users when they came within 200 m of a sponsored pharmacy. Those who visited the pharmacy collected bonus points and completed a follow up quiz tracking influenza vaccine behaviour. A sub-sample of users completed the Flu Campaign between their baseline and follow up Health Risk Assessment (HRA), a survey which asked about influenza vaccine uptake behaviour. Descriptive statistics were summarized.

RESULTS

A total of 38.1% (30,538/80,228) registered Carrot users completed the Flu Campaign quiz. Of those in participating cities (n = 21,469), 41% clicked on the map to show the nearest sponsored pharmacy and 78% enabled their smartphone's "locations" feature, allowing them to receive the push notifications. A small number of users spoke to a pharmacist (n = 96) and less than half reported receiving the influenza vaccine (38/96; 39.6%). From the HRA sub-sample (n = 3693), approximately 5% more users reported receiving the influenza vaccine during the 2017 influenza season compared to the previous year.

CONCLUSIONS

Carrot Rewards used a novel delivery method to educate the general population and showed geolocation could be used to facilitate influenza vaccine uptake. Future iterations could tailor content to target those most at risk and should consider more robust evaluation methods to determine the app's effectiveness.

Text4Heart II - improving medication adherence in people with heart disease: a study protocol for a randomized controlled trial

Background

Cardiac rehabilitation (CR) is an essential component of contemporary management for patients with coronary heart disease, including following an acute coronary syndrome (ACS). CR typically involves education and support to assist people following an ACS to make lifestyle changes and prevent subsequent events. Despite its benefits, uptake and participation in tradition CR programs is low. The use of mobile technologies (mHealth) offers the potential to improve reach, access, and delivery of CR support. We aim to determine the effectiveness and cost-effectiveness of a text-messaging intervention (Text4Heart II) to improve adherence to medication and lifestyle change in addition to usual care in people following an ACS. A second aim is to use the RE-AIM framework to inform the potential implementation of Text4Heart II within health services in New Zealand.

Methods

Text4Heart II is a two-arm, parallel, superiority randomized controlled trial conducted in two large metropolitan hospitals in Auckland, New Zealand. Three hundred and thirty participants will be randomized to either a 24-week theory- and evidence-based personalized text message program to support self-management in addition to usual CR, or usual CR alone (control). Outcomes are assessed at 6 and 12 months. The primary outcome is the proportion of participants adhering to medication at 6 months as measured by dispensed records. Secondary outcomes include medication adherence at 12 months, the proportion of participants adhering to self-reported healthy behaviors (physical activity, fruit and vegetable consumption, moderating alcohol intake and smoking status) measured using a composite health behavior score, self-reported medication adherence, cardiovascular risk factors (lipids, blood pressure), readmissions and related hospital events at 6 and 12 months. A cost-effectiveness analysis will also be conducted. Using the RE-AIM framework, we will determine uptake and sustainability of the intervention.

Discussion

The Text4Heart II trial will determine the effectiveness of a text-messaging intervention to improve adherence to medication and lifestyle behaviors at both 6 and 12 months. Using the RE-AIM framework this trial will provide much needed data and insight into the potential implementation of Text4Heart II. This trial addresses many limitations/criticisms of previous mHealth trials; it builds on our Text4Heart pilot trial, it is adequately powered, has sufficient duration to elicit behavior change, and the follow-up assessments (6 and 12 months) are long enough to determine the sustained effect of the intervention.

Trial registration

Australian New Zealand Clinical Trials Registry, ID: ACTRN12616000422426. Registered retrospectively on 1 April 2016. 

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2468-z) contains supplementary material, which is available to authorized users.

Healthy living and cancer: evidence from UK Biobank

CONTEXT

UK Biobank is a prospective study of half a million subjects, almost all aged 40-69 years, identified in 22 centres across the UK during 2006-2010.

OBJECTIVE

A healthy lifestyle has been described as 'better than any pill, and no side effects [5]. We therefore examined the relationships between healthy behaviours: low alcohol intake, non-smoking, healthy BMI, physical activity and a healthy diet, and the risk of all cancers, colon, breast and prostate cancers in a large dataset.

METHOD

Data on lifestyle behaviours were provided by 343,150 subjects, and height and weight were measured at recruitment. 14,285 subjects were diagnosed with cancer during a median of 5.1 years of follow-up.

RESULTS

Compared with subjects who followed none or a single healthy behaviour, a healthy lifestyle based on all five behaviours was associated with a reduction of about one-third in incident cancer (hazard ratio [HR] 0.68; 95% confidence intervals [CI] 0.63-0.74). Colorectal cancer was reduced in subjects following the five behaviours by about one-quarter (HR 0.75; 95% CI 0.58-0.97), and breast cancer by about one-third (HR 0.65; 95% CI 0.52-0.83). The association between a healthy lifestyle and prostate cancer suggested a significant increase in risk, but this can be attributed to bias consequent on inequalities in the uptake of the prostate specific antigen screening test.

CONCLUSIONS

Taken together with reported reductions in diabetes, vascular disease and dementia, it is clearly important that every effort is taken to promote healthy lifestyles throughout the population, and it is pointed out that cancer and other screening clinics afford 'teachable moments' for the promotion of a healthy lifestyle.

Association Between a Healthy Lifestyle Score and the Risk of Cardiovascular Disease in the SUN Cohort

INTRODUCTION AND OBJECTIVES

A healthy lifestyle (HLS) is essential to attaining optimal cardiovascular health. Our objective was to assess the association between a HLS score and the incidence of hard cardiovascular disease (CVD) events.

METHODS

The SUN project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with a retention proportion of 92%. In 19 336 participants, we calculated a HLS score ranging from 0 to 10 points: never smoking, physical activity (> 20 METs-h/wk), Mediterranean diet adherence (≥ 4/8 points), low body mass index (≤ 22), moderate alcohol intake (women, 0.1-5g/d; men, 0.1-10g/d), low television exposure (≤ 2h/d), no binge drinking (≤ 5 alcoholic drinks anytime), taking a short afternoon nap (< 30min/d), meeting up with friends> 1h/d and working> 40h/wk.

RESULTS

After a median follow-up of 10.4 years, we identified 140 incident cases of CVD. After adjustment for potential confounders, the highest category of HLS score adherence (7-10 points) showed a significant 78% relative reduction in the risk of primary CVD compared with the lowest category (0-3 points) (adjusted HR, 0.22; 95%CI, 0.11-0.46). Each healthy habit was individually associated with a lower risk of CVD.

CONCLUSIONS

A HLS score including several simple healthy habits was associated with a lower risk of developing primary CVD. This index may be useful to reinforce CVD prevention without the need to include traditional risk factors.

Biopsychosocial predictors of perceived life expectancy in a national sample of older men and women

Perceived life expectancy (PLE) is predictive of mortality risk in older adults, but the factors that may contribute to mental conceptions of PLE are unknown. We aimed to describe the sociodemographic, biomedical, behavioral, and psychological predictors of self-reported PLE estimates among older English adults. Data were from 6662 adults aged 50–79 years in the population-based English Longitudinal Study of Ageing (cross-sectional sample from 2012/13). PLE was assessed in the face-to-face study interview (“What are the chances you will live to be age x or more?” where x = current age plus 10–15 years). Responses were categorized as ‘low’ (0–49%), ‘medium’ (50–74%), and ‘high’ (75–100%). Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for low vs. high PLE were estimated using population-weighted modified Poisson regression with robust error variance. Overall, 1208/6662 (18%) participants reported a low PLE, 2806/6662 (42%) reported a medium PLE, and 2648/6662 (40%) reported a high PLE. The predictors of reporting a low PLE included older age (PR = 1.64; 95% CI: 1.50–1.76 per 10 years), male sex (PR = 1.14; 95% CI: 1.02–1.26), being a smoker (PR = 1.39; 95% CI: 1.22–1.59 vs. never/former smoker), and having a diagnosis of cancer or diabetes. A low sense of control over life was associated with low PLE, as was low satisfaction with life and worse self-rated health. Those with a higher perceived social standing were less likely to report a low PLE (PR = 0.90; 95% CI: 0.87–0.93 per 10-point increase, out of 100). This study provides novel insight into potential influences on older adults’ expectations of their longevity, including aspects of psychological well-being. These results should be corroborated to better determine their implications for health-related decision-making, planning, and behavior among older adults.

Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care

Background

Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care.

Results

Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A’s evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records.

Conclusions

Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.

Informal care and health behaviors among elderly people with chronic diseases

BACKGROUND

The mechanism by which social relationships influence health can be interpreted as a social network regulating one's health behaviors. Based on the hypothesis that relatives, friends, or neighbors are sources of social support and may monitor one's health behaviors, researchers have gotten significant and consistent results that a social network can regulate health behaviors. However, few empirical studies have been conducted to examine the role of informal care in the regulation of health behaviors, especially for elderly individuals with chronic diseases that can be controlled by healthy behaviors. This paper researched the effects of informal care on health behaviors-smoking control, dietetic regulation, weight control, and maintenance of exercise-among elderly patients with chronic diseases in China who are facing the challenge of aging.

METHODS

We used the propensity score matching method to control the impacts of a very rich set of family and individual characteristics. The 2011-2012 national baseline data of the China Health and Retirement Longitudinal Study (CHARLS) was used.

RESULTS

Our findings showed that informal care could significantly help improve the health behaviors of elderly people. Informal care could improve the compliance of smoking control and dietetic regulation significantly. Elderly people with informal care smoked less and consumed more meals per day. For weight control, informal care helped decrease the possibility of weight gain of elderly people, but its impacts were not significant for BMI and weight loss. Last, for the elders, informal care could only help increase the probability of walking exercise; however, there was no significant result for moderate exercise.

CONCLUSIONS

Findings from this study highlight the importance of informal care among elderly people. Our results appeal to policy makers who aim to control chronic diseases that they should take informal care into account and provide appropriate policies to meet the demand of informal care for elderly people.

Health Lifestyle Behaviors among U.S. Adults

Existing research that studies individual health behaviors and conceive of behaviors as simplistically reflecting narrow intentions toward health may obscure the social organization of health behaviors. Instead, we examine how eight health behaviors group together to form distinct health behavior niches. Using nationally-representative data from U.S. adults aged 18 and over from the 2004-2009 National Health Interview Survey (NHIS), we use Latent Class Analysis to identify classes of behavior based on smoking status, alcohol use, physical activity, physician visits, and flu vaccination. We identify 7 distinct health behavior classes including concordant health promoting (44%), concordant health compromising (26%), and discordant classes (30%). We find significant race/ethnic, sex, regional, and age differences in class membership. We show that health behavior classes are associated with prospective mortality, suggesting that they are valid representations of health lifestyles. We discuss the implications of our results for sociological theories of health behaviors, as well as for multiple behavior interventions seeking to improve population health.

The joint effects of major lifestyle factors on colorectal cancer risk among Chinese men: A prospective cohort study

Previous studies have suggested individual healthy lifestyle factors are related to lower risk of colorectal cancer. Their joint effects, however, have rarely been investigated. We aimed to assess the combined lifestyle impact on colorectal cancer risk and to estimate the population attributable risks of these lifestyle factors. Using data from the Shanghai Men's Health Study (2002-2013), we constructed healthy lifestyle index composing the following lifestyle factors: smoking, alcohol consumption, diet, waist-hip ratio and exercise participation. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Over a median of 9.28 years' follow-up, 671 colorectal cancer cases occurred (400 colon cancer and 274 rectal cancer) among 59,503 men. Each increment of healthy lifestyle index was associated with a 17% lower risk of colorectal cancer (HR = 0.83, 95% CI: 0.78, 0.89), 10% of colon cancer (HR = 0.90, 95% CI: 0.83, 0.99) and 27% of rectal cancer (HR = 0.73, 95% CI: 0.66, 0.82). If all men in the cohort followed a lifestyle as defined by these five factors, 21% colorectal cancer cases would have been prevented (PAR = 21%, 95% CI: 4%, 36%). In conclusion, combined lifestyle factors are significantly related to lower risk of colorectal cancer and the effects are more pronounced on rectal cancer than on colon cancer.

'Forever Young'-Testosterone replacement therapy: a blockbuster drug despite flabby evidence and broken promises

In the last decade, testosterone replacement therapy (TRT) has been increasingly prescribed to treat a controversial condition known as 'late-onset hypogonadism (LOH)'. This syndrome is diagnosed in men who, for no discernible reason other than older age, obesity or ill health have serum testosterone concentrations below the normal range for healthy young men and report one or more of the following symptoms: muscle weakness or wasting, mood, behaviour and cognition-related symptoms and sexual function or libido impairment. However, recent evidence has demonstrated that testosterone drugs do not substantially ameliorate these symptoms and, more worryingly, that their long-term use may be associated with severe adverse effects (i.e. increased risk of prostate cancer, stroke and myocardial infarction, worsening of benign prostatic hyperplasia symptoms and testicular atrophy). Nonetheless, testosterone drugs have exhibited extraordinary commercial success and their pharmaceutical sales are steadily rising. Behind this apparently unjustifiable trend there are deliberate, well designed direct and indirect pharmaceutical marketing initiatives that exploit the conviction rooted in contemporary society that testosterone can reverse the effects of ageing and ensure social accomplishment. Commercial mechanisms have laid the foundation for disease mongering of LOH and also have resulted a considerable expansion of the indications for treatment. This promotion model deserves particular attention since it is applicable to any drug with a purportedly favourable risk-benefit ratio not supported by evidence.

A cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among adolescents aged 13-14 years

INTRODUCTION

Adolescent physical activity promotion is rarely effective, despite adolescence being critical for preventing physical activity decline. Low adolescent physical activity is likely to last into adulthood, increasing health risks. The Get Others Active (GoActive) intervention is evidence-based and was developed iteratively with adolescents and teachers. This intervention aims to increase physical activity through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented using a tiered-leadership system. We previously established feasibility in one school and conducted a pilot randomised controlled trial (RCT) in three schools.

METHODS AND ANALYSIS

We will conduct a school-based cluster RCT (CRCT) in 16 secondary schools targeting all year 9 students (n=2400). In eight schools, GoActive will run for two terms: weekly facilitation support from a council-funded intervention facilitator will be offered in term 1, with more distant support in term 2. Tutor groups choose two weekly activities, encouraged by older adolescent mentors and weekly peer leaders. Students gain points for trying new activities; points are entered into a between-class competition. Outcomes will be assessed at baseline, interim (week 6), postintervention (week 14-16) and 10-month follow-up (main outcome). The primary outcome will be change from baseline in daily accelerometer-assessed moderate-to-vigorous physical activity. Secondary outcomes include accelerometer-assessed activity intensities on weekdays/weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness and cost-utility analyses; mixed-methods process evaluation integrating information from focus groups and participation logs/questionnaires.

ETHICS AND DISSEMINATION

Ethical approval for the conduct of the study was gained from the University of Cambridge Psychology Research Ethics Committee. Given the lack of rigorously evaluated interventions, and the inclusion of objective measurement of physical activity, long-term follow-up and testing of causal pathways, the results of a CRCT of the effectiveness and cost-effectiveness of GoActive are expected to add substantially to the limited evidence on adolescent physical activity promotion. Workshops will be held with key stakeholders including students, parents, teachers, school governors and government representatives to discuss plans for wider dissemination of the intervention.

TRIAL REGISTRATION NUMBER

ISRCTN31583496.

Exploring the adaptive experiences of children with parents of myocardial infarction: A Qualitative Study

Background

Cardiovascular diseases are the world’s leading cause of mortality. These diseases are rooted in an unhealthy lifestyle. In order to confront this subject, it is essential to identify several risk factors that contribute to heart disease (HD) in people with different attitudes, values, beliefs, expectations and motivations. This study was therefore an attempt to explain the adaptive experiences of children whose parents were involved in myocardial infarction since they were more likely subjected to get the so-called disease.

Objective

To identify the risk factors and to clear ambiguity using a qualitative research method from the experiences of people at risk of the above mentioned disease.

Methods

This qualitative study was a directed content analysis. Eighteen children (above 18 years old) of parents with a history of myocardial infarction participated, and were chosen with purposive sampling and the highest diversity. Data were collected through deep and semi structure interviews based on Protection Motivation Theory (PMT) from March to November 2015, and were analyzed along with their data collection and with usage of Lundman and Graneheim method. Interviews were conducted in non-stressful conditions with a place and time agreement.

Results

During content analysis process, 220 codes were extracted. After reviewing several times and summarizing, the codes were categorized based on similarity and proportion, and finally 12 subcategories and three categories were elicited including efforts to perform self-care in order to prevent HD, poor life style as a factor not to do preventive HD and health continuation with positive changes in life style.

Conclusions

Most participants, despite intending to do self-care behaviors to prevent HD, due to factors such as time constraint, high costs, laziness, impatience and prioritizing other life affairs, did not pay attention to their health. Therefore, providing the training programs with an emphasis on life skills can play an important role in reducing perceived response cost and promoting health.

Combined impact of healthy lifestyle factors on lifespan: two prospective cohorts

BACKGROUND

The impact of multiple healthy lifestyle factors on survival time is unclear.

OBJECTIVE

The aim of this study was to examine differences in survival time associated with a healthy lifestyle versus a less healthy lifestyle.

METHODS

This study consisted of 33 454 men (Cohort of Swedish Men) and 30 639 women (Swedish Mammography Cohort) aged 45-83 years and free of cancer and cardiovascular disease at baseline. The healthy lifestyle factors included the following: (i) nonsmoking; (ii) physical activity at least 150 min per week; (iii) alcohol consumption of 0-14 drinks per week; (iv) and healthy diet defined as a modified Dietary Approaches to Stop Hypertension Diet score above the median. Cox proportional hazards regression models and Laplace regression were used to estimate, respectively, hazard ratios of all-cause mortality and differences in survival time.

RESULTS

During follow-up from 1998 through 2014, 8630 deaths amongst men and 6730 deaths amongst women were ascertained through linkage to the Swedish Cause of Death Register. Each of the four healthy lifestyle factors was inversely associated with all-cause mortality and increased survival time. Compared with individuals with no or one healthy lifestyle factor, the multivariable hazard ratios of all-cause mortality for individuals with all four health behaviours were 0.47 (95% 95% confidence interval [CI]: 0.44-0.51) in men and 0.39 (95% CI: 0.35-0.44) in women. This corresponded to a difference in survival time of 4.1 (95% CI: 3.6-4.6) years in men and 4.9 (95% CI: 4.3-5.6) years in women.

CONCLUSION

Adopting healthy lifestyle behaviours may markedly increase lifespan.

Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor

OBJECTIVE

To investigate associations between adverse childhood experiences (ACEs) and later-life depressive symptoms; and to explore whether perceived social support (PSS) moderates these.

METHOD

We analysed baseline data from the Mitchelstown (Ireland) 2010-2011 cohort of 2047 men and women aged 50-69 years. Self-reported measures included ACEs (Centre for Disease Control ACE questionnaire), PSS (Oslo Social Support Scale) and depressive symptoms (CES-D). The primary exposure was self-report of at least one ACE. We also investigated the effects of ACE exposure by ACE scores and ACE subtypes abuse, neglect and household dysfunction. Associations between each of these exposures and depressive symptoms were estimated using logistic regression, adjusted for socio-demographic factors. We tested whether the estimated associations varied across levels of PSS (poor, moderate and strong).

RESULTS

23.7% of participants reported at least one ACE (95% CI 21.9% to 25.6%). ACE exposures (overall, subtype or ACE scores) were associated with a higher odds of depressive symptoms, but only among individuals with poor PSS. Exposure to any ACE (vs none) was associated with almost three times the odds of depressive symptoms (adjusted OR 2.85; 95% CI 1.64 to 4.95) among individuals reporting poor PSS, while among those reporting moderate and strong PSS, the adjusted ORs were 2.21 (95% CI 1.52 to 3.22) and 1.39 (95% CI 0.85 to 2.29), respectively. This pattern of results was similar when exposures were based on ACE subtype and ACE scores, though the interaction was clearly strongest among those reporting abuse.

CONCLUSIONS

ACEs are common among older adults in Ireland and are associated with higher odds of later-life depressive symptoms, particularly among those with poor PSS. Interventions that enhance social support, or possibly perceptions of social support, may help reduce the burden of depression in older populations with ACE exposure, particularly in those reporting abuse.

Healthy lifestyle impact on breast cancer-specific and all-cause mortality

PURPOSE

While several studies have evaluated the association of combined lifestyle factors on breast cancer-specific mortality, few have included Hispanic women. We constructed a "healthy behavior index" (HBI) and evaluated its associations with mortality in non-Hispanic White (NHW) and Hispanic women diagnosed with breast cancer from the southwestern U.S.

METHODS

Diet and lifestyle questionnaires were analyzed for 837 women diagnosed with invasive breast cancer (1999-2004) in New Mexico as part of the 4-Corners Women's Health Study. An HBI score ranging from 0 to 12 was based on dietary pattern, physical activity, smoking, alcohol consumption, and body size and shape, with increasing scores representing less healthy characteristics. Hazard ratios for mortality over 14 years of follow-up were estimated for HBI quartiles using Cox proportional hazards models adjusting for education and stratified by ethnicity and stage at diagnosis.

RESULTS

A significant increasing trend was observed across HBI quartiles among all women, NHW women, and those diagnosed with localized or regional/distant stage of disease for all-cause (AC) mortality (p-trend = 0.006, 0.002, 0.03, respectively). AC mortality was increased >2-fold for all women and NHW women in HBI Q4 versus Q1 (HR = 2.18, 2.65, respectively). The association was stronger in women with regional/distant than localized stage of disease (HR = 2.62, 1.94, respectively). Associations for Hispanics or breast cancer-specific mortality were not significant.

CONCLUSIONS

These findings indicate the associations between the HBI and AC mortality, which appear to differ by ethnicity and stage at diagnosis. Interventions for breast cancer survivors should address the combination of lifestyle factors on prognosis.

Alcohol and Alzheimer's Disease-Does Alcohol Dependence Contribute to Beta-Amyloid Deposition, Neuroinflammation and Neurodegeneration in Alzheimer's Disease?

Aims

To investigate the underlying neurobiology between alcohol use, misuse and dependence and cognitive impairment, particularly Alzheimer's disease (AD).

Methods

Review of the literature using searches of Medline, Pubmed, EMBASE, PsycInfo, and meeting abstracts and presentations.

Results

The role of alcohol as a risk factor and contributor for cognitive decline associated with AD has received little attention. This is despite the high prevalence of alcohol use, the potential reversibility of a degree of cognitive impairment and the global burden of AD. Until now the focus has largely been on the toxic effects of alcohol, neuronal loss and the role of thiamine.

Conclusion

We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation. We describe the common underlying neurobiology in alcohol and AD, and examine ways alcohol likely contributes to neuroinflammation directly via stimulation of Toll-like receptors and indirectly from small bowel changes, hepatic changes, withdrawal and traumatic brain injury to the pathogenesis of AD.

Short Summary

Alcohol use, misuse and dependence cause cognitive impairment. We propose alcohol adds to the cognitive burden seen in dementia through additional mechanisms to neurodegenerative processes or may contribute at various mechanistic points in the genesis and sustenance of AD pathology via neuroinflammation.

Change in physical activity from adolescence to early adulthood: a systematic review and meta-analysis of longitudinal cohort studies

Objective

To systematically review and meta-analyse how physical activity (PA) changes from adolescence to early adulthood (13–30 years).

Data sources

Seven electronic databases were searched: Medline, Embase, PsycInfo, SCOPUS, ASSIA, SPORTdiscus and Web of Science.

Eligibility criteria for selecting studies

English-language, longitudinal studies (from 01/1980 to 01/2017) assessing PA ≥twice, with the mean age of ≥1 measurement in adolescence (13–19 years) and ≥1 in young adulthood (16–30 years) were included. Where possible, data were converted to moderate-to-vigorous physical activity (MVPA) min/day, and meta-analyses were conducted between weighted mean differences (WMDs) in adolescence and adulthood. Heterogeneity was explored using meta-regression.

Results

Of 67 included studies, 49 were eligible for meta-analysis. PA was lower during adulthood than adolescence WMD (95% CI) −5.2 (−7.3 to –3.1) min/day MVPA over mean (SD) 3.4 (2.6) years; heterogeneity was high (I² >99.0%), and no predictors explained this variation (all p>0.05). When we restricted analysis to studies with data for males (n=29) and females (n=30) separately, there were slightly larger declines in WMD (−6.5 (−10.6 to –2.3) and −5.5 (−8.4 to −2.6) min/day MVPA) (both I² >99.0%). For studies with accelerometer data (n=9), the decline was −7.4 (−11.6 to –3.1) and longer follow-up indicated more of a decline in WMD (95% CI) (−1.9 (−3.6 to –0.2) min/day MVPA), explaining 27.0% of between-study variation. Of 18 studies not eligible for meta-analysis, nine statistically tested change over time: seven showed a decline and two showed no change.

Conclusion

PA declines modestly between adolescence and young adulthood. More objective longitudinal PA data (eg, accelerometry) over this transition would be valuable, as would investigating how PA change is associated with contemporaneous social transitions to better inform PA promotion interventions.

Registration

PROSPERO ref:CRD42015030114.

Combined Impact of Known Lifestyle Factors on Total and Cause-Specific Mortality among Chinese Men: A Prospective Cohort Study

Impact of combined lifestyles on risk of mortality needs to be explored quantitatively. We aimed to evaluate the associations of combined lifestyle factors with total and cause-specific mortality in Chinese men. We used data from the Shanghai Men's Health Study (2002-2013), an on-going population-based prospective cohort study of men (aged 40 to 74 years). Four traditional unfavorable lifestyle factors were included: smoking, heavy alcohol use, unhealthy diet and physical inactivity. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Among about 61,480 men in the cohort, a total of 4,952 men died, of which 1,637 men died from cardiovascular diseases (CVD), 2,122 from cancer during a median of 9.29 years' follow-up. The HRs of men with four risk practices comparing to those with zero were 2.92 (95%CI: 2.53, 3.38) for all-cause mortality, 3.15 (95%CI: 2.44, 4.05) for CVD mortality, and 3.18 (95%CI: 2.55, 3.97) for cancer mortality. The population attributable risks (PARs) were 0.41, 0.40 and 0.38 for total, CVD and cancer mortality, accordingly. As combined unhealthy lifestyle behaviors had substantial impact on total and cause-specific mortality, promotion of healthy lifestyle should be a public health priority.

Online nutrition and T2DM continuing medical education course launched on state-level medical association

OBJECTIVE

The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians.

METHODS

A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association's education library, available to all physicians.

RESULTS

Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME (P<0.0001).

CONCLUSIONS

Online CME courses launched via state-level medical associations offer convenient continuing education to assist practicing physicians in addressing patient nutrition and lifestyle concerns related to chronic disease. The present diabetes CME one-credit course allowed physicians to develop basic nutrition care concepts on this topic to assist patients in a better way.

Stroke in Older Survivors of Ischemic Stroke: Standard Care or Something Different?

Stroke is one of the leading causes of death and disability and it is more likely to occur in those who are older. Because people are living longer, the definition of "old" continues to evolve. Age alone should not influence the healthcare that a patient receives, however, evidence indicates that this does occur, especially in older patients. On the basis of the available evidence, it is time to reconsider whether or not stroke care should differ in older survivors of stroke and if so, why. This is a narrative review of stroke-related health care in those with a recent ischemic stroke. It seeks to answer the following question: Should patients aged ≥80 years who have experienced a recent ischemic stroke receive standard care or something different, and if they should receive something different, what should they receive and why? The review focusses on long-term survival, hyper-acute care, secondary prevention, and rehabilitation. The authors propose a number of recommendations in relation to stroke care in older survivors of a recent ischemic stroke.

Multiple health behaviour change interventions for primary prevention of cardiovascular disease in primary care: systematic review and meta-analysis

BACKGROUND

It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness.

METHODS

The search included randomised controlled trials of MHBC interventions aimed at reducing CVD risk in primary prevention population up to 2017. Theoretical frameworks and intervention components were evaluated using standardised methods. Meta-analysis with stratification and meta-regression were used to evaluate intervention effects.

RESULTS

We identified 31 trials (36 484 participants) with a minimum duration of 12 months follow-up. Pooled net change in systolic blood pressure (16 trials) was -1.86 (95% CI -3.17 to -0.55; p=0.01) mm Hg; diastolic blood pressure (15 trials), -1.53 (-2.43 to -0.62; p=0.001) mm Hg; body mass index (14 trials), -0.13 (-0.26 to -0.01; p=0.04) kg/m²; serum total cholesterol (14 trials), -0.13 (-0.19 to -0.07; p<0.001) mmol/L. There was no significant association between interventions with a reported theoretical basis and improved intervention outcomes. No association was observed between intervention intensity (number of sessions and intervention duration) and intervention outcomes. There was significant heterogeneity for some risk factor analyses, leading to uncertain validity of some pooled net changes.

CONCLUSIONS

MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions' rationale, content and delivery is essential to understanding their effectiveness.

Screen Time, Other Sedentary Behaviours, and Obesity Risk in Adults: A Review of Reviews

PURPOSE OF REVIEW

The aim of this paper is to assess the association between sedentary behaviours, including screen time, and risk of obesity in adults. A review of 10 systematic reviews was undertaken.

RECENT FINDINGS

Available evidence is generally not supportive of associations between sedentary behaviour and obesity in adults. Most studies that found significant associations indicated mostly small effect sizes. Somewhat more consistent associations were shown for screen time (mainly TV viewing), among older adults, and for pre-adult sedentary behaviour to increase the risk of obesity in adulthood. Some evidence also exists for breaks in sedentary time to be associated with a more favourable BMI, and for use of a car to be associated with greater risk of obesity. There is limited evidence for an association between sedentary behaviour in adulthood and obesity and any association that exists does not seem to be causal. Future research is required investigating potentially positive effects for frequent breaks from sitting, less car use, and an uncoupling of TV viewing and dietary intake.

Health-related behaviour in Europe - A comparison of selected indicators for Germany and the European Union

Demographic change, new health threats, but also inequalities in health and health care provision in and between European Union (EU) member states pose major albeit similar challenges to European health systems. Regular information on health and health-related behaviour is essential if member states' health systems are to respond and develop appropriately to these challenges. The 'European Health Interview Survey' (EHIS) is a vital source of data for indicators of health status and health-related behaviour in the EU. This article presents a comparative review of health-related behaviour at the European level. Health-related behaviour is of particular relevance because an unhealthy diet, physical inactivity, obesity, smoking, and harmful use of alcohol are among the most important determinants associated with non-communicable chronic diseases. Eurostat has used data from EHIS Wave 2 to publish details about the current prevalence of obesity, daily fruit and vegetable intake, health-enhancing aerobic physical activity, smoking and heavy episodic drinking for the EU's member states. In the following, the figures for Germany are compared to the European average. A wide range of prevalences exists between the various EU member states, in some cases stretching to more than 50 percentage points. In Germany, the prevalence of obesity and smoking remains relatively close to the EU average. Moreover, the results on physical activity are especially welcome. In particular, the proportion of women and men who undertake adequate levels of physical activity decreases more slowly with increasing age compared to the EU average. Nevertheless, the low fruit and vegetable intake, especially among younger generations, and the high proportion of women and men who drink six or more alcoholic beverages on one occasion (heavy episodic drinking) at least once a month pose problems for Germany. In summary, the results provided by EHIS offer a basis for sharing experiences between EU member states regarding effective measures in health promotion and disease prevention.

Life-course and Cohort Trajectories of Chronic Non-communicable Diseases Risk Factors in China

BACKGROUND

NCDs are the leading disease burdens in China and the NCDs risk factors shifts have accelerated at an unprecedented scale over the past 30 years. The aim of this study was to analysis the natural trajectories of NCDs risk factors over the life course.

METHODS

The large-scale longitudinal data from the CHNS includes nine rounds of surveys between 1989 and 2011. Overall, 145913 observations (29719 individuals) at multiple exams have been followed up over a 23-year period. The mixed-effects models with random intercepts were used to the characterize shifts in the distribution of these risk factors across the whole life course.

RESULTS

During about 23 years observational period across all age bands, the mean AMC, UAC, TSF, BMI, WC, DBP, SD, DD, and PA trajectory all increased until a certain age. Then decreased in both gender, whereas SBP strictly increased across lifespan; and the secular trend in AMC and WC, SBP, DBP was greater in women than in men; younger generations had higher AMC, UAC, TSF, BMI, WC, WHR, WHtR, SBP, DBP levels across adulthood, whereas younger birth cohorts had lower SD, DD, and PA levels.

CONCLUSION

We observed in a large and comprehensive longitudinal dataset that provided strong evidence of population-wide secular shifts from childhood onwards, which suggests that promoting healthier lifestyles, body weight, blood pressure and enhancing the primary practitioner's capability should be required to reduce the burden of NCDs in China.

Typical patterns of modifiable health risk factors (MHRFs) in elderly women in Germany: results from the cross-sectional German Health Update (GEDA) study, 2009 and 2010

BACKGROUND

Modifiable health risk factors (MHRFs) significantly affect morbidity and mortality rates and frequently occur in specific combinations or risk clusters. Using five MHRFs (smoking, high-risk alcohol consumption, physical inactivity, low intake of fruits and vegetables, and obesity) this study investigates the extent to which risk clusters are observed in a representative sample of women aged 65 and older in Germany. Additionally, the structural composition of the clusters is systematically compared with data and findings from other countries.

METHODS

A pooled data set of Germany's representative cross-sectional surveys GEDA09 and GEDA10 was used. The cohort comprised 4,617 women aged 65 and older. Specific risk clusters based on five MHRFs are identified, using hierarchical cluster analysis. The MHRFs were defined as current smoking (daily or occasionally), risk alcohol consumption (according to the Alcohol Use Disorders Identification Test, a sum score of 4 or more points), physical inactivity (less active than 5 days per week for at least 30 min and lack of sports-related activity in the last three months), low intake of fruits and vegetables (less than one serving of fruits and one of vegetables per day), and obesity (a body mass index equal to or greater than 30). A total of 4,292 cases with full information on these factors are included in the cluster analysis. Extended analyses were also performed to include the number of chronic diseases by age and socioeconomic status of group members.

RESULTS

A total of seven risk clusters were identified. In a comparison with data from international studies, the seven risk clusters were found to be stable with a high degree of structural equivalency.

CONCLUSION

Evidence of the stability of risk clusters across various study populations provides a useful starting point for long-term targeted health interventions. The structural clusters provide information through which various MHRFs can be evaluated simultaneously.

Lifestyle changes and prevention of metabolic syndrome in the Heart of New Ulm Project

Prior research has shown that unhealthy lifestyles increase the risk for developing a number of chronic diseases, but there are few studies examining how lifestyle changes impact metabolic syndrome. This study analyzed the association between two-year changes in key lifestyle risk metrics and incident metabolic syndrome in adults. A retrospective cohort study was conducted using data from metabolic syndrome free adults in the Heart of New Ulm Project (New Ulm, MN). The outcome was incident metabolic syndrome observed two years after baseline in 2009. The primary predictor was change in optimal lifestyle score based on four behavioral risk factors, including smoking, alcohol use, fruit/vegetable consumption, and physical activity. In the analytical sample of 1059 adults, 12% developed metabolic syndrome by 2011. Multivariable regression models (adjusted for baseline lifestyle score, age, sex, education, cardiovascular disease, and diabetes) revealed that a two-year decrease in optimal lifestyle score was associated with significantly greater odds of incident metabolic syndrome (OR = 2.92; 95% CI: 1.69, 5.04; p < 0.001). This association was primarily driven by changes in obesity, fruit/vegetable consumption, and alcohol intake. As compared to improving poor lifestyle habits, maintaining a healthy lifestyle seemed to be most helpful in avoiding metabolic syndrome over the two-year study timeframe.

Alterations in microRNA expression associated with alcohol consumption in rectal cancer subjects

Purpose

Alcohol consumption has been purported to influence many diseases. MicroRNAs (miRNAs) may be influenced by compounds found in alcohol. In this investigation, we test the hypothesis that total alcohol, beer, wine, and hard liquor influence miRNA expression.

Methods

We studied 1447 colorectal (CR) cancer cases with normal CR mucosa and carcinoma miRNA expression data along with alcohol consumption data. We analyzed long-term and long-term and current (LTC) alcohol use for beer, liquor, and wine with miRNA expression between paired carcinoma and normal colon and rectal tissues, adjusting for multiple comparisons using the positive false discovery rate q-value. MiRNAs associated significantly with alcohol were examined with all-cause mortality (ACM). MiRNAs associated significantly with ACM were examined with RNA-Seq data.

Results

Expression of 84 miRNAs was associated significantly with LTC wine use in normal rectal mucosa. Higher expression of two of these miRNAs significantly worsened ACM: hsa-miR-210 (Hazard Ratio [HR] 1.12, 95% CI (1.03, 1.21), p-value = 0.004), and hsa-miR-92a-1-5p (HR 1.20, 95% CI (1.04, 1.38), p-value = 0.013). These miRNAs were downregulated across levels of LTC wine consumption.

Conclusions

Our results suggest that wine influences miRNA expression in rectal cancer, supporting the hypothesis that components in alcohol influence miRNA expression.

Electronic supplementary material

The online version of this article (doi:10.1007/s10552-017-0882-2) contains supplementary material, which is available to authorized users.

Psychosocial determinants of clustering health-compromising behaviors among Saudi male adolescents

BACKGROUND AND OBJECTIVES

To assess whether the clustering of six specific health-compromising behaviors, namely, low fruit consumption, high sweet consumption, infrequent tooth brushing, physical inactivity, fighting and smoking, varied by different psychosocial determinants such as life satisfaction, peer relationships, self-confidence, and future orientation among male adolescents in Saudi Arabia.

PATIENTS AND METHODS

A representative stratified cluster random sample of 1335 Saudi Arabian male adolescents living in the city of Riyadh answered a questionnaire on health-related behaviors. Poisson regression models were constructed separately for younger (13-14-years-old) and older (17-19-years-old) adolescents to assess variations between explanatory psychosocial variables and the clustering of six health-compromising behaviors, adjusting for father's education.

RESULTS

Older adolescents who perceived high levels of life satisfaction had a lower rate of clustering of multiple health-compromising behaviors compared to those reporting lower levels (RR: 1.22; 95%CI: 1.09-1.37), and the respective difference between those with high and those with middle levels of satisfaction was marginally non-significant (RR: 1.08; 95%CI: 0.98-1.19). Younger adolescents who reported that they felt "less than always" self-confident were more likely to have high clustering of health compromising behaviors compared to those who were always confident (RR: 1.08; 95%CI: 1.01-1.21). The clustering of multiple health-compromising behaviors was marginally associated with the frequency of evening meetings among older adolescents (RR: 1.03; 95%CI: 1.01-1.04 for each extra meeting), while the respective association among younger adolescents was marginally non-significant (RR: 1.02; 95%CI: 0.99-1.05). The association between clustering of health-compromising behaviors and future orientation was non-significant among both younger and older adolescents.

CONCLUSIONS

Clustering of health-compromising behaviors was found to be associated with perceived life satisfaction and peer relationships among older male Saudi adolescents and with self-confidence among younger male Saudi adolescents in Riyadh.