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Liu Z, Zheng P, Fang Y, Huang J, Huang J, Chen L, Hu Q, Zou C, Tao J, Chen L. Joint association of sedentary time and physical activity with abnormal heart rate recovery in young and middle-aged adults. BMC Public Health 2024; 24:1787. [PMID: 38965484 PMCID: PMC11225313 DOI: 10.1186/s12889-024-19298-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 06/27/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Abnormal heart rate recovery (HRR), representing cardiac autonomic dysfunction, is an important predictor of cardiovascular disease. Prolonged sedentary time (ST) is associated with a slower HRR. However, it is not clear how much moderate-to-vigorous physical activity (MVPA) is required to mitigate the adverse effects of sedentary behavior on HRR in young and middle-aged adults. This study aimed to examine the joint association of ST and MVPA with abnormal HRR in this population. METHODS A cross-sectional analysis was conducted on 1253 participants (aged 20-50 years, 67.8% male) from an observational study assessing cardiopulmonary fitness in Fujian Province, China. HRR measured via cardiopulmonary exercise tests on a treadmill was calculated as the difference between heart rate at peak exercise and 2 min after exercise. When the HRR was ≤ 42 beats·minute-1 within this time, it was considered abnormal. ST and MVPA were assessed by the IPAQ-LF. Individuals were classified as having a low sedentary time (LST [< 6 h·day-1]) or high sedentary time (HST [≥ 6 h·day-1]) and according to their MVPA level (low MVPA [0-149 min·week-1], medium MVPA [150-299 min·week-1], high MVPA [≥ 300 min·week-1]). Finally, six ST-MVPA groups were derived. Associations between ST-MVPA groups with abnormal HRR incidence were examined using logistic regression models. RESULTS 53.1% of the young and middle-aged adults had less than 300 min of MVPA per week. In model 2, adjusted for possible confounders (e.g. age, sex, current smoking status, current alcohol consumption, sleep status, body mass index), HST was associated with higher odds of an abnormal HRR compared to LST (odds ratio (OR) = 1.473, 95% confidence interval (CI) = 1.172-1.852). Compared with the reference group (HST and low MVPA), the HST and high MVPA groups have a lower chance of abnormal HRR (OR, 95% CI = 0.553, 0.385-0.795). Compared with individuals with HST and low MVPA, regardless of whether MVPA is low, medium, or high, the odds of abnormal HRR in individuals with LST is significantly reduced (OR, 95% CI = 0.515, 0.308-0.857 for LST and low MVPA; OR, 95% CI = 0.558, 0.345-0.902 for LST and medium MVPA; OR, 95% CI = 0.476, 0.326-0.668 for LST and high MVPA). CONCLUSION Higher amounts of MVPA appears to mitigate the increased odds of an abnormal HRR associated with HST for healthy young and middle-aged adults.
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Affiliation(s)
- Zhizhen Liu
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Peiyun Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Yong Fang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jie Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Jia Huang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Liming Chen
- Health Management Center, The Second People's Hospital Affiliated to Fujian University of Chinese Medicine, Fuzhou, 350003, China
| | - Qiaoling Hu
- Health Management Center, The Second People's Hospital Affiliated to Fujian University of Chinese Medicine, Fuzhou, 350003, China
| | - Chunyan Zou
- Health Management Center, The Second People's Hospital Affiliated to Fujian University of Chinese Medicine, Fuzhou, 350003, China
| | - Jing Tao
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
| | - Lidian Chen
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
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Zhou H, Nie J, Cao Y, Diao L, Zhang X, Li J, Chen S, Zhang X, Chen G, Zhang Z, Li B. Association of daily sitting time and coffee consumption with the risk of all-cause and cardiovascular disease mortality among US adults. BMC Public Health 2024; 24:1069. [PMID: 38632571 PMCID: PMC11022421 DOI: 10.1186/s12889-024-18515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sedentary behavior has been demonstrated to be a modifiable factor for several chronic diseases, while coffee consumption is believed to be beneficial for health. However, the joint associations of daily sitting time and coffee consumption with mortality remains poorly understood. This study aimed to evaluate the independent and joint associations of daily sitting time and coffee intakes with mortality from all-cause and cardiovascular disease (CVD) among US adults. METHODS An analysis of a prospective cohort from the 2007-2018 National Health and Nutrition Examination Survey of US adults (n = 10,639). Data on mortality were compiled from interview and physical examination data until December 31, 2019. Daily sitting time was self-reported. Coffee beverages were from the 24-hour diet recall interview. The main outcomes of the study were all-cause and cardiovascular disease mortality. The adjusted hazard ratios [HRs] and 95% confidence intervals [CI] were imputed by Cox proportional hazards regression. RESULTS Among 10,639 participants in the study cohort, there were 945 deaths, 284 of whom died of CVD during the follow-up period of up to 13 years. Multivariable models showed that sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.46; 95% CI, 1.17-1.81) and CVD (HR, 1.79; 95% CI, 1.21-2.66) mortality, compared with those sitting for less than 4 h/d. People with the highest quartile of coffee consumption were observed for the reduced risks of both all-cause (HR, 0.67; 95% CI, 0.54-0.84) and CVD (HR, 0.46; 95% CI, 0.30-0.69) mortality compared with non-coffee consumers. Notably, joint analyses firstly showed that non-coffee drinkers who sat six hours or more per day were 1.58 (95% CI, 1.25-1.99) times more likely to die of all causes than coffee drinkers sitting for less than six hours per day, indicating that the association of sedentary with increased mortality was only observed among adults with no coffee consumption but not among those who had coffee intake. CONCLUSIONS This study identified that sedentary behavior for more than 6 h/d accompanied with non-coffee consumption, were strongly associated with the increased risk of mortality from all-cause and CVD.
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Affiliation(s)
- Huimin Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jing Nie
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Soochow University, Suzhou, China
| | - Yanmei Cao
- Department of Occupational Medicine, The Affiliated Infectious Diseases Hospital of Soochow University, The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Linjing Diao
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Xiaoli Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jiafu Li
- Department of Occupational and Environmental Health, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Siyu Chen
- Department of Endocrinology, The Dushu Lake Hospital affiliated to Soochow University, 215000, Suzhou, Jiangsu, China
| | - Xu Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Guochong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Zengli Zhang
- Department of Occupational and Environmental Health, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Bingyan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Medical College of Soochow University, Suzhou, China.
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Zhou W, Zhu L, Yu Y, Yu C, Bao H, Cheng X. A Body Shape Index is positively associated with all-cause and cardiovascular disease mortality in the Chinese population with normal weight: A prospective cohort study. Nutr Metab Cardiovasc Dis 2023; 33:1702-1708. [PMID: 37414663 DOI: 10.1016/j.numecd.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND AIM A body shape index (ABSI) is a valuable predictor of mortality in the Western population, but similar evidence in the general Chinese population is limited. This study aims to evaluate the association between the ABSI and all-cause and cardiovascular disease (CVD) mortality in the Chinese population with normal weight. METHODS AND RESULTS 9046 participants with normal BMI (18.5-24.9 kg/m2) from the China Hypertension Survey were enrolled. The baseline ABSI was calculated as waist circumference/(BMI2/3height1/2). Cox proportional hazards regression was performed to evaluate the association of the ABSI with all-cause and CVD mortality. Over an average follow-up of 5.4 years, 686 all-cause and 215 CVD deaths occurred. A 0.01-unit increment in the ABSI was associated with a 31% greater risk of all-cause mortality (hazard ratio [HR], 1.31; 95% CI: 1.12, 1.48) and CVD mortality (HR, 1.30; 95% CI: 1.08, 1.58). Compared with quartile 1 of the ABSI, the adjusted HRs of all-cause mortality for quartiles 2-4 were, respectively, 1.25 (95% CI: 0.98, 1.59), 1.28 (95% CI: 0.99, 1.67), and 1.54 (95% CI: 1.17, 2.03) (Ptrend = 0.004), and those of CVD mortality for quartiles 2-4 were, respectively, 1.28 (95% CI: 0.88, 1.83), 1.42 (95% CI: 0.97, 2.08), and 1.45 (95% CI: 0.98, 2.170) (Ptrend = 0.043). The dose-response analysis showed a linear positive association of the ABSI with all-cause (Pnonlinearity = 0.158) and CVD mortality (Pnonlinearity = 0.213). CONCLUSION The ABSI was positively associated with all-cause and CVD mortality among the general Chinese population with normal BMI. The data suggest that the ABSI may be an effective tool for central fatness for mortality risk assessment.
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Affiliation(s)
- Wei Zhou
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi 330006, China
| | - Lingjuan Zhu
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi 330006, China
| | - Yu Yu
- Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Chao Yu
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi 330006, China.
| | - Huihui Bao
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi 330006, China; Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiaoshu Cheng
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi 330006, China; Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
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Mantzorou M, Mentzelou M, Vasios GK, Kontogiorgis C, Antasouras G, Vadikolias K, Psara E, Vorvolakos T, Poulios E, Serdari A, Papadopoulou SK, Giaginis C. Mediterranean Diet Adherence Is Associated with Favorable Health-Related Quality of Life, Physical Activity, and Sleep Quality in a Community-Dwelling Greek Older Population. Antioxidants (Basel) 2023; 12:antiox12050983. [PMID: 37237849 DOI: 10.3390/antiox12050983] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The Mediterranean diet (MD) is a beneficial dietary pattern with strong antioxidant and anti-inflammatory properties that can promote mental and physical human health. This study aims to assess the impact of MD adherence on health-related quality of life, physical activity levels, and sleep quality in a representative Greek elderly population. METHODS This is a cross-sectional study. A total of 3254 persons ≥65 years from 14 different Greek regions, urban, rural and islands participated in this study, of which 48.4% were female and 51.6% were male. Health-Related Quality of Life (HRQOL) was evaluated utilizing a short form healthy survey, physical activity was determined by the International Physical Activity Questionnaire (IPAQ), sleep quality was assessed utilizing the Pittsburgh Sleep Quality Index (PSQI) and MD adherence was assessed via the Mediterranean Diet Score (MedDietScore). RESULTS Moderate adherence to the MD and an increased prevalence of poor quality of life, low physical activity levels and inadequate sleep quality among the elderly population were recorded. High MD adherence was independently associated with better quality of life (OR: 2.31, 95% CI: 2.06-2.68, p = 0.0008), higher physical activity (OR: 1.89, 95% CI: 1.47-2.35, p = 0.0141) and adequate sleep quality (OR: 2.11, 95%: 1.79-2.44, p = 0.0018), female sex (OR: 1.36, 95% CI: 1.02-1.68, p = 0.0032) and living with others (OR: 1.24, 95% CI: 0.81-1.76, p = 0.0375), after adjustment for potential confounding factors. In unadjusted analysis, participants' age (p < 0.0001), anthropometric characteristics (p < 0.005), educational (p = 0.0026) and financial status (p = 0.0005) and smoking habits (p = 0.0031) were also identified as indicators of MD adherence; however, their impact on MD adherence was considerably attenuated after adjusting for confounding factors (p > 0.05). CONCLUSION High MD adherence was correlated with favorable quality of life, higher levels of physical activity, and a more adequate sleep quality score. Strategies and public health policies that facilitate MD adherence and physical activity in older adults may improve sleep and quality of life, impacting overall wellbeing in this age group.
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Affiliation(s)
- Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, Democritus University of Thrace, 68100 Alexadroupolis, Greece
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
| | - Theofanis Vorvolakos
- Department of Geriatric Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexadroupolis, Greece
| | - Efthymios Poulios
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
| | - Aspasia Serdari
- Department of Psychiatry and Child Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexadroupolis, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Lemnos, Greece
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Zhao Y, Zhang X, Yang L, Li T, Zhang J, Yuan L, Hu H, Wu Y, Hu F, Sun L, Hu D, Liu Y, Sun X, Zhang M. Independent and interactive effect of sedentary time and physical activity on risk of all-cause mortality: A prospective cohort study. Scand J Med Sci Sports 2023. [PMID: 36843531 DOI: 10.1111/sms.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES Sedentary behavior (SB) and physical inactivity have been associated with an increased risk of all-cause mortality. Evidence in China is scarce, and it is unclear whether physical activity (PA) attenuates or even eliminates the harmful effects of prolonged SB in the Chinese population. METHODS We conducted a prospective cohort study of 17 084 Chinese adults. PA and sitting time (ST) were assessed using the IPAQ. Cox proportional hazards models were used to estimate the risk of PA and ST with all-cause mortality. Interaction plots were used to visualize the interaction effects. RESULTS During a median follow-up of 6.01 years, a total of 1106 deaths occurred. PA level was inversely associated with the incidence of all-cause mortality, while ST showed a detrimental association (all ptrend < 0.05). In the stratified analysis, ST was associated with all-cause mortality in the low PA, while the association was attenuated in the moderate PA group: the HRs (95% CI) comparing ST of 4-8, 8-11, and ≥11 to <4 h/day were 1.15 (0.73-1.81), 1.55 (0.92-2.59), and 2.70 (1.52-4.80), respectively. In the high PA group, no significant association was found across all ST levels. In the joint analysis, compared with the high PA and ST <4 h/day, the harmful effect was found only in the combined low PA and moderate PA groups with ST ≥11 h/day (HR:2.71, 95% CI:1.69-4.35). In addition, a significant interaction association was found. CONCLUSION Our study, based on a prospective cohort, suggests that the detrimental effect of ST on all-cause mortality is attenuated or eliminated by high PA levels in the Chinese population.
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Affiliation(s)
- Yang Zhao
- Department of General Practice, Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, China
| | - Xing Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Longkun Yang
- Department of Biostatistics and Epidemiology, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Tianze Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jinli Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lijun Yuan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Huifang Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuying Wu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, China
| | - Liang Sun
- Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dongsheng Hu
- Department of General Practice, Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, China.,Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China.,Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, China
| | - Yu Liu
- Department of General Practice, Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, China
| | - Xizhou Sun
- Department of General Practice, Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, China
| | - Ming Zhang
- Department of General Practice, Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, China
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Nutritional Status Is Associated with Health-Related Quality of Life, Physical Activity, and Sleep Quality: A Cross-Sectional Study in an Elderly Greek Population. Nutrients 2023; 15:nu15020443. [PMID: 36678316 PMCID: PMC9862893 DOI: 10.3390/nu15020443] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
This study aims to explore the associations between nutritional status and health-related quality of life, physical activity, and sleep quality in older exclusively Caucasian adults from Greec who were free of any severe disease. This is a cross-sectional study. Mini Nutritional Assessment was used to assess nutritional status, health-related quality of life was assessed using the Short Form Healthy Survey questionnaire, sleep quality was assessed using the Pittsburgh Sleep Quality Index, and physical activity levels were assessed via the International Physical Activity Questionnaire. 3405 community-dwelling men and women, over 65 years old from14 different Greek regions were enrolled. Ten-point four percent (10.4%) of the participants were classified as malnourished, while 35.6% were "at risk of malnutrition". A better nutritional status was significantly and independently associated with higher physical activity levels (p = 0.0011) and better quality of life (p = 0.0135), as well as better sleep quality (p = 0.0202). In conclusion, our study highlights the interrelationships between a good nutritional status, a high-quality sleep, active lifestyle, and good quality of life. Further interventional studies are needed to clarify the associations, and test the feasibility of improving the nutritional status, physical activity levels and sleep quality of the elderly, and the impact of these changes on quality of life, and healthy ageing in races beyond Caucasian populations. Public health strategies and policies should be recommended to inform older adults for the necessity to improve their nutritional status and lifestyle habits to improve their health status and to obtain better life expectancy.
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Lyden K, Abraham N, Boucher R, Wei G, Gonce V, Carle J, Hartsell SE, Christensen J, Beddhu S. Predicting hospitalization from real-world measures in patients with chronic kidney disease: A proof-of-principle study. Digit Health 2023; 9:20552076231181234. [PMID: 37361437 PMCID: PMC10286549 DOI: 10.1177/20552076231181234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To investigate if in-clinic measures of physical function and real-world measures of physical behavior and mobility effort are associated with one another and to determine if they predict future hospitalization in participants with chronic kidney disease (CKD). Methods In this secondary analysis, novel real-world measures of physical behavior and mobility effort, including the best 6-minute step count (B6SC), were derived from passively collected data from a thigh worn actigraphy sensor and compared to traditional in-clinic measures of physical function (e.g. 6-minute walk test (6MWT). Hospitalization status during 2 years of follow-up was determined from electronic health records. Correlation analyses were used to compare measures and Cox Regression analysis was used to compare measures with hospitalization. Results One hundred and six participants were studied (69 ± 13 years, 43% women). Mean ± SD baseline measures for 6MWT was 386 ± 66 m and B6SC was 524 ± 125 steps. Forty-four hospitalization events over 224 years of total follow-up occurred. Good separation was achieved for tertiles of 6MWT, B6SC and steps/day for hospitalization events. This pattern persisted in models adjusted for demographics (6MWT: HR = 0.63 95% CI 0.43-0.93, B6SC: HR = 0.75, 95% CI 0.56-1.02 and steps/day: HR = 0.75, 95% CI 0.50-1.13) and further adjusted for morbidities (6MWT: HR = 0.54, 95% CI 0.35-0.84, B6SC: HR = 0.70, 95% CI 0.49-1.00 and steps/day: HR = 0.69, 95% CI 0.43-1.09). Conclusion Digital health technologies can be deployed remotely, passively, and continuously to collect real-world measures of physical behavior and mobility effort that differentiate risk of hospitalization in patients with CKD.
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Affiliation(s)
- Kate Lyden
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Nikita Abraham
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert Boucher
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Guo Wei
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Victoria Gonce
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Judy Carle
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sydney E. Hartsell
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jesse Christensen
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Srinivasan Beddhu
- Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
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Li S, Lear SA, Rangarajan S, Hu B, Yin L, Bangdiwala SI, Alhabib KF, Rosengren A, Gupta R, Mony PK, Wielgosz A, Rahman O, Mazapuspavina MY, Avezum A, Oguz A, Yeates K, Lanas F, Dans A, Abat MEM, Yusufali A, Diaz R, Lopez-Jaramillo P, Leach L, Lakshmi PVM, Basiak-Rasala A, Iqbal R, Kelishadi R, Chifamba J, Khatib R, Li W, Yusuf S. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries. JAMA Cardiol 2022; 7:796-807. [PMID: 35704349 DOI: 10.1001/jamacardio.2022.1581] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.
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Affiliation(s)
- Sidong Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
| | - Bo Hu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jawahar Circle, Jaipur, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Rahman
- University of Liberal Arts, Dhaka, Bangladesh
| | - M Y Mazapuspavina
- Department of Primary Care Medicine, Faculty of Medicine UiTM Sg Buloh Campus, University Teknologi MARA UiTM, Malaysia
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | - Aytekin Oguz
- Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Antonio Dans
- Department of Medicine, University of the Philippines, Manila, Philippines
| | - Marc Evans M Abat
- Division of Adult Medicine, Department of Medicine, Philippine General Hospital, Ermita, Manila, Philippines
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Health Authority/Dubai Medical College, Dubai, United Arab Emirates
| | - Rafael Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Lloyd Leach
- University of the Western Cape, Bellville, Cape Town, South Africa
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jephat Chifamba
- Department of Biomedical Sciences Physiology Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois.,Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Wei Li
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada
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