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Wu J, Feng Y, Zhao Y, Guo Z, Liu R, Zeng X, Yang F, Liu B, Gu J, Tarimo CS, Shao W, Guo X, Li Q, Zhao L, Ma M, Shen Z, Zhao Q, Miao Y. Lifestyle behaviors and risk of cardiovascular disease and prognosis among individuals with cardiovascular disease: a systematic review and meta-analysis of 71 prospective cohort studies. Int J Behav Nutr Phys Act 2024; 21:42. [PMID: 38650004 PMCID: PMC11036700 DOI: 10.1186/s12966-024-01586-7] [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: 11/23/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Healthy lifestyle behaviors (LBs) have been widely recommended for the prevention and management of cardiovascular disease (CVD). Despite a large number of studies exploring the association between combined LBs and CVD, a notable gap exists in integration of relevant literatures. We conducted a systematic review and meta-analysis of prospective cohort studies to analyze the correlation between combined LBs and the occurrence of CVD, as well as to estimate the risk of various health complications in individuals already diagnosed with CVD. METHODS Articles published up to February 10, 2023 were sourced through PubMed, EMBASE and Web of Science. Eligible prospective cohort studies that reported the relations of combined LBs with pre-determined outcomes were included. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using either a fixed or random-effects model. Subgroup analysis, meta-regression, publication bias, and sensitivity analysis were as well performed. RESULTS In the general population, individuals with the healthiest combination of LBs exhibited a significant risk reduction of 58% for CVD and 55% for CVD mortality. For individuals diagnosed with CVD, adherence to the healthiest combination of LBs corresponded to a significant risk reduction of 62% for CVD recurrence and 67% for all-cause mortality, when compared to those with the least-healthy combination of LBs. In the analysis of dose-response relationship, for each increment of 1 healthy LB, there was a corresponding decrease in risk of 17% for CVD and 19% for CVD mortality within the general population. Similarly, among individuals diagnosed with CVD, each additional healthy LB was associated with a risk reduction of 27% for CVD recurrence and 27% for all-cause mortality. CONCLUSIONS Adopting healthy LBs is associated with substantial risk reduction in CVD, CVD mortality, and adverse outcomes among individuals diagnosed with CVD. Rather than focusing solely on individual healthy LB, it is advisable to advocate for the adoption of multiple LBs for the prevention and management of CVD. TRIAL REGISTRATION PROSPERO: CRD42023431731.
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Affiliation(s)
- Jian Wu
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yifei Feng
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuanyuan Zhao
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhiping Guo
- Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Rongmei Liu
- Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xin Zeng
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Fan Yang
- School of Public Health, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Bei Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Jianqing Gu
- Healthy Lifestyle Medicine Research Center, School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, People's Republic of China
| | - Clifford Silver Tarimo
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, P.O. Box 2958, Dar es Salaam, Tanzania
| | - Weihao Shao
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xinghong Guo
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Quanman Li
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lipei Zhao
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Mingze Ma
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhanlei Shen
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qiuping Zhao
- Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Yudong Miao
- Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Petermann-Rocha F, Diaz-Toro F, Troncoso-Pantoja C, Martínez-Sanguinetti MA, Leiva-Ordoñez AM, Nazar G, Concha-Cisternas Y, Díaz Martínez X, Lanuza F, Carrasco-Marín F, Martorell M, Ramírez-Alarcón K, Labraña AM, Parra-Soto S, Villagran M, Lasserre-Laso N, Cigarroa I, Mardones L, Vásquez-Gómez J, Celis-Morales CA. Association between a lifestyle score and all-cause mortality: a prospective analysis of the Chilean National Health Survey 2009-2010. Public Health Nutr 2023; 27:e9. [PMID: 38053402 PMCID: PMC10830369 DOI: 10.1017/s1368980023002598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/16/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To investigate the association between a lifestyle score and all-cause mortality in the Chilean population. DESIGN Prospective study. SETTINGS The score was based on seven modifiable behaviours: salt intake, fruit and vegetable intake, alcohol consumption, sleep duration, smoking, physical activity and sedentary behaviours. 1-point was assigned for each healthy recommendation. Points were summed to create an unweighted score from 0 (less healthy) to 7 (healthiest). According to their score, participants were then classified into: less healthy (0-2 points), moderately healthy (3-4 points) and the healthiest (5-7 points). Associations between the categories of lifestyle score and all-cause mortality were investigated using Cox proportional hazard models adjusted for confounders. Nonlinear associations were also investigated. PARTICIPANTS 2706 participants from the Chilean National Health Survey 2009-2010. RESULTS After a median follow-up of 10·9 years, 286 (10·6 %) participants died. In the maximally adjusted model, and compared with the healthiest participants, those less healthy had 2·55 (95 % CI 1·75, 3·71) times higher mortality risk due to any cause. Similar trends were identified for the moderately healthy group. Moreover, there was a significant trend towards increasing the mortality risk when increasing unhealthy behaviours (hazard ratio model 3: 1·61 (95 % CI 1·34, 1·94)). There was no evidence of nonlinearity between the lifestyle score and all-cause mortality. CONCLUSION Individuals in the less healthy lifestyle category had higher mortality risk than the healthiest group. Therefore, public health strategies should be implemented to promote adherence to a healthy lifestyle across the Chilean population.
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Affiliation(s)
- Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Felipe Diaz-Toro
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Facultad de Enfermería, Universidad Andres Bello, Santiago7550196, Chile
| | - Claudia Troncoso-Pantoja
- Centro de Investigación en Educación y Desarrollo (CIEDE-UCSC), Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | | | - Ana María Leiva-Ordoñez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Gabriela Nazar
- Departamento de Psicología, Facultad de Ciencias Sociales, Universidad de Concepción, Concepción, Chile
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
| | - Yeny Concha-Cisternas
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile
- Pedagogía en Educación Física, Facultad de Educación, Universidad Autónoma de Chile, Talca, Chile
| | - Ximena Díaz Martínez
- Departamento de Ciencias de la Educación, Grupo calidad de Vida en diferentes Poblaciones, Universidad del Biobio, Chillán, Chile
| | - Fabian Lanuza
- Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco4813302, Chile
| | - Fernanda Carrasco-Marín
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Departamento de Enfermería, Farmacología y Fisioterapia, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, España
| | - Miquel Martorell
- Centro de Vida Saludable, Universidad de Concepción, Concepción, Chile
- Departamento de Nutrición y Dietética, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Karina Ramírez-Alarcón
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Ana María Labraña
- Departamento de Nutrición y Dietética, Facultad de Farmacia, Universidad de Concepción, Concepción, Chile
| | - Solange Parra-Soto
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán3780000, Chile
| | - Marcelo Villagran
- Laboratorio de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Nicole Lasserre-Laso
- Escuela de Nutrición y Dietética, Facultad de Salud, Universidad Santo Tomás, Los Ángeles, Chile
| | - Igor Cigarroa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Los Ángeles 4440000, Chile
| | - Lorena Mardones
- Laboratorio de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
- Centro de Biodiversidad y Ambientes Sustentables (CIBAS) Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Jaime Vásquez-Gómez
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Laboratorio de Rendimiento Humano, Universidad Católica del Maule, Talca, Chile
| | - Carlos A Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, 3466706, Chile
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Robb C, Carr PR, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a healthy lifestyle with mortality in older people. BMC Geriatr 2023; 23:646. [PMID: 37821846 PMCID: PMC10568769 DOI: 10.1186/s12877-023-04247-9] [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: 02/02/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their relationship to the health of older people is less certain. METHODS The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with subsequent all-cause and cause-specific mortality. RESULTS In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. CONCLUSIONS In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality. Adherence to all four lifestyle factors resulted in the strongest protection.
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Affiliation(s)
- Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia.
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Anne B Newman
- Department of Epidemiology, Centre for Aging and Population Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
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Simjanoski M, de Azevedo Cardoso T, Frey BN, Minuzzi L, De Boni RB, Balanzá-Martínez V, Kapczinski F. Lifestyle in bipolar disorder: A cross-sectional study. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:244-250. [PMID: 37839960 DOI: 10.1016/j.rpsm.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Modifiable lifestyle behaviors are important factors for improving mental health, yet there has been a lack of research studying lifestyle as a multidimensional construct in bipolar disorder (BD). The aim of this cross-sectional study was to compare the lifestyle patterns of individuals with BD in a current mood episode with healthy controls (HCs) using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE). MATERIALS AND METHODS The sample consisted of 46 individuals with BD currently experiencing a depressive or manic episode and 50 HC, assessed using the MINI International Neuropsychiatric Interview, Montgomery-Åsberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). The SMILE scale assesses lifestyle across seven domains: diet and nutrition, substance abuse, physical activity, stress management, restorative sleep, social support, and environmental exposures. Between-groups comparisons were performed based on the presence of a psychiatric diagnosis and the type of BD episode. RESULTS We found significant differences in the total SMILE score (r=0.75, p<0.001) and in scores from each domain of the scale between BD and HC (p<0.05), where individuals with BD in a depressive or manic episode with or without mixed features reported worse lifestyle across all domains. Differences between individuals with BD in different mood episodes across domains on the SMILE scale were non-significant. CONCLUSION Findings from this study highlight the presence of unhealthy lifestyle patterns in people with BD regardless of the polarity of their mood episode. Implementation of multidimensional lifestyle assessments is an essential step toward detecting the clustering of unhealthy lifestyle patterns in BD.
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Affiliation(s)
- Mario Simjanoski
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada.
| | - Taiane de Azevedo Cardoso
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Women's Health Concerns Clinic and Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, Canada
| | - Luciano Minuzzi
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Women's Health Concerns Clinic and Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, Canada
| | - Raquel B De Boni
- Institute of Scientific and Technological Communication and Information in Health (ICICT), Oswaldo Cruz Foundation (FIOCRUZ), 4365 Manguinhos, Rio de Janeiro, Brazil
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Av. de Blasco Ibáñez, 13, Valencia, Spain
| | - Flavio Kapczinski
- Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Paulo Gama, 110, Porto Alegre, Brazil
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Robb C, Carr P, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a Healthy Lifestyle with Mortality in Older People. RESEARCH SQUARE 2023:rs.3.rs-2541145. [PMID: 36993471 PMCID: PMC10055537 DOI: 10.21203/rs.3.rs-2541145/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Background Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and premature mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their impact on the health of older people is less certain. Methods The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with all-cause and cause-specific mortality. Results In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. Stratified analysis indicated larger effect sizes among males, those ≤ 73 years old and among those in the aspirin treatment group. Conclusions In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality.
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Li Y, Fan X, Wei L, Yang K, Jiao M. The impact of high-risk lifestyle factors on all-cause mortality in the US non-communicable disease population. BMC Public Health 2023; 23:422. [PMID: 36864408 PMCID: PMC9979572 DOI: 10.1186/s12889-023-15319-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Previous studies have suggested that lifestyle factors are associated with mortality in different population. However, little is known about the impact of lifestyle factors on all-cause mortality in non-communicable disease (NCD) population. METHODS This study included 10,111 NCD patients from the National Health Interview Survey. The potential high-risk lifestyle factors were defined as smoking, excessive drinking, abnormal body mass index, abnormal sleep duration, insufficient physical activity (PA), overlong sedentary behavior (SB), high dietary inflammatory index (DII) and low diet quality. Cox proportional hazard model was used to evaluate the impact of the lifestyle factors and the combination on all-cause mortality. The interaction effects and all combinations of lifestyle factors were also analyzed. RESULTS During 49,972 person-years of follow-up, 1040 deaths (10.3%) were identified. Among eight potential high-risk lifestyle factors, smoking (HR = 1.25, 95% CI 1.09-1.43), insufficient PA (HR = 1.86, 95% CI 1.61-2.14), overlong SB (HR = 1.33, 95% CI 1.17-1.51) and high DII (HR = 1.24, 95% CI 1.07-1.44) were risk factors for all-cause mortality in the multivariable Cox proportional regression. The risk of all-cause mortality was increased linearly as the high-risk lifestyle score increased (P for trend < 0.01). The interaction analysis showed that lifestyle had stronger impact on all-cause mortality among patients with higher education and income level. The combinations of lifestyle factors involving insufficient PA and overlong SB had stronger associations with all-cause mortality than those with same number of factors. CONCLUSION Smoking, PA, SB, DII and their combination had significant impact on all-cause mortality of NCD patients. The synergistic effects of these factors were observed, suggesting some combinations of high-risk lifestyle factor may be more harmful than others.
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Affiliation(s)
- Ying Li
- Department of Science and Education, the Third People's Hospital of Longgang District Shenzhen, Shenzhen, 518100, China
| | - Xue Fan
- Department of Science and Education, the Third People's Hospital of Longgang District Shenzhen, Shenzhen, 518100, China
| | - Lifeng Wei
- The Personnel Department, Harbin Medical University, Harbin, 150086, China
| | - Kai Yang
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology), Shenzhen, 518001, China.
| | - Mingli Jiao
- Research Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, 150086, China.
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Wang T, Ding C, Zhou W, Zhu L, Yu C, Huang X, Bao H, Cheng X. Associations of combined lifestyle behaviors with all-cause and cardiovascular mortality in adults: A population-based cohort study in Jiangxi Province of China. Front Public Health 2022; 10:942113. [PMID: 36388373 PMCID: PMC9651958 DOI: 10.3389/fpubh.2022.942113] [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] [Received: 07/26/2022] [Accepted: 10/05/2022] [Indexed: 01/25/2023] Open
Abstract
Background Data are limited on the impact of combined lifestyle behaviors on mortality in Jiangxi Province, China. Objective The study examined the association between combined lifestyle behaviors and all-cause and cardiovascular disease (CVD) mortality in Jiangxi province. Methods The baseline survey was completed in Jiangxi Province from November 2013 to August 2014. We conducted a follow-up on 12,608 participants of 35 years of age or older from July 2019 to October 2020. Four known lifestyle behaviors were evaluated: alcohol consumption, smoking, diet (AHEI scores), and physical activity. Cox regression analysis was performed to determine the association of combined lifestyle behaviors with all-cause and CVD mortality. Results During 65,083 person-years of follow-up, among the 11,622 participants (mean age 59.1 years; 40.1% men) 794 deaths occurred, including 375 deaths from CVD disease in this study. Compared to the favorable lifestyle group, the adjusted HR of all-cause mortality was 1.25 (95% CI, 1.03-1.53) for the intermediate lifestyle group and 1.37 (95% CI, 1.11-1.71) for the unfavorable lifestyle group. Compared to the favorable lifestyle group, the adjusted HR of CVD mortality was 1.50 (95% CI, 1.11-2.03) for the intermediate lifestyle group and 1.58 (95% CI, 1.14-2.20) for the unfavorable lifestyle group. Significant interactions of lifestyle and BMI (P for interaction <0.05) with the risk of all-cause mortality and CVD mortality were observed. Conclusion In the current study, we reaffirm the associations of combined lifestyle factors with total and CVD mortality in Jiangxi Province, our data suggest that an unfavorable lifestyle was associated with a substantially increased risk of all-cause and CVD mortality.
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Affiliation(s)
- Tao Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Congcong Ding
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chao Yu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China,*Correspondence: Huihui Bao
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China,Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China,Xiaoshu Cheng
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Combined lifestyle factors on mortality among the elder population: evidence from a Chinese cohort study. BMC Geriatr 2022; 22:474. [PMID: 35650518 PMCID: PMC9158191 DOI: 10.1186/s12877-022-03017-3] [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: 07/09/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Numerous studies have suggested that lifestyle-related factors are associated with mortality, however limited evidence is available for the Chinese elder population. Methods The data of this study was obtained from the Chinese Longitudinal Health Survey (CLHLS) during 2008 − 2018, lifestyle-related factors including body mass index (BMI), smoking, drinking, consumption of vegetables and fruits, physical activity and sleep duration were included as dependent variables in the analysis. A lifestyle risk score was created using six unhealthy behaviors: smoking, drinking, unhealthy weight, physical inactivity, not eat vegetables or fruits and short or prolonged sleep. The Kaplan–Meier curves were used to illustrate the cumulative effect of lifestyle factors on mortality and cox regression models were conducted to estimate the combined effects of lifestyle-related factors on total mortality. Results The results illustrated that low BMI, smoking, no fruit eating, and no physical inactivity were risk factors for total mortality. KM curves showed significant cumulative effect of unhealthy lifestyle factors on mortality. Compared with participants without any unhealthy factors, the hazard ratio (HR) for participants with six unhealthy factors was 1.335 (1.015,1.757) for all-cause mortality. Conclusions This study demonstrated poor adherence to a healthy lifestyle may increase all-cause mortality and specific combinations of lifestyle related factors have different effects on mortality among Chinese elderly population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03017-3.
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9
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Sapranaviciute-Zabazlajeva L, Sileikiene L, Luksiene D, Tamosiunas A, Radisauskas R, Milvidaite I, Bobak M. Lifestyle factors and psychological well-being: 10-year follow-up study in Lithuanian urban population. BMC Public Health 2022; 22:1011. [PMID: 35590278 PMCID: PMC9118629 DOI: 10.1186/s12889-022-13413-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background Several lifestyle behaviours, including physical activity, smoking, alcohol consumption, nutrition habits, and social activity have been associated with psychological well-being (PWB). However, their effect on PWB prospectively has been less studied. The aim of the present study was to evaluate the influence of lifestyle factors on higher future PWB during the 10-year follow-up of middle-aged and elderly urban population. Methods In the baseline survey (2006 to 2008), 7115 men and women 45–72 years of age were examined within the framework of the international study Health, Alcohol and Psychosocial Factors in the Eastern Europe (HAPIEE). In the follow-up survey (in 2016), which was performed among all 6210 participants who survived till that year, 4266 individuals participated responding to postal questionnaires. PWB was assessed by a CASP-12 questionnaire. The lifestyle behaviours, including smoking and nutrition habits, alcohol consumption, social and physical activity, were evaluated by the questionnaire. Multivariable logistic regression models were applied for statistical data analysis. Results After accounting for several potential confounders, healthy levels of lifestyle behaviours were associated with higher PWB after 10-year follow-up. Never-smokers in men and former smokers in women had higher PWB by 43 and 67% odds respectively in comparison with smokers. Physical activity in women and high social activity both in men in women was positively related to higher PWB. More frequent fresh vegetable and fruit consumption was associated with higher odds of higher PWB (odds ratio 1.57 in men and 1.36 in women, p < 0.05) compared to less frequent consumption of such food groups. Dose-response relationship between increasing number of healthy lifestyle factors and higher PWB was determined both in men and women. Conclusions Lifestyle factors such as never smoking and former smoking, high social activity, and more frequent fresh vegetable and fruit consumption increased the odds of higher PWB over 10 years of follow-up in men and women groups. The increase of the protective health behaviour score was directly associated with the odds of higher PWB.
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Affiliation(s)
| | - Lolita Sileikiene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania.
| | - Dalia Luksiene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Irena Milvidaite
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu av. 15, LT-50162, Kaunas, Lithuania
| | - Martin Bobak
- Institute of Epidemiology and Health care, University College London, London, UK
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10
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Lian Z, Zhu C, Yuan H, Chen Y. Combined impact of lifestyle-related factors on total mortality among the elder Chinese: a prospective cohort study. BMC Geriatr 2022; 22:325. [PMID: 35418015 PMCID: PMC9009055 DOI: 10.1186/s12877-022-02982-z] [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: 12/27/2021] [Accepted: 03/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background The combined impact of healthy lifestyle factors on total mortality among elder Chinese is unclear. This study aimed to investigate the overall impact of lifestyle factors on total mortality in a senior Chinese population, and determine whether these associations were consistent in the presence of different characteristics, including physical comorbidities. Methods The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is a large population-based prospective cohort study in 22 of 31 provinces from mainland China. We included 15,163 adults aged ≥65 years recruited from 1998- to 2002 and followed-up until 2014. A healthy lifestyle score was calculated considering five lifestyle factors (exercise, smoking, dietary diversity, body mass index and drinking). The scores ranged from zero to five points and were classified into the following three categories: unhealthy (0-1 point), intermediate (2-3 points) and healthy (4-5 points). Cox proportional hazards regression analyses were used to assess the associations between the combined healthy lifestyle score and total mortality, adjusting for demographic characteristics and physical comorbidities, as appropriate. Stratification analyses and interaction analyses were further performed. Results Among the 15,163 participants, the mean age (SD) was 86.2 (11.6) years. During an average follow-up period of 12.5 (SD = 3.9) years, 9655 deaths occurred. The adjusted hazard ratios (HRs) of total mortality decreased as the number of healthy lifestyle factors increased. Compared to the unhealthy lifestyle group, the healthy lifestyle group had a HR and 95% CI of 0.78 and 0.72-0.83. The population attributable risk of total death among those without a healthy lifestyle was 25.2%. A healthier lifestyle pattern was associated with a lower total mortality risk among individuals with different severities of physical comorbidities, although the associations were stronger among those with fatal physical comorbidities (p-interaction < .001). Conclusions In this large-scale study, a healthier lifestyle measured by regular exercise participation, never smoking, never drinking, good dietary diversity and normal weight, was inversely associated with total mortality, regardless of physical comorbidity status. These findings support the necessity of multiple lifestyle modifications to prevent premature death in both general elderly populations and those with physical comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02982-z.
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Affiliation(s)
- Zhiwei Lian
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
| | - Chunsu Zhu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China.
| | - Haowen Yuan
- School of Public Health, Peking University, 100191, Beijing, China
| | - Ying Chen
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Jinan District, Fuzhou, 350014, China
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11
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Li J, You L, Xu Z, Bai H, Fei X, Yang J, Li Q, Qian S, Lin S, Tang M, Wang J, Chen K, Jin M. Healthy lifestyle and the risk of conventional adenomas and serrated polyps: Findings from a large colonoscopy screening population. Int J Cancer 2022; 151:67-76. [PMID: 35191524 DOI: 10.1002/ijc.33974] [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: 11/02/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
Evidence on the link between healthy lifestyle and colorectal cancer (CRC) precursors is limited. Our study aimed to examine and compare the associations of healthy lifestyle with CRC precursors in adenoma (AD) -carcinoma and serrated pathways. A total of 24,480 participants including 6,309 ADs, 1,343 serrated polyps (SPs), and 16,828 polyp-free controls were included. A healthy lifestyle score (HLS) was constructed based on five lifestyle factors including cigarette smoking, alcohol drinking, physical activity, diet, and body weight, and categorized into least, slightly, moderately, and most healthy. Multivariable logistic regressions were used to estimate odds ratio (OR) and 95% confidence interval (CI). Inverse dose-response associations between the HLS and risk of ADs were observed (OR per 1 score increment for ADs: 0.82 [95% CI 0.79 - 0.84]; for SPs: 0.73 [95% CI 0.69 - 0.78]), and the association with SPs was more evident than with ADs (OR 0.90, 95% CI 0.85 - 0.96). Compared with participants with the least healthy lifestyle, those with the most healthy lifestyle had 47% lower risk of ADs (OR 0.53, 95% CI 0.47 - 0.59) and 70% lower risk of SPs (OR 0.30, 95% CI 0.23 - 0.39), respectively. These inverse associations were consistent across lesion stage and anatomic subsite and not modified by any stratification factors. The risk advancement periods for the most vs. the least healthy lifestyle were -9.49 years for ADs and -20.69 years for SPs. Our findings help confirm the preventive role of healthy lifestyle in colorectal carcinogenesis.
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Affiliation(s)
- Jiayu Li
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liuqing You
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zenghao Xu
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Bai
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinglin Fei
- Jiashan Institute of Cancer Prevention and Treatment, Jiashan, China
| | - Jinhua Yang
- Jiashan Institute of Cancer Prevention and Treatment, Jiashan, China
| | - Qilong Li
- Jiashan Institute of Cancer Prevention and Treatment, Jiashan, China
| | - Sangni Qian
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shujuan Lin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianbing Wang
- Department of Public Health, National Clinical Research Center for Child Health of Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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12
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Castro R, Ribeiro-Alves M, Oliveira C, Romero CP, Perazzo H, Simjanoski M, Kapciznki F, Balanzá-Martínez V, De Boni RB. What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review. Front Public Health 2022; 9:735624. [PMID: 35047469 PMCID: PMC8761632 DOI: 10.3389/fpubh.2021.735624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.
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Affiliation(s)
- Rodolfo Castro
- Escola Nacional de Saúde Pública Sergio Arouca, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- Instituto de Saúde Coletiva, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Ribeiro-Alves
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Cátia Oliveira
- Centro de Desenvolvimento Tecnológico em Saúde, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Carmen Phang Romero
- Centro de Desenvolvimento Tecnológico em Saúde, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Hugo Perazzo
- Instituto Nacional de Infectologia Evandro Chagas, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Mario Simjanoski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Flavio Kapciznki
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Instituto Nacional de Ciência e Tecnologia Translacional em Medicina, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Raquel B. De Boni
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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13
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Yang Z, Wu M, Lu J, Gao K, Yu Z, Li T, Liu W, Shen P, Lin H, Shui L, Tang M, Jin M, Chen K, Wang J. Interaction between walkability and fine particulate matter on risk of ischemic stroke: A prospective cohort study in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 292:118482. [PMID: 34763020 DOI: 10.1016/j.envpol.2021.118482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
Living in walkable neighborhoods has been reported to be associated with a lower risk of cardiovascular disease. Features of walkable neighborhoods, however, may be related to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), which could increase risk of cardiovascular disease. The interaction effect between walkability and PM2.5 on risk of ischemic stroke remains to be elucidated. In this study, we recruited a total of 27,375 participants aged ≥40 years from Yinzhou District, Ningbo, Zhejiang Province, China to investigate the associations of walkability and PM2.5 with risk of ischemic stroke. We used amenity categories and decay functions to evaluate walkability and high-spatiotemporal-resolution land-use regression models to assess PM2.5 concentrations. We used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 4.08 years, we identified a total of 637 incident cases of ischemic stroke in the entire cohort. Higher walkability was associated with a lower risk of ischemic stroke (quartile, Q4 vs. Q1 walkability: HR = 0.59, 95% CI: 0.47-0.75), whereas PM2.5 was positively associated with risk of ischemic stroke (Q4 vs. Q1 PM2.5: HR = 1.70, 95% CI: 1.29-2.25). Furthermore, we observed a significant interaction between walkability and PM2.5 on risk of ischemic stroke. Walkability was inversely associated with risk of ischemic stroke at lower PM2.5 concentrations, but this association was attenuated with increasing PM2.5 concentrations. Although walkable neighborhoods appear to decrease the risk of ischemic stroke, benefits may be offset by adverse effects of PM2.5 exposure in the most polluted areas. These findings are meaningful for future neighborhood design, air pollution control, and stroke prevention.
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Affiliation(s)
- Zongming Yang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mengyin Wu
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jieming Lu
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Kai Gao
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Zhebin Yu
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Tiezheng Li
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Wen Liu
- Department of Urban Planning, Wuhan University School of Urban Design, Wuhan, 430072, China
| | - Peng Shen
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Hongbo Lin
- Department of Chronic Disease and Health Promotion, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Liming Shui
- Yinzhou District Health Bureau of Ningbo, Ningbo, 315040, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics at School Public Health and the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mingjuan Jin
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Kun Chen
- Department of Epidemiology and Biostatistics at School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Jianbing Wang
- Department of Epidemiology and Biostatistics at School of Public Health and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
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14
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Lohman T, Bains G, Berk L, Lohman E. Predictors of Biological Age: The Implications for Wellness and Aging Research. Gerontol Geriatr Med 2021; 7:23337214211046419. [PMID: 34595331 PMCID: PMC8477681 DOI: 10.1177/23337214211046419] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 12/26/2022] Open
Abstract
As healthspan and lifespan research breakthroughs have become more commonplace, the need for valid, practical markers of biological age is becoming increasingly paramount. The accessibility and affordability of biological age predictors that can reveal information about mortality and morbidity risk, as well as remaining years of life, has profound clinical and research implications. In this review, we examine 5 groups of aging biomarkers capable of providing accurate biological age estimations. The unique capabilities of these biomarkers have far reaching implications for the testing of both pharmaceutical and non-pharmaceutical interventions designed to slow or reverse biological aging. Additionally, the enhanced validity and availability of these tools may have increasingly relevant clinical value. The authors of this review explore those implications, with an emphasis on lifestyle modification research, and provide an overview of the current evidence regarding 5 biological age predictor categories: Telomere length, composite biomarkers, DNA methylation “epigenetic clocks,” transcriptional predictors of biological age, and functional age predictors.
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Affiliation(s)
- Trevor Lohman
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Gurinder Bains
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Lee Berk
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
| | - Everett Lohman
- School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
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15
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De Boni RB, Ribeiro-Alves M, Mota JC, Gomes M, Balanzá-Martínez V, Kapczinski F, Bastos FI. The cumulative effect of multiple dimensions of lifestyle on risky drinking during the Covid-19 pandemic. Prev Med 2021; 150:106718. [PMID: 34242667 PMCID: PMC8662552 DOI: 10.1016/j.ypmed.2021.106718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 07/03/2021] [Indexed: 02/07/2023]
Abstract
Lifestyle impacts morbidity and mortality worldwide. Herein, we evaluated the association of a multidimensional lifestyle measure and its domains (diet/nutrition, substance use, physical activity, social, stress management, sleep, environmental exposure) with risky drinking. Also, we analyzed the cumulative effect of unhealthy domains in the likelihood of presenting risky drinking. To reach these objectives, data from a web survey conducted in Brazil and Spain was analyzed. The main outcome was risky drinking assessed by the AUDIT-C. Lifestyle was measured using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE). Fixed logistic models were used to evaluate associations between lifestyle and risky drinking. Between April and May 2020, 22,785 individuals answered the survey. The prevalence of risky drinking was 45.6% in Brazil and 30.8% in Spain. The SMILE score was lower (unhealthier lifestyle) among at-risk drinkers. Worse scores on Diet, Substance use, Stress management and Environment were associated with an increased likelihood of risky drinking. The higher the number of unhealthy domains, the higher the likelihood of presenting risky drinking: adjusted odds ratio (aOR) for risky drinking was 1.15 (IC95% 0.98-1.35) and 23.42 (IC95% 3.08-178.02) for those presenting worse lifestyle in 1 and 5 domains, respectively. Finally, interactions suggest that improvement in lifestyle domains would have a larger effect in Spain than in Brazil. Our results suggest that future interventions aiming at reducing Risky drinking may benefit from strategies targeting multiple domains of lifestyle.
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Affiliation(s)
- Raquel B De Boni
- Institute of Scientific and Technological Communication and Information in Health (ICICT), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
| | - Marcelo Ribeiro-Alves
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Jurema C Mota
- Institute of Scientific and Technological Communication and Information in Health (ICICT), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Mariana Gomes
- Universidade Federal do Estado do Rio de Janeiro, Escola de Medicina e Cirurgia (EMC - Unirio), Rio de Janeiro, Brazil
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Francisco I Bastos
- Institute of Scientific and Technological Communication and Information in Health (ICICT), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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16
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Atorkey P, Paul C, Wiggers J, Bonevski B, Nolan E, Oldmeadow C, Mitchell A, Byrnes E, Tzelepis F. Clustering of multiple health-risk factors among vocational education students: a latent class analysis. Transl Behav Med 2021; 11:1931-1940. [PMID: 34155507 DOI: 10.1093/tbm/ibab068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Physical and mental health risks often commence during young adulthood. Vocational education institutions are an ideal setting for understanding how health-risks cluster together in students to develop holistic multiple health-risk interventions. This is the first study to examine clustering of tobacco smoking, fruit intake, vegetable intake, alcohol consumption, physical inactivity, overweight/obesity, depression, and anxiety in vocational education students and the socio-demographic characteristics associated with cluster membership. A cross-sectional survey with vocational education students (n = 1134, mean age = 24.3 years) in New South Wales, Australia. Latent class analysis identified clusters and latent class regression examined characteristics associated with clusters. Four clusters were identified. All clusters had moderate inadequate fruit intake and moderate overweight/obesity. Cluster 1 (13% of sample) had "high anxiety, high inadequate vegetable intake, low tobacco, and low alcohol use." Cluster 2 (16% of sample) had "high tobacco smoking, high alcohol use, high anxiety, high depression, and high inadequate vegetable intake." Cluster 3 (52% of sample) had "high risky alcohol use, high inadequate vegetable intake, low depression, low anxiety, low tobacco smoking, and low physical inactivity." Cluster 4 (19% of sample) was a "lower risk cluster with high inadequate vegetable intake." Compared to cluster 4, 16-25-year-olds and those experiencing financial stress were more likely to belong to clusters 1, 2, and 3. Interventions for vocational education students should address fruit and vegetable intake and overweight/obesity and recognize that tobacco use and risky alcohol use sometimes occurs in the context of mental health issues.
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Affiliation(s)
- Prince Atorkey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Health Behaviour, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Health Behaviour, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Health Behaviour, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
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Modifiable Lifestyle Recommendations and Mortality in Denmark: A Cohort Study. Am J Prev Med 2021; 60:792-801. [PMID: 33775511 DOI: 10.1016/j.amepre.2021.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/14/2020] [Accepted: 01/03/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Modifiable lifestyle behaviors represent a central target for public health interventions. This study investigates the association between adherence to 4 modifiable lifestyle recommendations and all-cause, cancer, or cardiovascular disease mortality. METHODS Investigators used data from the Danish Diet, Cancer and Health cohort (1993-2013; N=54,276). Lifestyle recommendations included smoking (never smoking), diet (adherence to 6 national food-based dietary guidelines), alcohol consumption (≤7 units per week for women and ≤14 units per week for men), and physical activity (≥30 minutes per day of moderate-to-vigorous leisure-time physical activity). Pseudo-values were used to estimate the adjusted risk differences and 95% CIs for all-cause, cancer, or cardiovascular disease mortality. Data were analyzed in 2019-2020. RESULTS A total of 8,860 participants died during a median follow-up of 17.0 years. Adherence to all modifiable lifestyle recommendations was associated with an 18.46% (95% CI= -20.52%, -16.41%) lower absolute risk of all-cause mortality than no adherence. Never smokers had a 13.19% (95% CI= -13.95%, -12.44%) lower risk, those adhering to dietary guidelines (diet score ≥5) had a 7.52% (95% CI= -8.89%, -6.14%) lower risk, and those adhering to recommended levels of alcohol (2.11%, 95% CI= -2.75%, -1.48%) and physical activity (1.58%, 95% CI= -2.20%, -1.00%) had a lower risk than those who did not adhere. Stronger associations were observed in men than in women and in older than in middle-aged participants. CONCLUSIONS Findings suggest that adherence to modifiable lifestyle recommendations is associated with a lower risk of mortality from all causes, cancer, and cardiovascular disease, underlining the importance of supporting adherence to national guidelines for lifestyle recommendations.
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