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Long D, Mackenbach JP, Klokgieters S, Kalėdienė R, Deboosere P, Martikainen P, Heggebø K, Leinsalu M, Bopp M, Brønnum-Hansen H, Costa G, Eikemo T, Nusselder WJ. Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries. J Epidemiol Community Health 2023; 77:400-408. [PMID: 37094941 PMCID: PMC10176379 DOI: 10.1136/jech-2023-220342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts. DATA AND METHODS In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30-79 years in the period 1971-2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period. RESULTS Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes. CONCLUSIONS Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.
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Affiliation(s)
- Di Long
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | | | - Silvia Klokgieters
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Kristian Heggebø
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
- NOVA, Oslo Metropolitan University, Oslo, Norway
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, Sweden
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Giuseppe Costa
- Department of Clinical Medicine and Biology, University of Turin, Torino, Italy
| | - Terje Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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Ali J, Haider SMS, Ali SM, Haider T, Anwar A, Hashmi AA. Overall Clinical Features of Type 2 Diabetes Mellitus With Respect to Gender. Cureus 2023; 15:e35771. [PMID: 37020489 PMCID: PMC10071047 DOI: 10.7759/cureus.35771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Since patients with type 2 diabetes are frequently misdiagnosed, provided inappropriate management, or poorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients with respect to gender. Methods This was a multicenter, cross-sectional study that was conducted at various hospitals, using a non-probability sampling technique. The duration of the study was about six months, from January 1, 2022 to June 30, 2022. The study included 590 type 2 diabetes patients, ranging in age from 35 to 70 years. Age, gender, socioeconomic status, health status, co-morbidities, and diabetes symptoms were documented. A chi-square was applied to determine the association between overall symptoms associated with type 2 diabetes and gender. An independent t-test was applied to determine the significance level between means of demographic parameters. Results The study findings showed that out of 590 patients with diabetes, 310 (52.5%) were males and 280 (47.5%) were females. The male and female mean ages were 57.46±14.93 and 50.38±14.85 years, respectively, with a statistically significant gender difference (p<0.001). The prevalence of renal manifestation in type 2 patients with diabetes revealed a significant relationship (p<0.05) for both genders. The prevalence of ocular manifestations revealed a significant relationship with both genders (p<0.05) in terms of distortion and blurred vision. The prevalence of ocular manifestations revealed a significant relationship observed with both genders (p<0.05) in terms of shortness of breath, dyspnea severity, and severity of chest pain. Conclusion This study concluded that women with type 2 diabetes mellitus have a significantly higher frequency of muscular pain, urinary symptoms, neurological symptoms, and dermatological manifestations than men. In contrast, respiratory symptoms were significantly more pronounced in males than in females. The presence of comorbidities such as dyslipidemia significantly increased the probability of developing type 2 diabetes in both genders.
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Smoking and diabetes: sex and gender aspects and their impact on vascular diseases. Can J Cardiol 2023; 39:681-692. [PMID: 36702239 DOI: 10.1016/j.cjca.2023.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Smoking and diabetes mellitus (DM) have been identified as two major cardiovascular risk factors for many years. In the field of cardiovascular diseases, considering sex differences, or gender differences, or both has become an essential element in moving toward equitable and quality healthcare. We reviewed the impact of sex or gender on the link between smoking and DM. The risk of type 2 DM (T2DM) due to smoking has been established in both sexes at the same level. As is the case in the general population, the prevalence of smoking in those with DM is higher in men than in women, although the decrease in smoking observed in recent years is more pronounced in men than in women. Regarding chronic DM complications, smoking is an independent risk factor for all-cause mortality, as well as macrovascular and microvascular complications, in both sexes. Nevertheless, in T2DM, the burden of smoking appears to be greater in women than in men for coronary heart disease morbidity, women having a 50% higher risk of fatal coronary event. Women are more dependent to nicotine, cumulate psychosocial barriers to quitting smoking, and are more likely to gain weight, which might make it more difficult for them to quit smoking. Smoking cessation advice and treatments should take into account gender differences to improve the success and long-term maintenance of abstinence in people with and without DM. This might include interventions that address emotions and stress in women or designed to reach specific populations of men.
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Ciarambino T, Crispino P, Leto G, Mastrolorenzo E, Para O, Giordano M. Influence of Gender in Diabetes Mellitus and Its Complication. Int J Mol Sci 2022; 23:8850. [PMID: 36012115 PMCID: PMC9408508 DOI: 10.3390/ijms23168850] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
In medicine, there is growing evidence that gender differences are important and lead to variations in the pathophysiology and treatment of many diseases with traits that appear to be particularly relevant in influencing the outcomes of many morbid forms. Today, the inclusion of gender in biomedical research, to improve the scientific quality and scientific relevance of knowledge, of technology is an increasingly present element precisely due to the practical implications that derive from it. Gender differences describe the biological variability between women and men, which is, in turn, related to differences in the information contained in sex chromosomes, the specific gene expression of autosomes linked to sex, the different number and quality of sex hormones, and their different effects on systems and organs, without neglecting the fact that each of the sexes has different target organs on which these hormones act. Additionally, both genders undergo metabolic changes throughout their lives, and this is especially true for women who show more dramatic changes due to their role in reproduction. Gender differences are not only the result of our genetic makeup but are also mixed with socio-cultural habits, behaviors, and lifestyles, differences between women and men, exposure to specific environmental influences, different food and lifestyle styles or stress, or different attitude in compliance with treatments and disease prevention campaigns. Gender differences also affect behavior throughout life, and physical changes can have implications for lifestyle, social roles, and mental health. Therefore, determinism and therapeutic outcome in chronic diseases are influenced by a complex combination of biological and environmental factors, not forgetting that there are many interactions of social and biological factors in women and men. This review will address the role of gender differences in the management of various forms of diabetes and its complications considering the different biological functions of hormones, the difference in body composition, physiological differences in glucose and fat metabolism, also considering the role of the microbiota. intestinal, as well as the description of gestational diabetes linked to possible pathophysiological events typical of reproduction.
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Affiliation(s)
- Tiziana Ciarambino
- Internal Medicine Department, Hospital of Marcianise, ASL Caserta, 81037 Caserta, Italy
| | - Pietro Crispino
- Emergency Department, Hospital of Latina, ASL Latina, 04100 Latina, Italy
| | - Gaetano Leto
- Department of Experimental Medicine, University La Sapienza Roma, 00185 Roma, Italy
| | - Erika Mastrolorenzo
- Emergency Department, Hospital of Careggi, University of Florence, 50121 Florence, Italy
| | - Ombretta Para
- Internal Emergency Department, Hospital of Careggi, University of Florence, 50121 Florence, Italy
| | - Mauro Giordano
- Department of Medical Science, University of Campania, L. Vanvitelli, 81100 Naples, Italy
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Sialino LD, Picavet HSJ, Wijnhoven HAH, Loyen A, Verschuren WMM, Visser M, Schaap LS, van Oostrom SH. Exploring the difference between men and women in physical functioning: How do sociodemographic, lifestyle- and health-related determinants contribute? BMC Geriatr 2022; 22:610. [PMID: 35864451 PMCID: PMC9306105 DOI: 10.1186/s12877-022-03216-y] [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] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background To explore whether differences between men and women in the sensitivity to (strength of the association) and/or in the exposure to determinants (prevalence) contribute to the difference in physical functioning, with women reporting more limitations. Methods Data of the Doetinchem Cohort Study was used (n = 5856, initial ages 26–70 years), with follow-up measurements every 5 years (up to 20). Physical functioning (subscale SF-36, range:0–100), sex (men or women) and a number of socio-demographic, lifestyle- and health-related determinants were assessed. Mixed-model multivariable analysis was used to investigate differences between men and women in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to determinants of physical functioning. Results The physical functioning score among women was 6.55 (95%CI:5.48,7.61) points lower than among men. In general, men and women had similar determinants, but pain was more strongly associated with physical functioning (higher sensitivity), and also more prevalent among women (higher exposure). The higher exposure to low educational level and not having a paid job also contributed to the lower physical functioning score among women. In contrast, current smoking, mental health problems and a low educational level were more strongly associated with a lower physical functioning score among men and lower physical activity and higher BMI were more prevalent among men. Conclusions Although important for physical functioning among both men and women, our findings provide no indications for reducing the difference in physical functioning by promoting a healthy lifestyle but stress the importance of differences in pain, work and education.
Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03216-y.
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Affiliation(s)
- Lena Dirkje Sialino
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Susan J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne Loyen
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - W M Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura S Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sandra H van Oostrom
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Klokgieters S, Kok A, Rijnhart J, Visser M, Broese van Groenou M, Verschuren M, Picavet S, Huisman M. Comparative study of two birth cohorts: did the explanatory role of behavioural, social and psychological factors in educational inequalities in mortality change over time? BMJ Open 2022; 12:e052204. [PMID: 35260451 PMCID: PMC8905994 DOI: 10.1136/bmjopen-2021-052204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the contribution of behavioural, social and psychological factors to inequalities in mortality by educational level between birth cohorts. DESIGN Cohort-sequential design. SETTING Two population-based studies in the Netherlands: the Longitudinal Aging Study Amsterdam (LASA) and the Doetinchem Cohort Study (DCS). PARTICIPANTS Data from the LASA included 1990 individuals with birth years 1928-1937 (cohort 1) and 1938-1947 (cohort 2) and, for replication, data from the DCS included 2732 individuals with birth years 1929-1941 (cohort 1) and 1939-1951 (cohort 2). METHODS Years of education, 15-year mortality, lifestyle factors, social factors and psychological factors were modelled using multiple-group accelerated failure time models based on structural equation modelling to compare indirect effects between cohorts. RESULTS Both studies showed similar educational inequalities, with higher mortality among those with lower education. The indirect effects of education via smoking (LASA: difference in survival time ratio (TR)=1.0018, 95% CI 1.0000 to 1.0155, DCS: TR=1.0051, 95% CI 1.0000 to 1.0183), physical activity (LASA: TR=1.0056, 95% CI 1.00009 to 1.0132) and alcohol use (LASA: TR=1.0275, 95% CI 1.0033 to 1.0194) on mortality were stronger in cohort 2 than in cohort 1. In contrast to the other effects, alcohol use was the only factor that was associated positively with education and survival time, which effect increased in the most recent cohort. Emotional support, network size and cognitive functioning showed no difference between cohorts. CONCLUSIONS Smoking, physical activity and alcohol use contributed more to educational inequalities in mortality in recent cohorts. Hence, in addition to tackling fundamental social causes of inequality, policies focusing on intermediary mechanisms such as lifestyle need to adapt their targets to those that prove to be most important within a given time frame.
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Affiliation(s)
- Silvia Klokgieters
- Deparment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, The Netherlands
| | - Almar Kok
- Deparment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Judith Rijnhart
- Deparment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marjolein Broese van Groenou
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, Noord-Holland, The Netherlands
| | - Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Amsterdam, The Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Susan Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Martijn Huisman
- Deparment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, Noord-Holland, The Netherlands
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7
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Klokgieters SS, Kok AAL, Visser M, van Groenou MIB, Huisman M. Changes in the role of explanatory factors for socioeconomic inequalities in physical performance: a comparative study of three birth cohorts. Int J Equity Health 2021; 20:252. [PMID: 34895239 PMCID: PMC8665629 DOI: 10.1186/s12939-021-01592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to societal changes and changes in the availability of health promoting factors, explanatory factors of socioeconomic inequalities in health (SIH) may change with time. We investigate differences in the relative importance of behavioural, social and psychological factors for explaining inequalities in physical performance between three birth cohorts. METHODS Data came from N = 988, N = 1002, and N = 1023 adults aged 55-64 years, collected in 1992, 2002 and 2012 as part of the Longitudinal Aging Study Amsterdam. Physical performance was measured by three performance tests. We included lifestyle factors (physical activity, smoking, alcohol use and Body Mass Index (BMI)); social factors (network size, network complexity, divorce, social support); and psychological factors (mastery, self-efficacy and neuroticism). In multi-group mediation models, we tested whether the strength of indirect effects from socioeconomic position (SEP) via the explanatory factors to health differed between birth cohorts. Stronger indirect effects indicate an increase in the importance; weaker indirect effects indicate a decrease in importance. RESULTS Absolute SIH were present and similar across cohorts. The strength of indirect effects of SEP on physical performance through smoking, binge alcohol use, emotional support and mastery increased across cohorts. The indirect effects of BMI, network size, self-efficacy and neuroticism were similar across cohorts. CONCLUSIONS Inequalities in smoking, binge alcohol use, emotional support and mastery may have become more important for explaining SIH in recent cohorts of middle-aged adults. Policies that aim to reduce socioeconomic inequalities may need to adapt their targets of intervention to changing mechanisms in order to reduce SIH.
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Affiliation(s)
- Silvia S Klokgieters
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Uniersiteit Amsterdam, Amsterdam Public Health, de Boelelaan 1117, Amsterdam, Netherlands.
| | - Almar A L Kok
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Uniersiteit Amsterdam, Amsterdam Public Health, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Uniersiteit Amsterdam, Amsterdam Public Health, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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8
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Ibi D, Rietman ML, Picavet HSJ, van Klinken JB, van Dijk KW, Dollé MET, Verschuren WM. Adverse generational changes in obesity development converge at midlife without increased cardiometabolic risk. Obesity (Silver Spring) 2021; 29:1925-1938. [PMID: 34514749 PMCID: PMC8597017 DOI: 10.1002/oby.23260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obesity is becoming a global public health problem, but it is unclear how it impacts different generations over the life course. Here, a descriptive analysis of the age-related changes in anthropometric measures and related cardiometabolic risk factors across different generations was performed. METHODS The development of anthropometric measures and related cardiometabolic risk factors was studied during 26 years of follow-up in the Doetinchem Cohort Study (N = 6,314 at baseline). All analyses were stratified by sex and generation, i.e., 10-year age groups (20-29, 30-39, 40-49, and 50-59 years) at baseline. Generalized estimating equations were used to test for generational differences. RESULTS Weight, BMI, waist circumference, and prevalence of overweight and obesity were higher, in general, in the younger generations during the first 10 to 15 years of follow-up. From age 50 to 59 years onward, these measures converged in all generations of men and women. Among cardiometabolic risk factors, only type 2 diabetes showed an unfavorable shift between the two oldest generations of men. CONCLUSIONS It was observed that, compared with the older generations, the younger generations had obesity at an earlier age but did not reach higher levels at midlife and beyond. This increased exposure to obesity was not (yet) associated with increased prevalence of cardiometabolic risk factors.
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Affiliation(s)
- Dorina Ibi
- Leiden University Medical CenterLeidenthe Netherlands
- National Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - M. Liset Rietman
- National Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - H. S. J. Picavet
- National Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | | | | | - Martijn E. T. Dollé
- Leiden University Medical CenterLeidenthe Netherlands
- National Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - W.M. Monique Verschuren
- National Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
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9
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The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med 2018; 113:15-31. [PMID: 29752959 DOI: 10.1016/j.ypmed.2018.05.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health.
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Jeuring HW, Comijs HC, Deeg DJH, Stek ML, Huisman M, Beekman ATF. Secular trends in the prevalence of major and subthreshold depression among 55-64-year olds over 20 years. Psychol Med 2018; 48:1824-1834. [PMID: 29198199 DOI: 10.1017/s0033291717003324] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Studying secular trends in the exposure to risk and protective factors of depression and whether these trends are associated with secular trends in the prevalence of depression is important to estimate future healthcare demands and to identify targets for prevention. METHODS Three birth cohorts of 55-64-year olds from the population-based Longitudinal Aging Study Amsterdam were examined using identical methods in 1992 (n = 944), 2002 (n = 964) and 2012 (n = 957). A two-stage screening design was used to identify subthreshold depression (SUBD) and major depressive disorder (MDD). Multinomial logistic regression analyses were used to identify secular trends in depression prevalence and to identify factors from the biopsychosocial domains of functioning that were associated with these trends. RESULTS Compared with 1992, MDD became more prevalent in 2002 (OR 1.90, 95% CI 1.10-3.28, p = 0.022) and 2012 (OR 1.80, 95% CI 1.03-3.14, p = 0.039). This was largely attributable to an increase in the prevalence of chronic diseases and functional limitations. Socioeconomic and psychosocial improvements, including an increase in labor market participation, social support and mastery, hampered MDD rates to rise more and were also associated with a 32% decline of SUBD-rates in 2012 as compared with 2002 (OR 0.68, 95% CI 0.48-0.96, p = 0.03). CONCLUSIONS Among late middle-aged adults, there is a substantial net increase of MDD, which is associated with deteriorating physical health. If morbidity and disability continue to increase, a further expansion of MDD rates may be expected. Improving socioeconomic and psychosocial conditions may benefit public health, as these factors were protective against a higher prevalence of both MDD and SUBD.
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Affiliation(s)
- Hans W Jeuring
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Max L Stek
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
- Department of Sociology, VU University, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
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11
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Balaj M, McNamara CL, Eikemo TA, Bambra C. The social determinants of inequalities in self-reported health in Europe: findings from the European social survey (2014) special module on the social determinants of health. Eur J Public Health 2018; 27:107-114. [PMID: 28355634 DOI: 10.1093/eurpub/ckw217] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH). Method Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors. Result Absolute and relative inequalities in SRH were found in all countries and the magnitude of socio-economic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors. Conclusion The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors.
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Affiliation(s)
- Mirza Balaj
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Courtney L McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje A Eikemo
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clare Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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12
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Picavet HSJ, Blokstra A, Spijkerman AMW, Verschuren WMM. Cohort Profile Update: The Doetinchem Cohort Study 1987-2017: lifestyle, health and chronic diseases in a life course and ageing perspective. Int J Epidemiol 2017; 46:1751-1751g. [PMID: 29040549 PMCID: PMC5837330 DOI: 10.1093/ije/dyx103] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
- H S J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands and
| | - Anneke Blokstra
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands and
| | - Annemieke MW Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands and
| | - WM Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands and
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Braeken DCW, Rohde GGU, Franssen FME, Driessen JHM, van Staa TP, Souverein PC, Wouters EFM, de Vries F. Risk of community-acquired pneumonia in chronic obstructive pulmonary disease stratified by smoking status: a population-based cohort study in the United Kingdom. Int J Chron Obstruct Pulmon Dis 2017; 12:2425-2432. [PMID: 28860737 PMCID: PMC5565243 DOI: 10.2147/copd.s138435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Smoking increases the risk of community-acquired pneumonia (CAP) and is associated with the development of COPD. Until now, it is unclear whether CAP in COPD is due to smoking-related effects, or due to COPD pathophysiology itself. OBJECTIVE To evaluate the association between COPD and CAP by smoking status. METHODS In total, 62,621 COPD and 191,654 control subjects, matched by year of birth, gender and primary care practice, were extracted from the Clinical Practice Research Datalink (2005-2014). Incidence rates (IRs) were estimated by dividing the total number of CAP cases by the cumulative person-time at risk. Time-varying Cox proportional hazard models were used to estimate the hazard ratios (HRs) for CAP in COPD patients versus controls. HRs of CAP by smoking status were calculated by stratified analyses in COPD patients versus controls and within both subgroups with never smoking as reference. RESULTS IRs of CAP in COPD patients (32.00/1,000 person-years) and controls (6.75/1,000 person-years) increased with age and female gender. The risk of CAP in COPD patients was higher than in controls (HR 4.51, 95% CI: 4.27-4.77). Current smoking COPD patients had comparable CAP risk (HR 0.92, 95% CI: 0.82-1.02) as never smoking COPD patients (reference), whereas current smoking controls had a higher risk (HR 1.23, 95% CI: 1.13-1.34) compared to never smoking controls. CONCLUSION COPD patients have a fourfold increased risk to develop CAP, independent of smoking status. Identification of factors related with the increased risk of CAP in COPD is warranted, in order to improve the management of patients at risk.
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Affiliation(s)
- Dionne CW Braeken
- Department of Research and Education, CIRO, Horn
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
| | - Gernot GU Rohde
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht
| | - Frits ME Franssen
- Department of Research and Education, CIRO, Horn
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht
| | - Johanna HM Driessen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre (MUMC+), Maastricht
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Tjeerd P van Staa
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
- Department of Health eResearch, University of Manchester, Manchester
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
| | - Emiel FM Wouters
- Department of Research and Education, CIRO, Horn
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht
| | - Frank de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre (MUMC+), Maastricht
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
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14
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Tsiligianni I, Rodríguez MR, Lisspers K, LeeTan T, Infantino A. Call to action: improving primary care for women with COPD. NPJ Prim Care Respir Med 2017; 27:11. [PMID: 28202995 PMCID: PMC5434777 DOI: 10.1038/s41533-017-0013-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 01/15/2023] Open
Abstract
In this perspective-based article, which is based on findings from a comprehensive literature search, we discuss the significant and growing burden of chronic obstructive pulmonary disease in women worldwide. Chronic obstructive pulmonary disease now affects both men and women almost equally. Despite this, there remains an outdated perception of chronic obstructive pulmonary disease as a male-dominated disease. Primary care physicians play a central role in overseeing the multidisciplinary care of women with chronic obstructive pulmonary disease. Many women with chronic obstructive pulmonary disease delay seeking medical assistance, due to fear of stigmatization or dismissing symptoms as a 'smoker's cough'. Improving awareness is important to encourage women with symptoms to seek advice earlier. Once women do seek help, primary care physicians need to have knowledge of the nuances of female chronic obstructive pulmonary disease disease presentation to avoid mis- or delayed diagnosis, both of which are more common in women with chronic obstructive pulmonary disease than men. Subsequent management should consider gender-specific issues, such as differential incidences of comorbid conditions, potentially higher symptom burden, and a higher risk of exacerbations. Chronic obstructive pulmonary disease treatment and smoking cessation management should be specifically tailored to the individual woman and reviewed regularly to optimize patient outcomes. Finally, education should be an integral part of managing chronic obstructive pulmonary disease in women as it will help to empower them to take control of their disease.
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Affiliation(s)
- Ioanna Tsiligianni
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - Miguel Román Rodríguez
- Son Pisà Primary Care Health Center, Majorca, Baleares, Spain
- Instituto de Investigación Sanitaria de Mallorca (IdISPa) Baleares, Majorca, Spain
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Tze LeeTan
- The Edinburgh Clinic 306 Choa Chu Kang Ave 4 #01-685, Singapore, 680306, Singapore
| | - Antonio Infantino
- Italian Interdisciplinary Society for Primary Care, Casamassima, Bari, Italy
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15
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Hoogendijk EO, Deeg DJH, Poppelaars J, van der Horst M, Broese van Groenou MI, Comijs HC, Pasman HRW, van Schoor NM, Suanet B, Thomése F, van Tilburg TG, Visser M, Huisman M. The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings. Eur J Epidemiol 2016; 31:927-45. [PMID: 27544533 PMCID: PMC5010587 DOI: 10.1007/s10654-016-0192-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/13/2016] [Indexed: 12/14/2022]
Abstract
The Longitudinal Aging Study Amsterdam (LASA) is an ongoing longitudinal study of older adults in the Netherlands, which started in 1992. LASA is focused on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. The study is based on a nationally representative sample of older adults aged 55 years and over. The findings of the LASA study have been reported in over 450 publications so far (see www.lasa-vu.nl ). In this article we describe the background and the design of the LASA study, and provide an update of the methods. In addition, we provide a summary of the major findings from the period 2011-2015.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Poppelaars
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Marleen van der Horst
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Psychiatry, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bianca Suanet
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Fleur Thomése
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | | | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth and Life Sciences, EMGO + Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
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16
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Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev 2016; 37:278-316. [PMID: 27159875 PMCID: PMC4890267 DOI: 10.1210/er.2015-1137] [Citation(s) in RCA: 1057] [Impact Index Per Article: 132.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The steep rise of type 2 diabetes mellitus (T2DM) and associated complications go along with mounting evidence of clinically important sex and gender differences. T2DM is more frequently diagnosed at lower age and body mass index in men; however, the most prominent risk factor, which is obesity, is more common in women. Generally, large sex-ratio differences across countries are observed. Diversities in biology, culture, lifestyle, environment, and socioeconomic status impact differences between males and females in predisposition, development, and clinical presentation. Genetic effects and epigenetic mechanisms, nutritional factors and sedentary lifestyle affect risk and complications differently in both sexes. Furthermore, sex hormones have a great impact on energy metabolism, body composition, vascular function, and inflammatory responses. Thus, endocrine imbalances relate to unfavorable cardiometabolic traits, observable in women with androgen excess or men with hypogonadism. Both biological and psychosocial factors are responsible for sex and gender differences in diabetes risk and outcome. Overall, psychosocial stress appears to have greater impact on women rather than on men. In addition, women have greater increases of cardiovascular risk, myocardial infarction, and stroke mortality than men, compared with nondiabetic subjects. However, when dialysis therapy is initiated, mortality is comparable in both males and females. Diabetes appears to attenuate the protective effect of the female sex in the development of cardiac diseases and nephropathy. Endocrine and behavioral factors are involved in gender inequalities and affect the outcome. More research regarding sex-dimorphic pathophysiological mechanisms of T2DM and its complications could contribute to more personalized diabetes care in the future and would thus promote more awareness in terms of sex- and gender-specific risk factors.
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Affiliation(s)
- Alexandra Kautzky-Willer
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Jürgen Harreiter
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
| | - Giovanni Pacini
- Gender Medicine Unit (A.K.-W., J.H.), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria; and Metabolic Unit (G.P.), Institute of Neuroscience, National Research Council, 35127 Padua, Italy
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17
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Hulsegge G, Herber-Gast GCM, Spijkerman AMW, Susan H, Picavet J, van der Schouw YT, Bakker SJL, Gansevoort RT, Dollé MET, Smit HA, Monique Verschuren WM. Obesity and Age-Related Changes in Markers of Oxidative Stress and Inflammation Across Four Generations. Obesity (Silver Spring) 2016; 24:1389-96. [PMID: 27145150 DOI: 10.1002/oby.21515] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/24/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The prevalence of obesity increases with age and is higher in each younger generation (unfavorable generation shift). This may influence patterns of oxidative stress and inflammation. Age-related changes and generation shifts in markers of oxidative stress and inflammation were investigated, specifically addressing the role of body mass index (BMI). METHODS Four generations (aged 26-35, 36-45, 46-55, and 56-65 at baseline) (N = 5,155) were examined every 5 years for 15 years between 1993 and 2012. Random coefficient analyses were used to study age-related changes and generation shifts in BMI, γ-glutamyltransferase (GGT), uric acid (UA), and C-reactive protein (CRP). RESULTS Levels of BMI, UA, and CRP increased in all generations up to age 75, whereas GGT increased up to age 55. No consistent generation shifts were observed for GGT, UA, and CRP (P ≥ 0.05). Participants with a stable BMI (change ≤1 kg/m(2) /15 years) had either no or small increases with age in GGT, UA, and CRP, whereas participants with increasing BMI (increase >1 kg/m(2) /15 years) had much larger increases (P < 0.01). CONCLUSIONS The unfavorable age-related changes in obesity-related biochemical markers, particularly among individuals with increasing BMI, show the importance of maintaining a healthy weight to improve population levels of oxidative stress and inflammation.
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Affiliation(s)
- Gerben Hulsegge
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerrie-Cor M Herber-Gast
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annemieke M W Spijkerman
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | | - J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Martijn E T Dollé
- Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W M Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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