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Li D, Pan E, Sun Z, Wen J, Su M, Wu M, Su J, Zhou J, Fan H, Shen C. Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program. BMC Public Health 2024; 24:1964. [PMID: 39044169 DOI: 10.1186/s12889-024-19538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors. METHODS Conducted from April to November 2020 in Huai'an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables. RESULTS Higher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels. CONCLUSIONS This study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.
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Affiliation(s)
- Dianjiang Li
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Zhongming Sun
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Jinbo Wen
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Ming Su
- Huai'an District Center for Disease Control and Prevention, Huai'an, China
| | - Ming Wu
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hong Fan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chong Shen
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
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2
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Foster HM, Polz P, Gill JM, Celis-Morales C, Mair FS, O'Donnell CA. The influence of socioeconomic status on the association between unhealthy lifestyle factors and adverse health outcomes: a systematic review. Wellcome Open Res 2023; 8:55. [PMID: 38533439 PMCID: PMC10964004 DOI: 10.12688/wellcomeopenres.18708.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 03/28/2024] Open
Abstract
Background Combinations of lifestyle factors (LFs) and socioeconomic status (SES) are independently associated with cardiovascular disease (CVD), cancer, and mortality. Less advantaged SES groups may be disproportionately vulnerable to unhealthy LFs but interactions between LFs and SES remain poorly understood. This review aimed to synthesise the available evidence for whether and how SES modifies associations between combinations of LFs and adverse health outcomes. Methods Systematic review of studies that examine associations between combinations of >3 LFs (eg.smoking/physical activity/diet) and health outcomes and report data on SES (eg.income/education/poverty-index) influences on associations. Databases (PubMed/EMBASE/CINAHL), references, forward citations, and grey-literature were searched from inception to December 2021. Eligibility criteria were analyses of prospective adult cohorts that examined all-cause mortality or CVD/cancer mortality/incidence. Results Six studies (n=42,467-399,537; 46.5-56.8 years old; 54.6-59.3% women) of five cohorts were included. All examined all-cause mortality; three assessed CVD/cancer outcomes. Four studies observed multiplicative interactions between LFs and SES, but in opposing directions. Two studies tested for additive interactions; interactions were observed in one cohort (UK Biobank) and not in another (National Health and Nutrition Examination Survey (NHANES)). All-cause mortality HRs (95% confidence intervals) for unhealthy LFs (versus healthy LFs) from the most advantaged SES groups ranged from 0.68 (0.32-1.45) to 4.17 (2.27-7.69). Equivalent estimates from the least advantaged ranged from 1.30 (1.13-1.50) to 4.00 (2.22-7.14). In 19 analyses (including sensitivity analyses) of joint associations between LFs, SES, and all-cause mortality, highest all-cause mortality was observed in the unhealthiest LF-least advantaged suggesting an additive effect. Conclusions Limited and heterogenous literature suggests that the influence of SES on associations between combinations of unhealthy LFs and adverse health could be additive but remains unclear. Additional prospective analyses would help clarify whether SES modifies associations between combinations of unhealthy LFs and health outcomes. Registration Protocol is registered with PROSPERO (CRD42020172588;25 June 2020).
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Affiliation(s)
- Hamish M.E. Foster
- General Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, G12 9LX, UK
| | - Peter Polz
- General Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, G12 9LX, UK
| | - Jason M.R. Gill
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scoland, G12 8TA, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scoland, G12 8TA, UK
| | - Frances S. Mair
- General Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, G12 9LX, UK
| | - Catherine A. O'Donnell
- General Practice and Primary Care, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, G12 9LX, UK
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3
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da Silva Goncalves dos Santos J, de Farias Meirelles B, de Souza da Costa Brum I, Zanchetta M, Xerem B, Braga L, Haiut M, Lanziani R, Musa TH, Cordovil K. First Clinical Nutrition Outpatient Consultation: A Review of Basic Principles in Nutritional Care of Adults with Hematologic Disease. ScientificWorldJournal 2023; 2023:9303798. [PMID: 37780637 PMCID: PMC10539097 DOI: 10.1155/2023/9303798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Methods A bibliographic survey was carried out between 2020 and 2022 using two databases: PubMed/MEDLINE and Scientific Electronic Library Online (SciELO) and the information source Academic Google, irrespective of language or geography. Results In the first nutrition consultation (FNC), there should be an investigative direction focused on nutritional interventions in the short, medium, and long term. The record in the patient's medical record is relevant for carrying out the consultation, according to the recommendations of the normative councils of medicine and nutrition. The main steps to be followed are the investigation of the presence of food allergies and intolerances; the drugs/nutritional supplements in use; changes in the digestive tract; the presence or absence of picamalacia; and socioeconomic and lifestyle data. In addition, it is necessary to carry out laboratory evaluations, semiological assessment, anthropometric assessment, and assessment of food consumption. In the end, the nutritional approach should be composed of calculation of energy and macronutrient and micronutrient needs, intervention in nutritional status deviations, nutritional guidelines, and nutritional therapeutic planning of return, focusing on adherence to treatment. Conclusion The first nutrition consultation may represent investigative steps that help the clinical nutritionist in the management, allowing a longitudinal and specific nutritional therapeutic planning for patients assisted in large reference centers for hematological disease.
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Affiliation(s)
- Julia da Silva Goncalves dos Santos
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Isabela de Souza da Costa Brum
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Mariana Zanchetta
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Bruna Xerem
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Lucas Braga
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Marcia Haiut
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Renata Lanziani
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Taha Hussein Musa
- Biomedical Research Institute, Darfur University College, Nyala, Sudan
| | - Karen Cordovil
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
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Cockerham WC. Health Lifestyle Theory in a Changing Society: The Rise of Infectious Diseases and Digitalization. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:437-451. [PMID: 36912383 DOI: 10.1177/00221465231155609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Social change produces alterations in society that necessitate changes in sociological theories. Two significant changes affecting health lifestyle theory are the behaviors associated with the COVID-19 pandemic and the digitalization of society. The health-protective practices emerging from the ongoing pandemic and the recent parade of other newly emerging infectious diseases need to be included in the theory's framework. Moreover, the extensive digitalization of today's society leads to the addition of connectivities (electronic networks) as a structural variable. Connectivities serve as a computational authority influencing health lifestyle practices through health apps and other digital resources in contrast to collectivities (human social networks) as a normative authority. The recent literature supporting these features in an updated and expanded model of health lifestyle theory is discussed.
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Affiliation(s)
- William C Cockerham
- University of Alabama at Birmingham, Birmingham, AL, USA
- College of William & Mary, Williamsburg, VA, USA
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5
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Niemelä O, Bloigu A, Bloigu R, Aalto M, Laatikainen T. Associations between Liver Enzymes, Lifestyle Risk Factors and Pre-Existing Medical Conditions in a Population-Based Cross-Sectional Sample. J Clin Med 2023; 12:4276. [PMID: 37445311 DOI: 10.3390/jcm12134276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
While alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) enzymes are commonly used indicators of liver dysfunction recent studies have suggested that these may also serve as predictive biomarkers in the assessment of extrahepatic morbidity. In order to shed further light on the interactions between serum liver enzyme abnormalities, factors of lifestyle and health status we examined ALT and GGT activities in a population-based sample of 8743 adult individuals (4048 men, 4695 women from the National FINRISK 2002 Study, mean age 48.1 ± 13.1 years) with different levels of alcohol drinking, smoking, physical activity, body weight and the presence or absence of various pre-existing medical conditions. The assessments also included laboratory tests for inflammation, lipid status and fatty liver index (FLI), a proxy for fatty liver. The prevalence of ALT and GGT abnormalities were significantly influenced by alcohol use (ALT: p < 0.0005 for men; GGT: p <0.0005 for both genders), smoking (GGT: p <0.0005 for men, p =0.002 for women), adiposity (p < 0.0005 for all comparisons), physical inactivity (GGT: p <0.0005; ALT: p <0.0005 for men, p <0.05 for women) and coffee consumption (p <0.0005 for GGT in both genders; p <0.001 for ALT in men). The total sum of lifestyle risk factor scores (LRFS) influenced the occurrence of liver enzyme abnormalities in a rather linear manner. Significantly higher LRFS were observed in the subgroups of individuals with pre-existing medical conditions when compared with those having no morbidities (p <0.0005). In logistic regression analyses adjusted for the lifestyle factors, both ALT and GGT associated significantly with fatty liver, diabetes and hypertension. GGT levels also associated with coronary heart disease, angina pectoris, cardiac insufficiency, cerebrovascular disease, asthma and depression. Combinations of abnormal ALT and GGT activities significantly increased the odds for hypertension coinciding with abnormalities in biomarkers of inflammation, lipid status and FLI. The data indicates that ALT and GGT activities readily respond to unfavorable factors of lifestyle associating also with a wide array of pre-existing medical conditions. The data supports close links between both hepatic and extrahepatic morbidities and lifestyle risk factors and may open new insights on a more comprehensive use of liver enzymes in predictive algorithms for assessing mechanistically anchored disease conditions.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Aini Bloigu
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, 33100 Tampere, Finland
| | - Tiina Laatikainen
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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6
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Troeschel AN, Byrd DA, Judd S, Flanders WD, Bostick RM. Associations of dietary and lifestyle inflammation scores with mortality due to CVD, cancer, and all causes among Black and White American men and women. Br J Nutr 2023; 129:523-534. [PMID: 35535479 PMCID: PMC9646926 DOI: 10.1017/s0007114522001349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One potential mechanism by which diet and lifestyle may affect chronic disease risk and subsequent mortality is through chronic systemic inflammation. In this study, we investigated whether the inflammatory potentials of diet and lifestyle, separately and combined, were associated with all-cause, all-CVD and all-cancer mortality risk. We analysed data on 18 484 (of whom 4103 died during follow-up) Black and White men and women aged ≥45 years from the prospective REasons for Geographic and Racial Differences in Stroke study. Using baseline (2003-2007) Block 98 FFQ and lifestyle questionnaire data, we constructed the previously validated inflammation biomarker panel-weighted, 19-component dietary inflammation score (DIS) and 4-component lifestyle inflammation score (LIS) to reflect the overall inflammatory potential of diet and lifestyle. From multivariable Cox proportional hazards models, the hazards ratios (HR) and their 95 % CI for the DIS-all-cause mortality and LIS-all-cause mortality risk associations were 1·32 (95 % CI (1·18, 1·47); Pfor trend < 0·01) and 1·25 (95 % CI (1·12, 1·38); Pfor trend < 0·01), respectively, among those in the highest relative to the lowest quintiles. The findings were similar by sex and race and for all-cancer mortality, but weaker for all-CVD mortality. The joint HR for all-cause mortality among those in the highest relative to the lowest quintiles of both the DIS and LIS was 1·91 (95 % CI 1·57, 2·33) (Pfor interaction < 0·01). Diet and lifestyle, via their contributions to systemic inflammation, separately, but perhaps especially jointly, may be associated with higher mortality risk among men and women.
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Affiliation(s)
- Alyssa N. Troeschel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Doratha A. Byrd
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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7
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Foster HM, Polz P, Gill JM, Celis-Morales C, Mair FS, O'Donnell CA. The influence of socioeconomic status on the association between unhealthy lifestyle factors and adverse health outcomes: a systematic review. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18708.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Combinations of lifestyle factors (LFs) and socioeconomic status (SES) are independently associated with cardiovascular disease (CVD), cancer, and mortality. Less advantaged SES groups may be disproportionately vulnerable to unhealthy LFs but interactions between LFs and SES remain poorly understood. This review aimed to synthesise the available evidence for whether and how SES modifies associations between combinations of LFs and adverse health outcomes. Methods: Systematic review of studies that examine associations between combinations of >3 LFs and health outcomes and report data on SES influences on associations. Databases (PubMed/EMBASE/CINAHL), references, forward citations, and grey-literature were searched from inception to December 2021. Eligibility criteria were analyses of prospective adult cohorts that examined all-cause mortality or CVD or cancer mortality/incidence. Results: Six studies (n=42,467–399,537; 46.5–56.8 years old; 54.6–59.3% women) of five cohorts were included. All examined all-cause mortality; three assessed CVD/cancer outcomes. Four studies observed multiplicative interactions between LFs and SES, but in opposing directions. Two studies tested for additive interactions; interactions were observed in one cohort (UK Biobank) and not in another (NHANES). All-cause mortality HRs (95% CIs) for unhealthy LFs (versus healthy LFs) from the most advantaged SES groups ranged from 0.68 (0.32–1.45) to 4.17 (2.27–7.69). Equivalent estimates from the least advantaged ranged from 1.30 (1.13–1.50) to 4.00 (2.22–7.14). In 19 analyses (including sensitivity analyses) of joint associations between LFs, SES, and all-cause mortality, highest all-cause mortality was observed in the unhealthiest LF-least advantaged suggesting an additive effect. Conclusions: Limited and heterogenous literature suggests that the influence of SES on associations between combinations of unhealthy LFs and adverse health could be additive but remains unclear. Additional prospective analyses would help clarify whether SES modifies associations between combinations of unhealthy LFs and health outcomes. Registration: Protocol is registered with PROSPERO (CRD42020172588; 25 June 2020).
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8
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Niemelä O, Bloigu A, Bloigu R, Halkola AS, Niemelä M, Aalto M, Laatikainen T. Impact of Physical Activity on the Characteristics and Metabolic Consequences of Alcohol Consumption: A Cross-Sectional Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15048. [PMID: 36429766 PMCID: PMC9690068 DOI: 10.3390/ijerph192215048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Sedentary lifestyle and excessive alcohol drinking are major modifiable risk factors of health. In order to shed further light on the relationships between physical activity and health consequences of alcohol intake, we measured biomarkers of liver function, inflammation, lipid status and fatty liver index tests in a large population-based sample of individuals with different levels of physical activity, alcohol drinking and other lifestyle risk factors. The study included 21,050 adult participants (9940 men, 11,110 women) (mean age 48.2 ± 13.3 years) of the National FINRISK Study. Data on physical activity, alcohol drinking, smoking and body weight were recorded. The participants were classified to subgroups according to gender, levels of physical activity (sedentary, low, moderate, vigorous, extreme), alcohol drinking levels (abstainers, moderate drinkers, heavy drinkers) and patterns (regular or binge, types of beverages preferred in consumption). Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques. Physical activity was linearly and inversely related with the amount of alcohol consumption, with the lowest alcohol drinking levels being observed in those with vigorous or extreme activity (p < 0.0005). Physically active individuals were less frequently binge-type drinkers, cigarette smokers or heavy coffee drinkers than those with sedentary activity (p < 0.0005 for linear trend in all comparisons). In the General Linear Model to assess the main and interaction effects of physical activity and alcohol consumption on biomarker status, as adjusted for anthropometric measures, smoking and coffee consumption, increasing levels of physical activity were found to be associated with more favorable findings on serum GGT (p < 0.0005), ALT (p < 0.0005 for men), cholesterol (p = 0.025 for men; p < 0.0005 for women), HDL-cholesterol (p < 0.0005 for men, p = 0.001 for women), LDL-cholesterol (p < 0.03 for men), triglycerides (p < 0.0005 for men, p < 0.03 for women), CRP (p < 0.0005 for men, p = 0.006 for women) and fatty liver index (p < 0.0005). The data support the view that regular moderate to vigorous physical activity may counteract adverse metabolic consequences of alcohol consumption on liver function, inflammation and lipid status. The role of physical activity should be further emphasized in interventions aimed at reducing health problems related to unfavorable risk factors of lifestyle.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine, Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, 90570 Oulu, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90570 Oulu, Finland
| | - Anni S. Halkola
- Department of Laboratory Medicine, Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Markus Niemelä
- Department of Laboratory Medicine, Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
- Department of Anesthesiology, Oulu University Hospital, 90220 Oulu, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, 33100 Tampere, Finland
| | - Tiina Laatikainen
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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Arena R, Pronk NP, Laddu D, Whitsel LP, Sallis JF, Lavie CJ. Mapping One Million COVID-19 Deaths and Unhealthy Lifestyle Behaviors in the United States: Recognizing the Syndemic Pattern and Taking Action. Am J Med 2022; 135:1288-1295. [PMID: 35820461 PMCID: PMC9270235 DOI: 10.1016/j.amjmed.2022.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/04/2022]
Abstract
Tragically, the United States (US) surpassed one million documented deaths due to the coronavirus disease 2019 (COVID-19) pandemic. A convincing association between unhealthy lifestyle behaviors and poorer outcomes associated with COVID-19 infection has already been demonstrated and communicated by the Centers for Disease Control and Prevention in public health messaging. The US is experiencing not a pandemic, but a syndemic, specifically an unhealthy lifestyle behaviors-chronic diseases-COVID-19 syndemic. This syndemic has almost certainly significantly contributed to the more than one million deaths the United States has experienced during the pandemic. Decades of a high prevalence of unhealthy lifestyle behaviors laid the foundation for our current unfortunate situation by increasing vulnerability to a novel virus, especially among subgroups who have been historically marginalized. As such, a major pathway to defeating this syndemic is through the promotion of healthy living behaviors for all. Now is the time for action appropriate to meet the demands of a syndemic and a new path forward to a healthier and more equitable future.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill.
| | - Nicolaas P Pronk
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; HealthPartners Institute, Minneapolis, Minn; Department of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Science, University of Illinois Chicago; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill
| | - Laurie P Whitsel
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; American Heart Association, Washington, DC
| | - James F Sallis
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, Australia
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Ill; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, La
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10
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Effects of lifestyle risk behaviour clustering on cardiovascular disease among UK adults: latent class analysis with distal outcomes. Sci Rep 2022; 12:17349. [PMID: 36253519 PMCID: PMC9576714 DOI: 10.1038/s41598-022-22469-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/14/2022] [Indexed: 01/10/2023] Open
Abstract
Lifestyle risk behaviours such as smoking, physical inactivity, and unhealthy diet account for a considerable disease burden globally. These risk behaviours tend to cluster within an individual, which could have detrimental health effects. In this study, we aimed to examine the clustering effect of lifestyle risk behaviours on cardiovascular disease (CVD) and CVD risk among adults in the United Kingdom (UK). We performed a latent class (LC) analysis with distal outcomes using the UK Biobank baseline (2006-2010) data. First, we estimated LC measurement models, followed by an auxiliary model conditional on LC variables. We reported continuous (mean difference-MD) and binary (odds ratio-OR) outcomes with 95% confidence intervals. We included 283,172 and 174,030 UK adults who had data on CVD and CVD risk, respectively. Multiple lifestyle risk behaviour clustering (physically inactive, poor fruit & vegetable intake, high alcohol intake, and prolonged sitting) had a 3.29 mean increase in CVD risk compared to high alcohol intake. In addition, adults with three risk behaviours (physically inactive, poor fruit & vegetable intake, and high alcohol intake) had 25.18 higher odds of having CVD than those with two risk behaviours (physically inactive, and poor fruit and vegetable intake). Social deprivation, gender and age were also associated with CVD. Individuals' LC membership with two or more lifestyle risk behaviours negatively affects CVD. Interventions targeting multiple lifestyle behaviours and social circumstances should be prioritized to reduce the CVD burden.
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11
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Menotti A, Puddu PE, Catasta G. Determinants of longevity and age at death in a practically extinct cohort of middle-aged men followed-up for 61 years. Aging Clin Exp Res 2022; 34:1247-1258. [PMID: 35032326 DOI: 10.1007/s40520-021-02059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore possible determinants of longevity as a function of many personal characteristics in a cohort of middle-aged men followed-up until practical extinction. MATERIALS AND METHODS In the Italian Rural Area of the Seven Countries Study, 1712 men aged 40-59 were examined in 1960 and 35 personal characteristics were measured. The subsequent follow-up for life status was of 61 years when only 3 men survived. A Kaplan-Meier curve was computed. A Cox model was solved with all-cause mortality as end-point and 35 potential determinants as covariates. A Multiple Linear Regression (MLR) model was also solved with the same covariates and age at death (AD) as end-point. RESULTS After 61 years, 99.8% of men had died and median age at death was 75. Beneficial risk factors for both models (p < 0.05) were: never smoker, vigorous physical activity, prudent and Mediterranean diets, arm circumference, subscapular skinfold, and vital capacity. Adverse risk factors (p < 0.05) were: mother early death, laterality/linearity index, systolic blood pressure, serum cholesterol, corneal arcus, xanthelasma, cardiovascular diseases, cancer, diabetes, and chronic bronchitis. Some arbitrary combinations of selected risk factors were used to estimate AD as a function of coefficients of the MLR, showing large differences up to 10 years or more. CONCLUSIONS Several personal characteristics of anthropometric, behavioral, biophysical, biochemical, and clinical nature are strongly associated with longevity when measured in middle-aged men and then followed up until extinction.
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Affiliation(s)
| | - Paolo Emilio Puddu
- Association for Cardiac Research, Via Savoia, 78, 00198, Rome, Italy.
- EA 4650, Signalisation, Electrophysiologie et Imagerie des Lésions d'Ischémie Reperfusion Myocardique, UNICAEN, 14000, Caen, France.
| | - Giovina Catasta
- Centro di Ricerca per gli Alimenti e la Nutrizione, CREA-NUT, Rome, Italy
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12
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Mo PKH, Wong ELY, Yeung NCY, Wong SYS, Chung RY, Tong ACY, Ko CCY, Li J, Yeoh EK. Differential associations among social support, health promoting behaviors, health-related quality of life and subjective well-being in older and younger persons: a structural equation modelling approach. Health Qual Life Outcomes 2022; 20:38. [PMID: 35246166 PMCID: PMC8895671 DOI: 10.1186/s12955-022-01931-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Extensive studies have confirmed social support as a critical protective factor of people’s health-related quality of life (HRQoL) and subjective well-being (SWB). However, health promoting behaviors as a potential mechanism and age differences in this mechanism has received fewer attention. This study aims to examine the associations among social support, health promoting behaviors, HRQoL and SWB in older and younger persons in Hong Kong. Method A convenience sample of both younger (12–35 years old) and older persons (55 years old and above) were recruited from three non-government organizations to complete a survey. Structural Equation Model (SEM) was conducted to test both the measurement model and structural models to examine the relationship between social support, health promoting behaviors, HRQoL and SWB. Multi-group SEM was also performed and compared to test whether there were significant age differences in the pathways between the key variables. Results A final sample of 408 participants (older-persons: N = 200 (mean age: 71.63 (8.16); 180/200 female), younger-persons: N = 208 (mean age: 18.10 (5.04); 155/208 female) were included in the final analysis. Results showed that social support was positively associated with SWB directly and indirectly through health promoting behaviors for the whole sample (CFI = .95, IFI = .94, RMSEA = .07, SRMR = 0.056). Results suggested that the association between the variables differed across age samples. While social support showed a positive association with health promoting behaviors for both younger and older persons, how each of them associated with HRQoL and SWB was different. Conclusion Findings suggest that the pathway which social support linked with HRQoL and SWB might differ across age groups. Age-specific strategies should be considered when promoting HRQoL and SWB among the younger and older population. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01931-z.
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Affiliation(s)
- Phoenix K H Mo
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eliza L Y Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Nelson C Y Yeung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Y S Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Roger Y Chung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chris C Y Ko
- Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Jia Li
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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13
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Gray KE, Hoerster KD, Taylor L, Krieger J, Nelson KM. Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Transl Behav Med 2021; 11:2144-2154. [PMID: 34424331 PMCID: PMC8670415 DOI: 10.1093/tbm/ibab113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
People with low incomes have a disproportionate prevalence of diabetes and its complications and experience many barriers to self-management, which community health workers (CHWs) may help address. We sought to examine the effects of an in-home CHW-led intervention for adults with diabetes and incomes <250% of the federal poverty line on self-management behaviors and test mediators and moderators. From 2010 to 2013, we randomized participants from three Washington State health systems with type 2 diabetes and hemoglobin A1c (HbA1c) ≥ 8% to the CHW intervention (N = 145) or usual care control (N = 142) arms. We examined effects on 12-month self-management: physical activity, dietary behaviors, medication taking, blood glucose monitoring, foot care, and tobacco use. For behaviors with significant intervention-control group differences, we tested mediation by self-efficacy and social support. We also investigated whether intervention-associated changes in behaviors varied by race/ethnicity, gender, and baseline values of HbA1c, diabetes distress, depression, and food insecurity (moderators). Compared to controls, intervention participants engaged in more physical activity and reported better dietary behaviors for some measures (general diet, frequency of skipping meals, and frequency of eating out) at 12-months, but there was no evidence of mediation by self-efficacy or social support. Evidence of moderation was limited: improvements in the frequency of skipping meals were restricted to participants with baseline HbA1c < 10%. Study findings suggest CHWs could be integrated into diabetes care to effectively support lifestyle changes around physical activity and some eating behaviors among adults with low incomes. More research is needed to understand mechanisms of change.
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Affiliation(s)
- Kristen E Gray
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Katherine D Hoerster
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Leslie Taylor
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - James Krieger
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Healthy Food America, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karin M Nelson
- Department of Veterans Affairs, Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- General Internal Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA
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14
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Nanda S, Chon TY, Mahapatra S, Lindeen SA, Fischer KM, Krüger M, Schierwater B, Schmidt CO, Wahner-Roedler DL, Bauer BA. Preventiometer, a Novel Wellness Assessment Device, Used With Healthy Volunteers: A Phase 2 Study. Glob Adv Health Med 2021; 10:21649561211045016. [PMID: 34840917 PMCID: PMC8619782 DOI: 10.1177/21649561211045016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background We previously reported on a pilot study to assess the incorporation of a novel wellness assessment device, the Preventiometer (iPEx5 GmbH, Greifswald, Germany), into an academic medical practice. The present follow-up study expands on those data and evaluates the acceptability of the assessment process in a larger sample population. Objective The aim of this study was to evaluate participant satisfaction with the Preventiometer wellness assessment. Methods A total of 60 healthy volunteers participated. Each participant underwent a comprehensive wellness assessment with the Preventiometer and received data from more than 30 diagnostic tests. A 32-question survey (with a numeric rating scale from 0 to 10) was used to rate the wellness assessment tests and participants' impressions of the wellness assessment. Results Each assessment had a significantly higher rating than 7 (P < .001), and the majority of participants agreed or strongly agreed that they were satisfied (98.3%), and they strongly agreed that they were engaged the entire time (93.2%), and liked the instant test results feature of the Preventiometer device (93.2%). Conclusion This study confirms findings from our previous pilot study regarding the feasibility of the Preventiometer as a wellness assessment tool. The study further demonstrated that 98% of participants were satisfied with the assessment and that all of them would recommend it to others.
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Affiliation(s)
| | - Tony Y Chon
- Division of General Internal Medicine, MN, USA
| | | | | | | | - Markus Krüger
- Institute for Community Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Oral Health, Universitätsmedizin Greifswald, Germany
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15
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Aburto MJ, Romero D, Rezende LFM, Sanchez ZM, Bolados CC, Guzmán-Habinger J, Rios M, Suárez-Reyes M, Marques A, Drenowatz C, Cristi-Montero C, Ferrari G. Prevalence and co-occurrence of lifestyle risk factors for non-communicable diseases according to sociodemographic characteristics among adults Chilean residents. Sci Rep 2021; 11:21702. [PMID: 34737379 PMCID: PMC8569195 DOI: 10.1038/s41598-021-01167-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 01/03/2023] Open
Abstract
To examine the prevalence and co-occurrence of lifestyle risk factors for non-communicable diseases (NCDs) according to sociodemographic characteristics in Chilean residents. A cross-sectional study based on data from 5995 adults from the Chilean National Health Survey. The lifestyle risk factors included were physical inactivity, tobacco consumption, alcohol consumption, low fruits and vegetable consumption, and overweight/obesity. The most frequent risk factor was overweight/obesity (75.6%), followed by alcohol consumption (74.8%), low fruits and vegetable consumption (51.7%), physical inactivity (36.3%), and tobacco consumption (27.9%). Only 1.0% of the participants did not present any risk factor, while 9.6%, 30.4%, 34.0%, 20.3%, and 4.7% accumulated one, two, three, four, and five risk factors. Men (OR 1.56; 95% CI 1.18; 2.04), people who have secondary education (OR 1.59; 95% CI 1.20; 2.10), and those with lower household income (OR 1.39; 95% CI 1.09; 1.59) had higher odds of three or more risk factors. Associations were inverse for older adults (OR 0.57; 95% CI 0.41; 0.79) and rural geographic areas (OR 0.77; 95% CI 0.67; 0.89). The prevalence of risk factors for NCDs is fairly high in Chilean residents. Interventions may need to target these co-occurrences rather than emphasizing individual risk factors for NCDs. Interventions could further consider these co-occurrences as a potential target for population stratification.
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Affiliation(s)
- María José Aburto
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Las Sophoras 175, Estación Central, Santiago, Chile
| | - Dayna Romero
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Las Sophoras 175, Estación Central, Santiago, Chile
| | - Leandro F M Rezende
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cristian Cofre Bolados
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Las Sophoras 175, Estación Central, Santiago, Chile
| | - Juan Guzmán-Habinger
- Universidad Mayor, Facultad de Ciências, Santiago de Chile, Chile.,Especialidad medicina del deporte y la actividad física, Universidad Mayor, Facultad de Ciencias, Santiago de Chile, Chile
| | - Mario Rios
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Las Sophoras 175, Estación Central, Santiago, Chile
| | - Mónica Suárez-Reyes
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Las Sophoras 175, Estación Central, Santiago, Chile
| | - Adilson Marques
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1499-002, Lisbon, Portugal.,ISAMB, Faculdade de Medicina, Universidade de Lisboa, 1649-028, Lisbon, Portugal
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University of Education Upper Austria, 4020, Linz, Austria
| | - Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaiso, Chile
| | - Gerson Ferrari
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Las Sophoras 175, Estación Central, Santiago, Chile.
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16
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Lifestyle as determinant of all-cause mortality and age at death. A middle-aged male population followed-up 60 years until the survivors were aged 100 years. Aging Clin Exp Res 2021; 33:3091-3098. [PMID: 33835426 DOI: 10.1007/s40520-021-01849-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To relate major lifestyle habits with all-cause mortality in an almost extinct male middle-aged population. MATERIAL AND METHODS A 40-59 aged male population of 1712 subjects was enrolled and examined in 1960 and then followed-up for 60 years. Baseline smoking habits, working physical activity and dietary habits, each subdivided into 3 classes, were related to 60-year mortality, by Kaplan-Meier survival curves, Cox proportional hazards model and to age at death during 60 years by multiple linear regression. RESULTS Death rate in 60 years was of 99.7% with only 5 survivors and 2 lost to follow-up after 50 years. Two out of three classes of each behavior were significantly protective versus the third class in all the statistical approaches. Cox hazard ratios (and their 95% confidence limits) of never smokers versus smokers was 0.71 (0.63-0.79); that of vigorous physical activity versus sedentary activity was 0.75 (0.64-0.89); that of Mediterranean diet versus Not Mediterranean diet was 0.74 (0.66-0.84). The gain of age at death for never smokers versus smokers was 3.32 years (2.05-4.54); of vigorous physical activity versus sedentary activity was 3.53 years (1.68-5.37); that of Mediterranean diet versus Not Mediterranean diet was 3.67 years (2.32-5.02). Age at death was more than 10 years longer for men with the 3 best behaviors than for those with the 3 worst behaviors. CONCLUSIONS Some lifestyle habits are strongly related to lifetime mortality and longevity.
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17
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Maciel de Lima AP, Schneider BC, Bertoldi AD, Tomasi E, Gonzalez MC, Demarco FF, Domingues MR, Bielemann RM. NCD behavioral risk factors and mortality among older adults in Brazil. Clin Nutr ESPEN 2021; 45:462-468. [PMID: 34620356 DOI: 10.1016/j.clnesp.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUNDS & AIMS Literature shows that the most studied concurrent risk factors for mortality in elderly individuals are smoking, inadequate diet, alcohol consumption and physical inactivity. The combination of such habits can increase from 3 to 11 times the chance of death. To measure the association between concurrence of behavioral risk factors (BRF) for non-communicable diseases (NCD's) and mortality up to three years among the elderly. METHODS Cohort study started in 2014 named "COMO VAI?" with community-dwelling aged ≥60 years in Pelotas, Rio Grande do Sul, Brazil. We investigated the deaths from all causes occurred until April 2017. The exposure was defined by the presence of physical inactivity, low-quality diet, alcohol consumption and smoking that composed a score ranging from 0 (none) to 4 (all). Cox proportional hazard regression models were used to evaluate the association between BRF concurrence and mortality. RESULTS In 2014, 1451 elderly people were interviewed, 145 deaths were identified (10%) by April 2017. Higher risk of death was observed for the combinations of physical inactivity + smoking and low-quality diet + physical inactivity. The simultaneous presence of three or more BRF was associated with a nearly six-fold higher risk of death. CONCLUSIONS Higher mortality during a 3-year period was observed among those with at least three BRF for NCD's.
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Affiliation(s)
| | | | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Elaine Tomasi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, RS, Brazil
| | | | | | - Renata Moraes Bielemann
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
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18
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The Mediterranean diet and physical activity: better together than apart for the prevention of premature mortality. Br J Nutr 2021; 128:1413-1424. [PMID: 34462020 PMCID: PMC9530916 DOI: 10.1017/s0007114521002877] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diet and physical activity (PA) have been studied extensively in epidemiology as single or combined lifestyle factors; however, their interaction has not been studied thoroughly. Studying potential synergisms between lifestyle components with a comprehensive interaction analysis, including additive measures of interaction, provides key insights into the nature of their joint effect and helps target interventions more effectively. First, a comprehensive review was conducted to assess the potential research gap regarding reported interaction analyses conducted in studies assessing the Mediterranean diet (MedDiet) in combination with PA on all-cause mortality. Thereafter, we prospectively assessed the joint association of the MedDiet with PA on all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort, followed by both multiplicative and additive interaction analyses. The conjoint effect of low adherence to the MedDiet and low PA observed an increased risk greater than the individual risk factors, suggesting a potential additive interaction or synergism between both exposures, with relative risk due to interaction (RERI) and (95 % confidence interval (95 % CI)) = 0·46 (–0·83 to 1·75) and attributable proportion (95 % CI) due to interaction of 36 % (–0·62, 1·34). No multiplicative interaction was detected. Studying interactions between lifestyle factors, such as the MedDiet and PA, is particularly relevant given the current research gaps in studying the complexities of combined aspects of lifestyle in comparison with isolated behaviours. Our findings underline the important public health message of adhering to both the MedDiet and PA for the prevention of premature mortality.
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19
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English LK, Ard JD, Bailey RL, Bates M, Bazzano LA, Boushey CJ, Brown C, Butera G, Callahan EH, de Jesus J, Mattes RD, Mayer-Davis EJ, Novotny R, Obbagy JE, Rahavi EB, Sabate J, Snetselaar LG, Stoody EE, Van Horn LV, Venkatramanan S, Heymsfield SB. Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review. JAMA Netw Open 2021; 4:e2122277. [PMID: 34463743 PMCID: PMC8408672 DOI: 10.1001/jamanetworkopen.2021.22277] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
Importance The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)? Objective To ascertain the association between dietary patterns consumed and ACM. Evidence Review Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements. Findings A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings. Conclusions and Relevance In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.
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Affiliation(s)
- Laural K. English
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Marlana Bates
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Lydia A. Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Carol J. Boushey
- Epidemiology Program, University of Hawai’i Cancer Center, Honolulu
| | | | - Gisela Butera
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Emily H. Callahan
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
| | - Richard D. Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill
| | - Rachel Novotny
- Nutritional Sciences, Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai’i at Mānoa, Honolulu
| | - Julie E. Obbagy
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
| | | | - Joan Sabate
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
| | | | | | - Linda V. Van Horn
- Nutrition Division, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sudha Venkatramanan
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge
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Botteri E, Berstad P, Sandin S, Weiderpass E. Lifestyle changes and risk of cancer: experience from the Swedish women's lifestyle and health cohort study. Acta Oncol 2021; 60:827-834. [PMID: 33988490 DOI: 10.1080/0284186x.2021.1919756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/15/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND The impact of lifestyle changes on cancer risk is yet to be elucidated. We investigated this issue in the Swedish Women's Lifestyle and Health Cohort Study. MATERIAL AND METHODS We measured changes by comparing two questionnaires, filled in 1991/92 and 2003. We followed women for cancer from 2003 until 2012. We used Cox regression models to assess the effect of changes in smoking, alcohol consumption, body mass index (BMI), physical activity and a lifestyle score on the risk of lifestyle-related cancer. One point was added to the lifestyle score for each of these: non-smoking, alcohol consumption ≤12 grams/day, BMI <25 kg/m2 and high level of physical activity. RESULTS We included 29,930 women. From 1991/92 to 2003, median age changed from 40.0 to 51.7 years, alcohol consumption from 2.5 to 4.7 grams/day, BMI from 22.7 to 24.5 kg/m2, proportion of current smokers from 31.0 to 20.6% and women reporting high physical activity from 27.2 to 37.0%. Women who quit smoking had lower risk of smoking-related cancers compared to women who continued (hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.55-1.00). Women who reduced their weight by more than 5%, compared to women with stable weight, had lower risk of breast cancer (HR 0.49, 95% CI 0.31-0.78). Among women with score of 0-2 in 1992/93, those who improved to 3-4 had lower risk of lifestyle-related cancers compared to women who did not (HR 0.81, 95% CI 0.66-0.99). CONCLUSIONS Healthy lifestyle changes, particularly smoking cessation and weight reduction, were associated with a decreased risk of cancer.
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Affiliation(s)
- Edoardo Botteri
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, NY, USA
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A novel evolutionary-concordance lifestyle score is inversely associated with all-cause, all-cancer, and all-cardiovascular disease mortality risk. Eur J Nutr 2021; 60:3485-3497. [PMID: 33675389 DOI: 10.1007/s00394-021-02529-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/26/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Evolutionary discordance may contribute to the high burden of chronic disease-related mortality in modern industrialized nations. We aimed to investigate the associations of a 7-component, equal-weight, evolutionary-concordance lifestyle (ECL) score with all-cause and cause-specific mortality. METHODS Baseline data were collected in 2003-2007 from 17,465 United States participants in the prospective REasons for Geographic and Racial Differences in Stroke (REGARDS) study. The ECL score's components were: a previously reported evolutionary-concordance diet score, alcohol intake, physical activity, sedentary behavior, waist circumference, smoking history, and social network size. Diet was assessed using a Block 98 food frequency questionnaire and anthropometrics by trained personnel; other information was self-reported. Higher scores indicated higher evolutionary concordance. We used multivariable Cox proportional hazards regression models to estimate ECL score-mortality associations. RESULTS Over a median follow-up of 10.3 years, 3771 deaths occurred (1177 from cardiovascular disease [CVD], 1002 from cancer). The multivariable-adjusted hazard ratios (HR) (95% confidence intervals [CI]) for those in the highest relative to the lowest ECL score quintiles for all-cause, all-CVD, and all-cancer mortality were, respectively, 0.45 (0.40, 0.50), 0.47 (0.39, 0.58), and 0.42 (0.34, 0.52) (all P trend < 0.01). Removing smoking and diet from the ECL score attenuated the estimated ECL score-all-cause mortality association the most, yielding fifth quintile HRs (95% CIs) of 0.56 (0.50, 0.62) and 0.50 (0.46, 0.55), respectively. CONCLUSIONS Our findings suggest that a more evolutionary-concordant lifestyle may be inversely associated with all-cause, all-CVD, and all-cancer mortality. Smoking and diet appeared to have the greatest impact on the ECL-mortality associations.
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Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain. Cardiovasc Diabetol 2021; 20:5. [PMID: 33402187 PMCID: PMC7786987 DOI: 10.1186/s12933-020-01195-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain. Methods Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence). Results Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality. Conclusions The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.
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Cham B, Scholes S, Groce NE, Badjie O, Mindell JS. High level of co-occurrence of risk factors for non-communicable diseases among Gambian adults: A national population-based health examination survey. Prev Med 2020; 141:106300. [PMID: 33121964 DOI: 10.1016/j.ypmed.2020.106300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality globally. Co-occurrence of risk factors predisposes an individual to NCDs; the burden increases cumulatively with the number of risk factors. Our study aimed to examine the co-occurrence of NCD risk factors among adults in The Gambia. This study is based on a random nationally representative sample of 4111 adults aged 25-64 years (78% response rate) with data collected between January and March 2010 in The Gambia using the WHO STEPwise survey methods. We restricted our analysis to non-pregnant participants with valid information on five NCD risk factors: high blood pressure, smoking, obesity, low fruit and vegetable consumption, and physical inactivity (n = 3000 adults with complete data on all risk factors). We conducted age-adjusted and fully-adjusted gender stratified multinomial logistic regression analysis to identify factors associated with the number of NCD risk factors. More than 90% of adults had at least one risk factor. Only 7% (95% CI: 5.2-9.8) had no risk factor; 22% (95% CI: 19.1-24.9) had at least three. Older age and ethnicity were significantly associated with having three or more risk factors (versus none) among men in the fully adjusted model. Lower education, older age, and urban residence were significantly associated with three or more risk factors (versus none) among women. The burden of NCDs is expected to increase in The Gambia if preventive and control measures are not taken. There should be an integrated approach targeting all risk factors, including wider treatment and control of hypertension.
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Affiliation(s)
- Bai Cham
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom; Department of Public Health, University of The Gambia, Brikama Campus, P.O.Box, 3530, Serrekunda, The Gambia; Disease Control and Elimination theme, Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, P.O.Box 273, Banjul, The Gambia.
| | - Shaun Scholes
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
| | - Nora E Groce
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
| | - Omar Badjie
- Non-Communicable Diseases Unit, Ministry of Health, Banjul, The Gambia
| | - Jennifer S Mindell
- Research Department of Epidemiology and Public Health, UCL (University College London), London WC1E 6BT, United Kingdom
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The Association Between the Mediterranean Lifestyle Index and All-Cause Mortality in the Seguimiento Universidad de Navarra Cohort. Am J Prev Med 2020; 59:e239-e248. [PMID: 33220762 DOI: 10.1016/j.amepre.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/22/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Overall lifestyle patterns rather than individual factors may exert greater reductions on chronic disease risk and mortality. The objective is to study the association between a Mediterranean lifestyle index and all-cause and cause-specific mortality. METHODS Investigators analyzed data from 20,494 participants in the Seguimiento Universidad de Navarra cohort in 2019. The Mediterranean lifestyle index is composed of 28 items on food consumption, dietary habits, physical activity, rest, and social interactions that score 0 or 1 point; scores theoretically could range from 0 to 28 points. RESULTS After a median follow-up of 12.1 years, 407 deaths were observed. In the multivariable-adjusted model, high adherence (>14 points) to the Mediterranean lifestyle was associated with a 41% relative reduction in all-cause mortality (hazard ratio=0.59, 95% CI=0.42, 0.83) compared with low adherence (3-10 points, p<0.001 for trend). For each additional point, the multivariable hazard ratios for all-cause mortality were 0.95 (95% CI=0.89, 1.02) for food consumption; 1.00 (95% CI=0.92, 1.08) for dietary habits; and 0.73 (95% CI=0.66, 0.80) for physical activity, rest, social habits, and conviviality. Significant interaction with age at last contact (p<0.001) suggested a lower risk for each additional point among participants aged ≥50 years (hazard ratio=0.50, 95% CI=0.34, 0.74), whereas no association was found for participants aged <50 years (hazard ratio=1.15, 95% CI=0.54, 2.44). CONCLUSIONS Adherence to a Mediterranean lifestyle may reduce the risk of mortality in a Spanish cohort of university graduates. Inverse associations were found for the overall Mediterranean lifestyle score and lifestyle block, whereas no associations were observed for the dietary blocks. Future research should consider the Mediterranean lifestyle beyond the Mediterranean diet in different populations for the promotion of healthy longevity. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02669602.
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Birch J, Petty R, Hooper L, Bauld L, Rosenberg G, Vohra J. Clustering of behavioural risk factors for health in UK adults in 2016: a cross-sectional survey. J Public Health (Oxf) 2020; 41:e226-e236. [PMID: 30192965 PMCID: PMC6785700 DOI: 10.1093/pubmed/fdy144] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/26/2018] [Indexed: 01/07/2023] Open
Abstract
Background Foods high in fat, sugar and salt (HFSS) are known to contribute to overweight and obesity. In addition to overweight and obesity, smoking, alcohol consumption and physical inactivity are known risk factors for non-communicable diseases, including several cancers and cardiovascular disease. Methods Secondary analysis of UK-representative cross-sectional survey data of 3293 adults aged 18+. Regression analyses were undertaken to understand the relationship between consumption of HFSS food and soft drinks, alcohol and tobacco and socio-demographics. Clustering analysis identified groupings of health risk factors. Results Males, those aged 18–24 and those from the more deprived groups consumed ready meals and fast food most frequently. Most of the sample (77.3%) engaged in at least one health risk behaviour. Six clusters were identified in the clustering analysis. Older (65+) female respondents were more likely to be inactive. Smokers exhibiting additional risk behaviours were more likely to be of working age from more deprived groups, and men over 65 were more likely to consume harmful levels of alcohol with additional risk factors. Conclusion Policies and services in the UK tend to focus on changing behaviour to address individual risk factors. This study shows that policies and interventions need to address multiple risk factors.
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Affiliation(s)
- Jack Birch
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Robert Petty
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Lucie Hooper
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Linda Bauld
- Cancer Research UK, Angel Building, 407 St. John Street, London, UK.,University of Stirling, Stirling, UK
| | - Gillian Rosenberg
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
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Williamson EJ, Polak J, Simpson JA, Giles GG, English DR, Hodge A, Gurrin L, Forbes AB. Sustained adherence to a Mediterranean diet and physical activity on all-cause mortality in the Melbourne Collaborative Cohort Study: application of the g-formula. BMC Public Health 2019; 19:1733. [PMID: 31878916 PMCID: PMC6933918 DOI: 10.1186/s12889-019-7919-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/08/2019] [Indexed: 12/27/2022] Open
Abstract
Background Adherence to a traditional Mediterranean diet has been associated with lower mortality and cardiovascular disease risk. The relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time remains unknown. Methods We used the parametric G-formula to account for time-dependent confounding, in order to assess the relative importance of diet compared to other lifestyle factors and effects of dietary patterns over time. We included healthy Melbourne Collaborative Cohort Study participants attending a visit during 1995–1999. Questionnaires assessed diet and physical activity at each of three study waves. Deaths were identified by linkage to national registries. We estimated mortality risk over approximately 14 years (1995–2011). Results Of 22,213 participants, 2163 (9.7%) died during 13.6 years median follow-up. Sustained high physical activity and adherence to a Mediterranean-style diet resulted in an estimated reduction in all-cause mortality of 1.82 per 100 people (95% confidence interval (CI): 0.03, 3.6). The population attributable fraction was 13% (95% CI: 4, 23%) for sustained high physical activity, 7% (95% CI: − 3, 17%) for sustained adherence to a Mediterranean-style diet and 18% (95% CI: 0, 36%) for their combination. Conclusions A small reduction in mortality may be achieved by sustained elevated physical activity levels in healthy middle-aged adults, but there may be comparatively little gain from increasing adherence to a Mediterranean-style diet.
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Affiliation(s)
- Elizabeth J Williamson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. .,, Health Data Research UK (HDR UK), UK.
| | - Julia Polak
- The Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Victoria, Australia
| | - Julie A Simpson
- The Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Allison Hodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Lyle Gurrin
- The Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew B Forbes
- The Victorian Centre for Biostatistics (ViCBiostat), Melbourne, Victoria, Australia.,Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sotos-Prieto M, Mattei J, Cook NR, Hu FB, Willett WC, Chiuve SE, Rimm EB, Sesso HD. Association Between a 20-Year Cardiovascular Disease Risk Score Based on Modifiable Lifestyles and Total and Cause-Specific Mortality Among US Men and Women. J Am Heart Assoc 2019; 7:e010052. [PMID: 30373451 PMCID: PMC6404201 DOI: 10.1161/jaha.118.010052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The previously validated Healthy Heart Score effectively predicted the 20‐year risk of cardiovascular disease (CVD). We examine whether the Healthy Heart Score may extend to an association with total and cause‐specific mortality. Methods and results The prospective cohort study investigated 58 319 women (mean age 50.2 years) in the Nurses’ Health Study (1984–2010) and 29 854 in men (mean age 52.7 years) in the Health Professionals’ Follow‐up Study (1986–2010) free of cancer and CVD at baseline. The Healthy Heart Score included baseline current smoking; high body mass index; low physical activity; no or excessive alcohol intake; low intake of fruits and vegetables, cereal fiber, or nuts; and high intake of sugar‐sweetened beverages or red/processed meats. There were 19 122 total deaths. Compared with participants in the first quintile of the Healthy Heart Score (lowest CVD risk), participants in the fifth quintile (highest CVD risk) had a pooled hazard ratio of 2.26 (95% confidence interval [CI], 1.53–3.33) for total mortality; 2.85 (95 % CI, 1.92–4.23) for CVD mortality, and 2.14 (95% CI, 1.56–2.95) for cancer mortality. Participants in the fifth versus the first quintile also had significantly greater risk of death due to coronary heart disease (3.37; 95% CI, 2.16–5.25), stroke (1.75; 95% CI, 1.02–2.99), lung cancer (6.04; 95% CI, 2.78–13.13), breast cancer (1.45; 95% CI, 1.14–1.86), and colon cancer (1.51; 95% CI, 1.18–1.93). Conclusions The Healthy Heart Score, composed of 9 self‐reported, modifiable lifestyle predictors of CVD, is a potentially useful tool for the counseling of healthy lifestyles that was strongly associated with greater risk of all‐cause, CVD, and cancer mortality.
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Affiliation(s)
- Mercedes Sotos-Prieto
- 1 School of Applied Health Sciences and Wellness Ohio University Athens OH.,2 Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,3 Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA
| | - Josiemer Mattei
- 2 Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA
| | - Nancy R Cook
- 4 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,6 Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Frank B Hu
- 2 Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,4 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,5 Channing Division of Network Medicine Harvard Medical School Boston MA
| | - Walter C Willett
- 2 Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,4 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,5 Channing Division of Network Medicine Harvard Medical School Boston MA
| | - Stephanie E Chiuve
- 2 Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,4 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,6 Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
| | - Eric B Rimm
- 2 Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA.,4 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,5 Channing Division of Network Medicine Harvard Medical School Boston MA
| | - Howard D Sesso
- 4 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,6 Division of Preventive Medicine Department of Medicine Brigham and Women's Hospital and Harvard Medical School Boston MA
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Lacombe J, Armstrong MEG, Wright FL, Foster C. The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: a systematic review. BMC Public Health 2019; 19:900. [PMID: 31286911 PMCID: PMC6615183 DOI: 10.1186/s12889-019-7030-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 05/22/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Regular physical activity improves overall health, and has the capacity to reduce risk of chronic diseases and death. However, better understanding of the relationship between multiple lifestyle risk behaviours and disease outcomes is pertinent for prioritising public health messaging. The aim of this systematic review is to examine the association between physical inactivity in combination with additional lifestyle risk behaviours (smoking, alcohol, diet, or sedentary behaviour) for cardiovascular disease, cancer, and all-cause mortality. METHODS We searched Ovid Medline, EMBASE, and the Cochrane Register from 1 January 2010 to 12 December 2017, for longitudinal observational studies of adults (18+ years) in the general population with a publication date of 2010 onwards and no language restriction. Main exposure variables had to include a physical activity measure plus at least one other lifestyle risk factor. In total, 25,639 studies were identified. Titles, abstracts and full-text articles of potentially relevant papers were screened for eligibility. Data was extracted and quality assessment was completed using a modified Newcastle-Ottawa Scale (NOS). RESULTS Across the 25 eligible studies, those participants who reported being physically active combined with achieving other health behaviour goals compared to those who were categorised as physically inactive and did not achieve other positive lifestyle goals, were at least half as likely to experience an incident cardiovascular disease (CVD) event, die from CVD, or die from any cause. These findings were consistent across participant age, sex, and study length of follow-up, and even after excluding lower quality studies. We also observed a similar trend among the few studies which were restricted to cancer outcomes. Most studies did not consider epidemiological challenges that may bias findings, such as residual confounding, reverse causality by pre-existing disease, and measurement error from self-report data. CONCLUSIONS High levels of physical activity in combination with other positive lifestyle choices is associated with better health outcomes. Applying new approaches to studying the complex relationships between multiple behavioural risk factors, including physical activity, should be a priority.
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Affiliation(s)
- Jason Lacombe
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
| | - Miranda E G Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, Bristol, UK
| | - F Lucy Wright
- Unit of Health Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Old Road, Oxford, OX3 7LF, UK
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, Bristol, UK
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Nivukoski U, Niemelä M, Bloigu A, Bloigu R, Aalto M, Laatikainen T, Niemelä O. Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status. PLoS One 2019; 14:e0218463. [PMID: 31220128 PMCID: PMC6586311 DOI: 10.1371/journal.pone.0218463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/03/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Adopting a healthy lifestyle is associated with prolonged life expectancy. The main modifiable lifestyle-related risk factors are hazardous alcohol drinking, smoking, excess body weight and lack of physical activity. Our aim was to estimate the impact of unfavourable lifestyle factors on abnormalities in laboratory tests reflecting liver status, inflammation and lipid metabolism in a population-based cross-sectional study. METHODS The study included 22,273 participants (10,561 men, 11,712 women) aged 25-74 years from the National FINRISK Study. Data on alcohol use, smoking, body weight, and physical activity were recorded from structured interviews. The risk scores for the various life style factors were established on a 0-8 scale and used to stratify the population in classes to allow estimates of their joint effects. Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques. RESULTS Consistent dose-response relationships were observed between the number of unfavourable risk factors and serum levels of GGT, ALT, CRP, cholesterol, HDL, LDL and triglycerides (p < 0.0005 for linear trend in all comparisons). When compared with those with zero risk factors, the multivariable-adjusted odds ratios (ORs) for abnormalities in all biomarkers were significantly higher in those with a sum of risk score two or more. The most striking increases in ORs in the group with the highest numbers of risk factors were observed among men in serum GGT: 26.6 (12.4-57.0), ALT: 40.3 (5.3-307.8), CRP: 16.2 (7.8-33.7) and serum triglycerides: 14.4 (8.6-24.0). CONCLUSIONS The data support the view that the presence of unfavourable life style risk factors is associated with distinct abnormalities in laboratory tests for liver function, inflammation and lipid status. Such biomarkers may prove to be of value in the assessment of interventions aimed at reducing unfavourable risk factors and in helping individuals in long-term maintenance of lifestyle modifications.
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Affiliation(s)
- Ulla Nivukoski
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland
| | - Markus Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland
- Department of Medicine, University of Oulu, Oulu, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Risto Bloigu
- Infrastructure for Population studies, University of Oulu, Oulu, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, Tampere, Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL), Helsinki, Finland
- The Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland
- * E-mail:
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Abstract
OBJECTIVE To summarize the recent scientific evidence regarding the wellness-promoting capacity of the Mediterranean lifestyle (ML), with a special focus on physical, social and environmental wellness. DESIGN Narrative review of English-language publications in PubMed, Scopus and Embase, from 1 January 2010 to 31 October 2018. SETTING Prospective cohort studies, interventional studies, meta-analyses and reviews of those investigating the effect of at least one component of the ML on wellness parameters. PARTICIPANTS General population. RESULTS Although an explicit definition of ML is missing, compliance with various combinations of its components improves metabolic health and protects against or ameliorates disease state. However, there is heterogeneity in the healthy behaviours that the ML-focused studies include in their design and the way these are assessed. Also, despite that features of the ML could contribute to other wellness dimensions, there are no studies exploring the effect this healthy lifestyle could confer to them. CONCLUSIONS Chronic lifestyle diseases are of multifactorial aetiology and they warrant multifaceted approaches targeting the general way of living. ML, if thoroughly evaluated, can provide a valuable tool to holistically promote health and wellness.
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Doherty TM, Del Giudice G, Maggi S. Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion. Ann Med 2019; 51:128-140. [PMID: 31025882 PMCID: PMC7857442 DOI: 10.1080/07853890.2019.1588470] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
As the global population ages, there is concern about the effect of an increased proportion of older individuals on the economic sustainability of healthcare systems and the social effects of an older society. Health authorities and advocacy groups in countries at the forefront of this trend are now developing strategies to ameliorate the social and financial effects of an ageing population. There is broad agreement that for both society and for the individuals, it is important to ensure that increasing lifespans are matched with increased "healthspans" - the number of years spent in good health. There is also growing consensus that vaccination is one of the tools that can play an important role in improving adult health - though currently vaccination coverage is often poor. This review focuses on two issues that consistently appear to be associated with under-vaccination: the low awareness of risk (and potential consequences) for vaccine-preventable diseases and a poor understanding of the value of improved vaccination coverage for adults. We suggest that understanding of vaccination as a health-promoting activity, rather than a medical intervention designed to prevent the spread of a specific pathogen - is a crucial step to improve vaccination uptake among adults (see Supplementary video abstract ). Key messages As populations age globally, we are seeing an increasing burden of vaccine-preventable disease in adults. Adult vaccination against some common diseases has been shown to dramatically improve health and quality of life for older people. Despite the attested benefits, vaccination coverage is almost always poor in adults, even in countries where access is free at point of care. In this article, we discuss what appears to a neglected issue in adult vaccination, that of personal autonomy. We argue that adult vaccination will only be successful if it respects individual autonomy and that this requires treating the choice to vaccinate as a public health issue akin to smoking cessation, exercise and healthy diet.
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Affiliation(s)
| | | | - Stefania Maggi
- c CNR, Institute of Neuroscience - Aging Branch , Padua , Italy
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Sarma EA, Moyer A, Messina CR, Laroche HH, Snetselaar L, Van Horn L, Lane DS. Is There a Spillover Effect of Targeted Dietary Change on Untargeted Health Behaviors? Evidence From a Dietary Modification Trial. HEALTH EDUCATION & BEHAVIOR 2019; 46:569-581. [PMID: 30808245 DOI: 10.1177/1090198119831756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The gateway behavior hypothesis posits that change in a health behavior targeted for modification may promote positive changes in other untargeted health behaviors; however, previous studies have shown inconsistent results. Aims. To examine the patterns and predictors of change in untargeted health behaviors in a large health behavior change trial. Method. Using repeated-measures latent class analysis, this study explored patterns of change in untargeted physical activity, alcohol consumption, and smoking behavior during the first year of the Women's Health Initiative dietary modification trial that targeted total fat reduction to 20% kcal and targeted increased fruit and vegetable intake. Participants were healthy postmenopausal women who were randomly assigned to either the low-fat dietary change intervention (n = 8,193) or a control (n = 12,187) arm. Results. Although there were increases in untargeted physical activity and decreases in alcohol consumption and smoking in the first year, these changes were not consistently associated with study arm. Moreover, although the results of the repeated-measures latent class analysis identified three unique subgroups of participants with similar patterns of untargeted health behaviors, none of the subgroups showed substantial change in the probability of engagement in any of the behaviors over 1 year, and the study arms had nearly identical latent class solutions. Discussion and Conclusion. These findings suggest that the dietary intervention did not act as a gateway behavior for change in the untargeted behaviors and that researchers interested in changing multiple health behaviors may need to deliberately target additional behaviors.
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Affiliation(s)
| | - Anne Moyer
- 1 Stony Brook University, Stony Brook, NY, USA
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Cheng E, Um CY, Prizment A, Lazovich D, Bostick RM. Associations of evolutionary-concordance diet, Mediterranean diet and evolutionary-concordance lifestyle pattern scores with all-cause and cause-specific mortality. Br J Nutr 2018:1-10. [PMID: 30560736 PMCID: PMC6581641 DOI: 10.1017/s0007114518003483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Various individual diet and lifestyle factors are associated with mortality. Investigating these factors collectively may help clarify whether dietary and lifestyle patterns contribute to life expectancy. We investigated the association of previously described evolutionary-concordance and Mediterranean diet pattern scores and a novel evolutionary-concordance lifestyle pattern score with all-cause and cause-specific mortality in the prospective Iowa Women's Health Study (1986-2012). We created the diet pattern scores from Willett FFQ responses, and the lifestyle pattern score from self-reported physical activity, BMI and smoking status, and assessed their associations with mortality, using multivariable Cox proportional hazards regression. Of the 35 221 55- to 69-year-old cancer-free women at baseline, 18 687 died during follow-up. The adjusted hazard ratios (HR) and 95 % CI for all-cause, all CVD, and all-cancer mortality among participants in the highest relative to the lowest quintile of the evolutionary-concordance lifestyle score were, respectively, 0·52 (95 % CI 0·50, 0·55), 0·53 (95 % CI 0·49, 0·57) and 0·51 (95 % CI 0·46, 0·57). The corresponding findings for the Mediterranean diet score were HR 0·85 (95 % CI 0·82, 0·90), 0·83 (95 % CI 0·76, 0·90) and 0·93 (95 % CI 0·84, 1·03), and for the evolutionary-concordance diet score they were close to null and not statistically significant. The lowest estimated risk was among those in the highest joint quintile of the lifestyle score and either diet score (both Pinteraction <0·01). Our findings suggest that (1) a more Mediterranean-like diet pattern and (2) a more evolutionary-concordant lifestyle pattern, alone and in interaction with a more evolutionary-concordant or Mediterranean diet pattern, may be inversely associated with mortality.
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Affiliation(s)
- En Cheng
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Caroline Y. Um
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anna Prizment
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberd M. Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Malakou E, Linardakis M, Armstrong MEG, Zannidi D, Foster C, Johnson L, Papadaki A. The Combined Effect of Promoting the Mediterranean Diet and Physical Activity on Metabolic Risk Factors in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2018; 10:nu10111577. [PMID: 30366431 PMCID: PMC6267322 DOI: 10.3390/nu10111577] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 12/11/2022] Open
Abstract
Adhering to the Mediterranean diet (MD) and physical activity (PA) public health guidelines have independently been linked to health benefits in adults. These behaviours form essential components of the traditional Mediterranean lifestyle. However, their combined effect on metabolic risk has not been systematically assessed. This systematic review with meta-analysis (PROSPERO; CRD42017073958) aimed to examine, for the first time, the combined effect of promoting the MD and PA compared with no treatment, treatment with MD or PA alone, or a different dietary and/or PA treatment, and estimate its magnitude on metabolic risk factors. Medline, Embase, CINAHL and Web of Science were systematically searched until March 2018 for English language controlled interventions reporting the combined effects of the MD and PA on one or multiple metabolic risk factors in adults. Two researchers independently conducted data extraction and risk of bias assessment using a rigorous methodology. Reporting followed PRISMA guidelines. Quality of reporting and risk of bias were assessed using the CONSORT guidelines and the Cochrane Collaboration’s tool, respectively. Data from 12 articles reporting 11 randomised controlled trials (n = 1684) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 42%, 25% and 33% of domains, respectively. Between-study heterogeneity ranged from 44% (triglycerides) to 98% (insulin and high density lipoprotein cholesterol (HDL)-cholesterol). Compared to a control condition, there was strong evidence (p < 0.001) of a beneficial effect of promoting the MD and PA on body weight (−3.68 kg, 95% CI (confidence intervals) −5.48, −1.89), body mass index (−0.64 kg/m2, 95% CI −1.10, −0.18), waist circumference (−1.62 cm, 95% CI −2.58, −0.66), systolic (−0.83 mmHg, 95% CI −1.57, −0.09) and diastolic blood pressure (−1.96 mmHg, 95% CI −2.57, −1.35), HOMA-IR index (−0.90, 95% CI −1.22, −0.58), blood glucose (−7.32 mg/dL, 95% CI −9.82, −4.82), triglycerides (−18.47 mg/dL, 95% CI −20.13, −16.80), total cholesterol (−6.30 mg/dL, 95% CI −9.59, −3.02) and HDL-cholesterol (+3.99 mg/dL, 95% CI 1.22, 6.77). There was no evidence of an effect on insulin concentrations. The data presented here provide systematically identified evidence that concurrently promoting the MD and PA is likely to provide an opportunity for metabolic risk reduction. However, due to the high degree of heterogeneity, most likely due to the variation in control group treatment, and the small number of included studies, findings from the pooled analysis should be interpreted with caution. These findings also highlight the need for high quality randomised controlled trials examining the combined effect of the MD and PA on metabolic risk.
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Affiliation(s)
- Evangelia Malakou
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion 71003, Crete, Greece.
| | - Miranda Elaine Glynis Armstrong
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Dimitra Zannidi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Eleftheriou Venizelou 70, Kallithea 176 76, Athens, Greece.
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, Kaptoge S, Di Angelantonio E, Stampfer M, Willett WC, Hu FB. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. Circulation 2018; 138:345-355. [PMID: 29712712 PMCID: PMC6207481 DOI: 10.1161/circulationaha.117.032047] [Citation(s) in RCA: 403] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/27/2018] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong D. Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiaoran Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Klodian Dhana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephen Kaptoge
- Department of Public Health and Primary Care University of Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- Department of Public Health and Primary Care University of Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom
- National Health Service Blood and Transplant, Cambridge, United Kingdom
| | - Meir Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
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.
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Affiliation(s)
- James W Larrick
- 1 Panorama Research Institute , Sunnyvale, California.,2 Regenerative Sciences Institute , Sunnyvale, California
| | - Andrew R Mendelsohn
- 1 Panorama Research Institute , Sunnyvale, California.,2 Regenerative Sciences Institute , Sunnyvale, California
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Cárdenas-Fuentes G, Subirana I, Martinez-Gonzalez MA, Salas-Salvadó J, Corella D, Estruch R, Fíto M, Muñoz-Bravo C, Fiol M, Lapetra J, Aros F, Serra-Majem L, Tur JA, Pinto X, Ros E, Coltell O, Díaz-López A, Ruiz-Canela M, Schröder H. Multiple approaches to associations of physical activity and adherence to the Mediterranean diet with all-cause mortality in older adults: the PREvención con DIeta MEDiterránea study. Eur J Nutr 2018; 58:1569-1578. [PMID: 29696401 DOI: 10.1007/s00394-018-1689-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/13/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Gabriela Cárdenas-Fuentes
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- PhD Programme in Biomedicine, Department of Experimental and Health Sciences, Universidad Pompeu Fabra, Barcelona, Spain
| | - Isaac Subirana
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel A Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain
| | - Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Valencia, Spain
| | - Ramon Estruch
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Montserrat Fíto
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Muñoz-Bravo
- Department of Public Health and Psychiatry, University of Málaga, Málaga, Spain
| | - Miguel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Institute of Health Sciences, University of Balearic Islands and Son Espases Hospital, Palma de Mallorca, Spain
| | - José Lapetra
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Research Unit, Seville, Spain
| | - Fernando Aros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, University Hospital Araba, Vitoria, Spain
| | - Luis Serra-Majem
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Josep A Tur
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Xavier Pinto
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipids and Vascular Risk Units, Internal Medicine, University Hospital of Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Oscar Coltell
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Computer Languages and Systems, Universitat Jaume I, Castellon, Spain
| | - Andres Díaz-López
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Unit, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, University Hospital of Sant Joan de Reus, Rovira i Virgili University, Reus, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- CIBER Epidemiologia y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
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Sanlier N, Pehlivan M, Sabuncular G, Bakan S, Isguzar Y. Determining the relationship between body mass index, healthy lifestyle behaviors and social appearance anxiety. Ecol Food Nutr 2017; 57:124-139. [PMID: 29281315 DOI: 10.1080/03670244.2017.1419343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to describe the relationship between nutritional status, healthy lifestyle behaviors and social appearance anxiety of individuals aged 20-65 (n = 500). A significant, positive relationship was seen between body mass index and nutrition, and negative relationship between body mass index and spiritual development, interpersonal relations, stress management. There was a negative relationship between the ORTO-15 score and health responsibility, physical activity, nutrition, spiritual development, interpersonal relationships, stress management. There was also a negative relationship between the Social Appearance Anxiety Scale and spiritual development, interpersonal relationships.
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Affiliation(s)
- Nevin Sanlier
- a Faculty of Health Sciences, Nutrition and Dietetics Department , Biruni University , Istanbul , Turkey
| | - Merve Pehlivan
- b Faculty of Health Sciences, Nutrition and Dietetics Department , Gazi University , Ankara , Turkey
| | - Güleren Sabuncular
- c Faculty of Health Sciences, Nutrition and Dietetics Department , Marmara University , İstanbul , Turkey
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Menotti A, Kromhout D, Puddu PE, Alberti-Fidanza A, Hollman P, Kafatos A, Tolonen H, Adachi H, Jacobs DR. Baseline fatty acids, food groups, a diet score and 50-year all-cause mortality rates. An ecological analysis of the Seven Countries Study. Ann Med 2017; 49:718-727. [PMID: 28847158 DOI: 10.1080/07853890.2017.1372622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This analysis deals with the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in 16 cohorts of the Seven Countries Study. MATERIAL AND METHODS A dietary survey was conducted at baseline in cohorts subsamples including chemical analysis of food samples representing average consumptions. Ecologic correlations of dietary variables were computed across cohorts with 50-year all-cause mortality rates, where 97% of men had died. RESULTS There was a 12-year average age at death population difference between extreme cohorts. In the 1960s the average population intake of saturated (S) and trans (T) fatty acids and hard fats was high in the northern European cohorts while monounsaturated (M), polyunsaturated (P) fatty acids and vegetable oils were high in the Mediterranean areas and total fat was low in Japan. The 50-year all-cause mortality rates correlated (r= -0.51 to -0.64) ecologically inversely with the ratios M/S, (M + P)/(S + T) and vegetable foods and the ratio hard fats/vegetable oils. Adjustment for high socio-economic status strengthened (r= -0.62 to -0.77) these associations including MAI diet score. CONCLUSION The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets. KEY MESSAGES We aimed at studying the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in the Seven Countries Study. The 50-year all-cause mortality rates correlated (r = -0.51 to -0.64) ecologically inversely with the ratios M/S [monounsaturated (M) + polyunsaturated (P)]/[saturated (S) + trans (T)] fatty acids and vegetable foods and the ratio hard fats/vegetable oils. After adjustment for high socio-economic status, associations with the ratios strengthened (r = -0.62 to -0.77) including also the MAI diet score. The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets.
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Affiliation(s)
| | - Daan Kromhout
- b Department of Epidemiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.,c Division of Human Nutrition , Wageningen University , Wageningen , The Netherlands.,d Division of Epidemiology and Community Health, School of Public Health , University of Minnesota , Minneapolis , MN , USA
| | - Paolo Emilio Puddu
- e Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences , Sapienza University of Rome , Rome , Italy
| | - Adalberta Alberti-Fidanza
- f Human Nutrition Section, Department of Neurosciences , Tor Vergata University of Rome , Rome , Italy
| | - Peter Hollman
- c Division of Human Nutrition , Wageningen University , Wageningen , The Netherlands
| | - Anthony Kafatos
- g Department of Social Medicine, Preventive Medicine and Nutrition Clinic , University of Crete , Heraklion , Crete , Greece
| | - Hanna Tolonen
- h Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Hisashi Adachi
- i Department of Internal Medicine, Division of Cardio-Vascular Medicine , Kurume University, School of Medicine , Kurume , Japan
| | - David R Jacobs
- d Division of Epidemiology and Community Health, School of Public Health , University of Minnesota , Minneapolis , MN , USA
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Bérard E, Bongard V, Haas B, Dallongeville J, Moitry M, Cottel D, Ruidavets JB, Ferrières J. Score of Adherence to 2016 European Cardiovascular Prevention Guidelines Predicts Cardiovascular and All-Cause Mortality in the General Population. Can J Cardiol 2017; 33:1298-1304. [DOI: 10.1016/j.cjca.2017.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/09/2017] [Accepted: 06/15/2017] [Indexed: 12/21/2022] Open
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Zhang QL, Zhao LG, Zhang W, Li HL, Gao J, Han LH, Zheng W, Shu XO, Xiang YB. Combined Impact of Known Lifestyle Factors on Total and Cause-Specific Mortality among Chinese Men: A Prospective Cohort Study. Sci Rep 2017; 7:5293. [PMID: 28706246 PMCID: PMC5509739 DOI: 10.1038/s41598-017-05079-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/24/2017] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Qing-Li Zhang
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China
| | - Long-Gang Zhao
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China
| | - Wei Zhang
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China
| | - Hong-Lan Li
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China
| | - Jing Gao
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China
| | - Li-Hua Han
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Yong-Bing Xiang
- SKLORG & Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200032, China.
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Byrne DW, Rolando LA, Aliyu MH, McGown PW, Connor LR, Awalt BM, Holmes MC, Wang L, Yarbrough MI. Modifiable Healthy Lifestyle Behaviors: 10-Year Health Outcomes From a Health Promotion Program. Am J Prev Med 2016; 51:1027-1037. [PMID: 27866595 DOI: 10.1016/j.amepre.2016.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Previous studies have examined the impact of healthy lifestyle choices on health-related outcomes; however, given their fragmented, often cross-sectional nature, assessing the relative impact of daily modifiable behaviors on overall long-term outcomes, particularly for a diverse working adult population, remains challenging. METHODS Relationships between ten self-reported healthy lifestyle behaviors and health outcomes during the subsequent 9 years in a cohort of 10,248 participants enrolled during 2003 in a voluntary workplace wellness program were assessed. Cox proportional-hazards models computed hazard ratios (HRs) for lifestyle characteristics associated with time to one of seven self-reported chronic diseases or death. Data were collected between 2003 and 2012 and analyzed between 2014 and 2016. RESULTS Behaviors that most significantly affected future outcomes were low-fat diet, aerobic exercise, nonsmoking, and adequate sleep. A dose-response effect was seen between dietary fat intake and hypertension, obesity, diabetes, heart disease, and hypercholesterolemia. After dietary fat intake, aerobic exercise was the next most significant behavior associated with development of outcomes. Compared with sedentary participants, those who exercised 4 days per week were less likely to develop new-onset diabetes (HR=0.31, 95% CI=0.20, 0.48); heart disease (HR=0.46, 95% CI=0.27, 0.80); and hypercholesterolemia (HR=0.61, 95% CI=0.50, 0.74). Low-fat diet and adequate sleep were more significant than commonly promoted healthy behaviors, such as eating a daily breakfast. CONCLUSIONS Modifiable lifestyle behaviors targeted in health promotion programs should be prioritized in an evidence-based manner. Top priorities for workplace health promotion should include low-fat diet, aerobic exercise, nonsmoking, and adequate sleep.
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Affiliation(s)
- Daniel W Byrne
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.
| | - Lori A Rolando
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Muktar H Aliyu
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Paula W McGown
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
| | - Lisa R Connor
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
| | - Bradley M Awalt
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
| | - Marilyn C Holmes
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
| | - Li Wang
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Mary I Yarbrough
- Vanderbilt Faculty/Staff Health and Wellness, Division of General Internal Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
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Warren Andersen S, Zheng W, Sonderman J, Shu XO, Matthews CE, Yu D, Steinwandel M, McLaughlin JK, Hargreaves MK, Blot WJ. Combined Impact of Health Behaviors on Mortality in Low-Income Americans. Am J Prev Med 2016; 51:344-55. [PMID: 27180031 PMCID: PMC4992598 DOI: 10.1016/j.amepre.2016.03.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION African Americans and low-income whites have higher mortality than the U.S. general population. This study prospectively investigated the combined influence of major lifestyle factors and poverty on mortality in this vulnerable population. METHODS Data were collected in 2002-2009 from 79,101 Southern Community Cohort Study participants, of which 67% were African American and 55% had household incomes <$15,000. Mortality outcomes were identified from the National Death Index though December 31, 2011 (data analyzed in 2014-2015). Healthy behavior scores were created based on tobacco smoking, alcohol intake, diet, physical activity, and sedentary time. The primary analysis was performed based on the score created by counting each participant as having met/not met public health guidelines for each behavior. RESULTS Healthy behavior scores were associated with reduced cancer, cardiovascular disease, and all-cause mortality. Associations were stronger for whites than African Americans: hazard ratios for all-cause mortality comparing participants meeting four or five guidelines versus participants meeting zero were 0.41 (95% CI=0.30, 0.55) for African American men; 0.36 (95% CI=0.24, 0.55) for white men; 0.46 (95% CI=0.36, 0.59) for African American women; and 0.27 (95% CI=0.18, 0.43) for white women. The association between healthy lifestyle and all-cause mortality was weaker among those with incomes <$15,000 than those with higher income, particularly in men (p<0.05 for interaction). CONCLUSIONS This study demonstrates the importance of health behaviors on mortality among all groups, but highlights the need for additional research to identify factors contributing to high risk of mortality among low-income and African American populations.
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Affiliation(s)
- Shaneda Warren Andersen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | | | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Charles E Matthews
- Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Joseph K McLaughlin
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee; International Epidemiology Institute, Rockville, Maryland
| | | | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee; International Epidemiology Institute, Rockville, Maryland
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Lohse T, Faeh D, Bopp M, Rohrmann S. Adherence to the cancer prevention recommendations of the World Cancer Research Fund/American Institute for Cancer Research and mortality: a census-linked cohort. Am J Clin Nutr 2016; 104:678-85. [PMID: 27488239 DOI: 10.3945/ajcn.116.135020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Modifiable lifestyle factors linked to cancer offer great potential for prevention. Previous studies suggest an association between adherence to recommendations on healthy lifestyle and cancer mortality. OBJECTIVES The aim of this study was to examine whether adherence to the cancer prevention recommendations of the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) is associated with reduced all-cause, total cancer, and specific cancer type mortality. DESIGN We built a lifestyle score that included 3 categories, based on the recommendations of the WCRF/AICR. Applying Cox regression models, we investigated the association with all-cause, total cancer, and specific cancer type mortality; in addition, we included cardiovascular disease (CVD) mortality. We used census- and death registry-linked survey data allowing a mortality follow-up for ≤32 y. Our analysis included 16,722 participants. Information on lifestyle score components and confounders was collected at baseline. RESULTS Over a mean follow-up of 21.7 y, 3730 deaths were observed (1332 cancer deaths). Comparing best with poorest category of the lifestyle score showed an inverse association with all-cause (HR: 0.82; 95% CI: 0.75, 0.89) and total cancer (men only, HR: 0.69; 95% CI: 0.57, 0.84) mortality. We estimated that ∼13% of premature cancer deaths in men would have been preventable if lifestyle score levels had been high. Inverse associations were observed for lung, upper aerodigestive tract, stomach, and prostate cancer mortality [men and women combined, HR: 0.72; 95% CI: 0.51, 0.99; HR: 0.49; 95% CI: 0.26, 0.92; HR: 0.34; 95% CI: 0.14, 0.83; HR: 0.48; 95% CI: 0.28, 0.82 (men only), respectively]. CVD mortality was not associated with the lifestyle score (men and women combined, HR: 0.96; 95% CI: 0.82, 1.13). CONCLUSIONS Our results support the importance of adhering to recommendations for a healthy lifestyle with regard to all-cause and cancer mortality. To reduce the burden of cancer in the population, preventive measures should stress the potential of low-risk health behavior patterns rather than of specific risk factors only.
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Affiliation(s)
- Tina Lohse
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | - David Faeh
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and Health Division-Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
| | - Matthias Bopp
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; and
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Berstad P, Botteri E, Larsen IK, Løberg M, Kalager M, Holme Ø, Bretthauer M, Hoff G. Lifestyle changes at middle age and mortality: a population-based prospective cohort study. J Epidemiol Community Health 2016; 71:59-66. [PMID: 27312250 DOI: 10.1136/jech-2015-206760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effect of modifying lifestyle at middle age on mortality has been sparsely examined. METHODS Men and women aged 50-54 years randomised to the control group (no intervention) in the population-based Norwegian Colorectal Cancer Prevention trial were asked to fill in lifestyle questionnaires in 2001 and 2004. Lifestyle scores were estimated ranging from 0 (poorest) to 4 (best) based on health recommendations (non-smoking, daily physical activity, body mass index <25.0 kg/m2 and healthy diet). Outcomes were all-cause, cancer and cardiovascular mortality before 31 December 2013. RESULTS Of the 6886 attainable individuals included in the study, 4211 (61%) responded to the baseline questionnaire in 2001. After a median follow-up of 12.3 years, 226 (5.4%) of the baseline questionnaire responders died; 110 (49%) from cancer and 32 (14%) from cardiovascular disease. For each increment in lifestyle score in 2001, a 21% lower all-cause mortality was observed (HR 0.79, 95% CI 0.67 to 0.94, adjusted for age, sex, occupational working hours and chronic disease or pain during 3 years before enrolment). A one-point increase in lifestyle score from 2001 to 2004 was associated with a 38% reduction in all-cause mortality (adjusted HR 0.62, CI 0.45 to 0.84). The group reporting lifestyle change from score 0-1 (unfavourable) in 2001 to score 2-4 (favourable) in 2004 had 4.8 fewer deaths per 1000 person years, compared with the group maintaining an 'unfavourable' lifestyle (adjusted HR 0.31, CI 0.13 to 0.70 for all-cause mortality). CONCLUSIONS Favourable lifestyle changes at age 50-60 years may prevent early death. TRIAL REGISTRATION NCT00119912; pre-results.
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Affiliation(s)
- Paula Berstad
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Telemark Hospital, Skien, Norway
| | - Edoardo Botteri
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Inger Kristin Larsen
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Magnus Løberg
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Mette Kalager
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Øyvind Holme
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Sørlandet Hospital, Kristiansand, Norway
| | - Michael Bretthauer
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Geir Hoff
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Telemark Hospital, Skien, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
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Menotti A, Puddu PE, Maiani G, Catasta G. Cardiovascular and other causes of death as a function of lifestyle habits in a quasi extinct middle-aged male population. A 50-year follow-up study. Int J Cardiol 2016; 210:173-8. [PMID: 26962972 DOI: 10.1016/j.ijcard.2016.02.115] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/12/2016] [Accepted: 02/20/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To relate major causes of death with lifestyle habits in an almost extinct male middle-aged population. MATERIAL AND METHODS A 40-59 aged male population of 1712 subjects was examined and followed-up for 50 years. Baseline smoking habits, working physical activity and dietary habits were related to 50 years mortality subdivided into 12 simple and 3 composite causes of death by Cox proportional hazard models. Duration of survival was related to the same characteristics by a multiple linear regression model. RESULTS Death rate in 50 years was of 97.5%. Out of 12 simple groups of causes of death, 6 were related to smoking habits, 3 to physical activity and 4 to dietary habits. Among composite groups of causes of death, hazard ratios (and their 95% confidence limits) of never smokers versus smokers were 0.68 (0.57-0.81) for major cardiovascular diseases; 0.65 (0.52-0.81) for all cancers; and 0.72 (0.64-0.81) for all-cause deaths. Hazard ratios of vigorous physical activity at work versus sedentary physical activity were 0.63 (0.49-0.80) for major cardiovascular diseases; 1.01 (0.72-1.41) for all cancers; and 0.76 (0.64-0.90) for all-cause deaths. Hazard ratios of Mediterranean Diet versus non-Mediterranean Diet were 0.68 (0.54-0.86) for major cardiovascular diseases; 0.54 (0.40-0.73) for all cancers; and 0.67 (0.57-0.78) for all-cause deaths. Expectancy of life was 12 years longer for men with the 3 best behaviors than for those with the 3 worst behaviors. CONCLUSIONS Some lifestyle habits are strongly related to lifetime mortality.
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Affiliation(s)
| | - Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
| | - Giuseppe Maiani
- Centro di Ricerca per gli Alimenti e la Nutrizione, CREA-NUT, Rome, Italy
| | - Giovina Catasta
- Centro di Ricerca per gli Alimenti e la Nutrizione, CREA-NUT, Rome, Italy
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Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Menotti A, Puddu PE, Maiani G, Catasta G. Lifestyle behaviour and lifetime incidence of heart diseases. Int J Cardiol 2015; 201:293-9. [PMID: 26301663 DOI: 10.1016/j.ijcard.2015.08.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/30/2015] [Accepted: 08/01/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Investigate the relationship of some behavioural characteristics of a male population with lifetime incidence of heart diseases. MATERIAL AND METHODS In the Italian Rural Areas of the Seven Countries Study of Cardiovascular Diseases, 1677 heart disease-free men aged 40-59 years were followed up during 50 years for lifetime incidence of heart disease up to the age of 90 years. They were classified as coronary heart disease (CHD) and heart diseases of uncertain etiology (HDUE). Baseline cigarette smoking habits (non-smokers and ex-smokers, moderate smokers, heavy smokers), physical activity (sedentary, moderate, vigorous) and eating habits (non-Mediterranean Diet, Prudent Diet and Mediterranean Diet) were related to incidence of heart disease. RESULTS Incidence of CHD and HDUE up to the age of 90 years was 28.8 and 17.7%, respectively. Univariate and multivariate analyses showed strong association of behavioural characteristics with CHD incidence, but not with HDUE incidence. Cox proportional hazard rates for CHD were 1.45 (95% confidence intervals, CI: 1.11-1.90) for heavy smokers versus non-smokers; 0.67 (CI 0.50-0.89) for vigorous activity versus sedentary habits and 0.62 (CI 0.47-0.83) for Mediterranean Diet versus non-Mediterranean Diet. Combining CHD cases with HDUE cases made the predictive picture similar to that of CHD. When some basic risk factors were added to the model results remained substantially unaltered, despite the existence of some correlations of behaviours with risk factors. CONCLUSIONS Behavioural factors including cigarette smoking, physical activity and diet are strong predictors of lifetime incidence of common heart diseases even adding other traditional risk factors.
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Affiliation(s)
| | - Paolo Emilio Puddu
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
| | - Giuseppe Maiani
- CRA Agricultural Research Council - Research Centre on Food and Nutrition (CRA-NUT), Rome, Italy
| | - Giovina Catasta
- CRA Agricultural Research Council - Research Centre on Food and Nutrition (CRA-NUT), Rome, Italy
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Affiliation(s)
- Manja Koch
- aInstitute of Epidemiology, Christian-Albrechts University Kiel, Kiel bNutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
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50
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Koch M, Borggrefe J, Schlesinger S, Barbaresko J, Groth G, Jacobs G, Lieb W, Laudes M, Müller MJ, Bosy-Westphal A, Heller M, Nöthlings U. Association of a lifestyle index with MRI-determined liver fat content in a general population study. J Epidemiol Community Health 2015; 69:732-7. [PMID: 25767131 DOI: 10.1136/jech-2014-204989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 02/24/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND In prior studies, lifestyle indices were associated with numerous disease end points, but the association with fatty liver disease (FLD), a key correlate of cardiometabolic risk, is unknown. The aim was to investigate associations between a lifestyle index with liver fat content. METHODS Liver fat was quantified by MRI as liver signal intensity (LSI) in 354 individuals selected from a population-based cohort from Germany. Exposure to favourable lifestyle factors was quantified using an additive score with each factor modelled as a dichotomous trait. Favourable lifestyle factors were defined as waist circumference below 102 (men) or 88 cm (women), physical activity ≥3.5 h/week, never-smoking and a favourable dietary pattern, which was derived to explain liver fat variation. In a cross-sectional study, multivariable adjusted linear and logistic regression was applied to investigate the association between the lifestyle index (range 0-4, exposure) and LSI (modelled as a continuous trait or dichotomised as a FLD indicator variable, respectively). RESULTS Individuals with four favourable lifestyle factors (n=9%) had lower LSI values (ß -0.40; 95% CI -0.61 to -0.19) and a lower OR (0.09; 95% CI 0.03 to 0.30) for FLD compared with individuals with zero favourable lifestyle factors (n=10%). CONCLUSIONS A healthy lifestyle pattern was associated with less liver fat. Prospective studies are warranted.
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Affiliation(s)
- Manja Koch
- Institute of Epidemiology, Christian-Albrechts University Kiel, Kiel, Germany Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany
| | - Jan Borggrefe
- Department of Radiology, University of Cologne, Cologne, Germany
| | - Sabrina Schlesinger
- Institute of Epidemiology, Christian-Albrechts University Kiel, Kiel, Germany Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany
| | - Janett Barbaresko
- Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany Nutritional Epidemiology, Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Godo Groth
- Clinic for Diagnostic Radiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Gunnar Jacobs
- PopGen Biobank, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts University Kiel, Kiel, Germany
| | - Matthias Laudes
- Institute of Internal Medicine I, Christian-Albrechts University Kiel, Kiel, Germany
| | - Manfred J Müller
- Institute of Human Nutrition and Food Science, Christian-Albrechts University Kiel, Kiel, Germany
| | - Anja Bosy-Westphal
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Martin Heller
- Clinic for Diagnostic Radiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ute Nöthlings
- Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany Nutritional Epidemiology, Department of Nutrition and Food Science, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
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