Evolution of obesity prevalence in France: an age-period-cohort analysis

Exploring Disparities for Obesity in Korea Using Hierarchical Age-Period-Cohort Analysis With Cross-Classified Random Effect Models

BACKGROUND

This research article investigates the age, period, and birth cohort effects on prevalence of obesity in the Korean population, with the goal of identifying key factors to inform effective public health strategies.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Survey, spanning 2007-2021, including 35,736 men and 46,756 women. Using the hierarchical age-period-cohort (APC) analysis with cross-classified random effects modeling, we applied multivariable mixed logistic regression to estimate the marginal prevalence of obesity across age, period, and birth cohort, while assessing the interaction between APC and lifestyle and socioeconomic factors.

RESULTS

Our findings reveal an inverted U-shaped age effect on obesity, influenced by smoking history (P for interaction = 0.020) and physical activity (I for interaction < 0.001). The period effect was positive in 2020 and 2021, while negative in 2014 (P for period effect < 0.001). A declining trend in obesity prevalence was observed in birth cohorts from 1980s onward. Notably, disparities in obesity rates among recent birth cohorts have increased in relation to smoking history (P for interaction = 0.020), physical activity (P for interaction < 0.001), and residence (P for interaction = 0.005). Particularly, those born after 1960 were more likely to be obese if they were ex-smokers, physical inactive, or lived in rural areas.

CONCLUSION

These findings highlight growing disparities in obesity within birth cohorts, underscoring the need for targeted health policies that promote smoking cessation and physical activity, especially in rural areas.

The Role of Cdc42 in the Insulin and Leptin Pathways Contributing to the Development of Age-Related Obesity

Age-related obesity significantly increases the risk of chronic diseases such as type 2 diabetes, cardiovascular diseases, hypertension, and certain cancers. The insulin-leptin axis is crucial in understanding metabolic disturbances associated with age-related obesity. Rho GTPase Cdc42 is a member of the Rho family of GTPases that participates in many cellular processes including, but not limited to, regulation of actin cytoskeleton, vesicle trafficking, cell polarity, morphology, proliferation, motility, and migration. Cdc42 functions as an integral part of regulating insulin secretion and aging. Some novel roles for Cdc42 have also been recently identified in maintaining glucose metabolism, where Cdc42 is involved in controlling blood glucose levels in metabolically active tissues, including skeletal muscle, adipose tissue, pancreas, etc., which puts this protein in line with other critical regulators of glucose metabolism. Importantly, Cdc42 plays a vital role in cellular processes associated with the insulin and leptin signaling pathways, which are integral elements involved in obesity development if misregulated. Additionally, a change in Cdc42 activity may affect senescence, thus contributing to disorders associated with aging. This review explores the complex relationships among age-associated obesity, the insulin-leptin axis, and the Cdc42 signaling pathway. This article sheds light on the vast molecular web that supports metabolic dysregulation in aging people. In addition, it also discusses the potential therapeutic implications of the Cdc42 pathway to mitigate obesity since some new data suggest that inhibition of Cdc42 using antidiabetic drugs or antioxidants may promote weight loss in overweight or obese patients.

An age-period-cohort approach to studying long-term trends in obesity and overweight in England (1992-2019)

OBJECTIVE

This study aims to understand long-term trends in obesity and overweight in England by estimating life-course transitions as well as historical and birth cohort trends for both children and adults.

METHODS

Data on individuals aged 5 to 85 years old from the Health Survey for England were used, covering the period 1992 to 2019 and birth cohorts born between 1909 and 2013. Individual BMI values were classified as healthy weight, overweight, or obesity. Trends were compared, and an age-period-cohort model was estimated using logistic regression and categorical age, period, and cohort groups.

RESULTS

There was significant variation in age trajectories by birth cohorts for healthy weight and obesity prevalence. The odds of having obesity compared with a healthy weight increased consistently with age, increased throughout the study period (but faster between 1992 and 2001), and were higher for birth cohorts born between 1989 and 2008. The odds of having overweight showed an inverted U-shape among children, increased through adulthood, have been stable since 2012, and were considerably higher for the youngest birth cohort (2009-2013).

CONCLUSIONS

Younger generations with higher overweight prevalence coupled with increasing obesity prevalence with age suggest that obesity should remain a high priority for public health policy makers in England.

Trends in U.S. adolescent physical activity and obesity: A 20-year age-period-cohort analysis

BACKGROUND

Adolescent obesity can lead to long-term health problems and is a topic of major concern in pediatric and broader medical and public health spheres. Numerous national and state-wide initiatives aimed at increasing physical activity and/or improving nutrition in this age group have assumed the goal of reducing the prevalence adolescent obesity.

OBJECTIVES

We assess trends in U.S. adolescent physical activity and body mass index between 1999 and 2019.

METHODS

Using data from the U.S. Youth Risk Behaviour Surveillance System, we analyse data from 144 544 14-to-18-year-old respondents. We use multilevel linear and logistic regression to perform age-period-cohort analyses attributing changes in physical activity and body mass index over time to these three sources.

RESULTS

Age and period effects are strong in all outcomes studied. Physical activity consistently decreases with age across the study period. Age trends in obesity have reversed in recent years, with older adolescents now more likely to be have obesity than younger adolescents. Both female and Asian adolescents report less physical activity but lower rates of obesity than their male and non-Asian counterparts.

CONCLUSIONS

The reversal of obesity trends by age with little change in physical activity over the study period suggests other lifestyle factors have changed over the study period to increase the prevalence of obesity in older adolescents.

An Evaluation of the Implementation of the European Calcified Tissue Society Recommendations on the Prevention and Treatment of Osteoporosis Secondary to Bariatric Surgery

The purpose of this study was to evaluate the implementation of the European Calcified Tissue Society (ECTS) 2022 recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery. The ECTS 2022 recommendations were applied in a retrospective cohort of postmenopausal women and men aged 50 years and older who were undergoing or had already undergone bariatric surgery. Osteoporosis medication was indicated if any of the following criteria were met: (i) history of recent (within 2 years) fragility fracture after the age of 40 years, (ii) BMD T score ≤ -2 at any of the sites of measurement, and (iii) FRAX^® ≥ 20% for major osteoporotic fractures and/or ≥3% for hip fractures. Of the 170 patients (144 women, mean age 59 (55 to 63) years) included between February 2019 and March 2022, 33 were eligible for osteoporosis medication based on the ECTS 2022 recommendations, i.e., a prevalence of 19.6% [CI95%: 13.9%; 26.5%]. Most patients met the BMD T score ≤ -2 criterion (n = 25/170, 14.7% [CI95%: 9.7%; 20.9%]) and/or the history of recent fragility fracture criterion (n = 12/170, 7.1% [CI95%: 3.7%; 12.0%]). In this study, a fifth of our population was found to be eligible for osteoporosis medication after the application of the ECTS 2022 recommendations.

Age-period-cohort analysis of depression trends: are depressive symptoms increasing across generations in Germany?

Several studies have examined trends in depression, but only few have explicitly considered possible generational differences. I examined changes in the burden of depressive symptoms between 2002 and 2017 according to age, time period and birth cohort in Germany. I used population-based data drawn from the German Aging Survey (N = 33,723, 54% female, ages 40 +) from 2002, 2008, 2011, 2014, and 2017. Depressive symptoms were measured via the CES-D 15. Hierarchical age-period-cohort models were used to examine trends in depression. I found that depressive symptoms changed across age, time period and birth cohorts. While there was a general decrease across time periods, strong evidence for a U-shaped cohort effect was also found: Younger generations, beginning with cohorts born after the World War II, increasingly report more depressive symptoms than older generations. This U-shaped cohort trend appeared most pronounced for the somatic symptoms subscale. Contrarily, only minimal cohort differences were found regarding the positive affect subscale. Therefore, depressive symptoms, and especially somatic symptoms, seem to increase in more recent birth cohorts in Germany, who might thus be at risk to experience more mental health problems in the future. Potential reasons for these trends and the generalizability of the results to other countries should be investigated by future studies.

Prevalence of cardiovascular risk factors and their association with renal impairment in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: a cross-sectional study

Introduction

the population of elderly with Type 2 Diabetes Mellitus (T2DM) has been on the increase. The burden of cardiovascular disease and renal impairment may also increase due to the relationship between cardiovascular risk factors and ageing in those with T2DM. The prevalence of cardiovascular risk factors and their association with renal impairment in elderly with T2DM were determined.

Methods

this is a cross-sectional study that involved 96 elderly patients with T2DM and 96 elderly individuals without DM as control. The prevalence of cardiovascular risk factors was determined among the study participants. Binary logistic regression was used to determine the significant cardiovascular factors associated with renal impairment among the elderly with T2DM. P-value <0.05 was taken as significant.

Results

the mean age of the elderly with T2DM and control group were 66.73±5.18 years and 66.78±5.25years, respectively. The male: female ratio was 1: 1 for both groups. The prevalence of the cardiovascular risk factors in the elderly with T2DM and control were; hypertension (72.9%vs39.6%; p ≤0.001), high glycated haemoglobin (77.1% vs 0%; p ≤0.001), generalized obesity (34.4%vs1.0%; p ≤0.001), central obesity (50.0%vs11.5%; p ≤0.001), dyslipidemia (97.9%vs89.6%; p=0.016), albuminuria (69.8% vs 11.2%; p ≤0.001), anaemia (53.1%vs18.8%; p ≤0.001). Renal impairment was present in 44.8% of the elderly T2DM. On multivariate analysis, the cardiovascular risk factors significantly associated with renal impairment in elderly with T2DM were high glycated haemoglobin (aOR: 6.21, 95% CI: 1.61-24.04; p=0.008), albuminuria (aOR: 4.77, 95% CI: 1.59-14.31; p=0.005) and obesity (aOR: 2.78, 95%CI 1.04-7.45; p=0.042).

Conclusion

cardiovascular risks factors were highly prevalent and closely associated with renal impairment in elderly with T2DM. Early cardiovascular risk factor modification may reduce both renal and cardiovascular disease burden.

Past, present, and future trends of overweight and obesity in Belgium using Bayesian age-period-cohort models

Background

Overweight and obesity are one of the most significant risk factors of the twenty-first century related to an increased risk in the occurrence of non-communicable diseases and associated increased healthcare costs. To estimate the future impact of overweight, the current study aimed to project the prevalence of overweight and obesity to the year 2030 in Belgium using a Bayesian age-period-cohort (APC) model, supporting policy planning.

Methods

Height and weight of 58,369 adults aged 18+ years, collected in six consecutive cross-sectional health interview surveys between 1997 and 2018, were evaluated. Criteria used for overweight and obesity were defined as body mass index (BMI) ≥ 25, and BMI ≥ 30. Past trends and projections were estimated with a Bayesian hierarchical APC model.

Results

The prevalence of overweight and obesity has increased between 1997 and 2018 in both men and women, whereby the highest prevalence was observed in the middle-aged group. It is likely that a further increase in the prevalence of obesity will be seen by 2030 with a probability of 84.1% for an increase in cases among men and 56.0% for an increase in cases among women. For overweight, it is likely to see an increase in cases in women (57.4%), while a steady state in cases among men is likely. A prevalence of 52.3% [21.2%; 83.2%] for overweight, and 27.6% [9.9%; 57.4%] for obesity will likely be achieved in 2030 among men. Among women, a prevalence of 49,1% [7,3%; 90,9%] for overweight, and 17,2% [2,5%; 61,8%] for obesity is most likely.

Conclusions

Our projections show that the WHO target to halt obesity by 2025 will most likely not be achieved. There is an urgent necessity for policy makers to implement effective prevent policies and other strategies in people who are at risk for developing overweight and/or obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13685-w.

Exploring the socioeconomic disparities of maternal body mass index: a national study in France

BACKGROUND

The prevalence of overweight and obesity has increased in various countries. Normal weight before pregnancy is important to protect maternal and newborn health. This study aimed to describe the evolution of body mass index (BMI) before pregnancy in France and explore its association with two measures of socioeconomic status (SES), education and household income.

METHODS

Data were from four national perinatal surveys in France in 1998, 2003, 2010 and 2016 to describe the time evolution of maternal BMI. We explored the links between BMI and women's characteristics in the most recent period (2010-2016 surveys) since income information was not available before. Risk ratios (RRs) of underweight, overweight and obesity for each measure of SES were computed by using multivariable Poisson regression models.

RESULTS

Overweight and obesity prevalence increased between 1998 and 2016, from 6% to 12% for obesity. Both were inversely associated with SES (higher prevalence among least educated and poorest women), with strong variations for each social indicator, even in multivariable analyses including both. Combining education and income revealed a wide gradient; RR for obesity was 6.01 (95% confidence interval 4.89-7.38) with low education and income <2000 euros/month vs. high education and income ≥4000 euros/month.

CONCLUSIONS

Public policies must implement programs to limit the increase in overweight and its unequal distribution in the population, alongside other policies to address the societal determinants of the obesogenic environment. Health professionals need to advise women to improve their eating and physical activity to limit weight gain from childhood to early adulthood.

Understanding long-term trends in smoking in England, 1972-2019: an age-period-cohort approach

BACKGROUND AND AIMS

Smoking prevalence has been falling in England for more than 50 years, but remains a prevalent and major public health problem. This study used an age-period-cohort (APC) approach to measure lifecycle, historical and generational patterns of individual smoking behaviour.

DESIGN

APC analysis of repeated cross-sectional smoking prevalence data obtained from three nationally representative surveys.

SETTING

England (1972-2019).

PARTICIPANTS

Individuals aged 18-90 years.

MEASUREMENTS

We studied relative odds of current smoking in relation to age in single years from 18 to 90, 24 groups of 2-year survey periods (1972-73 to 2018-19) and 20 groups of 5-year birth cohorts (1907-11 to 1997-2001). Age and period rates were studied for two groups of birth cohorts: those aged 18-25 years and those aged over 25 years.

FINDINGS

Relative to age 18, the odds of current smoking increased with age until approximately age 25 [odds ratio (OR) = 1.48, 95% confidence interval (CI) = 1.41-1.56] and then decreased progressively to age 90 (OR = 0.06, 95% CI = 0.04-0.08). They also decreased almost linearly with period relative to 1972-73 (for 2018-19: OR = 0.30, 95% CI = 0.26-0.34) and with birth cohort relative to 1902-06, with the largest decreased observed for birth cohort 1992-96 (OR = 0.44, 95% CI = 0.35-0.46) and 1997-2001 (OR = 0.35, 95% CI = 0.74-0.88). Smoking declined in the 18-25 age group by an average of 7% over successive 2-year periods and by an average of 5% in those aged over 25.

CONCLUSIONS

Smoking in England appears to have declined over recent decades mainly as a result of reduced smoking uptake before age 25, and to a lesser extent to smoking cessation after age 25.

Screening for sleep-disordered breathing in people with type 1 diabetes by combining polysomnography with glucose variability assessment

AIMS

There are few published data on sleep-disordered breathing (SDB) in type 1 diabetes (T1DM). Here, we used a combination of polysomnography and glucose variability assessment to screen for SDB.

METHODS

In a prospective, single-centre study, adults with T1DM underwent polysomnography and continuous glucose monitoring during a single night. We measured high glucose variability and the occurrence of a low or very low glucose level. Mild and moderate-to-severe SDB were defined as an apnoea-hypopnoea index above 5/h and 15/h, respectively.

RESULTS

We studied 46 patients (25 men; median age: 42 [35-54]; diabetes duration: 18 years [13-29]; body mass index (BMI): 24.8 kg/m² [23.0-28.9]). SDB was present in 17 patients (37.0%) overall (mild SDB: n = 9; moderate-to-severe SDB; n = 8). When compared with the absence of SDB or mild SDB, moderate-to-severe SDB was associated with a higher BMI (29.8 kg/m² [27.8-31.1]) and a longer diabetes duration (26 years [18-31]) but not with above-target glucose variability or more sleep disorder symptoms. Conversely, sleep disorder symptoms were not more frequent in patients with above-target glucose variability.

CONCLUSION

SDB was highly prevalent and associated with obesity. According to the methods used here, sleep disorders were not associated with above-target glucose variability or low glucose values.

Socio-Psychological Factors Associated with Young Australian Adults' Consumption of Energy Dense and Nutrient Poor (EDNP) Foods

Young Australian adults' exhibit high consumption of Energy Dense and Nutrient Poor (EDNP) foods; however, there is limited research concerning the factors influencing their consumption. This study aimed to explore socio-psychological factors associated with young Australian adults' (18-30 years) consumption of EDNP foods with consideration of the Food Related Lifestyle Model (FRLM) as a potential framework. Through qualitative descriptive research methodology, 38 young adults were interviewed. Data were thematically analyzed. Participants were classified into three groups based on their living arrangements namely, parental, shared and independent households. Five themes emerged, (1) psychological factors (2) intrinsic qualities of EDNP foods, (3) social factors, (4) accessibility and affordability and (5) health related beliefs. The FRLM takes into consideration some of the factors reported in this study as influencers of EDNP food intakes. However, the FRLM omits important psychological factors (motivation, restraint, cravings, coping strategies and habits) identified by participants as influencers over their EDNP food intakes. The FRLM may need to be extended in its application to EDNP food intakes of young Australian adults. Social marketing campaigns highlighting health risks, addressing social and environmental factors are suggested. The social desirability of healthier alternatives in social gatherings of young adults could be increased.

Spontaneously Low Protein Intake in Elderly CKD Patients: Myth or Reality? Analysis of Baseline Protein Intake in a Large Cohort of Patients with Advanced CKD

The recent guidelines on nutritional management of chronic kidney disease (CKD) advise a reduction in protein intake as early as CKD stage 3, regardless of age, to slow kidney function impairment. However, since elderly patients are usually considered as having a spontaneously reduced protein intake, nutritional interventions to reduce protein intake are often considered futile. This study aimed to assess the baseline protein intake of elderly CKD patients referred for nephrology care, and explore the need for dietary evaluations, focusing on the current recommendations for protein restriction in CKD. This is an observational study of CKD patients followed in the unit dedicated to advanced CKD patients in Le Mans, France. Patients with stages 3 to 5 not on dialysis were included. All patients were evaluated by an expert dietician to assess their baseline protein intake, whenever possible on the basis of a 7-days diet journal; when this was not available, dietary recall or analysis of delivered meals was employed. Demographic characteristics, underlying kidney disease, Charlson Comorbidity Index (CCI), Malnutrition-Inflammation Score (MIS), Subjective Global Assessment (SGA) and clinical and laboratory data were recorded. Between 15 November 2017 and 31 December 2020, 436 patients were evaluated in the unit. Their age distribution was as follows: "young": <60 (n = 62), "young-old": 60-69 (n = 74), "old": 70-79 (n = 108), "old-old": 80-89 (n = 140) and "oldest-old": ≥90 (n = 54). The prevalence of vascular nephropathies was higher in patients older than 70 years compared to younger ones, as did CCI and MIS (p < 0.001). Moderate nutritional impairment (SGA: B) was higher in elderly patients, reaching 53.7% at ≥90, while less than 3% of patients in the overall cohort were classified as SGA C (p < 0.001). The median protein intake was higher than the recommended one of 0.8 g/kg/day in all age groups; it was 1.2 g/kg/day in younger patients and 1.0 thereafter (p < 0.001). Patient survival depended significantly on age (p < 0.001) but not on baseline protein intake (p = 0.63), and younger patients were more likely to start dialysis during follow-up (p < 0.001). Over half of the patients, including the old-old and oldest-old, were still on follow-up two years after referral and it was found that survival was only significantly associated with age and comorbidity and was not affected by baseline protein intake. Our study shows that most elderly patients, including old-old and extremely old CKD patients, are spontaneously on diets whose protein content is higher than recommended, and indicates there is a need for nutritional care for this population.

Translation and Validation of a State-Measure of Body Image Satisfaction: The Body Image State Scale

The aim of the present study is to test the validity and reliability of the French Body Image State Scale (F-BISS). The scale was translated using a back-translation technique, with discrepancies being settled through consensus. Three hundred and twelve female participants were recruited. Convergent validity was assessed using eating disorder evaluation and social comparison. Exploratory and confirmatory factor analyses were also conducted. The translated Body Image State Scale (BISS) demonstrated good psychometric properties, with good internal consistency (α = 0.83), and adequate goodness-of-fit. The translated BISS presented a unifactorial structure, with one factor explaining 56% of the variance. The exploratory factor analysis led to the removal of a single item due to insufficient factor loading (<0.45). Its convergent validity seems consistent with previous literature. Discriminant analyses showed a significant difference in F-BISS score between participants relative to eating disorder symptomatology (t = 11.65; p < 0.001). This translation could prove useful in both research and clinical settings to assess state body satisfaction in French populations.

Detecting Welfare in a Non-Verbal Species: Social/Cultural Biases and Difficulties in Horse Welfare Assessment

Simple Summary

There is a paradox about the welfare of horses in the domestic situation: on the one hand, horses are beloved partners for most owners, but on the other hand, scientific studies are converging to show that there is a high prevalence of welfare problems. There seems to be a mismatch between theoretical knowledge and field applications. In this review, we aim at disentangling the possible factors explaining such a paradox. Among them, we consider the impact of anthropomorphic and cultural biases, popular beliefs, but also overexposure to horses with compromised welfare state, which can change owners’ representation of what is a “normal” horse, on the undervaluation of horse welfare state. We suggest that, rather than simply having knowledge on what should be done, identifying the horse welfare state using validated animal-based indicators is essential to identify and promote best practices.

Abstract

Horses were domesticated for more than 5000 years and have been one of the most emblematic species living alongside humans. This long-shared history would suggest that horses are well known and well understood, but scientific data raise many concerns about the welfare state of most domestic horses suggesting that many aspects have been largely misunderstood. In the present review, we will examine some of the possible human factors that may explain the huge prevalence of welfare problems, despite horses being of special importance to humans. First of all, as horses are non-verbal, current management practices rely upon what one thinks is good for them, which opens the way to subjective interpretations and projections, based on one’s own subjective experience but probably still more on cultural/social norms and influences, traditions and beliefs. The lack of recognition, identification, or even the misinterpretation of signals are other potential reasons for welfare issues. Lastly, the over-exposure to animals with expressions of compromised welfare may lead to lower sensitivity of owners/professionals. That is why we lastly suggest that instead of simply providing information on what to do, we should promote validated visible indicators that leave less room for personal interpretation.

Evolution of the prevalence of obesity in the adult population in France, 2013-2016: the Constances study

This study provides trends in obesity prevalence in adults from 2013 to 2016 in France. 63,582 men and women from independent samples upon inclusion from the Constances cohort were included. Anthropometrics were measured at Health Screening Centers and obesity defined as a Body mass index (BMI) ≥ 30 kg/m²; obesity classes according to BMI are as follows: class 1 [30–34.9]; class 2 [35–39.9]; class 3 [≥ 40 kg/m²]. Linear trends across obesity classes by sex and age groups were examined in regression models and percentage point change from 2013 to 2016 for each age category calculated. All analyses accounted for sample weights for non-response, age and sex-calibrated to the French population. Prevalence of obesity ranged from 14.2 to 15.2% and from 14 to 15.3% in women and men respectively from 2013 to 2016. Class 1 obesity category prevalence was the only one to increase significantly across survey years in both men and women (p for linear trend = 0.04 and 0.01 in women and men respectively). The only significant increase for obesity was observed in the age group 18–29 y in both women and men (+ 2.71% and + 3.26% point increase respectively, equivalent to an approximate rise of 50% in women and 93% in men, p = 0.03 and 0.02 respectively). After adjustment for survey non-response and for age and sex distribution, the results show that class 1 obesity prevalence has significantly increased in both women and men from 2013 to 2016, and only in young adults in a representative sample of the French population aged 18–69 years old.

Cancer incidence and mortality trends in France over 1990-2018 for solid tumors: the sex gap is narrowing

Objective

To analyze trends in cancer incidence and mortality (France, 1990–2018), with a focus on men-women disparities.

Methods

Incidence data stemmed from cancer registries (FRANCIM) and mortality data from national statistics (CépiDc). Incidence and mortality rates were modelled using bidimensional penalized splines of age and year (at diagnosis and at death, respectively). Trends in age-standardized rates were summarized by the average annual percent changes (AAPC) for all-cancers combined, 19 solid tumors, and 8 subsites. Sex gaps were indicated using male-to-female rate ratios (relative difference) and male-to-female rate differences (absolute difference) in 1990 and 2018, for incidence and mortality, respectively.

Results

For all-cancers, the sex gap narrowed over 1990–2018 in incidence (1.6 to 1.2) and mortality (2.3 to 1.7). The largest decreases of the male-to-female incidence rate ratio were for cancers of the lung (9.5 to 2.2), lip - oral cavity - pharynx (10.9 to 3.1), esophagus (12.6 to 4.5) and larynx (17.1 to 7.1). Mixed trends emerged in lung and oesophageal cancers, probably explained by differing risk factors for the two main histological subtypes. Sex incidence gaps narrowed due to increasing trends in men and women for skin melanoma (0.7 to 1, due to initially higher rates in women), cancers of the liver (7.4 to 4.4) and pancreas (2.0 to 1.4). Sex incidence gaps narrowed for colon-rectum (1.7 to 1.4), urinary bladder (6.9 to 6.1) and stomach (2.7 to 2.4) driven by decreasing trends among men. Other cancers showed similar increasing incidence trends in both sexes leading to stable sex gaps: thyroid gland (0.3 to 0.3), kidney (2.2 to 2.4) and central nervous system (1.4 to 1.5).

Conclusion

In France in 2018, while men still had higher risks of developing or dying from most cancers, the sex gap was narrowing. Efforts should focus on avoiding risk factors (e.g., smoking) and developing etiological studies to understand currently unexplained increasing trends.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08261-1.

Life stage-specific trends in educational inequalities in health-related quality of life and self-rated health between 2002 and 2016 in Germany: findings from the German Socio-Economic Panel Study (GSOEP)

OBJECTIVES

While evidence suggests persisting health inequalities, research on whether these trends may vary according to different stages of life has rarely been considered. Against this backdrop, we analysed life stage-specific trends in educational inequalities in health-related quality of life (HRQOL) and poor self-rated health (SRH) for individuals in 'later working life' (50-64 years), 'young seniors' (65-79 years) and persons of 'old age' (80+ years).

METHODS

We used survey data from the German Socio-Economic Panel Study comprising the period from 2002 to 2016. The sample consists of 26 074 respondents (160 888 person-years) aged 50 years and older. Health was assessed using the mental and physical component summary scale (MCS/PCS) of the HRQOL questionnaire (12-Item Short Form Health Survey V.2) and the single item SRH. To estimate educational health inequalities, we calculated the regression-based Slope Index of Inequality (SII) and Relative Index of Inequality (RII). Time trends in inequalities were assessed by the inclusion of a two-way interaction term between school education and time.

RESULTS

With increasing age, educational inequalities in PCS and poor SRH decreased whereas they rose in MCS. Over time, health inequalities decreased in men aged 65-79 years (MCSSII=2.76, 95% CI 0.41 to 5.11; MCSRII=1.05, 95% CI 1.01 to 1.10; PCSSII=2.12, 95% CI -0.27to 4.51; PCSRII=1.05, 95% CI 1.00 to 1.11; poor SRHSII=-0.10, 95% CI -0.19 to 0.01; poor SRHRII=0.73, 95% CI 0.48 to 1.13) and among women of that age for MCS (MCSSII=2.82, 95% CI 0.16 to 5.50; MCSRII=1.06, 95% CI 1.01 to 1.12). In contrast, health inequalities widened in the 'later working life' among women (PCSSII=-2.98, 95% CI -4.86 to -1.11; PCSRII=0.94, 95% CI 0.90 to 0.98; poor SRHSII=0.07, 95% CI 0.00 to 0.14) while remained largely stable at old age for both genders.

CONCLUSIONS

We found distinctive patterns of health inequality trends depending on gender and life stage. Our findings suggest to adopt a differentiated view on health inequality trends and to pursue research that explores their underlying determinants.

Obesity Prevalence in the Long-Term Future in 18 European Countries and in the USA

INTRODUCTION

Obesity constitutes a major public health problem in Europe, but how the obesity epidemic in European countries will evolve remains unknown. Most previous obesity projections considered the short-term future only, focused on single non-European countries, and projected ongoing increases foremost. We comparatively project obesity prevalence into the long-term future for 18 European countries and the USA.

DATA

We used national age-specific (20-84 years) and sex-specific obesity prevalence estimates (1975-2016) from the NCD Risk Factor Collaboration (NCD-RisC) 2017 study, which are based on available measured height and weight data, supplemented with estimates from a Bayesian hierarchical model.

METHODS

We projected age- and sex-specific obesity prevalence up to the year 2100 by integrating the notion of a wave-shaped obesity epidemic into conventional age-period projections.

RESULTS

In 1990-2016, the increasing trends in obesity prevalence were decelerating. Obesity is expected to reach maximum levels between 2030 and 2052 among men, and between 2026 and 2054 among women. The maximum levels will likely be reached first in The Netherlands, USA, and UK, and last in Switzerland; and are expected to be highest in the USA and UK, and lowest in The Netherlands for men and Denmark for women. In 2060, obesity prevalence is expected to be lowest among Dutch men and highest among Swiss men. The projected age-specific obesity prevalence levels have an inverse U-shape, peaking at around the age of 60-69 years.

DISCUSSION

Applying our novel approach to the NCD-RisC 2017 data, obesity prevalence is expected to reach maximum levels between 2026 and 2054, with the USA and UK reaching the highest maximum levels first, followed by other European countries.

A novel personalized approach to cardiovascular prevention: The VIVOPTIM programme

BACKGROUND

Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable.

AIMS

The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors.

METHODS

Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring.

RESULTS

Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2hours/week, P=0.619).

CONCLUSION

As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France.

Long-term trends in the body mass index and obesity risk in Estonia: an age-period-cohort approach

OBJECTIVES

To analyse the age, period and cohort effects on the mean body mass index (BMI) and obesity over the past two decades in Estonia.

METHODS

Study used data from nationally representative repeated cross-sectional surveys on 11,547 men and 16,298 women from 1996 to 2018. The independent effects of age, period and cohort on predicted mean BMI and probability of obesity (BMI ≥ 30 kg/m²) were modelled using hierarchical age-period-cohort analysis.

RESULTS

Curvilinear association between age and mean BMI was found for men, whereas the increase in mean BMI was almost linear for women. The predicted mean BMI for 40-year-old men had increased by 6% and probability of obesity by 1.8 times over 1996-2018; the period effects were slightly smaller for women. Men from the 1970s birth cohort had higher mean BMI compared to the average, whereas no significant cohort effects were found for obesity outcome.

CONCLUSIONS

Population-level BMI changes in Estonia during 1996-2018 were mostly driven by period rather than cohort-specific changes.

Diverging Trends in Age at First Myocardial Infarction: Evidence from Two German Population-Based Studies

Little is known about trends in the age of onset of first myocardial infarction. Thus, we examined trends in the age of onset distribution of first myocardial infarction using two population-based datasets from Germany. First, we used German claims data based on an annual case number of approximately 2 million women and men covering the period from 2006 to 2016. Second, we used data from the KORA (Cooperative Health Research in the Region of Augsburg) Myocardial Infarction Registry covering the period from 2000–2016. Analyses were performed by means of quantile regression to estimate trends across the whole distribution of age of onset. Overall, N_{Sample 1} = 69627 and N_{Sample 2} = 9954 first myocardial infarctions were observed. In both samples, we found highly heterogeneous trends in age of onset. In men, we consistently found that age of onset increased before 50 and after 70 but decreased within this age bracket. For women, on the other hand, we consistently found that age of onset decreased for first myocardial infarctions before 70 but increased slightly or remained relatively stable thereafter. Therefore, late myocardial infarctions tended to occur later in life, while regular myocardial infarctions tended to occur earlier. These results suggest that in myocardial infarction, both morbidity compression and morbidity expansion might have occurred at the same time but for different parts of the age at onset distribution.

Bounding Analyses of Age-Period-Cohort Effects

For more than a century, researchers from a wide range of disciplines have sought to estimate the unique contributions of age, period, and cohort (APC) effects on a variety of outcomes. A key obstacle to these efforts is the linear dependence among the three time scales. Various methods have been proposed to address this issue, but they have suffered from either ad hoc assumptions or extreme sensitivity to small differences in model specification. After briefly reviewing past work, we outline a new approach for identifying temporal effects in population-level data. Fundamental to our framework is the recognition that it is only the slopes of an APC model that are unidentified, not the nonlinearities or particular combinations of the linear effects. One can thus use constraints implied by the data along with explicit theoretical claims to bound one or more of the APC effects. Bounds on these parameters may be nearly as informative as point estimates, even with relatively weak assumptions. To demonstrate the usefulness of our approach, we examine temporal effects in prostate cancer incidence and homicide rates. We conclude with a discussion of guidelines for further research on APC effects.

Age, period and birth cohort effects on prevalence of obesity among reproductive-age women in India

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Cohort effect shows that obesity for recent cohort has narrowed down.

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Our study shows as age increases the risk of obesity also increases.

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Cohort relative risk is higher among women in rural area than women in urban area.

[Problems of optimal nutrition of elderly and senile patients with comorbidities against obesity]

AIM

To analyze the effectiveness of the main and low - calorie standard diets in elderly and senile patients with comorbidities against obesity.

MATERIALS AND METHODS

Retrospective analysis of the inpatient data. Patients received the main or low - calorie standard diet at the Nutrition clinic. The analysis included clinical, laboratory, body composition (bioimpedance) parameters and the results of indirect calorimetry. The primary endpoint was anthropometric and body composition data. Statistical analysis was performed using Statistica 10.0 for Windows 6.1 (StatSoft Inc., USA).

RESULTS AND DISCUSSION

46 patients were included in the analysis. The average age was 65 years (95% CI 63.63-66.37 years). All patients had abdominal obesity. 44 patients (97.78%) had hypertension, 32 (71.11%) - osteoarthrosis, 28 (60.87%) - dyslipidemia, 16 (35.56%) - diabetes mellitus; and сoronary artery disease was detected in 9 patients (20%). Diet therapy caused a statistically significant decrease in body weight, waist and hip circumferences, fat mass, lean mass, total body fluid and muscle mass (in particular, 25.35% weight loss was due to muscle mass loss), as well as the improvement of lipid profile.

CONCLUSION

Dietary interventions, such as main and low - calorie standard diets, routinely used for inpatient settings allow us to reduce body weight and improve anthropometric parameters in elderly and senile obese patients with comorbidities, which is accompanied by positive changes in lipid and carbohydrate metabolism even in a short - term follow - up. However, the protein content for standard diets is insufficient for this target group and leads to the loss of both fat and muscle mass.

Long-term trends (1973-14) for obesity and educational inequalities among Austrian adults: men in the fast lane

BACKGROUND

The examination of obesity trends is important to plan public health interventions specific to target-groups. We investigated long-term trends of obesity for the Austrian adult population between 1973 and 2014 according to their sex, age and education and the magnitude of educational-inequalities.

METHODS

Data were derived from six national, representative, cross-sectional interview surveys (N = 194 030). Data correction factors for self-reported body mass index (BMI) were applied. Obesity was defined as BMI ≥ 30 kg/m2. Absolute changes (ACs) and aetiologic fractions (AFs) were calculated to identify trends in the obesity prevalence. To measure the extent of social inequality, the relative index of inequality was computed based on educational levels.

RESULTS

In 2014, the age-adjusted prevalence of obesity was 14.6% (95%CI: 14.0-15.3) for women and 16.8% (95%CI: 16.1-17.9) for men. Obesity was most prevalent among subjects aged 55-74 years and those with low educational status. The AC in the obesity prevalence during the study period was highest for men aged 75 years and older with high/middle educational levels (16.2%) and also high for subjects aged 55 years and older with low educational levels. The greatest dynamics for obesity were observed among the oldest men with high/middle educational levels. Educational inequalities for obesity were higher among women, but only increased among men.

CONCLUSIONS

Since 1973, the prevalence for obesity was observed to be higher for men than women in Austria for the first time. Men showed the greatest increase in prevalence and risk for obesity during the study period. Further studies are needed to determine the drivers behind these trends.

The Risk of Hypertension Doubles Every 10 Years in China: Age, Period, and Birth Cohort Effects on the Prevalence of Hypertension From 2004 to 2013

BACKGROUND

Hypertension is a growing problem worldwide and can often result in a variety of negative health outcomes. The aim of this study was to assess the effects of age at diagnosis, calendar period, and birth cohort on the change in the prevalence rate of hypertension in Guangzhou from 2004 to 2013.

METHODS

We used data from the Guangzhou Community Health Survey, a population-based study designed by the National Health and Family Planning Commission of the PRC every 5 years. A total of 27,299, 23,467, and 18,362 participants aged 15-79 years completed the survey in 2004, 2009, and 2013, respectively.

RESULTS

Age effects increased slowly before the age of 42 years but increased rapidly after the age of 42 years, peaking at 79 years. Cohort effects grew slowly before the end of the 1960s but grew quickly after the end of the 1960s. The risk of suffering from hypertension among people born in 1962, 1972, 1982, and 1992 was 1.39, 2.68, 5.55, and 11.53 times, respectively, than that of people born in 1952. The period effects increased 25% from 2004 to 2009 and later declined 27% from 2009 to 2013 in the entire population. There was no gender difference in age effects and period effects, but strong cohort effects on hypertension were observed among males compared with females.

CONCLUSIONS

For Chinese individuals, the later one is born, the higher the risk is of suffering from hypertension. Strong cohort effects for hypertension were observed among males compared with females, indicating that males are more easily affected by hypertension based on the change in birth cohort.

The obesity transition: stages of the global epidemic

The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.

Global Patterns and Trends in Pancreatic Cancer Incidence: Age, Period, and Birth Cohort Analysis

OBJECTIVES

We aim to provide a global geographical picture of pancreatic cancer incidence and temporal trends from 1973 to 2015 for 41 countries.

METHODS

Joinpoint regression and age-period-cohort model was used.

RESULTS

In 2012, the highest age-adjusted rate was in Central and Eastern Europe for males and North America for females. Most regions showed sex disparities. During the recent 10 years, increasing trends were observed in North America, Western Europe, and Oceania. The greatest increase occurred in France. For recent birth cohorts, cohort-specific increases in risk were pronounced in Australia, Austria, Brazil, Canada, Costa Rica, Denmark, Estonia, France, Israel, Latvia, Norway, Philippines, Republic of Korea, Singapore, Spain, Sweden, the Netherlands, United States, and US white male populations and in Australia, Austria, Brazil, Bulgaria, Canada, China, Czech Republic, Finland, France, Italy, Japan, Lithuania, Norway, Republic of Korea, Singapore, Spain, The Netherlands, United Kingdom, United States, and US white female populations.

CONCLUSIONS

In contrast to the favorable effect of the decrease in smoking prevalence, other factors, including the increased prevalence of obesity and diabetes and increased physical inactivity, increased intake of red or processed meat and inadequate intake of fruits and vegetables are likely to have an unfavorable role in pancreatic cancer incidence worldwide.

Body Mass Index and Mortality in Elderly Subjects from the Moli-Sani Study: A Possible Mediation by Low-Grade Inflammation?

The association between obesity and mortality in the elderly remains controversial. To test the association between BMI and mortality, with the hypothesis of a mediation by low-grade inflammation (LGI), a prospective study design (median follow-up 7.8 years) was used on a sample of 4,970 elderly subjects (age ≥ 65 years) from the Moli-sani Study cohort. The association between BMI categories and overall or cause-specific mortality (hazard ratio, HR) was calculated by multivariable Cox regression. Dose-response relationship was tested using restricted cubic splines. Interaction between BMI and LGI, assessed through high-sensitivity C-reactive protein (hs-CRP) and INFLA-score, was also tested. In comparison with normal-weight, overweight was significantly associated with a 20% (adjusted HR = 0.80; 95%CI 0.67-0.95) reduced risk of total mortality, while severe obesity (BMI > 40) with an increased risk (HR = 1.81; 95%CI 1.13-2.93). Cubic spline curves showed a U-shaped relationship between BMI and total mortality (p value for nonlinear relationship = 0.001). Similar results were found for cardio-cerebrovascular and other causes mortality. Hs-CRP and INFLA-score were associated with an increased risk of total mortality in adjusted analyses. Mediation analysis did not show any effect of LGI on the association between BMI and mortality. However, after stratification for LGI under or below the population median, greater LGI increased the risk of mortality in obese elderly more than expected (p for interaction = 0.04). A U-shaped association between BMI and mortality was observed in Italian elderly subjects. While the association was independent of LGI levels, there was a significant interaction between BMI and LGI in increasing mortality risk in obese elderly individuals.

[VIVOPTIM: Feedback of an e-Health experimental program of primary prevention of cardiovascular risk on 30 to 70 years old volunteers]

Today by the e-health and the telemedicine, many people are more and more interested by the improvement of disease knowledge on cardiovascular diseases and associated risk factors, personalized self management support follow-up and e-Health monitoring. MGEN is a not-for-profit complementary health insurance gave itself the ways to use the new digital tools in health. MGEN developed an original and personalized program VIVOPTIM for the primary prevention of the cardiovascular risks for their members. The VIVOPTIM Pilot program is based upon digital services and was experimented by November 2015 to December, 2017 with 8000 members of the MGEN, from 30 to 70 years old and resident in two French areas (Occitanie and Bourgogne Franche-Comté). The assessment of the experiment VIVOPTIM e -health program was positive for the personalized cardiovascular support and for their health. Therefore, the MGEN generalized the VIVOPTIM program of cardiovascular prevention, to the whole France on July 11th, 2018.

Past trends in obesity-attributable mortality in eight European countries: an application of age-period-cohort analysis

Objectives

To assess age, period, and birth cohort effects and patterns of obesity-attributable mortality in Czech Republic, Finland, France, Germany, Hungary, Italy, Poland, and the UK (UK).

Methods

We obtained obesity prevalence and all-cause mortality data by age (20–79), sex and country for 1990–2012. We applied Clayton and Schifflers’ age–period–cohort approach to obesity-attributable mortality rates (OAMRs).

Results

Between 1990 and 2012, obesity prevalence increased and age-standardised OAMRs declined, although not uniformly. The nonlinear birth cohort effects contributed significantly (p < 0.01) to obesity-attributable mortality trends in all populations, except in Czech Republic, Finland, and among German women, and Polish men. Their contribution was greater than 25% in UK and among French women, and larger than that of the nonlinear period effects. In the UK, mortality rate ratios (MRRs) increased among the cohorts born after 1950. In other populations with significant birth cohort effects, MRRs increased among the 1935–1960 cohorts and decreased thereafter.

Conclusions

Given its potential effects on obesity-attributable mortality, the cohort dimension should not be ignored and calls for interventions early in life next to actions targeting broader societal changes.

Electronic supplementary material

The online version of this article (10.1007/s00038-018-1126-2) contains supplementary material, which is available to authorized users.

Effect of resistance training and protein intake pattern on myofibrillar protein synthesis and proteome kinetics in older men in energy restriction

KEY POINTS

Strategies to enhance the loss of fat while preserving muscle mass during energy restriction are of great importance to prevent sarcopenia in overweight older adults. We show for the first time that the integrated rate of synthesis of numerous individual contractile, cytosolic and mitochondrial skeletal muscle proteins was increased by resistance training (RT) and unaffected by dietary protein intake pattern during energy restriction in free-living, obese older men. We observed a correlation between the synthetic rates of skeletal muscle-derived proteins obtained in serum (creatine kinase M-type, carbonic anhydrase 3) and the synthetic rates of proteins obtained via muscle sampling; and that the synthesis rates of these proteins in serum revealed the stimulatory effects of RT. These results have ramifications for understanding the influence of RT on skeletal muscle and are consistent with the role of RT in maintaining muscle protein synthesis and potentially supporting muscle mass preservation during weight loss.

ABSTRACT

We determined how the pattern of protein intake and resistance training (RT) influenced longer-term (2 weeks) integrated myofibrillar protein synthesis (MyoPS) during energy restriction (ER). MyoPS and proteome kinetics were measured during 2 weeks of ER alone and 2 weeks of ER plus RT (ER + RT) in overweight/obese older men. Participants were randomized to consume dietary protein in a balanced (BAL: 25% daily protein per meal × 4 meals) or skewed (SKEW: 7:17:72:4% daily protein per meal) pattern (n = 10 per group). Participants ingested deuterated water during the consecutive 2-week periods, and skeletal muscle biopsies and serum were obtained at the beginning and conclusion of ER and ER + RT. Bulk MyoPS (i.e. synthesis of the myofibrillar protein sub-fraction) and the synthetic rates of numerous individual skeletal muscle proteins were quantified. Bulk MyoPS was not affected by protein distribution during ER or ER + RT (ER: BAL = 1.24 ± 0.31%/day, SKEW = 1.26 ± 0.37%/day; ER + RT: BAL = 1.64 ± 0.48%/day, SKEW = 1.52 ± 0.66%/day) but was ∼26% higher during ER + RT than during ER (P = 0.023). The synthetic rates of 175 of 190 contractile, cytosolic and mitochondrial skeletal muscle proteins, as well as synthesis of muscle-derived proteins measured in serum, creatine kinase M-type (CK-M) and carbonic anhydrase 3 (CA-3), were higher during ER + RT than during ER (P < 0.05). In addition, the synthetic rates of CK-M and CA-3 measured in serum correlated with the synthetic rates of proteins obtained via muscle sampling (P < 0.05). This study provides novel data on the skeletal muscle adaptations to RT and dietary protein distribution.

Cohort-based income gradients in obesity among U.S. adults

OBJECTIVES

No studies have focused on socioeconomic disparities in obesity within and between cohorts. Our objectives were to examine income gradients in obesity between birth-cohorts (inter-cohort variations) and within each birth-cohort (intra-cohort variations) by gender and race/ethnicity.

METHODS

Our sample includes 56,820 white and black adults from pooled, cross-sectional National Health and Nutrition Examination Surveys (1971-2012). We fit a series of logistic hierarchical Age-Period-Cohort models to control for the effects of age and period, simultaneously. Predicted probabilities of obesity by poverty-to-income ratio were estimated and graphed for 5-year cohort groups from 1901-1990. We also stratified this relationship for four gender and racial/ethnic subgroups.

RESULTS

Obesity disparities due to income were weaker for post-World War I and II generations, specifically the mid-1920s and the mid-1940s to 1950s cohorts, than for other cohorts. In contrast, we found greater income gradients in obesity among cohorts from the 1930s to mid-1940s and mid-1960s to 1970s. Moreover, obesity disparities due to income across cohorts vary markedly by gender and race/ethnicity. White women with higher income consistently exhibited a lower likelihood of obesity than those with lower income since early 1900s cohorts; whereas, black men with higher income exhibited higher risks of obesity than those with lower income in most cohorts.

CONCLUSIONS

Our findings suggest that strategies that address race and/or gender inequalities in obesity should be cognizant of significant historical factors that may be unique to cohorts. Period-based approaches that ignore life-course experiences captured in significant cohort-based experiences may limit the utility of policies and interventions.

Acute coronary syndrome in women: rising hospitalizations in middle-aged French women, 2004-14

Aims

We aimed to analyse trends in annual incidence of hospitalized acute coronary syndrome (ACS) in France from 2004 to 2014.

Methods and results

Primary diagnosis of ACS and subtypes on admissions were selected in national and exhaustive French Hospitalization Database from 2004 to 2014. Age-standardized rates were computed using standardization on the census of the 2010 European population and mean annual percent changes were estimated by using Poisson regression model. In 2014, 113 407 patients, 36 480 women (32.2%) and 76 927 men (67.8%) were hospitalized for ACS. Among women, the proportion aged under 65 years was 25.2% (n = 9206) and there was 34.4% of STEMI, 18.2% of NSTEMI and 47.4% of UA. From 2004 to 2014, the rates of age-standardized admissions for ACS in women less than 65 years old increased by 6.3%.This rise in ACS was driven by significant increases in STEMI (+21.7%) and NSTEMI (+53.7%). The largest increase in STEMI mean annual percent change was observed among women aged 45-54 years old (+3.6%/per year). After 65 years of age, significant decreases in all ACS types were observed.

Conclusion

This nationwide study showed substantial rising trends in STEMI annual incidence, especially among younger women. This increase could be attributed to increase in smoking and obesity. Efforts to strengthen primary prevention of CVD in younger women is needed as the main risk factors are modifiable, and as there is a growing evidence of higher short-term mortality of CHD in women.

Population-Based Study of Changes in Arthritis Prevalence and Arthritis Risk Factors Over Time: Generational Differences and the Role of Obesity

OBJECTIVE

To investigate cohort effects in arthritis prevalence across 4 birth cohorts: World War II (born 1935-1944), older and younger baby boomers (born 1945-1954 and 1955-1964, respectively), and Generation X (born 1965-1974), and to determine whether birth cohort effects in arthritis prevalence were associated with differences in risk factors over time or period effects.

METHODS

Analysis of biannually collected data from the longitudinal Canadian National Population Health Survey, 1994-2011 (n = 8,817 at baseline). Data included self-reported arthritis diagnosed by a health professional, risk factors (years of education, household income, smoking, physical activity, sedentary behavior, body mass index [BMI]), and survey year as an indicator of period. We used hierarchical age-period-cohort analyses to compare the age trajectory of arthritis by birth cohort and to examine the contribution of changes in risk factors and period to cohort differences.

RESULTS

More recent cohorts had successively a greater prevalence of arthritis. Risk factors were significantly associated with arthritis prevalence independently of cohort differences. The effects of increasing education and income over time on potentially reducing the arthritis prevalence were almost counter-balanced by effects of increasing BMI. Significant cohort-BMI and age-BMI interactions indicated an earlier age of arthritis onset for obese individuals than those of normal weight.

CONCLUSION

Projections that only take into account the changing age structure of the population may underestimate future trends. Our understanding of the impact of BMI on arthritis is likely an underestimate. Cohort differences focus attention on the need to target arthritis management education to young and middle-aged adults.

Trends in Child Obesity and Underweight in Spain by Birth Year and Age, 1983 to 2011

INTRODUCTION AND OBJECTIVES

The prevalences of child obesity and overweight are increasing worldwide and are a significant public health issue, particularly in terms of long-term cardiovascular risk profiles, which continue into adulthood unless obesity is reversed. Accurately identifying trends and at-risk subgroups is crucial to correctly target public health initiatives. The objective of this study was to examine changes in the prevalences of child obesity and underweight in Spain from 1983 to 2011 taking into consideration both age and birth year.

METHODS

A series of cross-sectional studies representative of the pediatric population in Spain between 1987 and 2011 was used to calculate the prevalence and trends of excess weight and underweight in girls and boys aged 2 to 14 years per survey year and per birth year.

RESULTS

The overall prevalence of overweight and obesity remained relatively stable. The prevalence of overweight in boys aged 10 to 14 years increased from 13.9% to 22.2%. The prevalence of obesity in girls aged 2 to 5 years decreased from 30% to 19.8%, whereas the prevalence of underweight in this group increased from 13.7% to 22.6%.

CONCLUSIONS

Child obesity trends in Spain over the last 2 decades appear to be stable with some fluctuations, but the trends differ depending on age and sex, and have stabilized at too high a level. The prevalence of underweight also appears to have increased and should be considered alongside excess weight when designing and implementing child health and weight measures.

Current challenges in providing bariatric surgery in France: A nationwide study

Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or depression. Universal health insurance coverage for low-income patients was inversely correlated with the probability of RYGB.Differences in access to surgery have been observed in terms of the patient's profile, geographical variations, and predictors of types of procedures. Several challenges must be met when organizing the medical care of this growing number of patients, when delivering surgery through qualified centers while assuring the quality of long-term follow-up for all patients.

Are products sold in university vending machines nutritionally poor? A food environment audit

AIM

(i) To audit the nutritional composition, promotion and cost of products available from vending machines available to young adults; and (ii) to examine the relationship between product availability and sales.

METHODS

A cross-sectional analysis of snacks and beverages available and purchased at a large urban university was conducted between March and September 2014. Sales were electronically tracked for nine months.

RESULTS

A total of 61 vending machines were identified; 95% (n = 864) of the available snacks and 49% of beverages (n = 455) were less-healthy items. The mean (SD) nutrient value of snacks sold was: energy 1173 kJ (437.5), saturated fat 5.36 g (3.6), sodium 251 mg (219), fibre 1.56 g (1.29) and energy density 20.16 kJ/g (2.34) per portion vended. There was a strong correlation between the availability of food and beverages and purchases (R² = 0.98, P < 0.001).

CONCLUSIONS

Vending machines market and sell less-healthy food and beverages to university students. Efforts to improve the nutritional quality are indicated and afford an opportunity to improve the diet quality of young adults, a group at risk of obesity.

Age-period-cohort analyses of obesity prevalence in US adults

OBJECTIVES

Age-period-cohort analysis is a stream of methodologies that decompose the temporal trends for disease risk into three time scales-age, calendar year (period) and year of birth (cohort). This study conducted age-period-cohort analyses of obesity prevalence in US adults.

STUDY DESIGN

Retrospective data analysis.

METHODS

We constructed regression models based on anthropometric data from the 1999-2012 National Health and Nutrition Examination Survey to correct for the self-reported height/weight in the 1984-2014 Behavioral Risk Factor Surveillance System (BRFSS). We estimated fixed-effects age-period-cohort models based on the BRFSS data for the overall adult sample (n = 6,093,293) and by sex and race/ethnicity, adjusting for individual characteristics and the BRFSS survey design.

RESULTS

An inverted U-shaped age effect on obesity and a positive period effect characterized by over-time increase in obesity risk independent of age and cohort influences were identified in the overall sample and subgroups by sex and race/ethnicity. From 1984 to 2014, the adjusted obesity prevalence increased by 21.1 percentage points among US adults, and 20.9, 21.6, 21.0, 26.4 and 20.1 percentage points in men, women, non-Hispanic whites, African Americans and Hispanics, respectively. In contrast, no consistent evidence was found in support of the cohort effect-the adjusted obesity risk was comparable across birth cohorts after accounting for the age and period effects.

CONCLUSIONS

Shifts in the age distribution and nationwide secular changes may have fuelled the obesity epidemic in the USA over the past decades. Reversing the obesity epidemic may require understanding of the nationwide changes over time that affect weight gain across all population subgroups and promoting universal changes to diet, physical activity and the obesogenic environment.

The impact of area residential property values on self-rated health: A cross-sectional comparative study of Seattle and Paris

This study analyzed the impact of area residential property values, an objective measure of socioeconomic status (SES), on self-rated health (SRH) in Seattle, Washington and Paris, France. This study brings forth a valuable comparison of SRH between cities that have contrasting urban forms, population compositions, residential segregation, food systems and transportation modes. The SOS (Seattle Obesity Study) was based on a representative sample of 1394 adult residents of Seattle and King County in the United States. The RECORD Study (Residential Environment and Coronary Heart Disease) was based on 7131 adult residents of Paris and its suburbs in France. Socio-demographics, SRH and body weights were obtained from telephone surveys (SOS) and in-person interviews (RECORD). All home addresses were geocoded using ArcGIS 9.3.1 (ESRI, Redlands, CA). Residential property values were obtained from tax records (Seattle) and from real estate sales (Paris). Binary logistic regression models were used to test the associations among demographic and SES variables and SRH. Higher area property values significantly associated with better SRH, adjusting for age, gender, individual education, incomes, and BMI. The associations were significant for both cities. A one-unit increase in body mass index (BMI) was more detrimental to SRH in Seattle than in Paris. In both cities, higher area residential property values were related to a significantly lower obesity risk and better SRH. Ranked residential property values can be useful for health and weight studies, including those involving social inequalities and cross-country comparisons.

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We studied the impact of area property values on health in Seattle and Paris.

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Higher area property values associated with better SRH in both cities

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Ranked area property values can be useful for health and weight studies.

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BMI was more detrimental to SRH in Seattle than in Paris.

[Obesity in elderly]

The prevalence of obesity is increasing also in the elderly population. The European Euronut-Seneca study described an obesity prevalence of 12-41% in elderly women and of 8-24% in elderly men. Obesity in the elderly is related to the cardiometabolic risk, but also to degenerative joint diseases and impaired physical functions. Some discrepancies are caused by the description of a so-called obesity paradox with a more favourable prognosis for certain diseases in the presence of overweight compared to normal or reduced body weight. The so-called sarcopenic obesity is associated with the worst prognosis.Preventive and therapeutic regimens should consider the increased risk of malnutrition in elderly. The combinations of individually tailored nutritional recommendations and physical exercise is of advantage for the prognosis of comorbidities and the quality of life.

Arthroscopy and obesity

Obesity is a major public health issue, as incidence is rising in all developed countries, although the proportion is lower in Europe than in the U.S. Over and above the metabolic consequences and increased risk of diabetes, cardiovascular pathology and certain forms of cancer, the present study focuses on osteoarticular risk, and in particular on pathologies manageable by arthroscopy. It also analyzes results and complications specific to arthroscopy in these indications. Meniscal and ligamentous pathologies of the knee, rotator-cuff pathology in the shoulder and tendon pathology in the elbow were not significantly elevated, although a trend emerged. In contrast, there was significant elevation of Achilles and plantar aponeurosis pathology. In terms of postoperative complications, thromboembolic risk was elevated, but there were not significantly more complications specific to arthroscopy. Finally, subjective results were comparable to those for non-obese patients.

LEVEL OF EVIDENCE

Review.