Facing the noncommunicable disease (NCD) global epidemic--the battle of prevention starts in utero--the FIGO challenge

Epigenetic programming for obesity and noncommunicable disease: From womb to tomb

Several epidemiological, clinical and experimental studies in recent decades have shown the relationship between exposure to stressors during development and health outcomes later in life. The characterization of these susceptible phases, such as preconception, gestation, lactation and adolescence, and the understanding of factors that influence the risk of an adult individual for developing obesity, metabolic and cardiovascular diseases, is the focus of the DOHaD (Developmental Origins of Health and Disease) research line. In this sense, advancements in molecular biology techniques have contributed significantly to the understanding of the mechanisms underlying the observed phenotypes, their morphological and physiological alterations, having as a main driving factor the epigenetic modifications and their consequent modulation of gene expression. The present narrative review aimed to characterize the different susceptible phases of development and associated epigenetic modifications, and their implication in the development of non-communicable diseases. Additionally, we provide useful insights into interventions during development to counteract or prevent long-term programming for disease susceptibility.

Assessing and predicting the trend of cardiovascular risk factors in 40-80-year population based on the Ira-PEN program as an integrated service in primary health care

BACKGROUND

In Iran, half of all mortalities and 79% of those induced by noncommunicable diseases are attributed to cardiovascular diseases. In Iran, due to the high rate of noncommunicable diseases, a modified program (PEN) called Ira-PEN was integrated into the primary care program in health centers. The Ira-PEN program is adapted from the comprehensive WHO-PEN program to estimate the 10-year risk of cardiovascular diseases to control the main risk factors of noncommunicable diseases nationally. This study was conducted to investigate the process of service provision to determine the information needs and the necessary interventions in the comprehensive health service centers of Ardabil Province.

MATERIALS AND METHODS

The present descriptive and analytical study was conducted in the Ardabil University of Medical Sciences. It used the data available in the registration system of the Health Network. The research population consisted of all people aged between 40 and 80 who visited the comprehensive health service centers to perform risk assessment of cardiovascular strokes in the province from 2018 to the end of 2021. The collected data were added to Excel. FORCAST function was used to predict the future through a linear regression analysis. To compare the final results, which is actually a reduction in mortality due to cardiovascular diseases, the difference test of two mortality rates due to cardiovascular diseases was used in 2018 and 2021. Test of two death proportions was performed through z test and Minitab21 Software.

RESULTS

The prevalence of cardiovascular disease risk factors was as follows: history of heart attack (0.59%), history of stroke (0.51%), history of diabetes (7.9%), history of high blood pressure (15.7%), and history of prediabetics (12.8%). The probability of suffering from lipid disorder was 26.4% and BMI > 30 was 32.4%. The risk factors of hypertension, abdominal obesity, and smoking showed a decrease in the measurement of disease risk factors during 4 years.

CONCLUSIONS

Identification of the common risk factors in the region helps to focus interventions on effective prevention and treatment measures and adopt evidence-based policies in order to reduce these risk factors. Since the investigated risk factors are rooted in inappropriate behaviors and lifestyles, by modifying these behaviors and changing lifestyles, their prevalence can be reduced and reducing these risk factors will lead to a reduction in the prevalence of cardiovascular diseases.

Non-communicable Disease-Related Sustainable Development Goals for 66 Belt and Road Initiative Countries

BACKGROUND

Since 2015, the Global Burden of Disease Study (GBD) has measured progress in achieving health-related Sustainable Development Goals (SDGs) annually worldwide. Little is known about the status and attainment of indicators of non-communicable diseases (NCDs) by 65 countries from the Belt and Road Initiative (BRI) proposed by China in 2013.

METHODS

Data from GBDs were used to estimate 24 NCD-related SDG indicators in BRI countries from 1990 to 2017. Each indicator was scored from 0 to 100 to compare multiple indicators over the study period. The natural log of the annual change in each location and year and weighted annual rates of change were used to generate projections for 2030. National-level estimates were determined by socio-demographic index (SDI) quintiles in BRI countries with more than 1 million inhabitants.

RESULTS

In 2017, the median overall score of NCD-related SDG index for the 66 BRI countries was 60 points, ranging from 29 points in Afghanistan to 84 points in Israel. More than 80% of countries achieved the SDG 2030 maternal mortality (MM) rate target in 2017, and the national skilled birth attendance rate was above 99% in more than 59% countries. However, none of the BRI countries achieved the goal for children's overweight, modern methods of contraception, and universal health coverage. It was predicted that 80.4% of NCD-related SDG targets would be achieved in these countries by 2030. The overall score of NCD-related SDG index were positively associated with SDI quintiles.

CONCLUSION

For many indicators, the achieved progress in many countries is less than the annual rate necessary to meet SDG targets, indicating that substantial efforts need to be made in the coming years. Progress should be accelerated through collaborations between countries, implementation of NCD prevention and control strategies, and monitoring of inequalities in NCD-related SDGs within populations.

Lycopene in the Prevention of Cardiovascular Diseases

Cardiovascular diseases (CVDs) are the leading cause of human mortality worldwide. Oxidative stress and inflammation are pathophysiological processes involved in the development of CVD. That is why bioactive food ingredients, including lycopene, are so important in their prevention, which seems to be a compound increasingly promoted in the diet of people with cardiovascular problems. Lycopene present in tomatoes and tomato products is responsible not only for their red color but also for health-promoting properties. It is characterized by a high antioxidant potential, the highest among carotenoid pigments. Mainly for this reason, epidemiological studies show a number of favorable properties between the consumption of lycopene in the diet and a reduced risk of cardiovascular disease. While there is also some controversy in research into its protective effects on the cardiovascular system, growing evidence supports its beneficial role for the heart, endothelium, blood vessels, and health. The mechanisms of action of lycopene are now being discovered and may explain some of the contradictions observed in the literature. This review aims to present the current knowledge in recent years on the preventive role of lycopene cardiovascular disorders.

Maternal health and health-related behaviours and their associations with child health: Evidence from an Australian birth cohort

Objective

This study investigates the associations between maternal health and health-related behaviours (nutrition, physical activity, alcohol consumption and smoking) both during pregnancy and up to 15 months from childbirth and children’s health outcomes during infancy and adolescence (general health, presence of a chronic illness, and physical health outcome index).

Methods

This study used Wave 1 (2004) and Wave 7 (2016) data from the Longitudinal Survey of Australian Children (LSAC). We measured mothers’ general health, presence of a medical condition during pregnancy and mental health during pregnancy or in the year after childbirth. We subsequently measured the children’s general health, presence of a medical condition, and physical health outcome index at ages 0–1 (infancy) and 12–13 (adolescence). Binary logistic and linear regression analyses were performed to examine the association between the mothers’ health-related variables and their children’s health.

Results

Our results showed that poor general health of the mother in the year after childbirth was associated with higher odds of poor health in infants and adolescents in all three dimensions: poor general health (OR: 3.13, 95% CI: 2.16–4.52 for infants; OR: 1.39, 95% CI: 0.95–2.04 for adolescents), presence of a chronic condition (OR: 1.47, 95% CI: 1.19–1.81 for adolescents) and lower physical health score (b = −0.94, p-value <0.05 for adolescents). Our study also revealed that the presence of a chronic condition in mothers during pregnancy significantly increased the likelihood of the presence of a chronic condition in their offspring during infancy (OR: 1.31, 95% CI: 1.12–1.54) and during adolescence (OR: 1.45, 95% CI: 1.20–1.75). The study found that stressful life events faced by mothers increase the odds of poor general health or any chronic illness during adolescence, while stress, anxiety or depression during pregnancy and psychological distress in the year after childbirth increase the odds of any chronic illness during infancy.

Conclusions

The present study found evidence that poor maternal physical and mental health during pregnancy or up to 15 months from childbirth has adverse health consequences for their offspring as measured by general health, presence of chronic health conditions, and physical health index scores. This suggests that initiatives to improve maternal physical and mental health would not only improve child health but would also reduce the national health burden.

The Beneficial Role of Exercise on Treating Alzheimer's Disease by Inhibiting β-Amyloid Peptide

Alzheimer's disease (AD) is associated with a very large burden on global healthcare systems. Thus, it is imperative to find effective treatments of the disease. One feature of AD is the accumulation of neurotoxic β-amyloid peptide (Aβ). Aβ induces multiple pathological processes that are deleterious to nerve cells. Despite the development of medications that target the reduction of Aβ to treat AD, none has proven to be effective to date. Non-pharmacological interventions, such as physical exercise, are also being studied. The benefits of exercise on AD are widely recognized. Experimental and clinical studies have been performed to verify the role that exercise plays in reducing Aβ deposition to alleviate AD. This paper reviewed the various mechanisms involved in the exercise-induced reduction of Aβ, including the regulation of amyloid precursor protein cleaved proteases, the glymphatic system, brain-blood transport proteins, degrading enzymes and autophagy, which is beneficial to promote exercise therapy as a means of prevention and treatment of AD and indicates that exercise may provide new therapeutic targets for the treatment of AD.

Obesity as a contributor to immunopathology in pregnant and non-pregnant adults with COVID-19

The ongoing coronavirus disease 2019 (COVID-19) pandemic has led to a global public health emergency with the need to identify vulnerable populations who may benefit from increased screening and healthcare resources. Initial data suggest that overall, pregnancy is not a significant risk factor for severe coronavirus disease 2019 (COVID-19). However, case series have suggested that maternal obesity is one of the most important comorbidities associated with more severe disease. In obese individuals, suppressors of cytokine signaling are upregulated and type I and III interferon responses are delayed and blunted leading to ineffective viral clearance. Obesity is also associated with changes in systemic immunity involving a wide range of immune cells and mechanisms that lead to low-grade chronic inflammation, which can compromise antiviral immunity. Macrophage activation in adipose tissue can produce low levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6). Further, adipocyte secretion of leptin is pro-inflammatory and high circulating levels of leptin have been associated with mortality in patients with acute respiratory distress syndrome. The synergistic effects of obesity-associated delays in immune control of COVID-19 with mechanical stress of increased adipose tissue may contribute to a greater risk of pulmonary compromise in obese pregnant women. In this review, we bring together data regarding obesity as a key co-morbidity for COVID-19 in pregnancy with known changes in the antiviral immune response associated with obesity. We also describe how the global burden of obesity among reproductive age women has serious public health implications for COVID-19.

Maternal fats and pregnancy complications: Implications for long-term health

Pregnancy imposes increased nutritional requirements for the well being of the mother and fetus. Maternal lipid metabolism is critical for fetal development and long-term health of the offspring as it plays a key role in energy storage, tissue growth and cell signaling. Maternal fat composition is considered as a modifiable risk for abnormal lipid metabolism and glucose tolerance during pregnancy. Data derived from observational studies demonstrate that higher intake of saturated fats during pregnancy is associated with pregnancy complications (preeclampsia, gestational diabetes mellitus and preterm delivery) and poor birth outcomes (intra uterine growth retardation and large for gestational age babies). On the other hand, prenatal long chain polyunsaturated fatty acids status is shown to improve birth outome. In this article, we discuss the role of maternal lipids during pregnancy on fetal growth and development and its consequences on the health of the offspring.

Willingness to pay for pharmacist-provided home telemonitoring among patients with chronic diseases in Enugu metropolis

Home telemonitoring is a promising approach in the management of patients with chronic diseases. However, no study has assessed its acceptability and possible service charge in Nigeria. Therefore, this study aimed to evaluate willingness to pay for pharmacist-provided telemonitoring among patients with chronic diseases and to explore its determinants. Hence, using the contingent valuation method, a cross-sectional study was conducted among eligible patients visiting 15 selected community pharmacies in Enugu metropolis, over a period of 3 months. Of the 335 patients who participated in the study, about 40 percent (i.e. 39.4%) were willing to pay an average monthly fee of ₦915.91 ± 485.49 (US$2.99 ± 1.59) for home telemonitoring services. Significant predictors of willingness to pay for home telemonitoring were perceived insufficient income (odds ratio = 0.20, 95% confidence interval = 0.07-0.60, p = 0.040) and health insurance status (odds ratio = 0.39, 95% confidence interval = 0.18-0.86, p = 0.019). Our findings suggest a promising potential for adopting home telemonitoring services among patients with chronic diseases in Enugu metropolis.

Prevalence trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age based on sociodemographic characteristics

The authors estimated the prevalence and trends of overweight, obesity, diabetes and hypertension among Brazilian women of reproductive age. A time series was constructed with Vigitel data from 2008 to 2015 and we analyzed trends of the prevalence of these conditions, considering sociodemographic characteristics. We observed an increasing trend in prevalence of overweight, obesity, and diabetes (for some sociodemographic characteristics), and stationary trends for hypertension. Our results highlight the need for early interventions in lifestyle of this population to reduce the NCDs risk factors burden and potentially contribute to improve maternal and neonatal outcomes and reduce the NCDs load.

Strategies to reduce non-communicable diseases in the offspring: negative and positive in utero programming

Non-communicable diseases (NCDs) are a major problem as they are the leading cause of death and represent a substantial economic cost. The 'Developmental Origins of Health and Disease Hypothesis' proposes that adverse stimuli at different life stages can increase the predisposition to these diseases. In fact, adverse in utero programming is a major origin of these diseases due to the high malleability of embryonic development. This review provides a comprehensive analysis of the scientific literature on in utero programming and NCDs highlighting potential medical strategies to prevent these diseases based upon this programming. We fully address the concept and mechanisms involved in this programming (anatomical disruptions, epigenetic modifications and microbiota alterations). We also examine the negative role of in utero programming on the increased predisposition of NCDs in the offspring, which introduces the passive medical approach that consists of avoiding adverse stimuli including an unhealthy diet and environmental chemicals. Finally, we extensively discuss active medical approaches that target the causes of NCDs and have the potential to significantly and rapidly reduce the incidence of NCDs. These approaches can be classified as direct in utero programming modifications and personalized lifestyle pregnancy programs; they could potentially provide transgenerational NCDs protection. Active strategies against NCDs constitute a promising tool for the reduction in NCDs.

The combination of obesity and hypertension: a highly unfavorable phenotype requiring attention

PURPOSE OF REVIEW

Body habitus is a key lifestyle characteristic whose current status and future projections are disconcerting. The percentage of the global population who are either overweight or obese has substantially increased, with no indication that any country has a solution to this issue. Hypertension is a key unfavorable health metric that, like obesity, has disastrous health implications if left uncontrolled. Poor lifestyle characteristics and health metrics often cluster together to create complex and difficult to treat phenotypes. Excess body mass is such an example, creating an obesity-hypertension phenotype, which is the focus of this review.

RECENT FINDINGS

An increased risk for hypertension is clearly linked to obesity, indicating that the two conditions are intimately linked. The cascade of obesity-induced pathophysiologic adaptations creates a clear path to hypertension. Adopting a healthy lifestyle is a primary intervention for the prevention as well as treatment of the obesity-hypertension phenotype.

SUMMARY

The obesity-hypertension phenotype is highly prevalent and has disastrous health implications. A primordial prevention strategy, focused on lifelong healthy lifestyle patterns, is the optimal approach for this condition. For those individuals already afflicted by the obesity-hypertension phenotype, interventions must aggressively focus on weight loss and blood pressure control.

Let Us Talk About Moving: Reframing the Exercise and Physical Activity Discussion

Noncommunicable and chronic disease are interchangeable terms. According to the World Health Organization, "they are of long duration and generally slow progression. The 4 main types of chronic diseases are cardiovascular diseases (ie, heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes." We have known about the benefits of physical activity (PA) for thousands of years. Perhaps our approach, from public health messaging to the individual clinical encounter, as to how PA and exercise are discussed and prescribed can be improved upon, with the ultimate goal of increasing the likelihood that an individual moves more; ultimately moving more should be the goal. In fact, there is an incongruence between the evidence for the benefits of physical movement and how we message and integrate PA and exercise guidance into health care, if it is discussed at all. Specifically, evidence clearly indicates any migration away from the sedentary phenotype toward a movement phenotype is highly beneficial. As we necessarily move to a proactive, preventive healthcare model, we must reconceptualize how we evaluate and treat conditions that pose the greatest threat, namely chronic disease; there is a robust body of evidence supporting the premise of movement as medicine. The purpose of this perspective paper is to propose an alternate model for promoting, assessing, discussing, and prescribing physical movement.

The P4 Health Spectrum - A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan

Chronic diseases (i.e., noncommunicable diseases), mainly cardiovascular disease, cancer, respiratory diseases and type-2-diabetes, are now the leading cause of death, disability and diminished quality of life on the planet. Moreover, these diseases are also a major financial burden worldwide, significantly impacting the economy of many countries. Healthcare systems and medicine have progressively improved upon the ability to address infectious diseases and react to adverse health events through both surgical interventions and pharmacology; we have become efficient in delivering reactive care (i.e., initiating interventions once an individual is on the verge of or has actually suffered a negative health event). However, with slowly progressing and often 'silent' chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio. A new approach in medicine that is predictive, preventive, personalized and participatory, which we label here as "P4" holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases. In this concept paper, we propose a 'P4 Health Continuum' model as a framework to promote and facilitate multi-stakeholder collaboration with an orchestrated common language and an integrated care model to increase the healthspan.

Intersystem Implications of the Developmental Origins of Health and Disease: Advancing Health Promotion in the 21st Century

The developmental origins of health and disease (DOHaD) theory and life course theory (LCT) are emerging fields of research that have significant implications for the public health and health promotion professions. Using a DOHaD/LCT perspective, social determinants of health (SDH) take on new critical meaning by which health promotion professionals can implement DOHaD/LCT guided interventions, including recommended policies. Through these interventions, public health could further address the sources of worldwide chronic disease epidemics and reduce such disease rates substantially if related policy, programs, and interdisciplinary and multi-sector collaboration are emphasized. Additional characteristics of the most effective interventions involve context-specific adaptation and societal structures that impact upstream, early life environments on a broad scale, influencing multiple locations and/or diseases.

Associations between noncommunicable disease risk factors, race, education, and health insurance status among women of reproductive age in Brazil - 2011

BACKGROUND

Noncommunicable disease (NCD) risk factors increase the risk of adverse reproductive health outcomes and are becoming increasingly common in Brazil.

METHODS

We analyzed VIGITEL 2011 telephone survey data for 13,745 Brazilian women aged 18-44 years in a probabilistic sample from 26 Brazilian state capitals and the Federal District. We examined associations between NCD risk factors (fruit and vegetable intake, leisure time physical activity, alcohol consumption, smoking status, BMI and hypertension status) and race, education, and insurance using chi-square tests and multivariable logistic regression models, estimating the average marginal effects to produce adjusted relative risk ratios (aRRs). Analyses were conducted using SAS 9.3 survey procedures and weighted to reflect population estimates.

RESULTS

Women with less than a college education were more likely to report physical inactivity (adjusted relative risk (aRR) and 95% confidence interval = 1.1 (1.1-1.2)), smoking (aRR = 1.7 (1.3-2.2)), and self-reported diagnoses of hypertension (aRR = 2.0 (1.6-2.5)) compared to women with a college education or greater. Similarly, women without health insurance were more likely to report physical inactivity (aRR = 1.1 (1.1-1.2)), smoking (aRR = 1.4 (1.1-1.8)), and self-reported diagnoses of hypertension aRR = 1.4 (1.1-1.7)) compared to women with health insurance. Less variation was found by race and NCD risk factors.

CONCLUSION

Targeted public health strategies and policies are needed to increase healthcare access and decrease educational and racial disparities in NCD risk factors among women of reproductive age in Brazil.

Prevention of type 2 diabetes among women with prior gestational diabetes mellitus

The morbidity and mortality rates related to diabetes are constantly rising, as well as those for other noncommunicable diseases. The epidemic is spreading throughout the world, in both low- and high-resource countries. Prevention is a key aspect in the battle against the disease and obstetricians play a critical role in the fight. Prevention starts in utero-for the diabetic mother, her infant, and future generations. The postpartum period should not be neglected because it provides another window of opportunity to address prevention. Data on the prevention of type 2 diabetes among women diagnosed with gestational diabetes are discussed.