Cardiovascular risk factors attributable to obesity and overweight in Switzerland

A quantitative synthesis study on body mass index and associated factors among adult men and women in Switzerland

Excess weight is caused by multiple factors and has increased sharply in Switzerland since the 1990s. Its consequences represent a major challenge for Switzerland, both in terms of health and the economy. Until now, there has been no cross-dataset overview study on excess weight in adults in Switzerland. Therefore, our aim was to conduct the first synthesis on excess weight in Switzerland. We included all existing nationwide Swiss studies (eight total), which included information on body mass index (BMI). Mixed multinomial logistic regression analyses were performed to assess the associations between different socio-demographic, lifestyle cofactors and the World Health Organization (WHO) categories for BMI. Along with lifestyle factors, socio-demographic factors were among the strongest determinants of BMI. In addition, self-rated health status was significantly lower for underweight, pre-obese and obese men and women than for normal weight persons. The present study is the first to synthesise all nationwide evidence on the importance of several socio-demographic and lifestyle factors as risk factors for excess weight. In particular, the highlighted importance of lifestyle factors for excess weight opens up the opportunity for further public health interventions.

Polypharmacy, potentially serious clinically relevant drug-drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life

The aim of the study is to investigate the patterns of polypharmacy, clinical-relevant drug-drug interactions (DDIs), and potentially inappropriate medicines (PIMs), and whether polypharmacy, potential serious clinically-relevant DDIs, or PIMs can be associated with low quality of life (QoL) index scores of older adults with type 2 diabetes (T2D). A cross-sectional study was conducted using data of 670 elderly T2D sub-cohort from a nationwide pharmacy-based intensive monitoring study of inception cohort of T2D in Portugal. 72.09% were found on polypharmacy (≥5 medicines). Participants on polypharmacy were mostly females (P = .0115); more obese (P = .0131); have more comorbid conditions (P < .0001); more diabetes complications (P < .0001); and use more of glucose lowering drugs (P = .0326); insulin (P < .0001); chronic medicines (P < .0001); and have higher diabetes duration (P = .0088) than those without polypharmacy. 10.59% of the participants were found to have potential serious clinically relevant DDIs. The most frequent drug-combinations were angiotensin-converting enzyme (ACE) inhibitors with angiotensin-receptor blockers (ARBs), aspirin with Selective serotonin reuptake inhibitors (SSRIs), and clopidogrel with calcium channel blockers. PIMs are found in 36.11% of the participants. The most common PIMs were benzodiazepines, long-acting sulfonylureas, and iron overdose. The adjusted multivariate models show that Polypharmacy, PIMs, and potential serious clinically relevant DDIs were associated with lower QoL index scores (OR 1.80 95% CI 1.15-2.82), (OR 1.57 95% CI 1.07-2.28), and (OR 1.34 95% CI 0.73-2.48) respectively. The study shows that polypharmacy, potential serious clinical-relevant DDIs, and PIMs may correlate with risk of reduced health related QoL outcome of older adults with T2D.

Illness perception in overweight and obese patients with cardiovascular diseases

OBJECTIVE

This study explored the relationship of illness perception with different aspects of cardiac anxiety, general anxiety and depression in a sample of male and female overweight and obese patients with cardiovascular diseases (CVD).

STUDY DESIGN

The clinical sample included 165 adults (113 males) aged from 32 to 89 years. The patients were admitted to the Department of Cardiology and Cardiac Rehabilitation for a major cardiovascular event, acute myocardial infarction or myocardial revascularization.

MEASUREMENTS

Psychological measurement included questionnaires of illness perception, cardiac anxiety, general anxiety and depression.

RESULTS AND CONCLUSIONS

Illness perception and cardiac anxiety in patients with CVD were associated with anxiety and depression. Regression analysis showed that illness perception accounts for a significant proportion of the variance in both anxiety and depression for males, but not for females. Gender-specific interrelations between perceptions of CVD and indices of mental health have an implication for interventions to maximize the effect of therapy with these patients.

LEVEL OF EVIDENCE

Level V, Descriptive study.

Induction of obesity impairs reverse cholesterol transport in ob/ob mice

Objectives

Obesity is an independent risk factor for cardiovascular disease. Reverse cholesterol transport (RCT) is an important cardioprotective mechanism. This study aimed to investigate RCT changes in a murine model of obesity.

Methods

Ob/ob and control mice were injected with [³H]-cholesterol-labelled macrophages and cholesterol accumulation quantified after 48 h. Ex vivo, cholesterol efflux and uptake were determined in hepatic and adipose tissues.

Results

Ob/ob mice had more labelled cholesterol in their plasma (86%, p<0.001), suggesting impaired RCT. SR-BI-mediated cholesterol efflux was elevated from ob/ob mice (serum, 33%; apoB-depleted plasma, 14%, p<0.01) and HDL-c were also higher (60%, p<0.01). Ex vivo it was found that cholesterol uptake was significantly lower into the livers and adipose tissue of ob/ob mice, compared to non-obese wildtype controls. Furthermore, ex vivo cholesterol efflux was reduced in ob/ob liver and adipose tissue towards apoA-I and HDL. Consistent with this, protein levels of SR-BI and ABCG1 were significantly lower in ob/ob hepatic and adipose tissue than in wildtype mice. Finally, labelled cholesterol concentrations were lower in ob/ob bile (67%, p<0.01) and faeces (76%, p<0.0001).

Conclusion

Obesity causes impairment in RCT due to reduced plasma cholesterol uptake and efflux by hepatocytes and adipocytes. A reduction in the capacity for plasma cholesterol clearance may partly account for increased CVD risk with obesity.

Sense of Coherence, Smoking Status, Biochemical Cardiovascular Risk Factors and Body Mass in Blue Collar Workers-Short Report

The crucial cause of cardiovascular disorders is atherosclerosis developed by abnormal cholesterols levels or disorders affecting blood glucose. One of the best-known cardiovascular risk factors is also tobacco smoking. Simultaneously, sense of coherence (SoC) as a personal resource motivating to managing one's own health behaviors, such as avoiding tobacco smoking, was reported to be protective against coronary heart disease. Such association was observed in white-collar workers but not in blue-collar workers. According to the above, the present article aims to establish relationships between SoC, smoking behaviors, biochemical markers (BM): lipids and glucose levels and body mass index (BMI) in blue-collar workers. Sense of Coherence Questionnaire (SOC-29), fasting blood test, and BMI were used to assess such relationships. The study group consisted of 304 Polish males working 8-hr shifts in a 4-brigade rotating system. The analysis revealed that SoC level did not differ depending on smoking behavior. The analysis also showed no differences in BMI and BM depending on SoC. Concerning smoking status, the study group was divided into three subgroups which differed regarding triglycerides and glucose levels. The present findings considering SoC indicate that any psychological construct should not be studied separately because probably only some sets of different features may influence one's behavior and BM as well.

Associations between anthropometric indices, blood pressure and physical fitness performance in young Swiss men: a cross-sectional study

OBJECTIVES

To assess the benefit of waist circumference (WC) measurements during routine conscription medical examination in two military conscription centres in Switzerland. We compared the prevalence of overweight and obesity assessed by body mass index (BMI) with the prevalence of elevated disease risks assessed by WC and waist-to-height ratio (WHtR). We investigated how these measures were associated with systolic blood pressure, physical fitness performance and socioeconomic determinants.

DESIGN

Cross-sectional survey.

SETTING

Two Swiss conscription centres in 2016.

PARTICIPANTS

1548 Swiss male conscripts, 18-22 years old.

MAIN OUTCOME

Prevalences of elevated WC, WHtR and BMI values according to WHO categories. Secondary outcomes include systolic blood pressure, physical fitness performance and endurance performance.

RESULTS

Using BMI cut-points, 25.0% of all conscripts were overweight or obese. When applying WC cut-points, 9.2% had an increased disease risk, while 14.8% of the conscripts were at risk using WHtR cut-points. In the BMI range of 25.0-27.4 kg/m², 3.6% showed an increased disease risk when using WC and 24.6% when using WHtR cut-points. Of the conscripts with a BMI of 27.5-29.9 kg/m², 72.4% had an increased disease risk using WHtR, and 42.5% when using WC cut-points. Determinants of elevated BMI, WC and WHtR were low occupational status, rural residential area, older age and location in central and Northwest Switzerland. Systolic blood pressure increased with increasing BMI, WC and WHtR. Physical fitness and endurance test performances decreased with increasing BMI, WC and WHtR.

CONCLUSION

In addition to BMI, WC and WHtR add relevant information to the health assessment of young men. However, the prevalence of overweight/increased health risk differed when using BMI, WC or WHtR. Further studies should include measures of body composition to test whether these differences arise from muscular young men within the overweight BMI range, who had a normal WC.

Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study

Background

Polypharmacy is a frequent condition, but its prevalence and determinants in the Swiss mid-aged population are unknown. We aimed to evaluate the prevalence and determinants of polypharmacy in a large Swiss mid-aged population-based sample.

Methods

Data from 4938 participants of the CoLaus study (53% women, age range 40–81 years) were collected between 2009 and 2012. Polypharmacy was defined by the regular use of five or more drugs.

Results

Polypharmacy was reported by 580 participants [11.8%, 95% confidence interval (10.9; 12.6)]. Participants on polypharmacy were significantly older (mean ± standard deviation: 66.0 ± 9.1 vs. 56.6 ± 10.1 years), more frequently obese (35.9% vs. 14.7%), of lower education (66.6% vs. 50.7%) and former smokers (46.7% vs. 36.4%) than participants not on polypharmacy. These findings were confirmed by multivariate analysis: odds ratio and (95% confidence interval) for age groups 50–64 and 65–81 relative to 40–49 years: 2.90 (2.04; 4.12) and 10.3 (7.26; 14.5), respectively, p for trend < 0.001; for low relative to high education: 1.56 (1.17; 2.07); for overweight and obese relative to normal weight participants: 2.09 (1.65; 2.66) and 4.38 (3.39; 5.66), respectively, p for trend < 0.001; for former and current relative to never smokers: 1.42 (1.14, 1.75) and 1.63 (1.25, 2.12), respectively, p for trend < 0.001.

Conclusion

One out of nine participants of our sample is on polypharmacy. Increasing age, body mass index, smoking and lower education independently increase the likelihood of being on polypharmacy.

Electronic supplementary material

The online version of this article (10.1186/s12913-017-2793-z) contains supplementary material, which is available to authorized users.

Comparison of 3D laser-based photonic scans and manual anthropometric measurements of body size and shape in a validation study of 123 young Swiss men

Background

Manual anthropometric measurements are time-consuming and challenging to perform within acceptable intra- and inter-individual error margins in large studies. Three-dimensional (3D) laser body scanners provide a fast and precise alternative: within a few seconds the system produces a 3D image of the body topography and calculates some 150 standardised body size measurements.

Objective

The aim was to enhance the small number of existing validation studies and compare scan and manual techniques based on five selected measurements. We assessed the agreement between two repeated measurements within the two methods, analysed the direct agreement between the two methods, and explored the differences between the techniques when used in regressions assessing the effect of health related determinants on body shape indices.

Methods

We performed two repeated body scans on 123 volunteering young men using a Vitus Smart XXL body scanner. We manually measured height, waist, hip, buttock, and chest circumferences twice for each participant according to the WHO guidelines. The participants also filled in a basic questionnaire.

Results

Mean differences between the two scan measurements were smaller than between the two manual measurements, and precision as well as intra-class correlation coefficients were higher. Both techniques were strongly correlated. When comparing means between both techniques we found significant differences: Height was systematically shorter by 2.1 cm, whereas waist, hip and bust circumference measurements were larger in the scans by 1.17–4.37 cm. In consequence, body shape indices also became larger and the prevalence of overweight was greater when calculated from the scans. Between 4.1% and 7.3% of the probands changed risk category from normal to overweight when classified based on the scans. However, when employing regression analyses the two measurement techniques resulted in very similar coefficients, confidence intervals, and p-values.

Conclusion

For performing a large number of measurements in a large group of probands in a short time, body scans generally showed good feasibility, reliability, and validity in comparison to manual measurements. The systematic differences between the methods may result from their technical nature (contact vs. non-contact).

Temporal trends, regional variation and socio-economic differences in height, BMI and body proportions among German conscripts, 1956-2010

OBJECTIVE

We analyse temporal trends and regional variation among the most recent available anthropometric data from German conscription in the years 2008-2010 and their historical contextualization since 1956. Design/setting/subjects The overall sample included German conscripts (N 13 857 313) from 1956 to 2010.

RESULTS

German conscripts changed from growing in height to growing in breadth. Over the analysed 54 years, average height of 19-year-old conscripts increased by 6·5 cm from 173·5 cm in 1956 (birth year 1937) to 180·0 cm in 2010 (birth year 1991). This increase plateaued since the 1990s (1970s birth years). The increase in average weight, however, did not lessen during the last two decades but increased in two steps: at the end of the 1980s and after 1999. The weight and BMI distributions became increasingly right-skewed, the prevalence of overweight and obesity increased from 11·6 % and 2·1 % in 1984 to 19·9 % and 8·5 % in 2010, respectively. The north-south gradient in height (north = taller) persisted during our observations. Height and weight of conscripts from East Germany matched the German average between the early 1990s and 2009. Between the 1980s and the early 1990s, the average chest circumference increased, the average difference between chest circumference when inhaling and exhaling decreased, as did leg length relative to trunk length.

CONCLUSIONS

Measuring anthropometric data for military conscripts yielded year-by-year monitoring of the health status of young men at a proscribed age. Such findings contribute to a more precise identification of groups at risk and thus help with further studies and to target interventions.

Lipolysis and thermogenesis in adipose tissues as new potential mechanisms for metabolic benefits of dietary fiber

OBJECTIVE

Dietary fiber consumption is associated with reduced risk for the development of noncommunicable diseases. The aim of the present study was to evaluate the effects of cereal dietary fiber on the levels of proteins involved in lipolysis and thermogenesis in white adipose tissue (WAT) and brown adipose tissue (BAT) of C57 BL/6 J mice fed a high-fat diet (HFD).

METHODS

Male C57BL/6 J mice were fed normal chow diet (Chow), HFD, HFD plus oat fiber (H-oat), or HFD plus wheat bran fiber (H-wheat) for 24 wk. Body weight and food intake were recorded weekly. Serum adiponectin was assayed by an enzyme-linked immunosorbent assay kit. Western blotting was used to assess the protein expressions of adipose triacylglycerol lipase (ATGL), cAMP protein kinase catalytic subunit (cAMP), protein kinase A (PKA), perilipin A, hormone-sensitive lipase (HSL), uncoupling protein 1 (UCP1), fibroblast growth factor 21 (FGF-21), β3-adrenergic receptor (β3AR), and proliferator-activated receptor gamma coactivator-1 α (PGC-1 α) in the WAT and BAT.

RESULTS

At the end of the feeding period, body and adipose tissues weight in both H-oat and H-wheat groups were lower than in the HFD group. Mice in the H-oat and H-wheat groups showed an increasing trend in serum adiponectin level. Compared with the HFD group, cereal dietary fiber increased protein expressions involved in the lipolysis and browning process. Compared with the H-wheat group, H-oat was more effective in protein expressions of PKA, PGC-1 α, and UCP1 of the WAT samples. Compared with the H-oat group, H-wheat was more effective in protein expressions of PKA, ATGL, UCP1, β3AR, and FGF-21 of the BAT samples.

CONCLUSIONS

Taken together, our results suggested that cereal dietary fiber enhanced adipocyte lipolysis by the cAMP-PKA-HSL pathway and promoted WAT browning by activation of UCP1, and consequently reduced visceral fat mass in response to HFD feeding.

Diet in children with phenylketonuria and risk of cardiovascular disease: A narrative overview

AIMS

The aim of this paper is to review the possible relationship of restricted phenylalanine (Phe) diet, a diet primarily comprising low-protein foods and Phe-free protein substitutes, with major cardiovascular risk factors (overweight/obesity, blood lipid profile, plasma levels of homocysteine, adiponectin and free asymmetric dimethylarginine (ADMA), oxidative stress and blood pressure) in PKU children.

DATA SYNTHESIS

In PKU children compliant with diet, blood total cholesterol, low-density lipoprotein cholesterol (LDL-C), plasma ADMA levels and diastolic pressure were reported to be lower and plasma adiponectin levels to be higher compared to healthy controls. No difference was observed in overweight prevalence and in high-density lipoprotein cholesterol (HDL-C) levels. Inconsistent results were found for plasma homocysteine levels and antioxidant status.

CONCLUSIONS

PKU children compliant with diet seem to display non-different cardiovascular risks compared with the healthy population. Well-designed longitudinal studies are required to clarify the potential underlying mechanisms associated with PKU and cardiovascular risk factors.

Finding big shots: small-area mapping and spatial modelling of obesity among Swiss male conscripts

BACKGROUND

In Switzerland, as in other developed countries, the prevalence of overweight and obesity has increased substantially since the early 1990s. Most of the analyses so far have been based on sporadic surveys or self-reported data and did not offer potential for small-area analyses. The goal of this study was to investigate spatial variation and determinants of obesity among young Swiss men using recent conscription data.

METHODS

A complete, anonymized dataset of conscription records for the 2010-2012 period were provided by Swiss Armed Forces. We used a series of Bayesian hierarchical logistic regression models to investigate the spatial pattern of obesity across 3,187 postcodes, varying them by type of random effects (spatially unstructured and structured), level of adjustment by individual (age and professional status) and area-based [urbanicity and index of socio-economic position (SEP)] characteristics.

RESULTS

The analysed dataset consisted of 100,919 conscripts, out of which 5,892 (5.8 %) were obese. Crude obesity prevalence increased with age among conscripts of lower individual and area-based SEP and varied greatly over postcodes. Best model's estimates of adjusted odds ratios of obesity on postcode level ranged from 0.61 to 1.93 and showed a strong spatial pattern of obesity risk across the country. Odds ratios above 1 concentrated in central and north Switzerland. Smaller pockets of elevated obesity risk also emerged around cities of Geneva, Fribourg and Lausanne. Lower estimates were observed in North-East and East as well as south of the Alps. Importantly, small regional outliers were observed and patterning did not follow administrative boundaries. Similarly as with crude obesity prevalence, the best fitting model confirmed increasing risk of obesity with age and among conscripts of lower professional status. The risk decreased with higher area-based SEP and, to a lesser degree - in rural areas.

CONCLUSION

In Switzerland, there is a substantial spatial variation in obesity risk among young Swiss men. Small-area estimates of obesity risk derived from conscripts records contribute to its understanding and could be used to design further studies and interventions.

Type 2 diabetes mellitus incidence in Chinese: contributions of overweight and obesity

AIMS

To estimate the incidence of Type 2 diabetes mellitus (T2DM) and the number of those with T2DM attributable to overweight and obesity in China.

METHODS

We conducted a prospective cohort study among 15680 participants (46.4%, men) aged 35-74 years. The mean duration of follow-up was 8.0 years. We examined the relationship between overweight, obesity and risk of T2DM by Cox proportional hazards models. Population attributable risk (PAR) of overweight and obesity was also calculated. Moreover, we estimated the number of T2DM events attributed to overweight and obesity using PAR, incidence of T2DM and the population size of China in 2010.

RESULTS

During a mean follow-up of 8.0 years, the age-standardized incidence of T2DM was 9.5 per 1000 person-years in men and 9.2 in women. Overweight accounted for 28.3% (95% confidence interval [CI]: 20.1, 36.2) of incident T2DM among men and 31.3% (95% CI: 25.5, 36.9) among women. The corresponding PAR of obesity was 10.1% (95% CI: 6.0, 14.2) among men and 16.8% (95% CI: 12.0, 21.6) among women. Approximately 3.32 million (95% CI: 2.47, 4.24) incident T2DM were attributable to overweight and obesity in Chinese adults who were 35 to 74 years in 2010.

CONCLUSION

Our results indicate that incident T2DM is mainly attributable to overweight and obesity in China. It is extremely important to advocate healthy lifestyle and prevent excessive weight gain for reducing T2DM burden in China.

Effect of liraglutide administration and a calorie-restricted diet on lipoprotein profile in overweight/obese persons with prediabetes

BACKGROUND AND AIMS

To evaluate the effects of 14 weeks of liraglutide plus modest caloric restriction on lipid/lipoprotein metabolism in overweight/obese persons with prediabetes.

METHODS AND RESULTS

Volunteers with prediabetes followed a calorie-restricted diet (-500 Kcal/day) plus liraglutide (n = 23) or placebo (n = 27) for 14 weeks. The groups were similar in age (58 ± 7 vs. 58 ± 8 years) and body mass index (31.9 ± 2.8 vs. 31.9 ± 3.5 kg/m(2)). A comprehensive lipid/lipoprotein profile was obtained before and after intervention using vertical auto profile (VAP). Weight loss was greater in the liraglutide group than in the placebo group (6.9 vs. 3.3 kg, p < 0.001), as was the fall in fasting plasma glucose concentration (9.9 mg/dL vs. 0.3 mg/dL, p < 0.001). VAP analysis revealed multiple improvements in lipid/lipoprotein metabolism in liraglutide-treated compared with placebo-treated volunteers, including decreases in concentrations of total cholesterol, low-density lipoprotein cholesterol and several of its subclasses, triglyceride, and non-high-density cholesterol. The liraglutide-treated group also had a significant shift away from small, dense low-density lipoprotein-particles, as well as decreases in apolipoprotein B concentration and ratio of apolipoprotein B/apolipoprotein A-1. There were no significant changes in the lipoprotein profile in the placebo-treated group.

CONCLUSION

Treatment with liraglutide plus modest calorie restriction led to enhanced weight loss, a decrease in fasting plasma glucose concentration, and improvement in multiple aspects of lipid/lipoprotein metabolism associated with increased cardiovascular disease (CVD) risk. The significant clinical benefit associated with liraglutide-assisted weight loss in a group at high risk for CVD - obese/overweight individuals with prediabetes - as seen in our pilot study, suggests that this approach deserves further study.

Socioeconomic, temporal and regional variation in body mass index among 188,537 Swiss male conscripts born between 1986 and 1992

Background

Rising levels of overweight and obesity are important public-health concerns worldwide. The purpose of this study is to elucidate their prevalence and trends in Switzerland by analyzing variations in Body Mass Index (BMI) of Swiss conscripts.

Methods

The conscription records were provided by the Swiss Army. This study focussed on conscripts 18.5–20.5 years of age from the seven one-year birth cohorts spanning the period 1986–1992. BMI across professional status, area-based socioeconomic position (abSEP), urbanicity and regions was analyzed. Two piecewise quantile regression models with linear splines for three birth-cohort groups were used to examine the association of median BMI with explanatory variables and to determine the extent to which BMI has varied over time.

Results

The study population consisted of 188,537 individuals. Median BMI was 22.51 kg/m² (22.45–22.57 95% confidence interval (CI)). BMI was lower among conscripts of high professional status (−0.46 kg/m²; 95% CI: −0.50, −0.42, compared with low), living in areas of high abSEP (−0.11 kg/m²; 95% CI: −0.16, −0.07 compared to medium) and from urban communities (−0.07 kg/m²; 95% CI: −0.11, −0.03, compared with peri-urban). Comparing with Midland, median BMI was highest in the North-West (0.25 kg/m²; 95% CI: 0.19–0.30) and Central regions (0.11 kg/m²; 95% CI: 0.05–0.16) and lowest in the East (−0.19 kg/m²; 95% CI: −0.24, −0.14) and Lake Geneva regions (−0.15 kg/m²; 95% CI: −0.20, −0.09). Trajectories of regional BMI growth varied across birth cohorts, with median BMI remaining high in the Central and North-West regions, whereas stabilization and in some cases a decline were observed elsewhere.

Conclusions

BMI of Swiss conscripts is associated with individual and abSEP and urbanicity. Results show regional variation in the levels and temporal trajectories of BMI growth and signal their possible slowdown among recent birth cohorts.

Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial

BACKGROUND AND AIM

This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care.

METHODS AND RESULTS

Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity.

CONCLUSIONS

The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice.

REGISTRATION NUMBER

ACTRN12611000813987.

Periodic cohort health examinations in the TAMRISK study show untoward increases in body mass index and blood pressure during 15 years of follow-up

Background

Obesity is a significant risk factor for hypertension and diabetes. A cohort of 50-year-old voluntary periodic health examination (PHE) participants was analyzed 15 years retrospectively. Our aim was to evaluate changes in body mass index (BMI) and blood pressure in subjects diagnosed with hypertension and/or diabetes in comparison with healthy controls.

Methods

Voluntary periodic health examinations (PHE) of the citizens have been carried out by the city of Tampere, Finland. Health data, including body mass index (BMI) and blood pressure, were recorded every five years, starting at the age of 35 (baseline). A total of 339 subjects from the 50-year-old cohort having hypertension and/or diabetes were chosen to the study group. The control group included 604 subjects from the 50-year-old cohort who had the same follow-up information but were not diagnosed with hypertension and/or diabetes.

Results

In the study group the mean BMI had increased from 26.1 at baseline to 28.5 at the final 15-year follow-up examination. The corresponding increase in the control group was from 23.8 at baseline to 25.5 at the final follow-up. The difference in change with time between the groups was statistically significant (p = 0.04). On the average, the controls gained 4.9 kilograms, whereas subjects in the study group gained 7.0 kilograms over the 15 years of follow-up. Systolic and diastolic blood pressures were also higher in the study group already at baseline and systolic blood pressure increased with time more in the study group than in the control group (p = 0.004).

Conclusions

BMI and blood pressure were higher in the study group in comparison with the controls already at baseline at 35 years, and the differences were not favorably changed during the follow-up. Apparently, the effect of PHE had not been as efficient as planned on subjects in the study group, who were already slightly overweight at baseline.

Differing trends in the association between obesity and self-reported health in Portugal and Switzerland. Data from national health surveys 1992-2007

Background

The escalating prevalence of obesity might prompt obese subjects to consider themselves as normal, as this condition is gradually becoming as frequent as normal weight. In this study, we aimed to assess the trends in the associations between obesity and self-rated health in two countries.

Methods

Data from the Portuguese (years 1995–6, 1998–6 and 2005–6) and Swiss (1992–3, 1997, 2002 and 2007) National Health Surveys were used, corresponding to more than 130,000 adults (64,793 for Portugal and 65,829 for Switzerland). Body mass index and self-rated health were derived from self-reported data.

Results

Obesity levels were higher in Portugal (17.5% in 2005–6 vs. 8.9% in 2007 in Switzerland, p < 0.001) and increased in both countries. The prevalence of participants rating their health as “bad” or “very bad” was higher in Portugal than in Switzerland (21.8% in 2005–6 vs 3.9% in 2007, p < 0.001). In both countries, obese participants rated more frequently their health as “bad” or “very bad” than participants with regular weight. In Switzerland, the prevalence of “bad” or “very bad” rates among obese participants, increased from 6.5% in 1992–3 to 9.8% in 2007, while in Portugal it decreased from 41.3% to 32.3%. After multivariate adjustment, the odds ratio (OR) of stating one self’s health as “bad” or “very bad” among obese relative to normal weight participants, almost doubled in Switzerland: from 1.38 (95% confidence interval, CI: 1.01–1.87) in 1992–3 to 2.64 (95% CI: 2.14–3.26) in 2007, and similar findings were obtained after sample weighting. Conversely, no such trend was found in Portugal: 1.35 (95% CI: 1.23–1.48) in 1995–6 and 1.52 (95% CI: 1.37–1.70) in 2005–6.

Conclusion

Obesity is increasing in Switzerland and Portugal. Obesity is increasingly associated with poorer self-health ratings in Switzerland but not in Portugal.