Healthy Lifestyle Score Including Sleep Duration and Cardiovascular Disease Risk

Leisure Sedentary Behavior, Physical Activities, and Cardiovascular Disease Among Individuals With Metabolic Dysfunction-Associated Fatty Liver Disease

BACKGROUND

Metabolic dysfunction-associated fatty liver disease is a significant risk factor for cardiovascular disease (CVD). This study assesses the association between leisure-time physical activity, sedentary behavior, and CVD risk among patients with metabolic dysfunction-associated fatty liver disease, considering genetic predisposition to CVD.

METHODS

This cohort study included 157 794 participants with metabolic dysfunction-associated fatty liver disease from the UK Biobank who were free of CVD at baseline. The study measured leisure-time sedentary behaviors (watching TV, using a computer, and driving) and physical activities (walking for pleasure, light and heavy do-it-yourself activities, strenuous sports, and other exercises) in terms of frequency and duration over the 4 weeks before assessment. Both a Cox proportional hazard model and an isotemporal substitution model were utilized in the study to assess the association between leisure sedentary behavior, physical activities, and CVD risk.

RESULTS

During a median 12.5 years of follow-up, 26 355 CVD cases were reported, including 19 746 coronary heart disease, 4836 stroke, and 7398 heart failure cases. High physical activity levels were linked to a significantly lower risk of CVD (21%), coronary heart disease (20%), stroke (15%), and heart failure (31%). In contrast, individuals with >6.5 h/d of sedentary behavior faced a 16% to 21% higher risk of these conditions compared with those with ≤3.5 h/d. Notably, replacing 30 minutes of inactivity with physical activity reduced CVD risks by 3% to 16%, particularly with strenuous sports. A significant interaction was observed between physical activity, sedentary behavior, and genetic predisposition in relation to stroke risk.

CONCLUSIONS

Among patients with metabolic dysfunction-associated fatty liver disease, higher leisure-time physical activity levels correlate with reduced CVD risks, while increased sedentary behavior is linked to higher CVD risks. Replacing sedentary time with physical activity consistently shows benefits in reducing CVD outcomes, irrespective of genetic predisposition.

Association of lifestyle with sleep health in general population in China: a cross-sectional study

The concept of a healthy lifestyle is receiving increasing attention. This study sought to identify an optimal healthy lifestyle profile associated with sleep health in general population of China. An online cross-sectional survey was conducted from June to July 2022. Six healthy lifestyle factors were assessed: healthy diet, regular physical exercise, never smoking, never drinking alcohol, low sedentary behavior, and normal weight. Participants were categorized into the healthy lifestyle (5-6 factors), average (3-4 factors), and unhealthy lifestyle groups (0-2 factors). The study's primary outcome was sleep health, which included sleep quality, duration, pattern, and the presence of any sleep disorder or disturbance, including insomnia, excessive daytime sleepiness, obstructive apnea syndrome, and narcolepsy. Multivariable logistic regression analysis was applied to explore lifestyles associated with the selected sleep health outcomes. 41,061 individuals were included, forming 18.8% healthy, 63.8% average, and 17.4% unhealthy lifestyle groups. After adjusting for covariates, participants with healthy lifestyle were associated with a higher likelihood of good sleep quality (OR = 1.56, 95% CI = 1.46-1.68), normal sleep duration (OR = 1.60, 95% CI = 1.49-1.72), healthy sleep pattern (OR = 2.15, 95% CI = 2.00-2.31), and lower risks of insomnia (OR = 0.66, 95% CI = 0.61-0.71), excessive daytime sleepiness (OR = 0.66, 95% CI = 0.60-0.73), and obstructive apnea syndrome (OR = 0.40, 95% CI = 0.37-0.43), but not narcolepsy (OR = 0.92, 95% CI = 0.83-1.03), compared to those with unhealthy lifestyle. This large cross-sectional study is the first to our knowledge to quantify the associations of a healthy lifestyle with specific aspects of sleep health. The findings offer support for efforts to improve sleep health by modulating lifestyle.

On the use of the healthy lifestyle index to investigate specific disease outcomes

The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell's C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

Association of lifestyle with reduced stroke risk in 41 314 individuals with diabetes: Two prospective cohort studies in China

AIM

To investigate the associations of individual and combined healthy lifestyle factors (HLS) with the risk of stroke in individuals with diabetes in China.

METHODS

This prospective analysis included 41 314 individuals with diabetes [15 191 from the Comprehensive Research on the Prevention and Control of the Diabetes (CRPCD) project and 26 123 from the China Kadoorie Biobank (CKB) study]. Associations of lifestyle factors, including cigarette smoking, alcohol consumption, physical activity, diet, body shape and sleep duration, with the risk of stroke, intracerebral haemorrhage (ICH) and ischaemic stroke (IS) were assessed using Cox proportional hazard models.

RESULTS

During median follow-up periods of 8.02 and 9.05 years, 2499 and 4578 cases of stroke, 2147 and 4024 of IS, and 160 and 728 of ICH were documented in individuals with diabetes in the CRPCD and CKB cohorts, respectively. In the CRPCD cohort, patients with ≥5 HLS had a 14% lower risk of stroke (hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.75-0.98) than those with ≤2 HLS. In the CKB cohort, the adjusted HR (95% CI) for patients with ≥5 HLS were 0.74 (0.66-0.83) for stroke, 0.74 (0.66-0.83) for IS, and 0.57 (0.42-0.78) for ICH compared with those with ≤2 HLS. The pooled adjusted HR (95% CI) comparing patients with ≥5 HLS versus ≤2 HLS was 0.79 (0.69-0.92) for stroke, 0.80 (0.68-0.93) for IS, and 0.60 (0.46-0.78) for ICH.

CONCLUSIONS

Maintaining a healthy lifestyle was associated with a lower risk of stroke, IS and ICH among individuals with diabetes.

Relationship between COVID-19 pandemic-related experienced stress and lifestyle habits among university students from Québec, Canada

Whether COVID-19-related experienced stress influenced lifestyle habits remains to be thoroughly evaluated among university students. This study examined the relationship between COVID-19-related experienced stress and subsequent lifestyle habits among undergraduate students. This cross-sectional study included 708 undergraduate students from Université Laval (Québec, Canada) participating in the Expériences Pandémiques (ExPan) cohort. Data on COVID-19-related experienced stress and lifestyle were self-reported using a questionnaire completed between February and April of 2022. A stress index (SI) was computed by summing scores associated with 31 situational statements related to the pandemic (e.g., not being able to see friends, dealing with job loss). A healthy lifestyle score (HLS) ranging from zero to seven was calculated based on seven lifestyle habits: moderate-to-vigorous physical activity, sleep quality, fruit and vegetable intake, tobacco and electronic cigarette use, alcohol consumption, cannabis use, and hard or sedative-hypnotic drugs use. In multivariable-adjusted models, a negative association between the SI and the HLS was found (β10% increment SI = -0.23, 95% CI = -0.30, -0.16 HLS point; P < 0.0001). The SI was also negatively associated with sleep quality, and fruit and vegetable consumption, while being positively associated with at-risk alcohol consumption, cannabis use, and hard or sedative-hypnotic drug use. Subgroup analyses suggested a negative relationship between the SI and HLS among participants who did not receive academic accommodations (e.g., additional time for evaluations, personal notetaker), but not those who received such accommodations. This study suggests that COVID-19-related experienced stress was negatively associated with healthy lifestyle habits in this cohort of undergraduate students.

Spirituality, a Neglected Dimension in Improving the Lifestyle of Coronary Artery Patients by Nurses: A Scoping Review

Background

By modifying the lifestyle of patients, the risk factors of Coronary Artery Diseases (CADs) are adjusted. This study was performed with the aim to investigate the role of nurses in the lifestyle of coronary artery patients.

Materials and Methods

This scoping review was conducted with the question of the role of nurses in improving the lifestyle of coronary artery patients. This study was conducted in databases and search engines of ScienceDirect, Springer, Scopus, PubMed, MEDLINE, and Google Scholar for English texts, and in the Magiran and Scientific Information Database (SID) databases and search engines for the texts printed in Persian. The search for articles printed from 2012 to 2022 was conducted based on the keywords used in the title and abstract of the articles. The keywords used to search domestic databases included nursing, lifestyle and healthy lifestyle, and heart diseases (based on MeSH).

Results

Nurses have made significant efforts and performed interventions to improve the lifestyle of coronary artery patients through guidance and education regarding the improvement of their diet and mobility, compliance with their treatment regimen, and reduction of the risk factors of CAD. In the psychological dimension, they had a positive effect in some fields such as stress management and mental health. However, in the spiritual dimension, effective studies and interventions have not been conducted by nurses.

Conclusions

The role of nurses in the lifestyle of coronary artery patients is effective in the physical dimension, limited in the psychological dimension, and neglected in the spiritual dimension.

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

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.

Oral Health and Lifestyle Factors in Rural Adults of Jharkhand, India

Background

There is a lack of health care facilities and poor oral health awareness among the rural adult population of Jharkhand which may significantly influence oral health status and lifestyle scores.

Aim

To assess the oral hygiene status, lifestyle factors, and various risk factors associated with poor lifestyle scores in the rural adult population of Jharkhand.

Materials and Methods

This cross-sectional study included 400 rural adults (35-44 years) populations. Face-to-face interviews were used to collect sociodemographic data and data on oral hygiene practices. Lifestyle factors were assessed using Health Practice Index (HPI). Oral health status was assessed using the oral health assessment proforma provided by the World Health Organization (WHO).

Results

A significantly higher (p value < 0.0001) prevalence of tobacco consumption was reported by males (94.0%) compared to females (4.0%). The males (54.0%) reported significantly higher (p value < 0.0001) poor lifestyle scores compared to females (38.0%). A significantly higher (p value < 0.0001) number of oromucosal lesions (13.0%) was found in males compared to females (1.0%). There was a significant difference (p value < 0.0001) in the oral hygiene status between males and females with majority of males (60.0%) having poor oral hygiene. A bivariate analysis was performed, and unadjusted odds ratio was computed. The factors that became significant were then entered into logistic regression model (enter method). The results of logistic regression analysis showed that education (OR = 0.3, p value = 0.003), systemic diseases/long-term medication (OR = 2.9, p value = 0.004), tobacco consumption (OR = 2.9, p value = 0.006), oral hygiene status (OR = 2.4, p value = 0.007), and dental caries (OR = 2.9, p value = 0.004) were significant predictors of poor lifestyle scores.

Conclusion

The rural adult population in Jharkhand has poor oral hygiene status and poor lifestyle scores. It is important to raise awareness regarding good oral hygiene and the negative effects of tobacco consumption. The dental visit should be encouraged, and the concept of preventive care needs to be instilled.

Knowledge and attitude of Iranian dental practitioners toward teledentistry: A web-based descriptive survey

Background

It is necessary to improve the knowledge and attitude of dental practitioners toward teledentistry for its implementation in the oral healthcare system. The objective of the current study was to investigate the knowledge and attitude of Iranian dental practitioners toward teledentistry.

Methods

This descriptive, cross-sectional survey was performed among 387 dental practitioners working in two big cities in Iran. An online self-structured questionnaire that included 34 questions was applied to collect information about the general profile of participants (age, sex, work experience, city of work, and dental specialty), their knowledge, and attitude about teledentistry.

Results

Most participants were males (57.9%) and general practitioners (79.6%). Dental practitioners expressed poor knowledge and only 23.50% of them were familiar with teledentistry. However, most of the participants, mainly in Zahedan city, expressed agreement on the potential benefits of teledentistry for patient care and access. More than 80% of dental practitioners agreed with the statement on the application of teledentistry in enhancing access to guidelines, recommendations, and preventive dentistry. However, the majority of dental practitioners believe that the diagnosis by teledentistry is not as accurate as the diagnosis in clinical practice.

Conclusion

Our study reveals a positive attitude toward teledentistry among Iranian dentists with a significant knowledge gap. This knowledge gap may be a barrier to teledentistry adoption. Educational programs tailored to address these knowledge gaps are necessary to pave the way for the successful integration of teledentistry into routine dental practice.

Association Between the Healthy Lifestyle Index and Risk of Multimorbidity in the Women's Health Initiative

BACKGROUND

Multimorbidity, defined as the presence of 2 or more chronic health conditions, is increasingly common among older adults. The combination of lifestyle characteristics such as diet quality, smoking status, alcohol intake, physical activity (PA), sleep duration, and body fat as assessed by body mass index (BMI) or waist circumference, and risk of multimorbidity are not well understood.

OBJECTIVES

We investigated the association between the healthy lifestyle index (HLI), generated by combining indicators of diet quality, smoking, alcohol, PA, sleep amount, and BMI, and risk of multimorbidity, a composite outcome that included cardiovascular disease (CVD), diabetes, cancer, and fracture.

METHODS

We studied 62 037 postmenopausal women aged 50-79 years at enrollment in the Women's Health Initiative, with no reported history of CVD, diabetes, cancer, or fracture at baseline. Lifestyle characteristics measured at baseline were categorized and a score (0-4) was assigned to each category. The combined HLI (0-24) was grouped into quintiles, with higher quintiles indicating a healthier lifestyle. Multivariable adjusted estimates of hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of developing multimorbidity were obtained using Cox proportional hazard models.

RESULTS

Over an average follow-up period of 16.3 years, 5 656 women developed multimorbidity. There was an inverse association between the HLI levels and risk of multimorbidity (compared to the HLI_1st quintile: HR_2nd quintile = 0.81 95% CI 0.74-0.83, HR_3rd quintile = 0.77 95% CI 0.71-0.83, HR_4th quintile = 0.70 95% CI 0.64-0.76, and HR_5th quintile = 0.60 95% CI 0.54-0.66; p trend < .001). Similar associations were observed after stratification by age or BMI categories.

CONCLUSIONS

Among postmenopausal women, higher levels of the HLI were associated with a reduced risk of developing multimorbidity.

Chronotype, Unhealthy Lifestyle, and Diabetes Risk in Middle-Aged U.S. Women : A Prospective Cohort Study

BACKGROUND

Evening chronotype may promote adherence to an unhealthy lifestyle and increase type 2 diabetes risk.

OBJECTIVE

To evaluate the role of modifiable lifestyle behaviors in the association between chronotype and diabetes risk.

DESIGN

Prospective cohort study.

SETTING

Nurses' Health Study II.

PARTICIPANTS

63 676 nurses aged 45 to 62 years with no history of cancer, cardiovascular disease, or diabetes in 2009 were prospectively followed until 2017.

MEASUREMENTS

Self-reported chronotype using a validated question from the Morningness-Eveningness Questionnaire. The lifestyle behaviors that were measured were diet quality, physical activity, alcohol intake, body mass index (BMI), smoking, and sleep duration. Incident diabetes cases were self-reported and confirmed using a supplementary questionnaire.

RESULTS

Participants reporting a "definite evening" chronotype were 54% (95% CI, 49% to 59%) more likely to have an unhealthy lifestyle than participants reporting a "definite morning" chronotype. A total of 1925 diabetes cases were documented over 469 120 person-years of follow-up. Compared with the "definite morning" chronotype, the adjusted hazard ratio (HR) for diabetes was 1.21 (CI, 1.09 to 1.35) for the "intermediate" chronotype and 1.72 (CI, 1.50 to 1.98) for the "definite evening" chronotype after adjustment for sociodemographic factors, shift work, and family history of diabetes. Further adjustment for BMI, physical activity, and diet quality attenuated the association comparing the "definite evening" and "definite morning" chronotypes to 1.31 (CI, 1.13 to 1.50), 1.54 (CI, 1.34 to 1.77), and 1.59 (CI, 1.38 to 1.83), respectively. Accounting for all measured lifestyle and sociodemographic factors resulted in a reduced but still positive association (HR comparing "definite evening" vs. "definite morning" chronotype, 1.19 [CI, 1.03 to 1.37]).

LIMITATIONS

Chronotype assessment using a single question, self-reported data, and homogeneity of the study population.

CONCLUSION

Middle-aged nurses with an evening chronotype were more likely to report unhealthy lifestyle behaviors and had increased diabetes risk compared with those with a morning chronotype. Accounting for BMI, physical activity, diet, and other modifiable lifestyle factors attenuated much but not all of the increased diabetes risk.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Does digital financing influence renewable energy performance in China?

The objective of this study is to examine how digital finance influences renewable energy performance in China. Empirical data from China between 2007 and 2019 is used to evaluate the relationship among these variables. The study uses two techniques, quantile regression (QR) and generalized methods of moments (GMM), to draw empirical conclusions. The results reveal that digital finance significantly influences the renewable energy performance, ecological growth, and financial performance of cities in China. Specifically, digital finance accounts for 45.92% of the variation in renewable energy indicators, 27.60% in ecological growth, and 24.39% in the improved financial performance of renewable energy at the city level. The study also observes that the city-level score for digital finance, renewable energy, and other indicators is heterogeneous in movement. Factors contributing to this heterogeneity include high population (16.05%), access to digital banking (23.11%), province-level renewable energy performance (39.62%), household financial stability (22.04%), and household renewable energy literacy (8.47%). Based on these findings, the study recommends practical implications for key stakeholders.

The U-Shaped Association between Sleep Duration, All-Cause Mortality and Cardiovascular Risk in a Hispanic/Latino Clinically Based Cohort

Sleep is essential for life, and inappropriate sleep duration patterns may lead to chronic consequences regarding human health. Several studies have confirmed the presence of a U-shaped association between sleep duration and mortality. Moreover, many consequences related to cardiometabolic aspects have been suggested in patients with abnormal sleep durations. In this study, we analyzed the associations between sleep duration, total sleep time (TST), the risk of all-cause mortality, and 10-year cardiovascular risk in a cohort of patients at a sleep medicine center in Santiago, Chile. We conducted a prospective cohort study of patients (SantOSA). A short TST was defined as ≤6 h, a normal TST as 6 to 9 h, and a long TST as ≥9 h. Adjusted hazard ratios (aHRs) for all-cause mortality were calculated. A cross-sectional analysis between TST and 10-year cardiovascular risk (calculated using the Framingham 2008 formula) was determined using logistic regression models. A total of 1385 subjects were included in the results (78% male; median age: 53, interquartile range (IQR): 42-64 years; median BMI: 29.5, IQR: 16.7-33.1). A total of 333 subjects (24%) reported short TSTs, 938 (67.7%) reported normal TSTs, and 114 (8.3%) reported long TSTs. In the fully adjusted model, the association remained significant for short (aHR: 2.51 (1.48-4.25); p-value = 0.01) and long TSTs (aHR: 3.97 (1.53-10.29); p-value = 0.04). Finally, a U-shaped association was found between short and long TSTs, with an increase in cardiovascular risk at 10 years. Compared with normal TSTs, short (≤6 h) and long (≥9 h) TSTs were significantly associated with all-cause mortality and increased 10-year cardiovascular risk.

Long Sleep Duration and Stroke-Highly Linked, Poorly Understood

Stroke is one of the leading causes of disability and mortality. Both short and long sleep durations are associated with adverse health outcomes. Cross-sectional studies have shown an increased prevalence of stroke in long sleepers. Long sleep duration increases stroke incidence and mortality in prospective epidemiological studies. Accumulating evidence suggests that the magnitude of the association between sleep and stroke appears to be stronger for longer sleep than shorter sleep, yielding a J-shaped curve. Potential links between long sleep duration and stroke include increased incidence of diabetes and atrial fibrillation, elevated levels of inflammation, arterial stiffness, and blood pressure variability. Long sleep duration is a strong marker and a plausible risk factor for stroke and should be considered in future scoring for risk stratification and stroke prevention.

Association of healthy lifestyle with incident cardiovascular diseases among hypertensive and normotensive Chinese adults

Background

Whether lifestyle improvement benefits in reducing cardiovascular diseases (CVD) events extend to hypertensive patients and whether these benefits differ between hypertensive and normotensive individuals is unclear. This study aimed to investigate the associations of an overall healthy lifestyle with the subsequent development of CVD among participants with hypertension and normotension.

Methods

Using data from the Suzhou subcohort of the China Kadoorie Biobank study of 51,929 participants, this study defined five healthy lifestyle factors as nonsmoking or quitting for reasons other than illness; nonexcessive alcohol intake; relatively higher physical activity level; a relatively healthy diet; and having a standard waist circumference and body mass index. We estimated the associations of these lifestyle factors with CVD, ischemic heart disease (IHD) and ischemic stroke (IS).

Results

During a follow-up of 10.1 years, this study documented 6,151 CVD incidence events, 1,304 IHD incidence events, and 2,243 IS incidence events. Compared to those with 0-1 healthy lifestyle factors, HRs for those with 4-5 healthy factors were 0.71 (95% CI: 0.62, 0.81) for CVD, 0.56 (95% CI: 0.42, 0.75) for IHD, and 0.63 (95% CI: 0.51, 0.79) for IS among hypertensive participants. However, we did not observe this association among normotensive participants. Stratified analyses showed that the association between a healthy lifestyle and IHD risk was stronger among younger participants, and the association with IS risk was stronger among hypertensive individuals with lower household incomes.

Conclusion

Adherence to a healthy lifestyle pattern is associated with a lower risk of cardiovascular diseases among hypertensive patients, but this benefit is not as pronounced among normotensive patients.

Lifestyle trajectories and ischemic heart diseases: a prospective cohort study in UK Biobank

AIMS

To evaluate the associations of baseline and long-term trajectories of lifestyle with incident ischemic heart diseases (IHD).

METHODS

29,164 participants in the UK Biobank who had at least one follow-up assessment and were free of IHD at the last follow-up assessment were included. We constructed a weighted unhealthy lifestyle score though summing five lifestyle factors (smoking, physical activity, diet, BMI, and sleep duration). Lifestyle assessed at baseline (2006-2009), the first follow-up assessment (2012-2013) and the second follow-up assessment (since 2014) were used to derive the trajectories of each individual. The joint categories were created through cross-classifying three baseline lifestyle categories (ideal, intermediate and poor) by three lifestyle trajectory categories (improve, maintain and decline).

RESULTS

During a median follow-up period of 4.2 years, 868 IHD events were recorded. The hazard ratio (HR) of incident IHD associated with per unit increase in unhealthy lifestyle trajectory was 1.08 (95% confidence interval (CI): 0.99-1.17). Subgroup analyses indicated such association was stronger among individuals with hypertension (HR: 1.13, 95%CI: 1.03-1.24), diabetes (HR: 1.23, 95%CI: 0.96-1.58) or hyperlipidemia (HR: 1.09, 95%CI: 0.97-1.22). Compared with participants consistently adhering to an ideal lifestyle (ideal-maintain), the HRs of incident IHD were: 1.30 (1.07-1.58) for intermediate-maintain, 1.52 (1.23-1.88) for poor-maintain, 1.25 (0.93-1.68) for intermedia-improve, 1.48 (1.17-1.88) for poor-improve, 1.46 (1.08-1.99) for intermedia-decline and 1.77 (1.21-2.59) for poor-decline.

CONCLUSIONS

A declined lifestyle trajectory increased the risk of incident IHD, irrespective of baseline lifestyle levels. Individuals with hypertension, diabetes or hyperlipidemia were more predisposed to the influence of lifestyle change.

Stroke mortality attributable to high red meat intake in China and South Korea: An age-period-cohort and joinpoint analysis

The high intake of red meat is well recognized as a major health concern worldwide. It has been recognized as a risk factor for several non-communicable chronic diseases, including stroke. However, previously published studies have not performed a comprehensive analysis of the long-time trend of stroke mortality attributable to high red meat intake in China and South Korea, two countries with similar dietary patterns and changing trends. Therefore, this study aimed to reveal the influence of age, time period, and birth cohort on long-term trends of stroke mortality attributable to high red meat intake and relative gender differences in China and South Korea. Data were obtained from the Global Burden of Disease 2019 database. The age–period–cohort model was used to estimate the effect of age, time period, and birth cohort. The average and annual percent changes were estimated using the joinpoint regression analysis. Results indicated that the overall attributable age-standardized mortality rates of stroke in China decreased by 1.0% (P < 0.05) for female and 0.1% (P > 0.05) for male individuals, compared with a decrease of 4.9% for female and 3.7% for male individuals in South Korea (both P < 0.05). Age–period–cohort analysis revealed that the attributable stroke mortality decreased along with the time period, and increased along with age. Significant gender differences were observed, male individuals in both countries were at higher risk than their female counterparts, especially in China. Joinpoint analysis suggested that the attributable stroke mortality for both genders in South Korea and female individuals in China showed a decreasing trend, while it is stable for male individuals in China. Although prominent reductions were observed during the past decades, the attributable stroke mortality risk in China and South Korea is still high. Our findings indicate that controlling the intake of red meat may be a cost-effective strategy to reduce stroke mortality risk and the corresponding disease burden, especially for Chinese male individuals.

Telehealth-based interventions on lifestyle, body mass index, and glucose concentration in university staff during the coronavirus disease 2019 pandemic: A pre-experimental study

Background: The coronavirus disease 2019 pandemic has impacted the health of the population. Technological advances become alternative tools for the promotion of lifestyle and prevention of non-communicable diseases in university personnel. Objective: This study analyzed the effect of an intervention based on a telehealth program and investigated its efficacy in improving lifestyle, body mass index, and glucose concentration in university staff during the coronavirus disease 2019 pandemic. Methods: A pre-experimental study was conducted between August and December 2021 on 100 workers of a private university located in Tarapoto, Peru. Information was collected on lifestyle practices and beliefs, body mass index, and glucose contraction before and after the intervention. After the intervention, 78 participants were analyzed; 22 workers did not respond to the invitation. Results: Comparison between pretest and follow-up showed an increase in lifestyle practices and beliefs (from 93.33 ± 9.44 to 96.23 ± 9.32, p < 0.01), although this value is considered an unhealthy lifestyle. Moreover, a decrease in body mass index (from 25.23 ± 3.08 to 24.98 ± 2.98, p < 0.05) and glucose concentration (from 98.35 ± 6.70 to 97.45 ± 5.61, p < 0.01) was observed. Conclusion: Telehealth-based educational interventions could be effective in university staff during the coronavirus disease 2019 pandemic, which, in turn, would support improved lifestyles and adequate body mass index and glucose levels.

The independent and combined effects of single-child status and ideal lifestyle on clustered cardio-metabolic risk factors among Chinese children and adolescents

Background

Cardio-metabolic risk factors (CMRFs) represent the accumulation of metabolic abnormalities, significantly increasing the likelihood of cardiovascular diseases. Although studies assessed the independent association of single-child status and lifestyle risk factors with components of CMRFs or clustered CMRFs, little has been known about the combined effect of single-child status and lifestyles on clustered CMRFs as well as sex differences.

Materials and methods

Data was collected from a cross-sectional survey conducted in September 2013 in China. A total of 13,859 children and adolescents aged 7–18 years with blood samples were included. Anthropometric measurements and serum biochemical indexes were collected to assess clustered CMRFs, while questionnaires were used to obtain single-child status, lifestyle information, and characteristics of children and their parents. Mixed effect logistic regression was applied to analyze the independent and the combined effects of single-child status and ideal lifestyle category on clustered CMRFs.

Results

The prevalence of clustered CMRFs was 3.4%, with a higher prevalence in boys (4.0%) than girls (2.7%). Children and adolescents with clustered CMRFs had a higher proportion of single children (76.6 vs. 69.7%) and unfavorable lifestyles (62.1 vs. 29.2%) compared with their peers with non-clustered CMRFs. Both single children (OR = 1.67, 95% CI: 1.32–2.11) and unfavorable lifestyles (OR = 9.03, 95% CI: 6.26–13.02) were associated with an increased risk of clustered CMRFs. The risk of clustered CMRFs increased significantly (OR = 12.79, 95% CI: 6.67–24.52) when single children and an unfavorable lifestyle were combined, which was almost neutralized (OR = 1.33, 95% CI: 0.63–2.82) when single children adhered to a favorable lifestyle. However, no sex differences were observed in this study.

Conclusion

Single children with unfavorable lifestyles were associated with an obvious risk of clustered CMRFs, which might be partially offset by expanding family size (the number of siblings) or establishing a favorable lifestyle. A birth-friendly social environment as well as a family environment with a favorable lifestyle are encouraged in China.