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Chen K, Kornas K, Rosella LC. Modeling chronic disease risk across equity factors using a population-based prediction model: the Chronic Disease Population Risk Tool (CDPoRT). J Epidemiol Community Health 2024; 78:335-340. [PMID: 38383145 PMCID: PMC11041567 DOI: 10.1136/jech-2023-221080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Predicting chronic disease incidence at a population level can help inform overall future chronic disease burden and opportunities for prevention. This study aimed to estimate the future burden of chronic disease in Ontario, Canada, using a population-level risk prediction algorithm and model interventions for equity-deserving groups who experience barriers to services and resources due to disadvantages and discrimination. METHODS The validated Chronic Disease Population Risk Tool (CDPoRT) estimates the 10-year risk and incidence of major chronic diseases. CDPoRT was applied to data from the 2017/2018 Canadian Community Health Survey to predict baseline 10-year chronic disease estimates to 2027/2028 in the adult population of Ontario, Canada, and among equity-deserving groups. CDPoRT was used to model prevention scenarios of 2% and 5% risk reductions over 10 years targeting high-risk equity-deserving groups. RESULTS Baseline chronic disease risk was highest among those with less than secondary school education (37.5%), severe food insecurity (19.5%), low income (21.2%) and extreme workplace stress (15.0%). CDPoRT predicted 1.42 million new chronic disease cases in Ontario from 2017/2018 to 2027/2028. Reducing chronic disease risk by 5% prevented 1500 cases among those with less than secondary school education, prevented 14 900 cases among those with low household income and prevented 2800 cases among food-insecure populations. Large reductions of 57 100 cases were found by applying a 5% risk reduction in individuals with quite a bit workplace stress. CONCLUSION Considerable reduction in chronic disease cases was predicted across equity-defined scenarios, suggesting the need for prevention strategies that consider upstream determinants affecting chronic disease risk.
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Affiliation(s)
- Kitty Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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Retat L, Webber L, Jepsen P, Martin A, Cortez-Pinto H, Lazarus JV, Negro F, Mitchyn M, Guzek J, Card-Gowers J, Graff H, Nahon P, Sheron N, Sagi SZ, Buti M. Preventing liver disease with policy measures to tackle alcohol consumption and obesity: The HEPAHEALTH II study. J Hepatol 2024; 80:543-552. [PMID: 38092157 DOI: 10.1016/j.jhep.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND & AIMS Chronic liver disease (CLD) causes 1.8% of all deaths in Europe, many of them from liver cancer. We estimated the impact of several policy interventions in France, the Netherlands, and Romania. METHODS We used a validated microsimulation model to assess seven different policy scenarios in 2022-2030: a minimum unit price (MUP) of alcohol of €0.70 or €1, a volumetric alcohol tax, a sugar-sweetened beverage (SSB) tax, food marketing restrictions, plus two different combinations of these policies compared against current policies (the 'inaction' scenario). RESULTS All policies reduced the burden of CLD and liver cancer. The largest impact was observed for a MUP of €1, which by 2030 would reduce the cumulative incidence of CLD by between 7.1% to 7.3% in France, the Netherlands, and Romania compared with inaction. For liver cancer, the corresponding reductions in cumulative incidence were between 4.8% to 5.8%. Implementing a package containing a MUP of €0.70, a volumetric alcohol tax, and an SSB tax would reduce the cumulative incidence of CLD by between 4.29% to 4.71% and of liver cancer by between 3.47% to 3.95% in France, the Netherlands, and Romania. The total predicted reduction in healthcare costs by 2030 was greatest with the €1 MUP scenario, with a reduction for liver cancer costs of €8.18M and €612.49M in the Netherlands and France, respectively. CONCLUSIONS Policy measures tackling primary risk factors for CLD and liver cancer, such as the implementation of a MUP of €1 and/or a MUP of €0.70 plus SSB tax could markedly reduce the number of Europeans with CLD or liver cancer. IMPACT AND IMPLICATIONS Policymakers must be aware that alcohol and obesity are the two leading risk factors for chronic liver disease and liver cancer in Europe and both are expected to increase in the future if no policy interventions are made. This study assessed the potential of different public health policy measures to mitigate the impact of alcohol consumption and obesity on the general population in three European countries: France, the Netherlands, and Romania. The findings support introducing a €1 minimum unit price for alcohol to reduce the burden of chronic liver disease. In addition, the study shows the importance of targeting multiple drivers of alcohol consumption and obesogenic products simultaneously via a harmonized fiscal policy framework, to complement efforts being made within health systems. These findings should encourage policymakers to introduce such policy measures across Europe to reduce the burden of liver disease. The modeling methods used in this study can assist in structuring similar modeling in other regions to expand on this study's findings.
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Affiliation(s)
| | | | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia, Centro de Nutrição e Metabolismo, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
| | - Francesco Negro
- Division of Gastroenterology and Hepatology, University Hospitals, Geneva, Switzerland
| | | | | | | | | | - Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny; Université Sorbonne Paris Nord, Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Nick Sheron
- The Foundation for Liver Research, The Institute of Hepatology, London111 Coldharbour Lane, London, SE5 9NT, UK
| | | | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebron, and CIBEREHD del Instituto de Salud Carlos III. Barcelona, Spain.
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Coker T, Saxton J, Retat L, Guzek J, Card-Gowers J, BinDhim NF, Althumiri NA, Aldubayan K, Razack HI, Webber L, Alqahtani SA. How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia? Obes Facts 2023; 16:559-566. [PMID: 37552973 PMCID: PMC10697749 DOI: 10.1159/000533301] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO "halt obesity" target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: (1) SA meets the "halt obesity" target; (2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040. METHODS We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline "no change" scenario. RESULTS Adults <35 years are expected to meet the "halt obesity" target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA's working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease, and liver cancer could be avoided by 2040. Healthcare cost savings for the "halt obesity" and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively. CONCLUSION SA's younger working-age population is set to meet the "halt obesity" target, but those aged 35-59 are off track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.
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Affiliation(s)
| | | | | | | | | | - Nasser F. BinDhim
- Sharik Association for Health Research, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Khalid Aldubayan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Saleh A. Alqahtani
- Liver Transplant Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA
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Vladimirov M, Wellner UF, Klinger C, Buhr HJ, Seyfried F. [Impact of the COVID pandemic on treatment of bariatric patients in Germany-An analysis of the national StuDoQ/MBE register]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:487-496. [PMID: 36894648 PMCID: PMC9998013 DOI: 10.1007/s00104-023-01838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic the standard inpatient care of patients was restricted to increase overall and intensive care capacity reserves for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected persons. OBJECTIVE This article presents the impact of the COVID-19 pandemic on the surgical and postoperative care of bariatric patients in Germany. MATERIAL AND METHODS A statistical analysis of the national StuDoQ/MBE register data for the period from 1 May 2018 until 31 May 2022 was performed. RESULTS Throughout the entire study period there was a continuous increase in documented operations, which continued even during the COVID-19 pandemic. A significant intermittent decline in surgery performed was observed only during the imposition of first lockdown in the months of March to May 2020, with a minimum number of 194 cases performed monthly in April 2020. The pandemic had no measurable effect on the surgically treated patient population, the type of surgical procedure, the perioperative and postoperative outcomes and follow-up care. CONCLUSION Based on the results of the StuDoQ data and the current literature, it can be deduced that bariatric surgery can be carried out with no increased risk during the COVID-19 pandemic and the quality of postoperative care is not impaired.
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Affiliation(s)
- M Vladimirov
- Metabolische und bariatrische Chirurgie, Klinik für Allgemein, Viszeral- und Thoraxchirurgie, PMU Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - U F Wellner
- Klinik für Chirurgie, UKSH Campus Lübeck, Lübeck, Deutschland
| | - C Klinger
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - H J Buhr
- Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - F Seyfried
- Klinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, 97080, Würzburg, Deutschland
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Guzman-Castillo M, Korhonen K, Murphy M, Martikainen P. Projections of future burden of pharmacologically treated type 2 diabetes and associated life expectancies by income in Finland: a multi-state modeling study. Front Public Health 2023; 11:1141452. [PMID: 37304089 PMCID: PMC10250626 DOI: 10.3389/fpubh.2023.1141452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
The burden of type 2 diabetes (T2D) differs between socioeconomic groups. The present study combines ongoing and plausible trends in T2D incidence and survival by income to forecast future trends in cases of T2D and life expectancy with and without T2D up to year 2040. Using Finnish total population data for those aged 30 years on T2D medication and mortality in 1995-2018, we developed and validated a multi-state life table model using age-, gender-, income- and calendar year-specific transition probabilities. We present scenarios based on constant and declining T2D incidence and on the effect of increasing and decreasing obesity on T2D incidence and mortality states up to 2040. With constant T2D incidence at 2019-level, the number of people living with T2D would increase by about 26% between 2020 and 2040. The lowest income group could expect more rapid increases in the number with T2D compared to the highest income group (30% vs. 23% respectively). If the incidence of T2D continues the recent declining trend, we predict about 14% fewer cases. However, if obesity increases two-fold, we predict 15% additional T2D cases. Unless, we reduce the obesity-related excess risk, the number of years lived without T2D could decrease up to 6 years for men in the lowest income group. Under all plausible scenarios, the burden of T2D is set to increase and it will be unequally distributed among socioeconomic groups. An increasing proportion of life expectancy will be spent with T2D.
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Affiliation(s)
- Maria Guzman-Castillo
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Michael Murphy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Kostanjsek L, Ardissino M, Moussa O, Rayes B, Amin R, Collins P, Purkayastha S. Bariatric Surgery and Incident Heart Failure: a Propensity Score Matched Nationwide Cohort Study. Int J Cardiol 2023; 378:42-47. [PMID: 36738843 DOI: 10.1016/j.ijcard.2023.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bariatric surgery results in significant weight loss and a reduction in the incidence of cardiovascular disease in patients with obesity; however, relatively little research considers its effect on the incidence of heart failure (HF). We aimed to determine whether bariatric surgery reduces the incidence of HF in patients with obesity, compared to non-surgical management. METHODS A propensity-score matched, retrospective cohort study using patients records from the nationwide Clinical Practice Research Database (CPRD) was conducted. 3052 patients who received bariatric surgery were matched with 3052 patients who did not, according to propensity to receive bariatric surgery, determined through a logistic regression model. Patients were eligible if >18 years old, BMI > 35 kg/m2, and no prior diagnosis of HF. The pre-defined primary endpoint was the development of new HF, and secondary endpoints were all-cause mortality and hospitalisations due to HF. RESULTS Patients who received bariatric surgery had a significantly lower incidence of new HF (hazard ratio 0.45, 95% confidence interval 0.28-0.73, p = 0.0011) and all-cause mortality (hazard ratio 0.56, 95% confidence interval 0.38-0.83, p = 0.0036). CONCLUSIONS This study provides evidence of lower rates of HF and all-cause mortality in patients who undergo bariatric surgery, compared to propensity-score matched controls. Future studies to understand the mechanism(s) involved in this reduction and explore the lifetime benefits in high-risk cohorts are paramount.
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Affiliation(s)
- Luke Kostanjsek
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Osama Moussa
- Division of Surgery and Cancer, Imperial College London, London, UK
| | - Bilal Rayes
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ravi Amin
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Collins
- National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK.
| | - Sanjay Purkayastha
- National Heart and Lung Institute, Imperial College London, London, UK; Division of Surgery and Cancer, Imperial College London, London, UK; Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, UK
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7
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Páscoa R, Teixeira A, Henriques TS, Monteiro H, Monteiro R, Martins C. Characterization of an obese population: a retrospective longitudinal study from real-world data in northern Portugal. BMC PRIMARY CARE 2023; 24:99. [PMID: 37061669 PMCID: PMC10105387 DOI: 10.1186/s12875-023-02023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 02/28/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Obesity is a serious and largely preventable global health problem. Obesity-related electronic health records can be a useful resource to identify and address obesity. The analysis of real-world data from T82-coded (International Classification of Primary Care coding, for obesity) primary care individuals can be an excellent national source of data on obesity's prevalence, characteristics, and impact on the National Health Service. METHODS Retrospective longitudinal study, based on a database of electronic medical records, from the Regional Health Administration of northern Portugal. The study objectives were to determine the prevalence of obesity and to characterize an adult obese population in northern Portugal from a bio-demographic point of view along with profiles of comorbidities and the use of health resources. This study used a database of 266,872 patients in December 2019 and screened for diagnostic code T82 from the International Classification of Primary Care. RESULTS The prevalence of obesity was 10.2% and the highest prevalence of obesity was in the 65-74 age group (16.1%). The most prevalent morbidities in patients with obesity as coded through ICPC-2 were K86 (uncomplicated hypertension), T90 (non-insulin-dependent diabetes), and K87 (complicated hypertension). Descriptive information showed that T82 subjects used more consultations, medications, and diagnostic tests than non-T82 subjects. CONCLUSIONS Routine recording of weight and height deserves special attention to allow obesity recognition at an early stage and move on to the appropriate intervention. Future work is necessary to automate the codification of obesity for subjects under 18 years of age, to raise awareness and anticipate the prevention of problems associated with obesity. Practical strategies need to be implemented, such as the creation of a specific program consultation with truly targeted approaches to obesity.
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Affiliation(s)
- Rosália Páscoa
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal.
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.
- Administração Regional de Saúde do Norte IP, Health Centre Grouping Porto Ocidental, Family Health Unit Homem do Leme, Porto, Portugal.
| | - Andreia Teixeira
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Instituto Politécnico de Viana do Castelo (IPVC), ADiT-LAB, Viana do Castelo, Portugal
| | - Teresa S Henriques
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Hugo Monteiro
- Studies and Planning Department, Administração Regional de Saúde do Norte IP, Porto, Portugal
| | - Rosário Monteiro
- Faculty of Medicine, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Al. Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Administração Regional de Saúde do Norte IP, Health Centre Grouping Porto Ocidental, Family Health Unit Homem do Leme, Porto, Portugal
| | - Carlos Martins
- University of Porto, Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- #H4A Primary Healthcare Research Network, Porto, Portugal
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Bauer DJM, Matic V, Mare R, Maiocchi L, Chromy D, Müllner-Bucsics T, Mandorfer M, Mustapic S, Sporea I, Ferraioli G, Grgurevic I, Reiberger T. Point Shear Wave Elastography by ElastPQ for Fibrosis Screening in Patients with NAFLD: A Prospective, Multicenter Comparison to Vibration-Controlled Elastography. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:169-178. [PMID: 35226932 PMCID: PMC10063334 DOI: 10.1055/a-1724-7289] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/08/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Since nonalcoholic fatty liver disease (NAFLD) has become the leading cause of liver disease in the Western world, clinicians need reliable noninvasive tools for the identification of NAFLD-associated fibrosis. Limited evidence on the performance of the novel shear wave elastography technique Elast-PQ (EPQ) in NAFLD is available. METHOD In this prospective, European multinational study we assessed the diagnostic accuracy of EPQ using vibration-controlled transient elastography (VCTE) as a reference standard. RESULTS Among 353 NAFLD patients, 332 (94.1%) fulfilled reliability criteria of VCTE and EPQ (defined by IQR/median ≤0.3; 41.3% female, mean age: 59 [IQR: 16.5], mean BMI: 29.0 (7.1)). 4/353 (1.1%) and 17/353 (4.8%) had unreliable VCTE and EPQ measurements, respectively. VCTE-based NAFLD fibrosis stages were F0/F1: 222(66.9%), F2: 41 (12.3%), F3: 30 (9.1%), F4: 39 (11.7%). We found a strong correlation (Pearson R=0.87; p<0.0001) and concordance (Lin's concordance correlation coefficient =0.792) of EPQ with VCTE. EPQ was able to identify NAFLD-fibrosis risk with the following EPQ cutoffs: ≥6.5 kPa for significant fibrosis (≥F2) (≥1.47 m/s; sensitivity: 78%; specificity: 95%; AUROC: 0.94), ≥6.9 kPa for advanced fibrosis (≥F3) (≥1.52 m/s; sens.: 88%, spec.: 89%; AUROC: 0.949), and ≥10.4 kPa for cirrhosis (F4) (≥1.86 m/s; sens.: 87%; spec.: 94%; AUROC: 0.949). CONCLUSION The point shear wave elastography technique EPQ shows excellent correlation to and concordance with VCTE. EPQ can reliably exclude NAFLD fibrosis <6.0 kPa (<1.41 m/s) and indicate a high risk of advanced fibrosis ≥10.4 kPa (≥1.86 m/s).
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Affiliation(s)
- David JM Bauer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Vladimir Matic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ruxandra Mare
- Division of Gastroenterology & Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Laura Maiocchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Chromy
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Theresa Müllner-Bucsics
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | | | - Ioan Sporea
- Department of Internal Medicine II,Division of Gastroenterology & Hepatology, Center for Advanced Research in Gastroenterology and Hepatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
| | - Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Medical University of Vienna, Vienna, Austria
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
- Christian-Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Wien, Austria
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Vesikansa A, Mehtälä J, Mutanen K, Lundqvist A, Laatikainen T, Ylisaukko-oja T, Saukkonen T, Pietiläinen KH. The association between body mass index groups and metabolic comorbidities with healthcare and medication costs: a nationwide biobank and registry study in Finland. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2166313. [PMID: 36684852 PMCID: PMC9858397 DOI: 10.1080/20016689.2023.2166313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The increasing prevalence of obesity imposes a significant cost burden on individuals and societies worldwide. OBJECTIVE In this nationally representative study, the association between body mass index (BMI) groups and the number of metabolic comorbidities (MetC) with total direct costs was investigated in the Finnish population. STUDY DESIGN, SETTING, AND PARTICIPANTS The study cohort included 5,587 adults with BMI ≥18.5 kg/m2 who participated in the cross-sectional FinHealth 2017 health examination survey conducted by the Finnish Institute for Health and Welfare. Data on healthcare resource utilization (HCRU) and drug purchases were collected from national healthcare and drug registers. MAIN OUTCOME MEASURE The primary outcome was total direct costs (costs of primary and secondary HCRU and prescription medications). RESULTS Class I (BMI 30.0-34.9 kg/m2) and class II - III (BMI ≥35.0 kg/m2) obesity were associated with 43% and 40% higher age- and sex-adjusted direct costs, respectively, compared with normal weight, mainly driven by a steeply increased comorbidity in the higher BMI groups. In all BMI groups combined, individuals with ≥2 MetCs comprised 39% of the total study population and 60% of the total costs. CONCLUSION To manage the cost burden of obesity, treatment should be given equal consideration as other chronic diseases, and BMIs ≥30.0 kg/m2 should be considered in treatment decisions.
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Affiliation(s)
| | | | | | | | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social andHealth Services (Siun Sote), Joensuu, Finland
| | - Tero Ylisaukko-oja
- MedEngine Oy, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki,Helsinki, Finland & Obesity Center, Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Feletto E, Kohar A, Mizrahi D, Grogan P, Steinberg J, Hughes C, Watson WL, Canfell K, Yu XQ. An ecological study of obesity-related cancer incidence trends in Australia from 1983 to 2017. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 29:100575. [PMID: 36106135 PMCID: PMC9465341 DOI: 10.1016/j.lanwpc.2022.100575] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Overweight and obesity is a growing public health issue as it contributes to the future burden of obesity-related diseases, including cancer, especially in high-income countries. In Australia, 4.3% of all cancers diagnosed in 2013 were attributable to overweight and obesity. Our aim was to examine Australian age-specific incidence trends over the last 35 years for obesity-related cancers based on expert review (colorectal, liver, gallbladder, pancreas, breast in postmenopausal women, uterine, ovary, kidney, thyroid, and multiple myeloma) individually and pooled. METHODS Australian incidence data for 10 obesity-related cancers among people aged 25-84 years, diagnosed from 1983 to 2017, were obtained from the Australian Cancer Database. We used age-period-cohort modelling and joinpoint analysis to assess trends, estimating incidence rate ratios (IRR) by birth-cohort for each individual cancer and pooled, and the annual percentage change. The analyses were also conducted for non-obesity-related cancers over the same period. FINDINGS The total number of cancers where some proportion is obesity-related, diagnosed from 1983-2017, was 1,005,933. This grouping was 34.7% of cancers diagnosed. The IRR of obesity-related cancers increased from 0.77 (95% CI 0.73, 0.81) for the 1903 birth-cohort to 2.95 (95% CI 2.58, 3.38) for the recent 1988 cohort relative to the 1943 cohort. The IRRs of non-obesity related cancers were stable with non-significant decreases in younger cohorts. These trends were broadly similar across sex and age groups. INTERPRETATION The incidence of obesity-related cancers in Australia has increased by birth-cohort across all age-groups, which should be monitored. Obesity, a public health epidemic, needs to be addressed through increased awareness, policy support and evidence-based interventions. FUNDING This research received no specific funding.
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Affiliation(s)
- Eleonora Feletto
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Ankur Kohar
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Paul Grogan
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Clare Hughes
- Cancer Prevention and Advocacy Division, Cancer Council NSW, Australia
| | - Wendy L. Watson
- Cancer Prevention and Advocacy Division, Cancer Council NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Australia
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Asiri F, Dixit S, Alsubaie SF, Gular K, Alshahrani A, Reddy RS, Gautam AP, Tedla JS. Comparison of Neck Circumference, Waist Circumference, and Skinfold Thickness in Measuring the Subcutaneous Fat Distribution and Their Association with Handgrip Strength: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14283. [PMID: 36361158 PMCID: PMC9656996 DOI: 10.3390/ijerph192114283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
Skinfold measurement (SKF) can accurately measure abdominal obesity and is regarded as a surrogate marker to predict non-communicable diseases. The objective of the present study was to observe the degree of association between neck circumference (NC), SKF and handgrip strength (HGS). Secondly, also to know the effects of smoking on NC, HGS and SKF. The mean and standard deviations and frequencies in percentage were analyzed, respectively. The degree of association between NC, anthropometric characters and HGS was also analyzed using the Pearson correlation. Furthermore, multiple linear regression models were used to study the degree of influence of independent variables on dependent variables. Correlation assessment for neck circumference with waist circumference and HGS revealed a weak association. While with SKF for four sites, a strong association was found. A significant regression was found among the smokers in the model (F (2, 7) = 5.2, p-value of 0.04 with an R2 of 0.598). The predictor variables, like waist and NC, can produce a variation of 59.8% in the dependent variable. Whereas, among non-smokers, an insignificant regression was seen. In conclusion, neck circumference is associated with SKF. However, a small sample size of young smokers revealed that NC and waist circumference influenced HGS.
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Affiliation(s)
- Faisal Asiri
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Saud F. Alsubaie
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences in Al-Kharj, Prince Sattam bin Abdul-Aziz University, Al-Kharj 11942, Saudi Arabia
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Adel Alshahrani
- Physical Therapy Program, Health Rehabilitation Department, College of Applied Medical Sciences, Najran University, Najran 11001, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
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12
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Nassar AHM, Khan KS, Ng HJ, Sallam M. Operative Difficulty, Morbidity and Mortality Are Unrelated to Obesity in Elective or Emergency Laparoscopic Cholecystectomy and Bile Duct Exploration. J Gastrointest Surg 2022; 26:1863-1872. [PMID: 35641812 PMCID: PMC9489587 DOI: 10.1007/s11605-022-05344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/30/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The challenges posed by laparoscopic cholecystectomy (LC) in obese patients and the methods of overcoming them have been addressed by many studies. However, no objective tool of reporting operative difficulty was used to adjust the outcomes and compare studies. The aim of this study was to establish whether obesity adds to the difficulty of LC and laparoscopic common bile duct exploration (LCBDE) and affects their outcomes on a specialist biliary unit with a high emergency workload. METHODS A prospectively maintained database of 4699 LCs and LCBDEs performed over 19 years was analysed. Data of patients with body mass index (BMI) ≥ 35, defined as grossly obese, was extracted and compared to a control group. RESULTS A total of 683 patients (14.5%) had a mean BMI of 39.9 (35-63), of which 63.4% met the definition of morbidly obese. They had significantly more females and significantly higher ASA II classifications. They had equal proportions of emergency admissions, similar incidence of operative difficulty grades 4 or 5 and no open conversions and were less likely to undergo LCBDE than non-obese patients. There were no significant differences in median operative times, morbidity, readmission or mortality rates. CONCLUSIONS This study, the first to classify gall stone surgery in obese patients according to operative difficulty grading, showed no difference in complexity when compared to the non-obese. Refining access and closure techniques is key to avoiding difficulties. Index admission surgery for biliary emergencies prevents multiple admissions with potential complications and should not be denied due to obesity.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Upper GI and Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK.
| | - Khurram S Khan
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Hwei J Ng
- Department of Surgery, Royal Alexandra Hospital, Paisley, Glasgow, Scotland, UK
| | - Mahmoud Sallam
- Laparoscopic Upper GI and Biliary Service, University Hospital Monklands, Airdrie, Scotland, UK
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Wanjau MN, Aminde LN, Veerman JL. The avoidable disease burden associated with overweight and obesity in Kenya: A modelling study. EClinicalMedicine 2022; 50:101522. [PMID: 35799846 PMCID: PMC9253160 DOI: 10.1016/j.eclinm.2022.101522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, there is a rising burden of non-communicable diseases related to high body mass index (BMI). Estimation of the magnitude of the avoidable disease burden related to high BMI in Kenya could inform priority setting in health. METHODS Using a proportional multistate life table model, we estimated the impact of the elimination of exposure to high BMI (>22·5 kg/m2) on health adjusted life years, health adjusted life expectancy, and burden of 27 obesity-related diseases. Participants were the 2019 Kenyan population modelled over their remaining lifetime. FINDINGS Elimination of high BMI could save approximately 83·5 million health-adjusted life years and increase the health-adjusted life expectancy by 2·3 (95% UI 2·0-2·8) years for females and 1·0 (95% UI 0·8-1·1) years for males. Over the first 25 years, over 7·4 million new cases of BMI-related diseases could be avoided and approximately half a million BMI related deaths postponed. The cumulative number of new cases of type 2 diabetes could reduce by approximately 1·6 million, cardiovascular diseases by over 1·3 million, chronic kidney disease by 850,473 and cancer would reduce by 55,624 estimated cases. In 2044, an estimated 867,664 prevalent cases of musculoskeletal disease would be prevented. INTERPRETATION The magnitude of avoidable high BMI-related disease burden in Kenya underscores the need to prioritise the control and prevention of overweight and obesity globally, especially in low- and middle-income settings, where obesity rates are rising rapidly. Reducing population BMI is challenging, but sustained and well-enforced system-wide approaches could be a great starting point. FUNDING Mary Njeri Wanjau is supported by the Griffith University International Postgraduate Research Scholarship (GUIPRS) and Griffith University Postgraduate Research Scholarship (GUPRS).
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Affiliation(s)
- Mary Njeri Wanjau
- University of Nairobi, School of Nursing Sciences, Nairobi, Kenya
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Corresponding author at: Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Gold Coast campus, Parklands Drive, Southport, Queensland 4222, Australia.
| | - Leopold Ndemnge Aminde
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Non-communicable Disease Unit, Clinical Research Education, Networking & Consultancy, Douala, Cameroon
| | - J. Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Coker T, Saxton J, Retat L, Alswat K, Alghnam S, Al-Raddadi RM, Abdul Razack HI, Webber L, Alqahtani SA. The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia. PLoS One 2022; 17:e0271108. [PMID: 35834577 PMCID: PMC9282435 DOI: 10.1371/journal.pone.0271108] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Obesity and type 2 diabetes (T2DM) are increasing in Saudi Arabia (SA). Among other conditions, these risk factors increase the likelihood of non-alcoholic fatty liver disease (NAFLD), which in turn increases risks for advanced liver diseases, such as non-alcoholic steatohepatitis (NASH), cirrhosis and cancer. The goal of this study was to quantify the health and economic burden of obesity-attributable T2DM and liver disease in SA.
Methods
We developed a microsimulation of the SA population to quantify the future incidence and direct health care costs of obesity-attributable T2DM and liver disease, including liver cancer. Model inputs included population demographics, body mass index, incidence, mortality and direct health care costs of T2DM and liver disease and relative risks of each condition as a function of BMI category. Model outputs included age- and sex-disaggregated incidence of obesity-attributable T2DM and liver disease and their direct health care costs for SA’s working-age population (20–59 years) between 2020 and 2040.
Results
Between 2020 and 2040, the available data predicts 1,976,593 [± 1834] new cases of T2DM, 285,346 [±874] new cases of chronic liver diseases, and 2,101 [± 150] new cases of liver cancer attributable to obesity, amongst working-age people. By 2040, the direct health care costs of these obesity-attributable diseases are predicted to be 127,956,508,540 [± 51,882,446] USD.
Conclusions
The increase in obesity-associated T2DM and liver disease emphasises the urgent need for obesity interventions and strategies to meaningfully reduce the future health and economic burden of T2DM, chronic liver diseases and liver cancer in SA.
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Affiliation(s)
| | | | | | - Khalid Alswat
- Liver Disease Research Centre, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Suliman Alghnam
- Population Health Department, King Abdullah International Medical Research Centre, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rajaa Mohammad Al-Raddadi
- Saudi Diabetes Study Research Group, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Habeeb Ibrahim Abdul Razack
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Sedang, Selangor, Malaysia
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Saleh A. Alqahtani
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, United States of America
- Liver Transplant Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- * E-mail:
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15
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Kim YH, Lee HJ, Cho KA, Woo SY, Ryu KH. Conditioned medium from human tonsil-derived mesenchymal stem cells inhibits glucocorticoid-induced adipocyte differentiation. PLoS One 2022; 17:e0266857. [PMID: 35648740 PMCID: PMC9159628 DOI: 10.1371/journal.pone.0266857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
Obesity, which has become a major global health problem, involves a constitutive increase in adipocyte differentiation signaling. Previous studies show that mesenchymal stem cells (MSCs) induce weight loss and glycemic control. However, the mechanisms by which MSCs regulate adipocyte differentiation are not yet known. In this study, we investigated the effects of conditioned medium obtained from human tonsil-derived MSCs (T-MSC CM) on adipocyte differentiation. We found that T-MSC CM attenuated adipocyte differentiation from early stages via inhibiting glucocorticoid signaling. T-MSC CM also increased the phosphorylation of p38 mitogen-activated protein kinase and glucocorticoid receptors and decreased the subsequent nucleus translocation of glucocorticoid receptors. Chronic treatment of mice with synthetic glucocorticoids induced visceral and bone marrow adipose tissue expansion, but these effects were not observed in mice injected with T-MSC CM. Furthermore, T-MSC CM injection protected against reductions in blood platelet counts induced by chronic glucocorticoid treatment, and enhanced megakaryocyte differentiation was also observed. Collectively, these results demonstrate that T-MSC CM exerts inhibitory effects on adipocyte differentiation by regulating glucocorticoid signal transduction. These findings suggest that the therapeutic application of T-MSC CM could reduce obesity by preventing adipose tissue expansion.
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Affiliation(s)
- Yu-Hee Kim
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
- Advanced Biomedical Research Institute, Ewha Womans University Seoul Hospital, Gangseo-Gu, Seoul, South Korea
| | - Hyun-Ji Lee
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
| | - Kyung-Ah Cho
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
| | - So-Youn Woo
- Department of Microbiology, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
| | - Kyung-Ha Ryu
- Department of Pediatrics, Ewha Womans University College of Medicine, Gangseo-Gu, Seoul, South Korea
- * E-mail:
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Martínez-Vargas L, Vermandere H, Bautista-Arredondo S, Colchero MA. The role of social determinants on unhealthy eating habits in an urban area in Mexico: A qualitative study in low-income mothers with a young child at home. Appetite 2021; 169:105852. [PMID: 34890724 DOI: 10.1016/j.appet.2021.105852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/15/2021] [Accepted: 12/05/2021] [Indexed: 01/12/2023]
Abstract
Overweight and obesity are a severe public health problem in Mexico. National policies to fight unhealthy eating have been implemented but they don't target social and family environment determinants. Our study aimed to gain a deeper understanding of the determinants of unhealthy eating by exploring the perspectives and experiences of low-income Mexican women with a young child at home. We conducted a purposeful sampling to include participating kindergartens in Morelos, México. Women with a child enrolled in the kindergarten were invited to focus group discussions. Afterward, women with specific profiles were invited to in-depth interviews. During analysis we applied Dahlgren and Whitehead's model of social determinants of health (SDH). Overall, we found that participants have unhealthy habits, for example: low variability in consumption patterns, regular sugar-sweetened beverages intake and insufficient fruit and vegetable intake. By low variability we mean frequently consumed products (on most days of the week) limited to a restricted food set. As for the determinants of unhealthy habits, we found at the community level that families encourage unhealthy eating. At the household and work level, tight schedules for food preparation determine unhealthy eating. And, at a socio-economic level, lack of access and money constraints shape unhealthy habits. Unhealthy habits are determined by factors on multiple levels and using an SDH approach can be an effective way to inform comprehensive strategies targeting the overweight and obesity epidemic in Mexico and other low- and middle-income countries.
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Affiliation(s)
| | - Heleen Vermandere
- Center for Health Systems Research, National Institute of Public Health, Mexico
| | | | - M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Mexico.
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Snelder SM, Pouw N, Aga Y, Cabezas MC, Zijlstra F, Kardys I, van Dalen BM. Biomarker profiles in obesity patients and their relation to cardiac dysfunction. Biomark Med 2021; 15:1211-1221. [PMID: 34498487 DOI: 10.2217/bmm-2021-0101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Current knowledge on the role of obesity in causing cardiac dysfunction is insufficient. Several biomarkers reflecting biological processes that may play a role in the occurrence of cardiac dysfunction in obesity patients are available. Purpose: To compare cardiovascular biomarker profiles between obesity patients and nonobese controls, and between obesity patients with and without cardiac dysfunction, in order to better understand the underlying pathophysiology of cardiac dysfunction in obesity patients. Materials & methods: Blood samples were obtained from 100 obesity patients (BMI ≥35 kg/m2) without known cardiovascular disease, and from 50 age- and gender-matched nonobese controls (BMI ≤30 kg/m2). The third cardiovascular panel of the Olink Multiplex platform was used for the measurement of 92 biomarkers. Results: The majority (53%) of biomarkers were elevated in obesity patients compared with nonobese controls. Only 5% of the biomarkers were elevated in obesity patients with cardiac dysfunction compared with those without. Biomarkers discriminating cardiac dysfunction from no cardiac dysfunction in obesity patients differed from those discriminating obese from nonobese patients. An elastic net model for the prediction of cardiac dysfunction in obesity patients had a high area under the receiver operating curve of 0.87 (95% CI: 0.79-0.94; p < 0.001). The sensitivity of this model was 84% and the specificity was 79%. Conclusion: A multiplex immunoassay was used for the first time in obesity patients without known cardiovascular disease. These patients have cardiovascular biomarker profiles that are clearly different from nonobese controls. Comparison of obesity patients with and without cardiac dysfunction suggested an important role for inflammation, atherosclerosis and insulin resistance in the underlying pathophysiology of cardiac dysfunction in obesity patients.
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Affiliation(s)
- Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Nadine Pouw
- Department of Clinical Chemistry, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Yaar Aga
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Manuel C Cabezas
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Erasmus MC, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Erasmus MC, Rotterdam, The Netherlands
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Cheatley J, Aldea A, Lerouge A, Devaux M, Vuik S, Cecchini M. Tackling the cancer burden: the economic impact of primary prevention policies. Mol Oncol 2021; 15:779-789. [PMID: 33021030 PMCID: PMC7931126 DOI: 10.1002/1878-0261.12812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 01/04/2023] Open
Abstract
Cancer is a noncommunicable disease (NCD) with increasing incidence and therefore constitutes a major public health issue. To reduce the health and economic burden of cancer, policy-makers across the world have implemented a range of preventative interventions targeting risk factors with a known link to the disease. In this article, we examine the impact of six primary prevention interventions - related to physical inactivity, unhealthy diet or harmful alcohol use - on cancer-related health outcomes and healthcare expenditure. Here, we used the OECD Strategic Public Health Planning for NCDs (SPHeP-NCDs) model to quantify outcomes and costs for each intervention for years 2020-2050 across 37 countries. Results from the model indicate that all interventions could lead to a reduction in the number of new cancer cases, in particular those targeting harmful alcohol consumption. Introducing an alcohol tax, for instance, is estimated to reduce related cancer cases by 5619 a year or 174 193 by 2050. A breakdown of results by type of cancer revealed interventions had the largest impact on colorectal cancer with, on average, 41 140 cases avoided per intervention by 2050. In proportional terms, interventions had the greatest impact on new oesophageal and liver cancers. Findings from this article are designed to assist decision-makers efficiently allocate limited resources to meet public health objectives.
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Affiliation(s)
- Jane Cheatley
- Health DivisionOrganization of Economic Cooperation and DevelopmentParisFrance
| | - Alexandra Aldea
- Health DivisionOrganization of Economic Cooperation and DevelopmentParisFrance
| | - Aliénor Lerouge
- Health DivisionOrganization of Economic Cooperation and DevelopmentParisFrance
| | - Marion Devaux
- Health DivisionOrganization of Economic Cooperation and DevelopmentParisFrance
| | - Sabine Vuik
- Health DivisionOrganization of Economic Cooperation and DevelopmentParisFrance
| | - Michele Cecchini
- Health DivisionOrganization of Economic Cooperation and DevelopmentParisFrance
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Multiple Health Risk Factors in Vocational Education Students: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020637. [PMID: 33451108 PMCID: PMC7828627 DOI: 10.3390/ijerph18020637] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
Health risk factors such as tobacco smoking, inadequate fruit intake, inadequate vegetable intake, risky alcohol consumption, physical inactivity, obesity, anxiety and depression often commence during adolescence and young adulthood. Vocational education institutions enrol many students in these age groups making them an important setting for addressing multiple health risk factors. This systematic review examined (i) co-occurrence of health risk factors, (ii) clustering of health risk factors, and (iii) socio-demographic characteristics associated with co-occurrence and/or clusters of health risks among vocational education students. MEDLINE, PsycINFO, EMBASE, CINAHL and Scopus were searched to identify eligible studies published by 30 June 2020. Two reviewers independently extracted data and assessed methodological quality using the National Heart, Lung and Blood Institute Quality Assessment Tool. Five studies assessed co-occurrence and three studies clustering of health risks. Co-occurrence of health risk factors ranged from 29–98% and clustering of alcohol use and tobacco smoking was commonly reported. The findings were mixed about whether gender and age were associated with co-occurrence or clustering of health risks. There is limited evidence examining co-occurrence and clustering of health risk factors in vocational education students. Comprehensive assessment of how all these health risks co-occur or cluster in vocational education students is required.
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Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait. Healthcare (Basel) 2020; 8:healthcare8030251. [PMID: 32756311 PMCID: PMC7551336 DOI: 10.3390/healthcare8030251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 11/16/2022] Open
Abstract
Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity and tobacco use in the world. Cardiovascular diseases stemming from complications related to these and other risk factors are important health issues based on their morbidity and mortality implications. These risks are spread across society and affect the old as well as young boys. The serious gaps between Kuwait's health-related needs and the existing policies to reduce public health risks in Kuwait create a significant obstacle to healthy behaviour change. Kuwait requires adequate laws, policies, regulations, activities, and programs to promote people's health. The Socio-Ecological Model (SEM) has been used successfully in health promotion in various behavioural settings, including obesity, physical inactivity, and smoking. We propose the use of SEM as a planning framework in building sustainable health promotion programs in Kuwait while paying attention to other concepts such as systems thinking, authentic community participation, community capacity, policy development, public health infrastructure enhancement, health coaching, and equity.
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Bayer S, Drabsch T, Schauberger G, Hauner H, Holzapfel C. Responsibility of Individuals and Stakeholders for Obesity and a Healthy Diet: Results From a German Survey. Front Psychiatry 2020; 11:616. [PMID: 32719623 PMCID: PMC7350775 DOI: 10.3389/fpsyt.2020.00616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Overweight and obesity are thought to be mainly caused by an energy-rich diet and a sedentary lifestyle. The opinions of those with and without obesity about an individual´s and stakeholder´s responsibility for overweight and obesity as well as a healthy diet is rather unclear. Therefore, a survey was conducted to assess the thoughts of persons with and without obesity about the responsibilities for a high body weight and healthy diet. METHODS This telephone-based survey was conducted in Germany. Landline and mobile phone users older than 17 years were quota sampled to represent the German population (n=1,003). Additionally, 354 adults with a body mass index (BMI) ≥ 30 kg/m2 were included in the survey population. Questions on weight management, eating and drinking and anthropometry were asked. Furthermore, the opinions of participants on the responsibility of individuals and stakeholders for obesity and a healthy diet were collected. Data was statistically weighted by age, gender, education, domicile, and BMI. RESULTS Data of 1,357 persons (51.1% female, age: 50.5 ± 18.5 years, 15.9% with BMI ≥ 30 kg/m2) were analyzed. Participants responded that the general causes of a high body weight were low physical activity (82.7%) and excessive caloric intake (80.5%) followed by a lack of will power (72.1%). Almost 90% of the survey population reported that each individual is responsible for his/her own healthy diet. More than 85% of the survey population agreed that a healthy diet in kindergarten and nutrition education at schools should be the preferred approaches when politics take care of a person´s healthy diet. Sub-analyses revealed that BMI, sex, age, and education are potential confounders. CONCLUSION This German survey showed that the majority of participants indicated that the responsibility for a healthy diet lies with the individual and high body weight is caused by self-controlled attitudes. These results suggest that the survey population underestimates societal and environmental factors that contribute to the development of obesity, which could lead to attitudes that facilitate weight-related stigmatization. Furthermore, survey participants indicated that they would support policy-driven measures that promote a healthy diet.
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Affiliation(s)
- Sandra Bayer
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Theresa Drabsch
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Gunther Schauberger
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
- ZIEL - Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
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Vinolas H, Barnetche T, Ferrandi G, Monsaingeon-Henry M, Pupier E, Collet D, Gronnier C, Gatta-Cherifi B. Oral Hydration, Food Intake, and Nutritional Status Before and After Bariatric Surgery. Obes Surg 2020; 29:2896-2903. [PMID: 31102207 DOI: 10.1007/s11695-019-03928-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery is considered to be the most effective treatment of morbid obesity. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are the most popular procedures. We evaluated nutritional status, micro- and macronutrient intake, and oral hydration in patients before and regularly during 1 year after RYGBP and SG. METHODS All patients that had been through bariatric surgery with at least 1-year post-surgery were retrospectively included in the study. All participants were evaluated once during the 2 months before the surgery and at 1, 3, 6, and 12 months after surgery. Clinical and biological evaluations as well as dietary investigations were performed. RESULTS Fifty-seven patients were included in this study (28 RYGBP and 29 SG). Patients in the RYGBP group had significantly higher body weight (132.3 ± 22 versus 122.2 ± 22.2 kg, p = 0.039) than patients in the SG group. Before surgery, total energy intake, oral hydration, and vitamin and mineral intakes were not different between the two groups. RYGBP and SG induced significant similar excess weight loss 1 year after surgery, 48.6 29.8% and 57.6 27.6% of body weight respectively. Energy intake significantly decreased 1 month after surgery and slightly increased from 1 to 12 months without reaching baseline intake levels. Macronutrient repartition did not change during follow-up. Oral hydration significantly decreased after RYGBP (- 58%) and showed a trend to be decreased after SG (- 49%). Sixty-five percent of patients still had vitamin D deficiency 1 year after surgery. Whatever the type of surgery, more than 20% had some vitamin deficiency 1 month after surgery. CONCLUSIONS Calories intake decreases after bariatric surgery, whatever the type of procedure. In addition, the prevalence of vitamin deficiency is high after bariatric surgery. Lastly, oral hydration is importantly decreased after bariatric surgery, especially after RYGBP.
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Affiliation(s)
- Hélène Vinolas
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France
| | - Thomas Barnetche
- Rheumatology Department, FHU ACRONIM, Bordeaux University Hospital, Bordeaux, France
| | - Genevieve Ferrandi
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Emilie Pupier
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France
| | - Denis Collet
- Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France.,University of Bordeaux, F-33000, Bordeaux, France
| | - Caroline Gronnier
- Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France.,University of Bordeaux, F-33000, Bordeaux, France
| | - Blandine Gatta-Cherifi
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France. .,University of Bordeaux, F-33000, Bordeaux, France. .,Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, University of Bordeaux, U1215, F-33000, Bordeaux, France.
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How will the main risk factors contribute to the burden of non-communicable diseases under different scenarios by 2050? A modelling study. PLoS One 2020; 15:e0231725. [PMID: 32348352 PMCID: PMC7190114 DOI: 10.1371/journal.pone.0231725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background The future burden of non-communicable diseases (NCDs) depends on numerous factors such as population ageing, evolution of societal trends, behavioural and physiological risk factors of individuals (e.g. smoking, alcohol use, obesity, physical inactivity, and hypertension). This study aims to assess the burden of NCDs in Europe by 2050 under alternative scenarios. Methods This study combines qualitative and quantitative forecasting techniques to examine how population health in Europe may evolve from 2015 to 2050, taking into account future societal trends. Four scenarios were developed (one business-as-usual scenario, two response scenarios and one pessimistic scenario) and assessed against ‘best’ and ‘worst’-case scenarios. This study provides quantitative estimates of both diseases and mortality outcomes, using a microsimulation model incorporating international survey data. Findings Each scenario is associated with a different risk factor prevalence rate across Europe during the period 2015–2050. The prevalence and incidence of NCDs consistently increase during the analysed time period, mainly driven by population ageing. In more optimistic scenarios, diseases will appear in later ages, while in the pessimistic scenarios, NCDs will impair working-age people. Life expectancy is expected to grow in all scenarios, but with differences by up to 4 years across scenarios and population groups. Premature mortality from NCDs will be reduced in more optimistic scenarios but stagnate in the worst-case scenario. Interpretation Population ageing will have a greater impact on the spread of NCDs by 2050 compared to risk factors. Nevertheless, risk factors, which are influenced by living environments, are an important factor for determining future life expectancy in Europe.
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Stillhart C, Vučićević K, Augustijns P, Basit AW, Batchelor H, Flanagan TR, Gesquiere I, Greupink R, Keszthelyi D, Koskinen M, Madla CM, Matthys C, Miljuš G, Mooij MG, Parrott N, Ungell AL, de Wildt SN, Orlu M, Klein S, Müllertz A. Impact of gastrointestinal physiology on drug absorption in special populations––An UNGAP review. Eur J Pharm Sci 2020; 147:105280. [DOI: 10.1016/j.ejps.2020.105280] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
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Tobore TO. Towards a comprehensive theory of obesity and a healthy diet: The causal role of oxidative stress in food addiction and obesity. Behav Brain Res 2020; 384:112560. [DOI: 10.1016/j.bbr.2020.112560] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
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The effect of high-intensity interval training and moderate-intensity continuous training on aerobic fitness and body composition in males with overweight or obesity: A randomized trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.obmed.2020.100187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Symonds P, Hutchinson E, Ibbetson A, Taylor J, Milner J, Chalabi Z, Davies M, Wilkinson P. MicroEnv: A microsimulation model for quantifying the impacts of environmental policies on population health and health inequalities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 697:134105. [PMID: 32380606 PMCID: PMC7212697 DOI: 10.1016/j.scitotenv.2019.134105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/30/2019] [Accepted: 08/24/2019] [Indexed: 05/07/2023]
Abstract
The Sustainable Development Goals (SDGs) recognise the critical need to improve population health and environmental sustainability. This paper describes the development of a microsimulation model, MicroEnv, aimed at quantifying the impact of environmental exposures on health as an aid to selecting policies likely to have greatest benefit. Its methods allow the integration of morbidity and mortality outcomes and the generation of results at high spatial resolution. We illustrate its application to the assessment of the impact of air pollution on health in London. Simulations are performed at Lower Layer Super Output Area (LSOA), the smallest geographic unit (population of around 1500 inhabitants) for which detailed socio-demographic data are routinely available in the UK. The health of each individual in these LSOAs is simulated year-by-year using a health-state-transition model, where transition probabilities from one state to another are based on published statistics modified by relative risks that reflect the effect of environmental exposures. This is done through linkage of the simulated population in each LSOA with 1 × 1 km annual average PM2.5 concentrations and area-based deprivation indices. Air pollution is a leading cause of mortality and morbidity globally, and improving air quality is critical to the SDGs for Health (Goal 3) and Cities (Goal 11). The evidence of MicroEnv is aimed at providing better understanding of the benefits for population health and health inequalities of policy actions that affect exposure such as air quality, and thus to help shape policy decisions. Future work will extend the model to integrate other environmental determinants of health.
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Affiliation(s)
- Phil Symonds
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | | | | | - Jonathon Taylor
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | - James Milner
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Zaid Chalabi
- Institute of Environmental Design and Engineering, UCL, London, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Michael Davies
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | - Paul Wilkinson
- Institute of Environmental Design and Engineering, UCL, London, UK.
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O'Neill M, Kornas K, Rosella L. The future burden of obesity in Canada: a modelling study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:768-778. [PMID: 31429040 PMCID: PMC6900264 DOI: 10.17269/s41997-019-00251-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/16/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We applied the validated Obesity Population Risk Tool (OPoRT) to estimate the future burden of obesity in Canada using baseline risk factors attained through routinely collected survey data. METHODS OPoRT was developed using logistic regression with sex-specific generalized estimating equations to predict the 10-year prevalence of obesity (outcome BMI ≥ 30.0) among adults 18 and older. The algorithm includes 17 predictive factors, including socio-demographic and health behavioural characteristics. OPoRT demonstrated excellent discrimination (C-statistic ≥ 0.89) and achieved calibration. We applied OPoRT to Canadian Community Health Survey (2013/14) data to predict the future prevalence of obesity in Canada for a variety of population subgroups. RESULTS The predicted burden of obesity grew from 261 cases per 1000 in 2013/14 to 326 cases per 1000 in 2023/24 corresponding to a total of 8.54 million individuals with obesity. The burden is expected to be higher among males (347 cases per 1000) than females (305 cases per 1000). Individuals aged 35-49 had the highest predicted burden of obesity (374 cases per 1000) and the largest number of predicted cases (2.42 million), while individuals in the ≥ 65 age group had the lowest predicted burden (236 cases per 1000). The number of individuals with obesity per 1000 is highest among those severely food insecure (452 cases per 1000), compared with food secure individuals (324 cases per 1000). CONCLUSIONS OPoRT can be used to estimate the future population burden of obesity, to identify priority subgroups at an elevated risk. Burden estimates should be reflected in approaches to curb the future burden of obesity.
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Affiliation(s)
- Meghan O'Neill
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Suite 600, Toronto, ON, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Suite 600, Toronto, ON, M5T 3M7, Canada
| | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Suite 600, Toronto, ON, M5T 3M7, Canada.
- Institute for Clinical Evaluative Sciences, Room 424, 155 College Street, Toronto, ON, Canada.
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
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Iturriaga T, Barcelo O, Diez-Vega I, Cordero J, Pulgar S, Fernandez-Luna A, Perez-Ruiz M. Effects of a short workplace exercise program on body composition in women: A randomized controlled trial. Health Care Women Int 2019; 41:133-146. [PMID: 31638477 DOI: 10.1080/07399332.2019.1679813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Physical inactivity and poor diet cause alterations in body composition, which in turn increases risk factors for cardiovascular and metabolic diseases. Sixty-three women from different work environments were randomly assigned to an intervention (n = 34) or control (n = 29) group. The intervention was a short-term aerobic exercise program (12 weeks) at their workplace. Participants assigned to the control group did not perform any form of physical exercise. Body composition was measured by dual-energy X-ray absorptiometry (DXA). Diet was assessed using the Mediterranean Diet Quality Questionnaire (KIDMED) and nutrient balance by the Food Frequency Questionnaire. Researchers suggest that a short-term aerobic exercise program produces beneficial effects on body composition.
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Affiliation(s)
- Tamara Iturriaga
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Olga Barcelo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Ignacio Diez-Vega
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Jorge Cordero
- Medical Service, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Susana Pulgar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Alvaro Fernandez-Luna
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Margarita Perez-Ruiz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
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Aizawa M, Inagaki S, Moriyama M, Asano K, Kakehashi M. Modeling the natural history of fatty liver using lifestyle-related risk factors: Effects of body mass index (BMI) on the life-course of fatty liver. PLoS One 2019; 14:e0223683. [PMID: 31634357 PMCID: PMC6802837 DOI: 10.1371/journal.pone.0223683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022] Open
Abstract
Background Incident fatty liver increases the risk of non–alcoholic fatty liver disease (NAFLD), which may lead to end-stage liver diseases, and increase the risk of cardiovascular disease and diabetes. For its prevention, modeling the natural history of fatty liver is useful to demonstrate which lifestyle-related risk factors (e.g. body mass index and cholesterol) play the greatest role in the life-course of fatty liver. Methods Model predictors and their predictive algorithms were determined by prospective regression analyses using 5–year data from approximately 2000 Japanese men aged 20–69 years. The participants underwent health examinations and completed questionnaires on their lifestyle behaviors annually from 2012 to 2016. The life–course of fatty liver was simulated based on this participant data using Monte Carlo simulation methods. Sensitivity analyses were performed. The validity of the model was discussed. Results The body mass index (BMI) and low–density/high–density lipoprotein cholesterol (LDL–C/HDL–C) ratio significantly aided in predicting incident fatty liver. When the natural history of fatty liver was simulated using the data of participants aged 30–39 years, the prevalence increased from 20% to 32% at 40–59 years before decreasing to 24% at 70–79 years. When annual updates of BMI and LDL–C/HDL–C ratio decreased/increased by 1%, the peak prevalence of fatty liver (32%) changed by −8.0/10.7% and −1.6/1.4%, respectively. Conclusions We modeled the natural history of fatty liver for adult Japanese men. The model includes BMI and LDL‒C/HDL‒C ratio, which played a significant role in predicting the presence of fatty liver. Specifically, annual changes in BMI of individuals more strongly affected the life‒course of fatty liver than those in the LDL–C/HDL–C ratio. Sustainable BMI control for individuals may be the most effective option for preventing fatty liver in a population.
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Affiliation(s)
- Mika Aizawa
- Department of Health Informatics, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
- * E-mail:
| | - Seiichi Inagaki
- International University of Health and Welfare, Narita, Chiba, Japan
| | - Michiko Moriyama
- Department of Chronic Care and Family Nursing, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
| | - Kenichiro Asano
- Human Resources Department Health Management Promotion Office, Fujikura Ltd. Kiba, Koto Ward, Tokyo, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical & Health Sciences, Hiroshima University, Kasumi, Hiroshima, Japan
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The Effectiveness of Two Interventions on Fundamental Movement Skill Proficiency Among a Cohort of Irish Primary School Children. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2019. [DOI: 10.1123/jmld.2018-0011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the effectiveness of a physical activity (Year 1) and a multicomponent fundamental movement skill (FMS) (Year 2) intervention on primary school children’s FMS proficiency. Data were collected from 6- and 10-year-old cohorts from two intervention schools and age-matched groups from one control school, in south Ireland. In Year 1 (N = 187), intervention (n = 96) and control (n = 91) groups were children from senior infant (6-year-old cohort) and 4th class (10-year-old cohort). In Year 2 (N = 357), intervention (n = 195) and control (n = 162) groups were children from senior infant and 1st class (6-year-old cohort) and 4th and 5th classes (10-year-old cohort). FMS assessment was conducted across both academic years, using the Test of Gross Motor Development-2. Linear mixed models were used to investigate the effectiveness of each intervention, adjusting for age group. Following Year 1, the intervention group significantly improved locomotor proficiency (p < .05), with no changes in object-control or overall proficiency. No group-time interactions were found. Following Year 2, the intervention group significantly improved locomotor, object-control, and overall proficiency (p < .001). Group-time interaction effects were found for both subsets and overall FMS in favor of the intervention group (p < .001). FMS proficiency among primary school children was significantly greater following the multicomponent FMS intervention.
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Samodien E, Johnson R, Pheiffer C, Mabasa L, Erasmus M, Louw J, Chellan N. Diet-induced hypothalamic dysfunction and metabolic disease, and the therapeutic potential of polyphenols. Mol Metab 2019; 27:1-10. [PMID: 31300352 PMCID: PMC6717768 DOI: 10.1016/j.molmet.2019.06.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/18/2019] [Accepted: 06/27/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prevalence of obesity and metabolic diseases continues to rise globally. The increased consumption of unhealthy energy-rich diets that are high in fat and sugars results in oxidative stress and inflammation leading to hypothalamic dysfunction, which has been linked with these diseases. Conversely, diets rich in polyphenols, which are phytochemicals known for their antioxidant and anti-inflammatory properties, are associated with a reduced risk for developing metabolic diseases. SCOPE OF REVIEW This review provides an overview of the effects of polyphenols against diet-induced hypothalamic dysfunction with respect to neural inflammation and mitochondrial dysfunction. Results show that polyphenols ameliorate oxidative stress and inflammation within the hypothalamus, thereby improving leptin signaling and mitochondrial biogenesis. Furthermore, they protect against neurodegeneration by decreasing the production of reactive oxygen species and enhancing natural antioxidant defense systems. MAJOR CONCLUSIONS The potential of polyphenols as nutraceuticals against hypothalamic inflammation, mitochondrial dysfunction, and neurodegeneration could hold tremendous value. With hypothalamic inflammation increasing naturally with age, the potential to modulate these processes in order to extend longevity is exciting and warrants exploration. The continued escalation of mental health disorders, which are characterized by heightened neuronal inflammation, necessitates the furthered investigation into polyphenol therapeutic usage in this regard.
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Affiliation(s)
- Ebrahim Samodien
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa.
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa; Department of Medical Physiology, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa; Department of Medical Physiology, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Lawrence Mabasa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Melisse Erasmus
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa; Department of Medical Physiology, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Johan Louw
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa; Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Nireshni Chellan
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, Cape Town, South Africa; Department of Medical Physiology, Stellenbosch University, Tygerberg, Cape Town, South Africa
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Senellart P, Saint-Jalmes G, Mfam WS, Abou-Mrad A. Laparoscopic versus full robotic Roux-en-Y gastric bypass: retrospective, single-center study of the feasibility and short-term results. J Robot Surg 2019; 14:291-296. [DOI: 10.1007/s11701-019-00976-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/21/2019] [Indexed: 01/06/2023]
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Notara V, Magriplis E, Prapas C, Antonogeorgos G, Rojas-Gil AP, Kornilaki EN, Lagiou A, Panagiotakos DB. Parental weight status and early adolescence body weight in association with socioeconomic factors. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:77. [PMID: 31143794 PMCID: PMC6512222 DOI: 10.4103/jehp.jehp_14_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Childhood obesity remains a major health issue. The understanding of the multifactorial nature of childhood obesity remains the cornerstone to eliminate the rising trends. This study aimed to examine the association between parental and childhood weight status, in relation to various socioeconomic (SE) factors. METHODS A cross-sectional survey was conducted including 1190 children aged 10-12 years and their parents, during school years 2014-2016. Primary schools from five Greek counties (including Athens metropolitan area) were randomly selected. Parental and child data were collected through self-administered, anonymous questionnaires. Children's weight status was based on gender- and age-specific tables derived from the International Obesity Task Force body mass index (BMI) cut offs. General Linear Model (GLM), Univariate and multivariate analyses were applied. Multiple logistic regressions was used to determine the association between children and parents' weight status. RESULTS Childhood prevalence of overweight and obesity was 25.9% (21.8% overweight and 4.1% obese), with prevalence being significantly higher in males (31.7% compared to 21.3%; P for gender differences < 0.001). The percent of overweight and obese male (34.4% and 43.1%) and female children (20.3% and 31.8%) significantly increased with paternal overweight and obesity status, respectively. The same relationship was observed between male children and maternal overweight and obesity status (43.4% and 65.7%). This was not evident among females (27% and 23.2%). Regression analysis showed a significant positive association with parental BMI, a negative association with both parental educational levels (low to high), living space, and parental age (P < 0.05, for all). Children's likelihood of being overweight or obese increased significantly with increasing parental weight status (P < 0.001). CONCLUSIONS Parental weight status remained the most significant predictive factor for early adolescence obesity among various SE factors. Health promotion strategies should consider parental education as an effective childhood obesity preventive measure.
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Affiliation(s)
- Venetia Notara
- Department of Public and Community Health, University of West Attica, Athens, Greece
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Christos Prapas
- Department of Public and Community Health, University of West Attica, Athens, Greece
| | - George Antonogeorgos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Andrea Paola Rojas-Gil
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese, Sparta, Greece
| | | | - Areti Lagiou
- Department of Public and Community Health, University of West Attica, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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Choi E, Cho HN, Seo DH, Park B, Park S, Cho J, Kim S, Park YR, Choi KS, Rhee Y. Socioeconomic inequalities in obesity among Korean women aged 19-79 years: the 2016 Korean Study of Women's Health-Related Issues. Epidemiol Health 2019; 41:e2019005. [PMID: 30917463 PMCID: PMC6446067 DOI: 10.4178/epih.e2019005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/13/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES While the prevalence of obesity in Asian women has remained stagnant, studies of socioeconomic inequalities in obesity among Asian women are scarce. This study aimed to examine the recent prevalence of obesity in Korean women aged between 19 years and 79 years and to analyze socioeconomic inequalities in obesity. METHODS Data were derived from the 2016 Korean Study of Women’s Health-Related Issues. The chi-square test and logistic regression analysis were used to analyze the associations between socioeconomic factors and obesity using Asian standard body mass index (BMI) categories: low (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23.0-24.9 kg/m2 ), and obese (≥25.0 kg/ m2 ). As inequality-specific indicators, the slope index of inequality (SII) and relative index of inequality (RII) were calculated, with adjustment for age and self-reported health status. RESULTS Korean women were classified into the following BMI categories: underweight (5.3%), normal weight (59.1%), overweight (21.2%), and obese (14.4%). The SII and RII revealed substantial inequalities in obesity in favor of more urbanized women (SII, 4.5; RII, 1.4) and against of women who were highly educated (SII, -16.7; RII, 0.3). Subgroup analysis revealed inequalities in obesity according to household income among younger women and according to urbanization among women aged 65-79 years. CONCLUSIONS Clear educational inequalities in obesity existed in Korean women. Reverse inequalities in urbanization were also apparent in older women. Developing strategies to address the multiple observed inequalities in obesity among Korean women may prove essential for effectively reducing the burden of this disease.
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Affiliation(s)
- Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Ha Na Cho
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Da Hea Seo
- Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, Korea
| | - Boyoung Park
- Department of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sohee Park
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Juhee Cho
- Department of Clinical Research and Evaluation, Sungkyunkwan University, Seoul, Korea
| | - Sue Kim
- College of Nursing, Yonsei University, Seoul, Korea
| | - Yeong-Ran Park
- Division of Silver Industry, Kangnam University, Yongin, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Głuszewska A, Gryglewska B, Gąsowski J, Bilo G, Zarzycki B, Dzieża-Grudnik A, Major P, Budzyński A, Faini A, Parati G, Grodzicki T. Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension. Eur J Intern Med 2019; 60:39-45. [PMID: 30420135 DOI: 10.1016/j.ejim.2018.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 12/24/2022]
Abstract
UNLABELLED Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. AIM To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. MATERIALS & METHODS A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ± 11.3, BMI = 46.7 ± 5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. RESULTS Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. CONCLUSIONS Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension.
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Affiliation(s)
- Anna Głuszewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland.
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Grzegorz Bilo
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Bartosz Zarzycki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Anna Dzieża-Grudnik
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Piotr Major
- Department of General Surgery, Jagiellonian University, Medical College, Krakow, Poland
| | - Andrzej Budzyński
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Andrea Faini
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
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Screening and brief intervention for obesity in primary care: cost-effectiveness analysis in the BWeL trial. Int J Obes (Lond) 2019; 43:2066-2075. [PMID: 30705390 PMCID: PMC6776469 DOI: 10.1038/s41366-018-0295-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/23/2018] [Accepted: 11/29/2018] [Indexed: 12/24/2022]
Abstract
Background The Brief Intervention for Weight Loss Trial enrolled 1882 consecutively attending primary care patients who were obese and participants were randomised to physicians opportunistically endorsing, offering, and facilitating a referral to a weight loss programme (support) or recommending weight loss (advice). After one year, the support group lost 1.4kg more (95%CI 0.9 to 2.0): 2.4 kg versus 1.0 kg. We use a cohort simulation to predict effects on disease incidence, quality of life, and healthcare costs over 20 years. Methods Randomly sampling from the trial population, we created a virtual cohort of 20 million adults and assigned baseline morbidity. We applied the weight loss observed in the trial and assumed weight regain over four years. Using epidemiological data, we assigned the incidence of 12 weight-related diseases depending on baseline disease status, age, gender, body mass index. From a healthcare perspective, we calculated the quality adjusted life years (QALYs) accruing and calculated the incremental difference between trial arms in costs expended in delivering the intervention and healthcare costs accruing. We discounted future costs and benefits at 1.5% over 20 years. Results Compared with advice, the support intervention reduced the cumulative incidence of weight-related disease by 722/100,000 people, 0.33% of all weight-related disease. The incremental cost of support over advice was £2.01million/100,000. However, the support intervention reduced health service costs by £5.86 million/100,000 leading to a net saving of £3.85 million/100,000. The support intervention produced 992 QALYs/100,000 people relative to advice. Conclusions A brief intervention in which physicians opportunistically endorse, offer, and facilitate a referral to a behavioural weight management service to patients with a BMI of at least 30kg/m2 reduces healthcare costs and improves health more than advising weight loss.
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Snelder SM, de Groot-de Laat LE, Biter LU, Castro Cabezas M, van de Geijn GJ, Birnie E, Boxma-de Klerk B, Klaassen RA, Zijlstra F, van Dalen BM. Cross-sectional and prospective follow-up study to detect early signs of cardiac dysfunction in obesity: protocol of the CARDIOBESE study. BMJ Open 2018; 8:e025585. [PMID: 30523132 PMCID: PMC6286494 DOI: 10.1136/bmjopen-2018-025585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In view of the increasing occurrence of both obesity and heart failure, a growing overlap of these two clinical entities in the near future is expected. Significant advances in our understanding of the pathophysiological consequences of obesity for the cardiovascular system have been made over the past two decades. However, to optimise management and treatment of obesity patients, further research is required to improve early identification of cardiac dysfunction in obesity and to gain insight in the underlying pathophysiology. The CARdiac Dysfunction In OBesity - Early Signs Evaluation (CARDIOBESE) study has been designed to address these issues. METHODS AND ANALYSIS CARDIOBESE is a cross-sectional multicentre study of 100 obesity patients scheduled for bariatric surgery (body mass index (BMI) ≥35 kg/m2) without known cardiovascular disease, and 50 age-matched and gender-matched non-obese controls (BMI <30 kg/m2). Echocardiography, blood and urine biomarkers and Holter monitoring will be used to identify parameters that are able to show cardiac dysfunction at a very early stage in obesity patients (primary objective). Furthermore, a prospective follow-up study of obesity patients before and 1 year after bariatric surgery will be done to gain insight in the pathophysiology of obesity causing cardiac dysfunction (secondary objective). ETHICS AND DISSEMINATION The study was approved by the Medical Ethics Committee Toetsingscommissie Wetenschappelijk Onderzoek Rotterdam e.o. (TWOR). Inclusion of patients and controls is almost complete. Analyses of the investigations are currently being performed, and dissemination through peer-reviewed publications and conference presentations is expected from the first quarter of 2019. By identifying early markers of cardiac dysfunction in obesity, and by understanding the underlying pathophysiology of the abnormalities of these markers, the CARDIOBESE study may provide guidance for risk stratification, monitoring and treatment strategies for obesity patients.
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Affiliation(s)
- Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Gert-Jan van de Geijn
- Department of Clinical Chemistry, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Erwin Birnie
- Franciscus Academy - Research Centre, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht University, Rotterdam, The Netherlands
| | - Bianca Boxma-de Klerk
- Franciscus Academy - Research Centre, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - René A Klaassen
- Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Bolger LE, Bolger LA, O'Neill C, Coughlan E, O'Brien W, Lacey S, Burns C. Accuracy of Children's Perceived Skill Competence and its Association With Physical Activity. J Phys Act Health 2018; 16:1-8. [PMID: 30518294 DOI: 10.1123/jpah.2017-0371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Perceived movement competence is important in the relationship between actual competence and physical activity (PA). This study examines the accuracy of children's perceptions and investigates the relationship between perceived competence (PC) and PA. METHODS Data collected were part of Project Spraoi, a PA and nutrition-based intervention. Participants (N = 419) were senior infant/first class (n = 202, mean age: 6.5 [0.6] y) and fourth/fifth class (n = 217, mean age: 10.4 [0.6] y) children from 3 schools in Cork, Ireland. The Test of Gross Motor Development-2 and Pictorial Scale of Perceived Movement Skill Competence for Young Children assessed actual and PC in 6 locomotor and 6 object-control fundamental movement skills. Moderate to vigorous PA levels were measured by accelerometry. Wilcoxon signed-rank tests assessed the accuracy of PC. Hierarchical regression analysis investigated relationships between PC and both actual competence and moderate to vigorous PA. RESULTS Children had greater perceived overall and object-control competence than actual. Among younger children, there was no difference between perceived locomotor and actual, while older children had lower perceived locomotor competence than actual. PC did not predict actual competence. Perceived object-control and total PC were significant predictors of moderate to vigorous PA. CONCLUSIONS Children have inflated perceptions of their overall and object-control movement skill competency. Perceived object-control and total FMS is associated with PA and thus, interventions aimed at increasing PA among children should target PC.
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Cardoso S, Moreira PI. Diabesity and brain disturbances: A metabolic perspective. Mol Aspects Med 2018; 66:71-79. [PMID: 30321556 DOI: 10.1016/j.mam.2018.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
The last decades have been marked by an increased prevalence in non-communicable diseases such as obesity and type 2 diabetes (T2D) as well as by population aging and age-related (brain) diseases. The current notion that the brain and the body are interrelated units is gaining the attention of the scientific and medical community. Growing evidence demonstrates that there is a significant overlap in risk, comorbidity, and pathophysiological mechanisms across obesity, T2D and brain disturbances; settings that seem to be worsened when both obesity and T2D occur simultaneously, the so-called diabesity. Thereupon, there is a great concern to critically appraise and understand the mechanisms by which diabesity can affect brain responses, and may accelerate the decline in brain health. In this framework, metabolic disturbances mediated by altered insulin signaling and mitochondrial function arise among the multifactorial interactions described to occur between obesity, T2D and neurocognitive deficits. In this review we have compiled all the notions and evidence describing how diabesity negatively influences brain function putting the emphasis on insulin signaling pathway disturbances and mitochondrial anomalies. We also debate lifestyle interventions as amenable strategies to lessen metabolic anomalies and, consequently, diabesity-associated brain alterations.
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Affiliation(s)
- Susana Cardoso
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504, Coimbra, Portugal.
| | - Paula I Moreira
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504, Coimbra, Portugal; Institute of Physiology - Faculty of Medicine - University of Coimbra, 3000-548, Coimbra, Portugal.
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Pineda E, Sanchez-Romero LM, Brown M, Jaccard A, Jewell J, Galea G, Webber L, Breda J. Forecasting Future Trends in Obesity across Europe: The Value of Improving Surveillance. Obes Facts 2018; 11:360-371. [PMID: 30308509 PMCID: PMC6257099 DOI: 10.1159/000492115] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To project the prevalence of obesity across the WHO European region and examine whether the WHO target of halting obesity at 2010 levels by 2025 is achievable. METHODS BMI data were collected from online databases and the literature. Past and present BMI trends were extrapolated to 2025 using a non-linear categorical regression model fitted to nationally representative survey data. Where only 1 year of data was available, a flat trend was assumed. Where no data were available, proxy country data was used adjusted for demographics. RESULTS By 2025, obesity is projected to increase in 44 countries. If present trends continue, 33 of the 53 countries are projected to have an obesity prevalence of 20% or more. The highest prevalence is projected for Ireland (43%, 95% confidence interval (CI): 28-58%). Lithuania, Finland, and the Netherlands were each estimated to have an absolute increase of 2 percentage points in the prevalence of obesity between 2015 and 2025. DISCUSSION The quality of BMI data across Europe is highly variable, with fewer than 50% of the 53 countries having measured nationally representative data and often not enough data to interpret projections meaningfully. Nevertheless, the prevalence of obesity in the European Region appears to be increasing in most countries and, with it, the health and economic burden of its associated diseases. This paints a concerning picture of the future burden of obesity-related noncommunicable diseases across the region. Greater and continued effort for the implementation of effective preventive policies and interventions is required from governments.
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Affiliation(s)
- Elisa Pineda
- UCL Research Department of Epidemiology & Public Health, London, UK
| | | | | | | | - Jo Jewell
- Nutrition, Division of Non-Communicable Diseases and Health Promotion through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Gauden Galea
- Nutrition, Division of Non-Communicable Diseases and Health Promotion through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - João Breda
- Nutrition, Division of Non-Communicable Diseases and Health Promotion through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
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Acceptance and Commitment Therapy to Promote Value Attainment Among Individuals with overweight: A multiple baseline evaluation. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus JV, Webber L, Sheron N. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018; 69:718-735. [PMID: 29777749 DOI: 10.1016/j.jhep.2018.05.011] [Citation(s) in RCA: 436] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 02/06/2023]
Abstract
The burden of liver disease in Europe continues to grow. We aimed to describe the epidemiology of liver diseases and their risk factors in European countries, identifying public health interventions that could impact on these risk factors to reduce the burden of liver disease. As part of the HEPAHEALTH project we extracted information on historical and current prevalence and mortality from national and international literature and databases on liver disease in 35 countries in the World Health Organization European region, as well as historical and recent prevalence data on their main determinants; alcohol consumption, obesity and hepatitis B and C virus infections. We extracted information from peer-reviewed and grey literature to identify public health interventions targeting these risk factors. The epidemiology of liver disease is diverse, with variations in the exact composition of diseases and the trends in risk factors which drive them. Prevalence and mortality data indicate that increasing cirrhosis and liver cancer may be linked to dramatic increases in harmful alcohol consumption in Northern European countries, and viral hepatitis epidemics in Eastern and Southern European countries. Countries with historically low levels of liver disease may experience an increase in non-alcoholic fatty liver disease in the future, given the rise of obesity across most European countries. Liver disease in Europe is a serious issue, with increasing cirrhosis and liver cancer. The public health and hepatology communities are uniquely placed to implement measures aimed at reducing their causes: harmful alcohol consumption, child and adult obesity, and chronic infection with hepatitis viruses, which will in turn reduce the burden of liver disease.
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Affiliation(s)
| | - Helena Cortez-Pinto
- Departamento de Gastrenterologia, CHLN, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain; CHIP, Rigshospitalet, University of Copenhagen, Øster Alle 56, 5. sal, DK-2100 Copenhagen, Denmark
| | | | - Nick Sheron
- University of Southampton, Southampton SO17 1BJ, United Kingdom.
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Gazan R, Brouzes CMC, Vieux F, Maillot M, Lluch A, Darmon N. Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review. Adv Nutr 2018; 9:602-616. [PMID: 30239584 PMCID: PMC6140431 DOI: 10.1093/advances/nmy049] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/14/2018] [Indexed: 12/22/2022] Open
Abstract
A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.
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Affiliation(s)
- Rozenn Gazan
- MS-Nutrition, Marseille, France
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Chloé M C Brouzes
- UMR PNCA, AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | | | | | - Anne Lluch
- Danone Nutricia Research, Centre Daniel Carasso, Palaiseau, France
| | - Nicole Darmon
- MOISA, INRA, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, University of Montpellier, Montpellier, France
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Keaver L, Xu B, Jaccard A, Webber L. Morbid obesity in the UK: A modelling projection study to 2035. Scand J Public Health 2018; 48:422-427. [DOI: 10.1177/1403494818794814] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Morbid obesity (body mass index ⩾40 kg/m2) carries a higher risk of non-communicable disease and is associated with more complex health issues and challenges than obesity body mass index ≥30kg/m2 and <40kg/m2, resulting in much higher financial implications for health systems. Although obesity trends have previously been projected to 2035, these projections do not separate morbid obesity from obesity. This study therefore complements these projections and looks at the prevalence and development of morbid obesity in the UK. Methods: Individual level body mass index data for people aged >15 years in England, Wales (2004–2014) and Scotland (2008–2014) were collated from national surveys and stratified by sex and five-year age groups (e.g. 15–19 years), then aggregated to calculate the annual distribution of healthy weight, overweight, obesity and morbid obesity for each age and sex group. A categorical multi-variate non-linear regression model was fitted to these distributions to project trends to 2035. Results: The prevalence of morbid obesity was predicted to increase to 5, 8 and 11% in Scotland, England and Wales, respectively, by 2035. Welsh women aged 55–64 years had the highest projected prevalence of 20%. In total, almost five million people are forecast to be classified as morbidly obese across the three countries in 2035. Conclusions: The prevalence of morbid obesity is predicted to increase by 2035 across the three UK countries, with Wales projected to have the highest rates. This is likely to have serious health and financial implications for society and the UK health system.
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Affiliation(s)
- Laura Keaver
- Clinical Health and Nutrition Centre (CHANCE), Department of Health and Nutritional Science, Institute of Technology Sligo, Ireland
| | - Benshuai Xu
- Public Health Modelling, UK Health Forum, London, UK
| | | | - Laura Webber
- Public Health Modelling, UK Health Forum, London, UK
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Verma RK, Paraidathathu T, Taha NA, Chong WW. Perceptions of the Malaysian general public on community pharmacy-based weight management services. J Pharm Policy Pract 2018; 11:17. [PMID: 30094032 PMCID: PMC6081823 DOI: 10.1186/s40545-018-0146-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is now widely regarded as a main contributor to poor health. Involvement of community pharmacists can be a valuable tool in obesity management. However, there is still a lack of data in Malaysia on the potential involvement of and opportunities for community pharmacists in providing weight management services. Thus, it is essential to investigate the perceptions of the general public on weight management services in the community pharmacy setting. To evaluate the general public's perceptions on weight management services by community pharmacists in terms of perceived availability, utilization and factors influencing acceptability of services. METHODS A descriptive, cross sectional-survey was conducted using a self-administered questionnaire comprising of sections that focused on public preferences and options on weight management approaches, perceived availability of extended services and resources provided by community pharmacists in relation to weight management, utilization of these services and resources, and factors influencing acceptability of weight management services provided by community pharmacists. The questionnaires were distributed to the general public aged 18 years and above in Klang Valley, Malaysia. RESULTS A total of 730 respondents with a median age of 31 years participated in this study. Majority of respondents ranked dieticians as their preferred first line of consultation, with only about a quarter of respondents ranking community pharmacists as their preferred first or second line of consultation. Although more than half show of the study respondents perceived that community pharmacies they had visited offered services for measuring weight, height, blood pressure, blood glucose and blood cholesterol, fewer perceived that community pharmacies provided advice on physical activity and healthy eating to achieve weight loss. Additionally, majority of the respondents indicated that they had not utilized these services. However, most respondents perceived that community pharmacists should provide weight management services. The main factors influencing acceptability show of services included training of pharmacists, payment, waiting time and the issue of privacy. CONCLUSION The findings of this study demonstrated that the majority of respondents were in support of weight management services in community pharmacy; however only a low percentage reported utilizing these services. Factors influencing acceptability of services included payment, waiting time and the issue of privacy. With adequate training among pharmacists and increased awareness of services among the public, community pharmacists could play a larger and important role in addressing the issue of obesity in Malaysia.
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Affiliation(s)
- Rohit Kumar Verma
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000 Kuala Lumpur, Malaysia
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Thomas Paraidathathu
- Faculty of Health and Medical Sciences, Taylor’s University, 47500 Subang Jaya, Malaysia
| | - Nur Akmar Taha
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Edusphere, Persiaran Bestari, 63200 Cyberjaya, Selangor Malaysia
| | - Wei Wen Chong
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Rodriguez-Alvarez E, Lanborena N, Borrell LN. Obesity Inequalities According to Place of Birth: The Role of Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081620. [PMID: 30065204 PMCID: PMC6121896 DOI: 10.3390/ijerph15081620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 01/08/2023]
Abstract
This study examined obesity inequalities according to place of birth and educational attainment in men and in women in Spain. A cross-sectional study was conducted using data from the Spanish National Health Survey 2011–2012 and from the European Health Survey in Spain 2014. We used data for 27,720 adults aged 18–64 years of whom 2431 were immigrants. We used log-binomial regression to quantify the association of place of birth with obesity before and after adjusting for the selected characteristics in women and in men. We found a greater probability of obesity in immigrant women (PR: 1.42; 95% CI: 1.22–1.64) and a lower probability of obesity in immigrant men (PR: 0.73; 95% CI: 0.59–0.89) relative to natives after adjustment. Significant heterogeneity was observed for the association of place of birth and obesity according to education in men (p-interactions = 0.002): Men with lower educational levels (PR: 0.47; 95% CI: 0.26–0.83) have a protective effect against obesity compared with their native counterparts. This study suggests that place of birth may affect obesity in women and in men. However, this effect may be compounded with education differently for women and men.
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Affiliation(s)
- Elena Rodriguez-Alvarez
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
| | - Nerea Lanborena
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
| | - Luisa N Borrell
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
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Balanova YA, Shalnova SA, Deev AD, Imaeva AE, Kontsevaya AV, Muromtseva GA, Kapustina АV, Evstifeeva SE, Drapkina ОM. OBESITY IN RUSSIAN POPULATION — PREVALENCE AND ASSOCIATION WITH THE NON-COMMUNICABLE DISEASES RISK FACTORS. ACTA ACUST UNITED AC 2018. [DOI: 10.15829/1560-4071-2018-6-123-130] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Aim. Evaluation of the prevalence of obesity and association with the risk factors of chronic non-communicable diseases of the inhabitants of selected regions of Russia, by the data from ESSE-RF study.Material and methods. Representative selections investigated, of the inhabitants of 13 regions of Russia, totally 21768 participants, males n=8 304, females n=13 464, age 25-64 y. o., under the circumstances of the study “Epidemiology of cardiovascular diseases (ESSE-RF)”, with response ~80%. Standard questionnaire, consisting 12 modules, was developed based upon adapted international methods. For the risk factors prevalence assessment, the standard epidemiological methods were applied. Body mass (BM) was evaluated in the categories of body mass index (BMI) (Ketle index: BMI — Body mass, kg / height, m2). BM as BMI was evaluated as insufficient (BMI <18,5), normal (18,5≤ BMI ≤24,9), overweight (25,0≤ BMI ≤29,9), obesity grade I (30,0 ≤BMI ≤34,9), obesity grade II (35,0 ≤BMI ≤39,9) and obesity grade III (BMI ≥40,0). Abdominal obesity (AO) was assessed with the criteria: for males waist circumference (WC) ≥102 cm and for females ≥88 cm.Results. Mean BMI value among the participants was 27,6 kg/m2, with no gender difference. BMI increases with the age only in women. WC — 87,8 cm ±0,1, among males it was significantly higher than in females (92,9 cm vs 84,1 cm, p<0,001), increasing with age. The prevalence of obesity was higher among females comparing to males: by BMI — 30,8% vs 26,9%, p<0,001; by AO — 38,4% vs 24,3%, p<0,001. The prevalence of obesity in female inhabitants of rural regions was significantly higher comparing to citizens (p<0,001), and in the group of higher education, there was no difference among males wither by BMI (p<0,005), or by AO (p<0,001). There was no clear geographic gradient of the risk factors. The prevalence of obesity increases linearly with the age, in males from 14,3% to 36,3%, p<0,001, and in females from 10,7% to 52,3%, p<0,001. AO was more prevalent in women comparing to men in every of analyzed age group, and with the age this difference gets more profound. In the multifactorial model the associations of risk factors were analyzed, with any type of obesity. Close relation was found for obesity and raised levels of glucose and triglycerides, with alcohol overconsumption. Most significant associations were found for obesity and AH in both genders — OR: 2,71 and 2,52 in men and women, respectively. There was linear increase of AH prevalence with mean SBP and DBP, together with BM.Conclusion. In Russian population, obesity is associated most closely with alcohol overconsumption, increased glucose level, lipid disorders and especially strongly — with systemic hypertension, the factors that increase prevalence with age. Burden of this closely interrelated factors on healthcare system will increase with the portion of elderly inhabitants of the country. State of affairs demand for a complex approach based on the governmental politics on the control of populational levels of bodyweight, beginning at elementary school, with mass-media involvement, as the groceries manufacturers, regional governments.
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Pimpin L, Retat L, Fecht D, de Preux L, Sassi F, Gulliver J, Belloni A, Ferguson B, Corbould E, Jaccard A, Webber L. Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035. PLoS Med 2018; 15:e1002602. [PMID: 29990358 PMCID: PMC6039053 DOI: 10.1371/journal.pmed.1002602] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.
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Affiliation(s)
| | | | - Daniela Fecht
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Laure de Preux
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, United Kingdom
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, United Kingdom
| | - John Gulliver
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
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