Educational attainment and obesity: a systematic review

Rising socioeconomic disparities in childhood overweight and obesity in Belgium

BACKGROUND

Childhood overweight, especially obesity, significantly impacts children's health and poses an increased risk of adult-onset diseases. This study aims to analyse the evolution of childhood overweight and obesity in Belgium from 1997 to 2018 and assess its variation across parental socioeconomic status (SES).

METHODS

The Health Interview Survey, a cross-sectional survey representative of the Belgian population, has been conducted since 1997, with the latest survey conducted in 2018. This study focuses on children aged 2-17 years. Body Mass Index (BMI, kg/m²) was derived from self-reported data, supplemented with proxy reports for children under 15 years old. Overweight and obesity were classified using age/sex-specific cut-off points. Highest parental educational level served as the indicator of SES. In addition to reporting the overall prevalence and the 95% confidence interval (95%CI) of childhood overweight and obesity by year, this study examines the absolute difference in prevalence between SES groups (low minus high) and calculates the Odds Ratio (OR, adjusted for age and sex) to evaluate the relative difference.

RESULTS

The overall prevalence of childhood overweight rose from 13.6% (95%CI = 11.2-16.1%) in 1997 to 18.9% (95%CI = 16.3-21.5%) in 2018; while it remained stable for obesity, fluctuating between 5.4% and 6.3% over the same period. This increase was more pronounced among children with low SES compared to those with high SES. Consequently, the absolute difference between children with low and high SES increased over time from 8.0% points (pp) in 1997 to 14.9 pp in 2018 for overweight, and from 3.1 pp to 6.8 pp for obesity. In terms of relative inequalities, overall, children with low SES exhibited significantly higher odds of overweight and of obesity than those with high SES (OR varying between 2 à 3 for overweight and between 2 and 4 for obesity).

CONCLUSIONS

The escalating disparities over time highlight SES as a significant risk factor for childhood overweight and obesity. Addressing these inequalities requires interventions such as providing healthy meals and increasing sports opportunities at school. Additionally, it is recommended to regulate fast food outlets near schools and limit unhealthy food marketing, particularly because children with low SES are more exposed to such influences.

Association between evacuation and becoming overweight after the Great East Japan Earthquake: a 7-year follow-up of the Fukushima Health Management Survey

OBJECTIVES

Disaster evacuation increases the risk of becoming overweight or obese owing to lifestyle changes and psychosocial factors. This study evaluated the effect of evacuation on becoming overweight during a 7-year follow-up among residents of Fukushima Prefecture during the Great East Japan Earthquake.

STUDY DESIGN

This was a prospective cohort study.

METHODS

We analysed data collected from 18,977 non-overweight Japanese participants who completed the 'Comprehensive Health Checkup Program' and 'Mental Health and Lifestyle Survey', as part of the Fukushima Health Management Survey, between July 2011 and November 2012. An evacuation was defined as the moving out of residents of municipalities designated as an evacuation zone by the government or having a self-reported experience of moving into shelters or temporary housing. Follow-up examinations were conducted in March 2018 to identify patients who became overweight. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using a Cox proportional hazards regression model.

RESULTS

Among 15,875 participants (6091 men and 9784 women; mean age 63.0 ± 11.1 years) who received follow-up examination (mean follow-up, 4.29 years), 2042 (856 men and 1186 women) became overweight. Age-, baseline body mass index-, lifestyle-, and psychosocial status-adjusted HRs (95% CIs) for becoming overweight after evacuation were 1.44 (1.24-1.66) for men and 1.66 (1.47-1.89) for women.

CONCLUSION

Evacuation was associated with the risk of becoming overweight 7 years after the disaster. Thus, maintaining physical activity, healthy diet, and sleep quality and removing barriers to healthy behaviour caused by disasters, including anxiety concerning radiation, may prevent this health risk among evacuees.

Factors Associated with the Health-Related Self-Care Capacity of Overweight and Obese People

This study aimed to investigate the relationship between beliefs about obese people and health-related self-care among overweight and obese people, considering sociodemographic aspects. This study adopted a cross-sectional design. The sample consisted of 207 participants selected through a simple random sampling method. The "Beliefs About Obese Persons Scale" (BAOP) and the "Self-Care Agency Rating Scale-Revised" (ASA-R) questionnaires were applied to data collection. The results showed that 82.6% believed that obesity is a condition the individual cannot control, and 74.4% expressed inadequate self-care regarding their health. A multivariate analysis found that belonging to the adult age group increases the probability of presenting adequate health-related self-care by 4.7 times (95% CI = 1.892-11.790) compared to older adults. The belief that obesity is an uncontrollable condition increases the probability of inadequate self-care by 6.3 times (95% CI = 2.360-16.924), in contrast to the perception that it is a controllable condition. Moreover, overweight people are 0.139 times (95% CI = 0.044-0.443) less likely to have adequate self-care compared to people with obesity. In conclusion, being an adult and having the belief that obesity is a condition that can be controlled is associated with adequate health-related self-care, while being overweight is associated with inadequate health care.

Educational inequalities and self-reported health among men and women aged 18-49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study

OBJECTIVES

To estimate the prevalence of good self-reported health (SRH) in subpopulations based on the social determinants of health and to investigate the association between education (measured in years of schooling) and good SRH among men and women aged 18-49 years in Yangon Region, Myanmar.

DESIGN

Analysis of data from a population-based, cross-sectional study conducted in Yangon, Myanmar, from October to November 2016. A multistage sampling procedure was employed, and structured face-to-face interviews were conducted with standardised questions adapted from the Myanmar Demographic and Health Survey. Prevalence ratios (PRs) with 95% CIs were estimated using Poisson regression analyses by sex.

SETTING

Urban and rural areas of Yangon Region, Myanmar.

PARTICIPANTS

The sample included 2,506 participants (91.8% response rate) aged 18-49 years and excluded nuns, monks, soldiers, institutionalised people and individuals deemed too ill physically and/or mentally to participate.

RESULTS

The prevalence of good SRH was 61.2% (95% CI 59.3 to 63.1), with higher rates among men (72.0%, 95% CI 69.3 to 74.5), younger individuals (69.2%, 95% CI 66.2 to 72.1), urban residents (63.6%, 95% CI 60.8 to 66.3), extended family dwellers (66.6%, 95% CI 63.7 to 69.4) and those with a higher level of education (66.0%, 95% CI 61.3 to 70.5). After adjusting for confounders (age and area of residence), the association between years of schooling and SRH (PR) was 1.01 (95% CI 1.01 to 1.02, p=0.002) in men and 1.01 (95% CI 0.99 to 1.02, p=0.415) in women.

CONCLUSIONS

Good SRH was more prevalent among men than among women. Additionally, a 1-year increase in education was associated with a 1% increase in the prevalence of good SRH among men, whereas the association was not statistically significant among women. In order to enhance the educational benefits of health in Myanmar, we recommend a higher focus on the length of education and addressing gender inequalities in wage return from education.

Maternal pre-pregnancy body mass index and related factors: A cross-sectional analysis from the Japan Environment and Children's Study

Socioeconomic status and smoking are reportedly associated with underweight and obesity; however, their associations among pregnant women are unknown. This study aimed to investigate whether socioeconomic factors, namely educational attainment, household income, marital status, and employment status, were associated with pre-pregnancy body mass index (BMI) categories, including severe-moderate underweight (BMI ≤ 16.9 kg/m2), mild underweight (BMI, 17.0-18.4 kg/m2), overweight (BMI, 25.0-29.9 kg/m2), and obese (BMI ≥ 30.0 kg/m2) among Japanese pregnant women using data from the Japan Environment and Children's Study (JECS). In total, pregnant women were included 96,751. Age- and parity-adjusted multivariable multinomial logistic regression analyses assessed socioeconomic factors and smoking associations with falling within abnormal BMI categories (normal BMI as the reference group). Lower education and lower household were associated with overweight and obesity, and, especially, lowest education and household income had relatively higher point estimate relative ratios (RRs) of 3.97 and 2.84, respectively. Regarding the risks for underweight, however, only junior high school education had a significantly higher RR for severely to moderately underweight. Regarding occupational status, homemakers or the unemployed had a higher RR for severe-moderate underweight, overweight, and obesity. Unmarried, divorced, or bereaved women had significantly higher RRs for mildly underweight status. Quitting smoking early in pregnancy/still smoking had higher RRs for all four not having normal BMI outcomes; however, quitting smoking before pregnancy had a higher RR only for obese individuals. Lower educational attainment and smoking are essential intervention targets for obesity and severe-moderate underweight prevention in younger women. Lower household income is also a necessary target for obesity.

COVID-19 Pandemic as an Equalizer of the Health Returns of Educational Attainment for Black and White Americans

BACKGROUND

COVID-19 pandemic has immensely impacted the social and personal lives of individuals around the globe. Marginalized-related diminished returns (MDRs) theory suggests that educational attainment shows a weaker protective effect for health and behavioral outcomes for Black individuals compared to White individuals. Previous studies conducted before the COVID-19 pandemic demonstrated diminished returns of educational attainment for Black individuals compared to White individuals.

OBJECTIVES

The study has three objectives: First, to test the association between educational attainment and cigarette smoking, e-cigarette vaping, presence of chronic medical conditions (CMC), self-rated health (SRH), depressive symptoms, and obesity; second, to explore racial differences in these associations in the USA during the COVID-19 pandemic; and third, to compare the interaction of race and return of educational attainment pre- and post-COVID-19 pandemic.

METHODS

This study utilized data from the Health Information National Trends Survey (HINTS) 2020. Total sample included 1313 adult American; among them, 77.4% (n = 1017) were non-Hispanic White, and 22.6% (n = 296) were non-Hispanic Black. Educational attainment was the independent variable operationalized as years of education. The main outcomes were cigarette smoking, e-cigarette vaping, CMC, SRH, depressive symptoms, and obesity. Age, gender, and baseline physical health were covariates. Race/ethnicity was an effect modifier.

RESULTS

Educational attainment was significantly associated with lower CMC, SRH, depressive symptoms, obesity, cigarette smoking, and e-cigarette vaping. Educational attainment did not show a significant interaction with race on any of our outcomes, suggesting that the health returns of education is similar between non-Hispanic White and non-Hispanic Black individuals.

CONCLUSION

COVID-19 may have operated as an equalizer of the returns of educational attainment. This observation may be because White may have more to lose; Black communities may be more resilient or have economic and social policies that buffered unemployment and poverty regardless of historical anti-Black oppression.

Prevalence of obesity and overweight in an adult population of Tehran metropolis

Purpose

Obesity is a chronic low-grade inflammatory condition with increasing global prevalence and is associated with cardiovascular diseases. In this study, we aimed to investigate the prevalence of obesity in the Tehran cohort study (TeCS) population.

Methods

We used the data collected by systematic random sampling during the recruitment phase of TeCS. The data comprised 4215 households from all districts of the Tehran metropolis, from which 8296 adults aged ≥ 35 years participated between May 2016 and February 2019. Sociodemographic data, medical history, laboratory tests, and anthropometric measurements were gathered from the participants. Participants with missing data were excluded from the final analysis. Finally, the data was analyzed using SPSS version 23, and distribution maps were created by Stata 14.2.

Results

A total of 8211 participants (53.9% women) with an average age of 53.7 ± 12.6 years were studied. The age-weighted prevalence of overweight and obese among women was (37.5% [95% confidence interval (CI): 34.5, 40.6] and 35.5% [95% CI: 32.6 -38.6]) compared to men (47% [95% CI: 43.6, 50.3] and 22.9% [95% CI: 20.1 -25.8]). The prevalence of substantially increased risk of metabolic complications (SIRMC) based on waist circumference (WC) and waist-to-hip ratio (WHR) was 49.2% (95% CI: 46.3 -52.2) and 75.5% (95% CI: 72.7 -78.1) respectively.

Conclusions

The prevalence of obesity in Tehran (29.3%) was much higher than in previous reports, particularly among older people, women, and socioeconomically underdeveloped districts. After age 55, more than 80% of women had SIRMC compared to 30% of men.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01365-4.

Body weight in childhood, adolescence, and young adulthood in relation to later risk of disabilities and early retirement among Danish female nurses

BACKGROUND

Obesity is now the most common health problem in the younger population in Western societies and obesity rates are higher in lower socioeconomic status (SES) groups. We investigated whether overweight in childhood, independently of overweight in adulthood, influenced adult employment status and later risk of having disabilities. Using data from the Danish Female Nurse Cohort study, we examined associations between overweight in childhood/adolescence, and young adulthood and disabilities and early retirement in later adulthood (>44 years) and whether it was influenced by menopausal age (

RESULTS

Our results showed that overweight in childhood, adolescence and young adulthood was associated with an increased risk of disabilities and early retirement. Especially childhood overweight that did not persist into adulthood was associated with an increased risk of disabilities (OR = 1.82, 95% CI = 1.26-2.63) and early retirement (OR = 2.05, 95% CI = 1.38-3.03) in the postmenopausal group. A similar increased risk for disabilities (OR = 1.76, 95% CI = 1.26-2.47) was seen for adolescent overweight that did not persist into adulthood.

CONCLUSION

The results show that in a well-educated population of women, overweight in childhood and/or adolescence had adverse socioeconomic consequences for later risk of disabilities and early retirement irrespective of weight status in adulthood.

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MESH Headings

• Humans
• Female
• Denmark/epidemiology
• Adolescent
• Retirement/statistics & numerical data
• Adult
• Risk Factors
• Disabled Persons/statistics & numerical data
• Child
• Nurses/statistics & numerical data
• Young Adult
• Body Mass Index
• Middle Aged
• Pediatric Obesity/epidemiology
• Overweight/epidemiology
• Socioeconomic Factors
• Employment/statistics & numerical data
• Body Weight/physiology
• Cohort Studies

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Affiliation(s)

Hanna Kruse Reiband The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
Rikke Tannenberg Klemmensen The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
Susanne Rosthøj The Danish Cancer Institute, Research Centre, Copenhagen, Denmark Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Thorkild I A Sørensen Center for Childhood Health, Copenhagen, Denmark Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark NNF Centre for Basic Metabolic Health, University of Copenhagen, Copenhagen, Denmark
Berit Lilienthal Heitmann The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark Department of Public Health, Section for general Practise, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark

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Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants

BACKGROUND AND AIMS

Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants.

METHODS

10,370 CAD patients (mean age ∼65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health).

RESULTS

During ∼10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI ∼27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25-30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95%CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level.

CONCLUSIONS

CAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.

The experiences of people living with obesity and chronic pain: A Qualitative Evidence Synthesis (QES) protocol

INTRODUCTION

There is a substantial and progressive association between chronic pain (CP) and living with overweight or obesity. The relationship between obesity and CP is intricate and complex, with obesity being associated with increased pain-related disability, pain intensity, reduction in physical functioning and poorer psychological well-being. A Qualitative Evidence Synthesis (QES) provides an opportunity to better understand and reveal key areas within the patient experience of these complex interactions to inform best practice and future intervention design.

AIMS

The aim of this QES is to methodically and systematically review and synthesise the qualitative literature reporting on the personal experiences of people who are both living with obesity (PwO) and chronic pain.

METHODS

The phenomenon of interest of this QES is the lived experiences of PwO and CP. The following research question was developed using a modified Population, Intervention, Comparison, Outcome and Study type (PICOS) framework: "What are the lived experiences of people living with obesity and chronic pain?". One review author will conduct a systematic search based on keywords and Medical Subject Headings (MeSH) terms for finding relevant articles in five peer-review databases, from inception to the date of searching. Two review authors will independently apply inclusion and exclusion criteria and screen articles in a two-stage process. The methodological quality of included studies will be assessed using the Critical Appraisal Skills Programme (CASP) tool and data will be extracted using a customised template. We will undertake a thematic synthesis of qualitative data from included studies and report our findings narratively. Confidence in the findings will be assessed based on the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CER-Qual) approach.

FINDINGS AND DISSEMINATION

This study will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. It is anticipated that the findings of the review will facilitate a deep and broad understanding of the complex interactions between CP and obesity and will help inform best practice and future intervention design. Findings will be disseminated through journals that undergo peer review, presentations at conferences, engagement with public and patient advocacy groups, and social media.

ETHICS AND DISSEMINATION

Ethical approval is not required to conduct this review.

TRAIL REGISTRATION

PROSPERO registration number: CRD42023361391.

Health Prompts Affect Consideration of Health but Not Intertemporal Preferences While Promoting Healthier Food Choices

Diet-related diseases impact populations across the globe. While intertemporal preferences-a fundamental preference for the distribution of benefits across time-have been used to explain low-quality food choices, the recent literature proposes another cause: inattention to the future implications (or opportunity costs) of the options faced. Food choices tend to become habitual to conserve cognitive resources, rather than carefully modeling future health impacts. Both low discount rates for future benefits and attention to future health impacts predict healthier decisions. While intertemporal preferences are stable, attention may provide an opportunity to intervene in the decision process to promote healthier decisions. In this study, we test the impact of a simple message that highlights health during food choice on the healthiness of the foods chosen and on health consideration and intertemporal preferences. Our results show that actively considering health outcomes and lower discount rates lead to healthier food choices. We find that messaging increases the consideration of health outcomes during food choice but does not affect intertemporal preferences, suggesting that simple prompts may be an effective way to promote decisions balancing short- and long-term benefits by drawing attention to the overlooked opportunity costs of choices.

Obesity-Related Traits Mediate the Effects of Educational Attainment on the Risk of Varicose Veins, Venous Thromboembolism, and Phlebitis

BACKGROUND

 The extent to which educational attainment (EA) influences the risk of varicose veins (VVs), venous thromboembolism (VTE), and phlebitis occurrence, whether this pathway is mediated by obesity-related traits, and the proportion of their mediation is unknown.

METHODS

 A Mendelian randomization (MR) design was used to genetically investigate the causal effects of EA on the risk of VV, VTE, and phlebitis and to assess the mediating effect of obesity-related traits. Causal effects were estimated using primarily the multiplicative random-effects inverse variance-weighted method. This was supplemented by Cochran's Q-statistic, MR-Egger regression, MR funnel plots, and leave-one-out test to evaluate the reliability of the results. For the individual mediation effect, the coefficient product method was mainly utilized to estimate.

RESULTS

 An increase in genetically predicted EA was associated with a lower risk of VV, VTE, and phlebitis, as well as lower body mass index, basal metabolic rate, hip circumference, and waist circumference. As genetically predicted body mass index, basal metabolic rate, hip circumference, and waist circumference increased, the risk of developing VV, VTE, and phlebitis increased, respectively. Body mass index, basal metabolic rate, hip circumference, and waist circumference were identified as mediators of the protective effects of EA on VV, VTE, and phlebitis.

CONCLUSION

 The findings support a causal relationship between higher EA and lower risk of VV, VTE, and phlebitis. Obesity-related traits play a significant mediating role in these pathways, and there are interactions between them, with hip circumference mediating these pathways relatively independently from the other three.

The changing relationship between bodyweight and longevity in high- and low-income countries

Standard measures of bodyweight (overweight and obese, for example) fail to reflect differences across populations and technological progress over time. This paper builds on the pioneering work of Hans Waaler (1984) and Robert Fogel (1994) to empirically estimate how the relationship between body mass index (BMI) and longevity varies across high-, middle-, and low-income countries. Importantly, we show that these differences are so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined)-and in fact, relative to current standards, a larger share of low-income countries' populations can be unhealthily heavy.

Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD)

BACKGROUND

Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment. Little is known about the specific features or processes underpinning education that are health protective. The objective of the current study was to address this gap by examining specific aspects of early education pertaining to student characteristics and experiences, as well as features of the classroom environment, in predicting cardiometabolic health in adulthood.

METHODS

Subjects were 1364 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD, 1991-2009) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE, 2018-2022). Models examined individual education indicators (student social skills, student-teacher relationship quality, and classroom emotional and instructional quality in the period of elementary school and student academic performance between ages 54 months and 15 years) in relation to a composite of cardiometabolic risk in adulthood (ages 26-31), reflecting central adiposity, blood pressure, insulin resistance, inflammation, and dyslipidemia. Models were adjusted for key explanatory factors including socio-demographics, infant characteristics, parental socioeconomic status (SES), and child health status. Follow-up analyses were performed to test potential mediators of early education effects on adult health, including adult SES (educational attainment, household income) and health behaviors (diet quality, activity level, sleep duration, smoking).

RESULTS

In adjusted models, results showed greater student social skills, indexed by a mean of annual teacher ratings between kindergarten and 6th grade, predicted lower cardiometabolic risk in adulthood (β=-0.009, p <.05). In follow-up analyses, results showed the protective effect of student social skills on cardiometabolic risk may be mediated by adult income (β=-0.0014, p <.05) and diet quality (β=-0.0031, p <.05). Effects of the other early education indicators were non-significant (ps > 0.05).

CONCLUSIONS

Findings point to the potential significance of early student social competence as a link to long-term health, possibly via the acquisition of resources needed for the maintenance of health, as well as through engagement in health behaviors supporting healthy eating. However, more research is needed to replicate these findings and to elaborate on the role of early student social competence and the pathways explaining its effects on cardiometabolic health in adulthood.

Study on the causal relationship between educational attainment and delirium: A two-sample Mendelian randomization study

This study aimed to investigate whether there is a causal relationship between educational attainment and delirium at the genetic level using the Mendelian randomization method, and provide new evidence for studies in this field. We found a causal relationship between educational attainment and delirium at the genetic level after excluding confounders using Mendelian randomization. The inverse variance weighting method of random effects was the main analysis method. The weighted median and Mendelian Randomization-Egger methods, as well as simple, and weighted modes were used as supplementary analysis methods. Additionally, horizontal pleiotropy tests were conducted, including the Mendelian Randomization-Egger intercept test and Mendelian Randomization Pleiotropy RESidual Sum and Outlier. Cochran's Q statistic was used to assess the size of heterogeneity. We retrieved all second single nucleotide polymorphism features and performed multivariate Mendelian randomization to adjust for the effect of potential confounders on our results. The inverse variance weighting suggested a negative correlation between genetically predicted educational attainment and delirium (0.67[0.49-0.92], p = 0.013); Mendelian Randomization Pleiotropy RESidual Sum and Outlier (0.67[0.49-0.92], p = 0.013) and multivariate Mendelian randomization (0.52[0.33-0.82], p = 0.005) results were generally consistent with the inverse variance weighting method. The Mendelian Randomization-Egger, simple, and weighted mode results were consistent with the inverse variance weighting results. Our results were not affected by pleiotropy or heterogeneity (p > 0.05, for both pleiotropy and heterogeneity). In addition, the "leave-one-out" analysis showed that the results of our Mendelian randomization analysis were not influenced by individual single nucleotide polymorphisms. Studies have found a causal relationship between educational attainment and delirium at the genetic level; higher educational attainment may be a protective factor against delirium. Clinically, more attention should be paid to patients at a high risk of delirium with low educational attainment.

Interactive Relations of Body Mass Index, Cardiorespiratory Fitness, and Sex to Cognitive Function in Older Adults

OBJECTIVE

The course of cognitive aging is influenced by multiple health factors. This cross-sectional study investigated the interactive relations between body mass index (BMI), maximum oxygen consumption (VO2max), and sex on neuropsychological outcomes in community-dwelling predominantly older adults.

METHODS

Participants were 164 healthy adults [M (SD) = 64.6 (12.5) years, 56% men, 87% white] who participated in an investigation of cardiovascular risk factors and brain health. Multivariable regression analysis, adjusted for age, education, ethnicity, smoking, alcohol consumption, and depression, examined the interactive relations of BMI, VO2max, and sex to multiple neuropsychological outcomes.

RESULTS

Significant BMI*VO2max*sex interactions for Grooved Pegboard dominant (p = .019) and nondominant (p = .005) hands revealed that men with lower VO2max (l/min) displayed worse performance with each hand as BMI increased (p's < .02). A significant BMI*sex interaction for Logical Memory-Delayed Recall (p = .036) (after adjustment for blood glucose) showed that men, but not women, with higher BMI demonstrated worse performance (p = .036). Lastly, significant main effects indicated that lower VO2max was related to poorer logical memory, and higher BMI was associated with poorer Trail Making B and Stroop interference scores (p's < .05).

CONCLUSIONS

Among men, higher cardiorespiratory fitness may protect against the negative impact of greater BMI on manual dexterity and motor speed, making VO2max a target for intervention. Higher BMI is further associated with poorer executive function and verbal memory (in men), and lower VO2max is associated with poorer verbal memory.

The mediation effect of breastfeeding duration on the relationship between maternal preconception BMI and childhood nutritional risk

BACKGROUND

Higher maternal preconception body mass index (BMI) is associated with lower breastfeeding duration, which may contribute to the development of poor child eating behaviours and dietary intake patterns (components of nutritional risk). A higher maternal preconception BMI has been found to be associated with higher child nutritional risk. This study aimed to determine whether breastfeeding duration mediated the association between maternal preconception BMI and child nutritional risk.

METHODS

In this longitudinal cohort study, children ages 18 months to 5 years were recruited from The Applied Research Group for Kids (TARGet Kids!) in Canada. The primary outcome was child nutritional risk, using The NutriSTEP®, a validated, parent-reported questionnaire. Statistical mediation analysis was performed to assess whether total duration of any breastfeeding mediated the association between maternal preconception BMI and child nutritional risk.

RESULTS

This study included 4733 children with 8611 NutriSTEP® observations. The mean (SD) maternal preconception BMI was 23.6 (4.4) and the mean (SD) breastfeeding duration was 12.4 (8.0) months. Each 1-unit higher maternal preconception BMI was associated with a 0.081 unit higher nutritional risk (95% CI (0.051, 0.112); p < 0.001) (total effect), where 0.011(95% CI (0.006, 0.016); p < 0.001) of that total effect or 13.18% (95% CI: 7.13, 21.25) was mediated through breastfeeding duration.

CONCLUSION

Total breastfeeding duration showed to mediate part of the association between maternal preconception BMI and child nutritional risk. Interventions to support breastfeeding in those with higher maternal preconception BMI should be evaluated for their potential effect in reducing nutritional risk in young children.

Slim north, fat south: explaining regional differences in abnormal weights in Nigeria

Weight abnormalities (underweight, overweight, and obesity) can cause life-threatening ailments. This study investigates disparities in the prevalence of underweight, overweight, and obesity between northern and southern Nigeria and their associated factors. Using the 2018 Nigeria Demographic and Health Survey (NDHS), the study analysed a sample of 12,333 women with complete records of body mass index. The study found that southern women had lower odds of being underweight than women in the north, but the reverse was the case for overweight and obesity. The prevalence of underweight was 11.6%, and it varies from 6.9% in the southern state of Enugu to 31.6% in the northern state of Jigawa. The national prevalence of overweight was 17.9%, ranging from 6.7% in Jigawa State of the northern region to 39.9% in Lagos State of the south. Similarly, the prevalence of obesity in the north was 6.1% compared to 14.4% in the south, with Anambra State of the southern region recording the highest figure of 35.5% compared to 2.1% in the Yobe State of the northern region. In all, the rate of abnormal weight was significantly higher in the south than in the north. However, the type of weight abnormality varies between the two regions. Religion, education, use of contraceptives, and wealth were associated with the three forms of abnormal weights. However, while religion was significantly associated with obesity in the north, the association was not significant in the south. This study found that wealth and education have dissimilar influences on overnutrition. While the odds of being overweight and obese increase with wealth, being educated up to a secondary level significantly reduces the odds in Nigeria and across the two regions.

The Contribution of the Underlying Factors to Socioeconomic Inequalities in Obesity: A Life Course Perspective

Objectives: Socioeconomic disparities in obesity have been observed in both childhood and adulthood. However, it remains unclear how the role of risk factors influencing these inequalities has evolved over time. Methods: Longitudinal data on 2,866 children and adolescents (6-17 years old) from the China Health and Nutrition Survey were used to track their BMI during childhood, adolescence, and adulthood. Concentration Index was utilized to measure socioeconomic inequalities in obesity, while Oaxaca decomposition was employed to determine the share of different determinants of inequality. Results: The concentration index for obesity during childhood and adulthood were 0.107 (95% CI: 0.023, 0.211) and 0.279 (95% CI: 0.203, 0.355), respectively. Changes in baseline BMI (24.6%), parental BMI (10.4%) and socioeconomic factors (6.7%) were found to be largely responsible for the increasing inequality in obesity between childhood and adulthood. Additionally, mother's education (-7.4%) was found to contribute the most to reducing these inequalities. Conclusion: Inequalities in obesity during childhood and adulthood are significant and growing. Interventions targeting individuals with higher BMI, especially those who are wealthy, can significantly reduce the gap.

Early Weight Status and Human Capital in Adulthood: A 32-Year Follow-Up of the 1970 British Cohort Study

Objectives: To prospectively evaluate the effects of early weight status (childhood and adolescence) and changes in obesity status on human capital in adulthood. Methods: We employed data from the 1970 Birth Cohort Study in the United Kingdom. Data on height and weight during childhood and adolescence, human capital variables in adulthood were collected from 2,444 participants. Human capital includes cognitive ability, non-cognitive skill, educational attainment and health status. Data were analyzed through linear regression and logistic regression models. Results: Our results showed that obesity during adolescence was negatively associated with cognitive ability (β = -0.83, p < 0.01), educational attainment (β = -0.49, p < 0.01), and some health outcomes; and that underweight in childhood also adversely affected educational attainment in females (β = -0.66, p < 0.05). In terms of changes in obesity status, becoming obese in adolescence negatively affected cognitive ability (β = -1.18, p < 0.01), educational attainment (β = -0.62, p < 0.05) and some health outcomes, remaining obese was associated with all adverse health outcomes. Conclusion: Our results suggest that obesity during adolescence negatively affects a range of human capital outcomes in adulthood, and adolescence is a critical period during which early obesity affects adult human capital.

Higher Imported Food Patterns Are Associated with Obesity and Severe Obesity in Tuvalu: A Latent Class Analysis

Background

Tuvalu is a Pacific Island country within the small island developing states that has observed a significant and alarming increase in obesity rates over the past 40 years, affecting ∼60 %-70 % of the current population.

Objectives

This study aimed to investigate the association between food patterns and the proportion of obesity in a Pacific Island country.

Methods

The 2022 COMmunity-based Behavior and Attitude survey in Tuvalu (COMBAT) included 985 adults with complete data on sociodemographic information and the frequency of consumption of 25 common foods. A latent class analysis determined 4 food patterns. Bayesian multilevel logistic and linear regression models estimated the association between food patterns and the proportion of obesity [body mass index (BMI) ≥30 kg/m2], severe obesity (BMI ≥40 kg/m2), and weight (kg), adjusting for potential confounders and accounting for clustering by region.

Results

The latent class analysis revealed 4 food patterns with an entropy of 0.94 and an average posterior probability of class assignment for each individual of 0.97, described as follows: 1) local: locally produced foods with moderate food diversity (proportion of individuals = 28 %); 2) diverse-local: local with greater food diversity (17 %); 3) restricted-imported: more imported with restricted diversity (29 %); and 4) imported: heavily imported with high diversity (26 %). Compared to those following the diverse-local pattern, the odds of having obesity were greater for those classified with the imported pattern [odds ratio (OR): 2.52; 95 % credible interval (CrI): 1.59, 3.99], restricted-imported pattern (OR: 1.89; 95 % CrI: 1.59, 3.99), and local pattern (OR: 1.54; 95 % CrI: 0.94, 2.50). Similar trends were observed for severe obesity while body weight was positively associated with both restricted-imported and imported food patterns.

Conclusions

The high consumption of imported foods, together with the low consumption of plant-based foods and protein-rich foods, could be a relevant modifiable lifestyle factor explaining the high levels of obesity and severe obesity in Tuvalu, a Pacific Island country.

Plasma Concentration of 36 (Poly)phenols and Prospective Body Weight Change in Participants from the EPIC Cohort

INTRODUCTION

Dietary intake of (poly)phenols has been linked to reduced adiposity and body weight (BW) in several epidemiological studies. However, epidemiological evidence on (poly)phenol biomarkers, particularly plasma concentrations, is scarce. We aimed to investigate the associations between plasma (poly)phenols and prospective BW change in participants from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

METHODS

This study included 761 participants with data on BW at baseline and after 5 years of follow-up. Plasma concentrations of 36 (poly)phenols were measured at baseline using liquid chromatography-tandem mass spectrometry. Associations were assessed through general linear mixed models and multinomial logistic regression models, using change in BW as a continuous or as a categorical variable (BW loss, maintenance, gain), respectively. Plasma (poly)phenols were assessed as log2-transformed continuous variables. The false discovery rate (FDR) was used to control for multiple comparisons.

RESULTS

Doubling plasma (poly)phenol concentrations showed a borderline trend towards a positive association with BW loss. Plasma vanillic acid showed the strongest association (-0.53 kg/5 years; 95% confidence interval [CI]: -0.99, -0.07). Similar results were observed for plasma naringenin comparing BW loss versus BW maintenance (odds ratio: 1.1; 95% CI: 1.0, 1.2). These results did not remain significant after FDR correction.

CONCLUSION

Higher concentrations of plasma (poly)phenols suggested a tendency towards 5-year BW maintenance or loss. While certain associations seemed promising, they did not withstand FDR correction, indicating the need for caution in interpreting these results. Further studies using (poly)phenol biomarkers are needed to confirm these suggestive protective trends.

An overlooked relationship in recovery from substance use disorders: Associations between body mass index and negative emotional states

Recovery from substance use disorders (SUD) is multifactorial. Being overweight could negatively impact physiological and psychological health-related parameters. Using model selection, we examined associations between body mass index (BMI) and negative emotional states (NES; e.g., stress, anxiety, depression) in 54 men with SUD and under treatment in five different therapeutic recovery centers. We found that BMI was positively associated with stress (p < .001), anxiety (p < .001), and depression (p = .002). Therefore, our findings suggest that decreasing the accumulation of body fat might contribute to improving mental health in individuals with SUD during recovery.

Environmental factors of obesity before and after COVID-19 pandemic: a review

In past decades the prevalence of overweight and obesity had grown rapidly. There are numerous factors contributing to this unfavorable change in people's health. This review article investigates the environmental factors which may play a role in the prevalence of overweight and obesity and additionally the novel factors which appeared after the beginning of the COVID-19 pandemic, which caused the increase in BMI during the lockdown period. Most of the studies reveal that the COVID-19 pandemic and lockdown contributed to the growth of BMI in numerous countries and, eventually the prevalence of overweight and obesity increased. Studies suggest that the physical activity was decreased while sleep time and screen time were increased and the amount of food consumed increased, additionally more processed food with long shelf life was consumed. The diverse environmental factors may have an impact on obesity and overweight development taking into account policy and local school policy issues, socioeconomic status, lifestyle including physical activity, diet habits, and amongst others, more trivial causes such as uninteresting neighborhoods, lack of sense of security outside the place of residence or a long distance from shops. Still, this is the object of debate if air pollution is an environmental risk factor influencing the unfavorable trends towards increasing body weight.

The relationship between overweight and education revisited: a test of the selection hypothesis based on adolescents' educational aspirations

OBJECTIVES

This paper examines the selection mechanism underlying the association between overweight/obesity and educational aspirations of adolescents.

STUDY DESIGN

This is a cross-sectional study based on a survey conducted in secondary schools in Spain in 2016.

METHODS

We estimate linear probability models to determine the association between adolescents' body mass index (BMI) and their expectations to obtain a university degree, as well as their school choices representing the most usual path towards higher studies. To address the potential endogeneity of BMI, we use the instrumental variables (IV) method. Additionally, we account for potential unobserved heterogeneity by including school fixed-effects and a wide set of individual and family characteristics in our analysis.

RESULTS

Our results indicate that adolescents with a higher BMI have lower expectations to obtain a university degree and are less likely to enrol in high school with the intention to pursue higher education in the future. The estimated effect is quite sizable and statistically significant only for girls. We estimate that a five-unit increase in BMI (e.g., the change between healthy weight and overweight) reduces girls' expectations to complete higher education by 19 percentage points and odds of enrolling in high school (vs. vocational training) by 21 percentage points.

CONCLUSIONS

We provide empirical evidence supporting the selection hypothesis behind the relationship between BMI and adolescents' educational aspirations. That is, unhealthy weight in adolescence is associated with poorer aspirations for further education. Lower educational aspirations during adolescence can lead to lower academic achievement, which in turn, may result in poorer health, labour market outcomes, and well-being during adulthood.

Sex and Race Differences in Obesity-Related Genetic Susceptibility and Risk of Cardiometabolic Disease in Older US Adults

Importance

The fat mass and obesity-associated gene (FTO) is associated with obesity phenotypes, but the association is inconsistent across populations. Within-population differences may explain some of the variability observed.

Objective

To investigate sex differences in the association between FTO single-nucleotide variants (SNVs) and obesity traits among self-identified non-Hispanic Black and non-Hispanic White US adults, to examine whether the SNVs were associated with cardiometabolic diseases, and to evaluate whether obesity mediated the association between FTO SNVs and cardiometabolic diseases.

Design, Setting, and Participants

This cross-sectional study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a US population-based cohort study with available genetic data (assayed in 2018) and phenotypic data at baseline (enrolled 2003-2007). Participants were aged 45 to 98 years at baseline. Data were analyzed from October 2021 to October 2022.

Exposures

Eleven SNVs in the FTO gene present among both Black and White participants.

Main Outcomes and Measures

Objectively measured obesity indicators (body mass index and waist-to-height ratio), objectively measured and/or self-reported cardiometabolic diseases (hypertension, stroke history, heart disease, and diabetes), and self-reported social-economic and psychosocial status.

Results

A total of 10 447 participants (mean [SD] age, 64.4 [9.7] years; 5276 [55.8%] women; 8743 [83.7%] Black and 1704 [16.3%] White) were included. In the White group, 11 FTO SNVs were significantly associated with obesity, hypertension, and diabetes using linear models (eg, body mass index: β = 0.536; 95% CI, 0.197-0.875), but none of the FTO SNVs were associated with obesity traits in the Black group. White males had a higher risk of obesity while White females had a higher risk of hypertension and diabetes. However, 1 FTO SNV (rs1121980) was associated with a direct increase in the risk of heart disease in Black participants not mediated by obesity (c' = 0.145 [SE, 0.0517]; P = .01).

Conclusions and Relevance

In this cross-sectional study of obesity phenotypes and their association with cardiometabolic diseases, the tested FTO SNVs reflected sex differences in White participants. Different patterns of associations were observed among self-identified Black participants. Therefore, these results could inform future work discovering risk alleles or risk scores unique to Black individuals or further investigating genetic risk in all US residents.

The Double Burden of Obesity and Underweight in Yemeni Adults

INTRODUCTION

 Yemen has a unique low-income population with several sociopolitical challenges and the association between weight disorders and sociodemographic and lifestyle factors is not clearly understood.

AIM

 The aim of this study is to estimate the prevalence of obesity, overweight and underweight among Yemeni adults, and to identify their associated factors.

METHODS

A cross-sectional study was conducted from 11 January to 25 March 2020, including 561 subjects of Yemen's adult population aged 18 and above, from four Yemeni governorates, who answered a questionnaire including demographic, socio-economic, and physical activity items after getting their signed consent. Height and weight were measured, and body mass index (BMI) was computed. The association between obesity or overweight (BMI ≥ 25.0kg/m2) or underweight (BMI < 18.5 kg/m2) and the other variables was analyzed using multinomial logistic regression.

RESULTS

A total of 561 subjects aged ≥ 18 years have participated in this survey. The overall prevalence of obesity and overweight was 10.3%, 95% CI [7.7%; 12.8%] and 20.3%, 95% CI [17%; 23.5%] respectively, while the one for underweight was 21.2%, 95% CI [17.8%; 24.5%]. The risk of overweight-obesity increased with age (OR=1.02, 95% CI (1.01-1.03)), living in urban areas (OR= 1.680, 95% CI (1.105-2.552)) and average-high socioeconomic status (SES) (OR= 1.729, 95% CI (1.156-2.587)) while the risk of underweight decreased with the age (OR= 0.981, 95% CI (0.964-0.998)).

CONCLUSION

These findings provide a special case of high prevalence of obesity, overweight, and underweight in Yemen. Therefore, implementing awareness and prevention programs is highly recommended there.

Distilling causality between physical activity traits and obesity via Mendelian randomization

BACKGROUND

Whether obesity is a cause or consequence of low physical activity levels and more sedentary time has not yet been fully elucidated. Better instrumental variables and a more thorough consideration of potential confounding variables that may influence the causal inference between physical activity and obesity are needed.

METHODS

Leveraging results from our recent genome-wide association study for leisure time moderate-to-vigorous intensity (MV) physical activity and screen time, we here disentangle the causal relationships between physical activity, sedentary behavior, education-defined by years of schooling-and body mass index (BMI), using multiple univariable and multivariable Mendelian Randomization (MR) approaches.

RESULTS

Univariable MR analyses suggest bidirectional causal effects of physical activity and sedentary behavior with BMI. However, multivariable MR analyses that take years of schooling into account suggest that more MV physical activity causes a lower BMI, and a higher BMI causes more screen time, but not vice versa. In addition, more years of schooling causes higher levels of MV physical activity, less screen time, and lower BMI.

CONCLUSIONS

In conclusion, our results highlight the beneficial effect of education on improved health and suggest that a more physically active lifestyle leads to lower BMI, while sedentary behavior is a consequence of higher BMI.

Gender-specific determinants of overweight and obesity among older adults in India: evidence from a cross-sectional survey, 2017-18

BACKGROUND

A major societal trend of the twenty-first century is the rapidly ageing population as a consequence of the decline in fertility and increase in life expectancy. Along with the rise in ageing population, the burden of obesity and related non-communicable diseases is also equally rising. In this study, we aimed to investigate the potential gender-specific determinants of overweight and obesity among older adults in India.

SUBJECTS AND METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate chi-square test, and logistic regression estimation were applied to accomplish the study objectives. Body mass index (BMI) has been classified in this study according to the WHO criteria.

RESULTS

The prevalence of overweight was higher among women (18.15% in rural areas and 46.62% in urban areas) compared to men (12.9% in rural areas and 30.61% in urban areas). Similarly, obesity was higher among women than men who were residing in urban areas (17.07% vs. 5.37%), had secondary or above education (32.38% vs. 6.1%) belonged to richest strata (16.37% vs. 4.50%), or had mobility impairment (9.2% vs. 2.8%). Despite adjustment for several confounders, women were more likely to be overweight (OR: 2.18; CI: 1.86, 2.55) and obese (OR: 3.79; CI: 2.86, 5.03) than men. However, among both the elderly men and women, those who were highly educated were 2.29 times (OR: 2.29; CI: 1.80, 4.11) and 2.71 times (OR: 2.71; CI: 1.78, 4.11), respectively more likely to be overweight than their illiterate counterparts. Older adults living in urban areas were more likely to suffer from obesity compared to rural men (OR: 1.47; CI: 1.07, 2.02) and women (OR: 2.58; CI: 1.85, 3.60). Both men and women, who were highly educated were 2.64 times (OR: 2.64; CI: 1.71, 4.09) and 2.94 times (OR: 2.94; CI: 1.40, 6.20), respectively, more likely to be obese than their illiterate counterparts. Older men and women who were richest (OR: 1.60; CI: 1.19, 2.14 & OR: 2.12; CI: 1.63,2.76), or had mobility impairment (OR: 1.33; CI: 1.09,1.61 & OR: 1.72; CI: 1.42,2.08) were more likely to be overweight than their counterparts who were poorest or did not have any mobility limitation, respectively.

CONCLUSIONS

This study found increased vulnerability of overweight and obesity among older women than men irrespective of their socioeconomic, demographic, and health status. The present study suggests that introducing preventative measures such as campaigns to encourage physical activity, and community awareness may help reduce the high burden of overweight and obesity. Finally, the findings are important for better functioning of any public health programme and suitable intervention techniques to maintain a healthy body in order to lower the prevalence and risk factors of non-communicable diseases in later life.

Pathways from childhood socioemotional characteristics and cognitive skills to midlife health behaviours

OBJECTIVE

This longitudinal study investigated the pathways from childhood socioemotional characteristics and cognitive skills to health behaviours in midlife. Methods: Participants in the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS) were followed from age 8 (n = 369) to age 50 (n = 271). Outcomes included physical activity, smoking, alcohol consumption and body mass index (BMI) assessed at ages 36, 42 and 50. Predictors were socioemotional characteristics (behavioural activity, negative emotionality, and well-controlled behaviour) and parents' occupational status collected at age 8, cognitive skills (school success at age 14 and the highest education at age 27) and adulthood personality traits (extraversion, neuroticism and conscientiousness). Longitudinal path modelling was used for analyses. Results: Well-controlled behaviour and extraversion predicted physical activity in women. Behavioural activity predicted alcohol consumption in women and smoking in men. Negative emotionality was not directly connected to health behaviours. Adulthood neuroticism was associated with smoking in men and with alcohol-related problems in both men and women. There were some indirect paths from childhood socioemotional characteristics to midlife health behaviours through cognitive skills. None of the study variables predicted midlife BMI. Conclusions: Childhood socioemotional characteristics have some predictive value on midlife health behaviours, both directly and through cognitive skills.

Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2022.2041639 .

Life-course social disparities in body mass index trajectories across adulthood: cohort study evidence from China health and nutrition survey

BACKGROUND

The social disparities in obesity may originate in early life or in adulthood, and the associations of socioeconomic position (SEP) with obesity could alter over time. It is unclear how lifetime-specific and life-course SEP influence adult obesity development in China.

METHODS

Based on the China Health and Nutrition Survey (CHNS), three SEP-related indicators, including the father's occupational position and the participant's education and occupational position, were obtained. The life-course socioeconomic changes and a cumulative SEP score were established to represent the life-course SEP of the participants in the study. The growth mixture modeling was used to identify BMI trajectories in adulthood. Multinomial logistic regression was adopted to assess the associations between SEP and adult BMI trajectories.

RESULTS

A total of 3,138 participants were included in the study. A positive correlation was found between the paternal occupational position, the participants' occupational position, education, and obesity in males, whereas an inverse correlation was observed among females. Males who experienced social upward mobility or remained stable high SEP during the follow-up had 2.31 and 2.52-fold risks of progressive obesity compared to those with a stable-low SEP. Among females, stable high SEP in both childhood and adulthood was associated with lower risks of progressive obesity (OR = 0.63, 95% CI: 0.43-0.94). Higher risks of obesity were associated with the life-course cumulative SEP score among males, while the opposite relationship was observed among females.

CONCLUSIONS

The associations between life-course SEP and BMI development trajectories differed significantly by gender. Special emphasis should be placed on males experiencing upward and stable high socioeconomic change.

Socio-demographic and behavioral correlates of excess weight and its health consequences among older adults in India: Evidence from a cross-sectional study, 2017-18

BACKGROUND

Rapid population aging is expected to become one of the major demographic transitions in the twenty-first century due to the continued decline in fertility and rise in life expectancy. Such a rise in the aged population is associated with increasing non-communicable diseases. India has suffered from obesity epidemic, with morbid obesity affecting 5% of the population and continuing an upward trend in other developing countries. This study estimates the prevalence of excess weight among older adults in India, and examines the socio-demographic and behavioral factors and its health consequences.

METHODS

The study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate Chi-Square test, and logistic regression models were applied to accomplish the study objectives. Body mass index (BMI) has been computed for the study according to the classification of the World Health Organization, and "excess weight" refers to a score of BMI ≥ 25.0 kg/m2.

RESULTS

Overall, 23% of older adults (≥ 60 years) were estimated with excess weight in India, which was higher among women irrespective of socioeconomic and health conditions. The higher levels of excess weight (than the national average of ≥22.7%) were observed among older adults in states like Haryana, Tamil Nadu, Telangana, Maharashtra, Gujarat, Manipur, Goa, Kerala, Karnataka, Himachal Pradesh, Punjab, Sikkim and some other states. After adjusting for selected covariates, the odds of excess weight were higher among females than males [OR: 2.21, 95% CI: 1.89, 2.60]. Similarly, the likelihood of excess weight was 2.18 times higher among older adults who were living in urban areas compared to their rural counterparts [OR: 2.18; 95% CI: 1.90, 2.49]. Higher level of education is significantly positively correlated with excess weight. Similarly, higher household wealth index was significantly positively correlated with excess weight [OR: 1.98, CI: 1.62, 2.41]. Having hypertension, diabetes and heart diseases were associated with excess weight among older adults. Regional variations were also observed in the prevalence of excess weight among older adults.

CONCLUSION

The findings suggest that introducing measures that help to reduce the risk of non-communicable diseases, and campaigns to encourage physical activity, and community awareness may help reduce the high burden of excess weight and obesity among older Indians. The findings are important for identifying the at-risk sub-populations and for the better functioning of any public health programme and suitable intervention techniques to lower the prevalence and risk factors for excess weight in later life.

Factors associated with the combination of general and abdominal obesity in middle-aged and older Korean women: a cross-sectional study

BACKGROUND

To identify factors associated with general and abdominal obesity in middle-aged and older Korean women based on the biopsychosocial model.

METHODS

Data from 4,076 women aged ≥45 years who participated in the Korea National Health and Nutrition Examination Survey from 2015 to 2020 were analyzed. Complex sampling analysis was performed using IBM SPSS ver. 26.0.

RESULTS

The combination of general and abdominal obesity was positively associated with age ≥65 years, postmenopausal status, and without breastfeeding experience among biomedical factors; depressive symptoms and prolonged (≥8 hours a day) sedentary behavior among psychosocial factors; and an educational level lower than middle or high school graduation and the first and second income quantiles among biosocial factors.

CONCLUSION

Healthcare providers in communities and public societies should screen for risk factors for the combination of general and abdominal obesity while considering non-modifiable biomedical (e.g., age) and biosocial factors (e.g., educational level). In addition, intervention strategies should be developed by considering modifiable psychosocial factors such as sedentary behavior.

Measuring the Indirect Cost of Illness Using EQ-5D-5L While Accounting for Job Characteristics

BACKGROUND

The EQ-5D-5L questionnaire is used to measure treatment effects on the quality of life. For cost-utility analyses, EQ-5D-5L profiles are assigned numbers representing societal preferences (index weights). On the cost side, the indirect costs are frequently included: the value of product lost due to illness-related absences (absenteeism) or diminished productivity (presenteeism). The possibility to use EQ-5D data to estimate absenteeism and presenteeism (A&P) would be useful, if real-world data on A&P are lacking. However, beyond-health factors may also matter for A&P.

OBJECTIVE

We aimed to assess how A&P depend on the EQ-5D-5L profile, while accounting for job characteristics (e.g. remote or in-office).

METHODS

We surveyed 756 employed Poles. Respondents reported their job characteristics and evaluated the impact of eight hypothetical EQ-5D-5L profiles on A&P (two blocks of states used). Econometric modelling was used to establish the determinants of A&P.

RESULTS

Both A&P increase with health problems as indicated across EQ-5D-5L dimensions (especially mobility and self-care), and this impact differs from the impact on index weight (e.g. pain/discomfort barely impact the A&P). The job characteristics mattered: absenteeism decreases in sedentary occupations and increases in those occupations performed remotely or requiring cooperation, while presenteeism increases in jobs performed remotely and decreases for those requiring creative thinking.

CONCLUSIONS

The entire EQ-5D-5L profile, not just index weights, should be used to estimate A&P. That job characteristics matter may be relevant in applications, as some diseases concentrate in specific subgroups.

Rural-urban disparities in nutritional status among women in Ethiopia based on HIV serostatus: a cross-sectional study using demographic and health survey data

BACKGROUND

Ethiopia is one of the sub-Saharan African countries most affected by the human immunodeficiency virus (HIV) epidemic and also by severe undernutrition, which is particularly prevalent among women. HIV infection, reproductive biology, and their role in society increase the vulnerability of women to malnutrition. Various factors including urbanization could cause differences in the nutritional status of rural and urban residents. In this study, we aimed to assess rural-urban disparities in nutritional status among women of reproductive age based on HIV serostatus in Ethiopia.

METHOD

Data from the Ethiopian Demographic and Health Survey (EDHS) conducted in 2016 were used. Among 15,683 women included in the survey, 8822 non-pregnant women aged 15-49 years, including those who gave birth two months before the DHS survey were included in this study. Multinomial logistic regression was used to determine the relative risk ratios (RRR) for the associations between study variables.

RESULTS

Generally, the prevalence of underweight among women of reproductive age was higher in rural residents (28.9%) than in urban residents (12.3%) in Ethiopia. Being overweight was more prevalent among urban women than rural women, (35.1% vs. 4.8%). About 32% of HIV-positive women were underweight in both rural and urban areas. About 29% of HIV-positive urban women were overweight compared to 3.4% of HIV-positive rural women. Among urban residents, HIV-positive women were about 4 times more likely to be underweight than their HIV-negative counterparts, RRR 3.8 (95% CI: 1.58, 9.26). However, there was no significant difference in nutritional status between HIV-positive and HIV-negative women living in rural areas. Anemic women were more likely to be underweight while, wealthy women were less likely to be underweight in both rural and urban areas. Women aged 25-49 years were generally more likely to be overweight/obese and less likely to be underweight compared to younger women aged [Formula: see text]years.

CONCLUSION

Malnutrition was more prevalent among HIV-positive women living in urban Ethiopia. Targeted nutritional interventions for HIV-positive women of reproductive age living in urban areas could be considered. Furthermore, efforts should be made to improve the nutritional status of women of reproductive age across the country.

Overweight and obesity in adulthood, sociodemographic factors, lifestyle, and the early burden of noncommunicable diseases among Americans: NHANES 2007-2018

OBJECTIVES

To evaluate the association between nutritional status in early adulthood and the burden of noncommunicable diseases (NCDs); To evaluate the influence of sociodemographic factors and lifestyle on the outcomes of BMI kg/m2  ≤24.9, ≥25.0, and ≥30.0; to estimate the population attributable fraction (PAF) to BMI elevated at 25 years old in the burden of NCDs in American adults.

METHODS

We used data from 15 721 American adults participating in the National Health and Nutrition Examination Survey from 2007 to 2018. The Hazard Ratio (HR), Incidence Rate Ratio (IRR), and 95% confidence intervals (CI) were estimated in the proportional risk regression models of Cox (entire population) and Poisson (restricted to non-patients), respectively. The proportionality of the risk between the burden of NCDs and BMI at 25 years old was drawn by the Kaplan-Meier curve, and the PAF was calculated. All analyses were adjusted taking into account the sample weights.

RESULTS

Health disparities (sex, age, race/ethnicity, education, poverty index, and education level), and lifestyle (physical activity, smoking, and alcohol consumption) influenced the current nutritional status. Cumulative survival in overweight and obese groups decreased considerably over time (p < .0001). Being overweight and obese in adulthood may increase the risk of early NCDs (HR: 1.68, 95% CI: 1.54-1.84 and HR: 2.87, 95% CI: 2.56-3.21, respectively). About 22.72% (95% CI: 19.99-25.36, p < .001) of the burden NCDs could have been avoided if overweight at age 25 had been prevented.

CONCLUSIONS

Monitoring weight change from young adulthood can provide a sensitive and useful clinical measure for early detection of adverse trends in NCDs risk.

The level of education is associated with an anxiety-depressive state among men and women - findings from France during the first quarter of the COVID-19 pandemic

CONTEXT

It is widely recognised that the COVID-19 pandemic has negatively impacted individuals' mental health. However, little emphasis has been put on the possible influence of socio-economic factors in the relationship. In the context of the COVID-19 pandemic, our objectives were (i) to assess the relationship between education level and mental health in French adults, and (ii) to study the influence of the economic, social, health and the COVID-19-related factors in men and women respectively.

METHOD

Data are from 32,581 individuals representative of the French population who responded to the weekly survey "Baromètre COVID-19" between April 7^th and May 31^st 2020. Education level was self-reported (university degree, high school qualification, vocational certificate/qualification, no diploma). Anxiety-depressive state was derived from four items related to the frequency of occurrence of depressive and anxiety symptoms, and summarized in an overall validated anxiety-depressive score. Multivariate linear regression analyses were carried out with nested adjustments of variables related to economic, social, health and COVID-19 contexts to assess the relationship between education and anxiety-depressive state.

RESULTS

In total, 45% of individuals reported symptoms of anxiety-depressive state (53% in women versus 36% in men). Among men, those with a vocational certificate/qualification and those with no diploma had a greater risk of having a higher anxiety-depressive state compared to those with a university degree (β_{Vocational certificate/qualification} = 0.16 [0.04; 0.27]; β_{No diploma} = 0.75 [0.43; 1.07]) while among women, the risk of anxiety-depressive state increased as education level decreased (β_{Baccalaureate} = 0.37 [0.25; 0.49]; β_{Vocational certificate/qualification} = 0.41 [0.28; 0.54]; β_{No diploma} = 0.8 [0.49; 1.12]). For both men and women, economic, health, and COVID-19 factors partly attenuate these associations while social factors marginally modified the relationship. After accounting for confounders and intermediate variables, the absence of a diploma remained associated with anxiety-depressive state among men, while the whole educational gradient of anxiety-depressive state persisted among women.

CONCLUSION

In France, at the end of the first wave of COVID-19, individuals with a lower level of education had a higher risk of anxiety-depressive state. This association was more pronounced for women, highlighting a process of social inequality in health possibly related to gender. This should be considered in future prevention and public health interventions.

Prevalence of uncontrolled hypertension and its associated factors in 50-74 years old Iranian adults: a population-based study

BACKGROUND

By the lengthening of life span, the incidence of chronic diseases such as hypertension and uncontrolled hypertension has increased. This study aims to determine the prevalence of uncontrolled hypertension and its related factors in the age group of 50-74 years in Shahroud, northeast Iran.

METHODS

The data of the third phase of the Shahroud Eye Cohort Study were used in this study. This phase of the cohort study included 4394 participants aged 50 to 74 years from the previous phases. In addition to ophthalmological and optometric examinations, demographic characteristics, blood biochemistry tests, and blood pressure measurements were performed in this phase. Individuals with a blood pressure ≥ 140/90 mm/Hg (being treated or not treated with antihypertensive medicines) were defined as uncontrolled hypertension. In patients with diabetes and chronic kidney disease, blood pressure equal to or higher than 130/80 mm/Hg was considered uncontrolled hypertension. Descriptive statistics and multiple logistic regression were used to analyze the data.

FINDINGS

Overall, the prevalence of uncontrolled hypertension out of all the participants was 61.7% (95% CI: 60.3-63.2). Multiple regression results showed that the male gender (OR: 2.1, 95% CI: 1.5-2.9), patients with diabetes (OR:3.2, 95% CI: 2.4-4.3), and patients with chronic kidney disease (CKD) (OR: 3.2, 95% CI: 2.5-4.1) increased the risk of uncontrolled hypertension while in patients with cardiovascular disease (OR: 0.6, 95% CI: 0.4-0.8) and polypharmacy (OR: 0.2, 95% CI: 0.1-0.2) reduced the risk of uncontrolled hypertension.

CONCLUSION

The present study showed that uncontrolled hypertension has a high prevalence, and factors such as male gender, diabetes, and CKD are associated with this disorder. So, it is recommended to take the necessary measures to formulate and implement immediate actions to prevent or control hypertension.

Lifestyle factors, metabolic factors and socioeconomic status for pelvic organ prolapse: a Mendelian randomization study

BACKGROUND

Previous observational studies have reported that lifestyle factors, metabolic factors and socioeconomic status are associated with the development of female pelvic organ prolapse (POP); however, whether these associations are causal remains unclear. The current study aimed to assess the causal effect of lifestyle factors, metabolic factors and socioeconomic status on POP risk.

METHODS

We conducted a two-sample Mendelian randomization (MR) study based on summary-level data from the largest available genome-wide association studies (GWAS) to evaluate whether lifestyle factors, metabolic factors and socioeconomic status are causally related to POP. We used single nucleotide polymorphisms that are strongly associated with exposure at the genome-wide significance level (P < 5 × 10-8) as instrumental variables from genome-wide association studies. The method of random-effect inverse-variance weighting (IVW) was used as the primary analysis method, supplemented with the weighted median, MR-Egger and the MR pleiotropy residual sum and outlier applied to verify the MR assumptions. Two-step MR was conducted to investigate potential intermediate factors that are on the causal pathway from exposure to POP.

RESULTS

There were associations with POP for genetically predicted waist-to-hip ratio (WHR) (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.03 per SD-increase, P < 0.001), WHR adjusted for body mass index (WHRadjBMI) (OR 1.017, 95% CI 1.01-1.025 per SD-increase, P < 0.001) and education attainment (OR 0.986, 95% CI 0.98-0.991 per SD-increase) in the meta-analysis. Additionally, genetically predicted coffee consumption (OR per 50% increase 0.67, 95% CI 0.47-0.96, P = 0.03), vigorous physical activity (OR 0.83, 95% CI 0.69-0.98, P = 0.043) and high-density lipoprotein cholesterol (HDL-C) (OR 0.91, 95% CI 0.84-0.98 per SD-increase, P = 0.049) were inversely associated with POP in the FinnGen Consortium. The mediation analysis showed that the indirect effects of education attainment on POP were partly mediated by WHR and WHRadjBMI, with a mediated proportion of 27% and 13% in the UK Biobank study, respectively.

CONCLUSIONS

Our study provides MR evidence of a robust causal association of WHR, WHRadjBMI and education attainment with POP.

Social determinants of health among family caregiver centered outcomes in lung cancer: a systematic review

Background

Lung cancer is the leading cause of cancer death globally. Both lung cancer patients and family caregivers (FCGs) have unmet quality of life (QOL) needs. An understudied topic in lung cancer research is the role of social determinants of health (SDOH) on QOL outcomes for this population. The purpose of this review was to explore the state of research on SDOH FCGs centered outcomes in lung cancer.

Methods

The databases PubMed/MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association (APA) PsycInfo were searched for peer-reviewed manuscripts evaluating defined SDOH domains on FCGs published within the last ten years. The information extracted using Covidence included patients, FCGs and study characteristics. Level of evidence and quality of articles were assessed using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale.

Results

Of the 344 full-text articles assessed, 19 were included in this review. The social and community context domain focused on caregiving stressors and interventions to reduce its effects. The health care access and quality domain showed barriers and underuse of psychosocial resources. The economic stability domain indicated marked economic burdens for FCGs. Four interconnected themes emerged among articles on the influence of SDOH on FCG-centered outcomes in lung cancer: (I) psychological well-being, (II) overall quality of life, (III) relationship quality, and (IV) economic hardship. Notably, most participants in the studies were White females. The tools used to measure SDOH factors included primarily demographic variables.

Conclusions

Current studies provide evidence on the role of SDOH factors on lung cancer FCGs' QOL. Expanded utilization of validated SDOH measures in future studies would provide greater consistency in data, that could in turn inform interventions to improve QOL. Further research focusing on the domains of education quality and access and neighborhood and built environment should be carried out to bridge gaps in knowledge.

Body Mass Index Trends among a Cohort of Subjects Enrolled in Medication-Assisted Treatment Programmes for Opioid Use Disorder: Racial/Ethnic, Gender, and Age Differences

Introduction

Opioid use disorder (OUD) and obesity are two pressing public health concerns in the United States (US). However, the relationship between these two epidemics has not been well-studied. Our study aims to describe the prevalence rates of obesity in individuals with OUD from a cohort study and compare that to the expected prevalence that would be observed based upon New Jersey state and US population survey data. Additionally, we sought to study whether Body Mass Index (BMI) distribution in this cohort varied by race/ethnicity, gender, and age.

Methods

Our subjects (N=151) are part of a drug user cohort study of persons enrolled in medication-assisted treatment (MAT) programmes in New Jersey. Using the New Jersey Behavioral Risk Factor Survey (NJBRFS) and the National Health Interview Survey (NHIS), we generated expected BMI distributions based on race/ethnicity, age, and sex. Expected rates were compared to observed BMI. Standardized prevalence ratios were calculated, and 95% confidence intervals were constructed.

Results

Among females, obesity was more prevalent in those with OUD than in the general US population. Among persons ≤50 years old, overweight and obesity were more prevalent in those with OUD than in NJBRFS. Persons who did not inject drugs were more likely to be overweight. The prevalence of underweight was significantly higher among Black non-Hispanic minorities, males, older subjects (aged 66-85), and persons who inject drugs.

Conclusion

In our study, the trends in BMI vary based on race/ethnicity, gender and age in these patients with OUD. These varying trends highlight the need for tailored screening and prevention strategies. Primary care providers should be aware that their patients with OUD have multiple health problems that need to be addressed beyond their OUD condition itself. Providers are in a pivotal role to screen and implement interventions to improve their health outcomes.

Socio-Demographic, Behavioral and Psychological Factors Associated with High BMI among Adults in a Southeast Asian Multi-Ethnic Society: A Structural Equation Model

While various influencing factors of overweight and obesity have been identified, the underlying mechanism remains unclear. We examined the relationships among sociodemographic, behavioral, and psychological factors on anthropometry in a multi-ethnic population with overweight and obesity. Participants (N = 251) were recruited from January to October 2022. Mean age and self-reported BMI were 31.7 ± 10.1 years and 29.2 ± 7.2 kg/m². Participants were mostly female (52.4%) and overweight (58.2%). Multivariate multiple regression was performed using maximum likelihood estimation. Body mass index was associated with waist circumference, age, sex, race, marital status, education level, residential region, overeating habit, immediate thinking, self-regulation, and physical activity, but not anxiety, depression, or the intention to change eating habits. Final model indicated good fit: χ² (30, N = 250) = 33.5, p = 0.32, CFI = 0.993, TLI = 0.988, RMSEA = 0.022, and SRMR = 0.041. Direct effects were found between BMI and overeating (β = 0.10, p = 0.004), race (β = -0.82, p < 0.001), marital status (β = -0.42, p = 0.001), and education level (β = -0.28, p = 0.019). Crisps (68.8%), cake (66.8%) and chocolate (65.6%) were identified as the most tempting foods. Immediate thinking indirectly increased overeating habits through poor self-regulation, although sociodemographic characteristics better predicted anthropometry than psycho-behavioral constructs.

Bayesian spatial modeling of childhood overweight and obesity prevalence in Costa Rica

BACKGROUND

Childhood overweight and obesity levels are rising and becoming a concern globally. In Costa Rica, the prevalence of these conditions has reached alarming values. Spatial analyses can identify risk factors and geographical patterns to develop tailored and effective public health actions in this context.

METHODS

A Bayesian spatial mixed model was built to understand the geographic patterns of childhood overweight and obesity prevalence in Costa Rica and their association with some socioeconomic factors. Data was obtained from the 2016 Weight and Size Census (6 - 12 years old children) and 2011 National Census.

RESULTS

Average years of schooling increase the levels of overweight and obesity until reaching an approximate value of 8 years, then they start to decrease. Moreover, for every 10-point increment in the percentage of homes with difficulties to cover their basic needs and in the percentage of population under 14 years old, there is a decrease of 7.7 and 14.0 points, respectively, in the odds of obesity. Spatial patterns show higher values of prevalence in the center area of the country, touristic destinations, head of province districts and in the borders with Panama.

CONCLUSIONS

Especially for childhood obesity, the average years of schooling is a non-linear factor, describing a U-inverted curve. Lower percentages of households in poverty and population under 14 years old are slightly associated with higher levels of obesity. Districts with high commercial and touristic activity present higher prevalence risk.

Obesity as a Main Threat to Future Improvements in Population Health: Policy Opportunities and Challenges

Policy Points Obesity has emerged as a main threat to future improvements in population health, and there is little evidence that the epidemic is retreating. The traditional model of "calories in, calories out," which has guided public health policy for decades, is increasingly viewed as far too simple a framing to explain the evolution of the epidemic or guide public policy. Advances in the science of obesity, coming from many fields, highlight the structural nature of the risk, which has provided an evidence base to justify and guide policies toward addressing the social and environmental drivers of obesity. Societies and researchers need to play the long game in that widespread reductions in obesity in the short run are unlikely. Nonetheless, there are opportunities. Policies specifically targeting the food environment such as taxing high-calorie beverages and foods, restricting the marketing of junk foods to children, enhancing food labeling, and improving the dietary environment at schools may yield long-run benefits.

Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population

BACKGROUND

Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities.

METHODS

In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults.

RESULTS

Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; P<0.05). Among women, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in non-Hispanic Black women (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.17 [0.03] points higher in non-Hispanic Black participants; P<0.05). Place of birth (born in the United States versus born outside the United States) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian women (if distribution of place of birth were similar to non-Hispanic White participants, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively; P<0.05).

CONCLUSIONS

Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.

Low subjective social status is associated with daily selection of fewer healthy foods and more high-fat/high sugar foods

Socioeconomic status has been related to poorer eating behaviors, potentially due to feeling of lower status relative to peers. Despite experimental evidence that temporarily feeling of lower status can contribute to greater caloric intake, it remains unclear how feeling of lower social status relate to eating behavior in daily life. This study aimed to test whether lower subjective social status (SSS)-the feeling of having relatively lower social status-in American society and relative to college peers were related to daily food selection. A sample of 131 young adults (Mage = 20.3, SD = 0.8; 60% female; 46% Latinos; 34% European American; 15% Asian American; 5% of other ethnicities) reported their SSS in society and in college and completed 15 daily reports regarding the number of daily servings they had of fruits, vegetables, fried foods, fast foods, desserts, and sugary drinks. Multilevel models with days nested within individuals were used to test whether low SSS in society or college related to daily food intake. Next, we examined whether associations were driven by young adults' perceived stress and daily stressors. Analyses controlled for age, gender, ethnicity, family and personal income, and parents' education to test the unique associations between subjective status and food intake. Whereas SSS in society was not related to food intake, young adults with lower SSS in their college consumed fewer daily servings of healthy foods and more daily servings of high-fat/high-sugar foods. Although lower college SSS was related to greater perceived stress, perceived stress and daily stressors were consistently unrelated to daily food intake. Findings suggested that lower SSS in local environments (e.g., college) may impact young adults' daily food choices through processes beyond heightened stress.

2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases

OBJECTIVES

A European League Against Rheumatism taskforce was convened to review the literature and develop recommendations on lifestyle behaviours for rheumatic and musculoskeletal diseases (RMDs).

METHODS

Six lifestyle exposures (exercise, diet, weight, alcohol, smoking, work participation) and seven RMDs (osteoarthritis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus, systemic sclerosis, gout) were considered. The taskforce included health professionals in rheumatology, geriatricians, epidemiologists, public health experts, people with RMDs and exposure domain experts. Systematic reviews were conducted to gather available evidence, from which recommendations were developed.

RESULTS

Five overarching principles and 18 specific recommendations were defined based on available evidence. The overarching principles define the importance of a healthy lifestyle, how lifestyle modifications should be implemented, and their role in relation to medical treatments. Exercise recommendations highlight the safety and benefits of exercise on pain and disability, particularly among people with osteoarthritis and axial spondyloarthritis. The diet recommendations emphasise the importance of a healthy, balanced diet for people with RMDs. People with RMDs and health professionals should work together to achieve and maintain a healthy weight. Small amounts of alcohol are unlikely to negatively affect the outcomes of people with RMDs, although people with rheumatoid arthritis and gout may be at risk of flares after moderate alcohol consumption. Smokers should be supported to quit. Work participation may have benefits on RMD outcomes and should be discussed in consultations.

CONCLUSIONS

These recommendations cover a range of lifestyle behaviours and can guide shared decision making between people with RMDs and health professionals when developing and monitoring treatment plans.

Dietary Intake of 91 Individual Polyphenols and 5-Year Body Weight Change in the EPIC-PANACEA Cohort

Polyphenols are bioactive compounds from plants with antioxidant properties that may have a protective role against body weight gain, with adipose tissue and systemic oxidative stress as potential targets. We aimed to investigate the dietary intake of individual polyphenols and their association with 5-year body weight change in a sub-cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). This study included 349,165 adult participants from nine European countries. Polyphenol intake was estimated through country-specific validated dietary questionnaires and the Phenol-Explorer database. Body weight was obtained at recruitment and after a mean follow-up time of 5 years. Associations were estimated using multilevel mixed linear regression models. From 91 polyphenols included, the majority (n = 67) were inversely associated with 5-year body weight change after FDR-correction (q < 0.05). The greatest inverse associations were observed for quercetin 3-O-rhamnoside (change in weight for doubling in intake: −0.071 (95% CI: −0.085; −0.056) kg/5 years). Only 13 polyphenols showed positive associations with body weight gain, mainly from the subclass hydroxycinnamic acids (HCAs) with coffee as the main dietary source, such as 4-caffeoylquinic acid (0.029 (95% CI: 0.021; 0.038) kg/5 years). Individual polyphenols with fruit, tea, cocoa and whole grain cereals as the main dietary sources may contribute to body weight maintenance in adults. Individual HCAs may have different roles in body weight change depending on their dietary source.