The Association of Healthy Lifestyle Behaviors with Overweight and Obesity among Older Adults from 21 Countries

Adherence to a healthy lifestyle and its association with cognitive impairment in community-dwelling older adults in Shanghai

Introduction

There is a growing body of recent literature linking the association of specific or multiple lifestyles with cognitive impairment, but most of these studies have been conducted in Western populations, and it is necessary to study multiple lifestyles and cognitive abilities in different populations, with the primary population of this study being a select group of community-dwelling older adults in Shanghai, China.

Methods

The sample included 2,390 community-dwelling Chinese participants. Their cognitive function was assessed using the Mini-Mental State Examination (MMSE). We defined a healthy lifestyle score on the basis of being non-smoking, performing ≥210 min/wk moderate/vigorous-intensity physical activity, having light to moderate alcohol consumption, eating vegetables and fruits daily, having a body mass index (BMI) of 18.5-23.9 kg/m2, and having a waist-to-hip ratio (WHR) <0.90 for men and <0.85 for women, for an overall score ranging from 0 to 6.

Results

Compared with participants with ≤2 healthy lifestyle factors, the adjusted odds ratio (OR) and 95% confidence interval (CI) for participants with 4, 5, and 6 healthy lifestyle factors were 0.53 (95% CI, 0.29-0.98), 0.40 (95% CI, 0.21-0.75), and 0.36 (95% CI, 0.16-0.79), respectively. Only WHR (OR = 0.54, 95% CI = 0.37-0.78) and physical activity (OR = 0.69, 95% CI = 0.51-0.92) were associated with cognitive impairment. A healthy lifestyle correlated with overall cognition (β = 0.066, orientation (β = 0.049), language ability (β = 0.060), delayed recall (β = 0.045) and executive function (β = 0.044) (P all < 0.05).

Conclusion

The study provides evidence on an inverse association between healthy lifestyles and cognitive impairment. We investigated whether healthy lifestyle was related to specific cognitive functions to provide a theoretical basis for accurate clinical prescription.

Dietary and Lifestyle Risk Factors of Obesity Among Young Adults: A Scoping Review of Observational Studies

PURPOSE OF REVIEW

Obesity is a growing public health concern worldwide, especially among young adults. This scoping review aims to identify and summarize the current evidence on dietary and lifestyle risk factors associated with obesity among young adults.

RECENT FINDINGS

A scoping review was performed using the PRISMA-ScR guidelines. A systematic search of five electronic databases published from inception to October 2023 was conducted. A total of 46 observational studies met the inclusion criteria and were included in the review. The findings suggest that high intake of energy-dense foods, unhealthy eating habits, poor sleep quality, and increased screen time were significant risk factors for obesity among young adults. In contrast, the association between obesity and sedentary behavior, low physical activity levels, alcohol consumption, and smoking habits was inconclusive. The reviewed evidence suggests that unhealthy dietary habits and lifestyle behaviors are associated with an increased risk of obesity among young adults. The findings highlight the need for further research on these modifiable risk factors to prevent and manage obesity among young adults.

Healthy lifestyle in late-life, longevity genes, and life expectancy among older adults: a 20-year, population-based, prospective cohort study

BACKGROUND

Lifestyle and longevity genes have different and important roles in the human lifespan; however, the association between a healthy lifestyle in late-life and life expectancy mediated by genetic risk is yet to be elucidated. We aimed to investigate the associations of healthy lifestyle in late-life and genetic risk with life expectancy among older adults.

METHODS

A weighted healthy lifestyle score was constructed from the following variables: current non-smoking, non-harmful alcohol consumption, regular physical activity, and a healthy diet. Participants were recruited from the Chinese Longitudinal Healthy Longevity Survey, a prospective community-based cohort study that took place between 1998 and 2018. Eligible participants were aged 65 years and older with available information on lifestyle factors at baseline, and then were categorised into unhealthy (bottom tertile of the weighted healthy lifestyle score), intermediate (middle tertile), and healthy (top tertile) lifestyle groups. A genetic risk score was constructed based on 11 lifespan loci among 9633 participants, divided by the median and classified into low and high genetic risk groups. Stratified Cox proportional hazard regression was used to estimate the interaction between genetic and lifestyle factors on all-cause mortality risk.

FINDINGS

Between Jan 13, 1998, and Dec 31, 2018, 36 164 adults aged 65 years and older were recruited, among whom a total of 27 462 deaths were documented during a median follow-up of 3·12 years (IQR 1·62-5·94) and included in the lifestyle association analysis. Compared with the unhealthy lifestyle category, participants in the healthy lifestyle group had a lower all-cause mortality risk (hazard ratio [HR] 0·56 [95% CI 0·54-0·57]; p<0·0001). The highest mortality risk was observed in individuals in the high genetic risk and unhealthy lifestyle group (HR 1·80 [95% CI 1·63-1·98]; p<0·0001). The absolute risk reduction was greater for participants in the high genetic risk group. A healthy lifestyle was associated with a gain of 3·84 years (95% CI 3·05-4·64) at the age of 65 years in the low genetic risk group, and 4·35 years (3·70-5·06) in the high genetic risk group.

INTERPRETATION

A healthy lifestyle, even in late-life, was associated with lower mortality risk and longer life expectancy among Chinese older adults, highlighting the importance of a healthy lifestyle in extending the lifespan, especially for individuals with high genetic risk.

FUNDING

National Natural Science Foundation of China.

TRANSLATION

For the Mandarin translation of the abstract see Supplementary Materials section.

Changes in health behaviours during the COVID-19 pandemic and effect on weight and obesity among older people in England

During COVID-19 lockdown, negative changes in health behaviours have been reported in European older adults. However, less is known about the consequences of these changes on weight gain and obesity, especially in older adults living in England. This study explored the association of health behaviour changes with weight and obesity in English older adults aged 50 years and older, during lockdowns in 2020. We included 4182 participants of the English Longitudinal Study of Ageing COVID-19 sub-study in June/July and Nov/Dec 2020 who also had pre-pandemic data. Perceived changes in health behaviours were regressed on weight and obesity, adjusted for pre-pandemic weight or obesity, and several covariates. Results suggested that less exercise, more sedentariness, eating more and alcohol drinking were associated with a significant increase in weight at both timepoints. Meanwhile, less sedentariness and eating less significantly reduced weight in Nov/Dec 2020. A higher risk of obesity at both timepoints was found in adults sitting, eating, or sleeping more than usual. To conclude, during UK lockdown, older people who engaged in risky health behaviours were at higher risks of weight gain and obesity both in the short run and long term. Considering potential health risks associated with obesity and disruptions in routine lifestyle in the older population even after the pandemic, improved weight management interventions are necessary nationwide.

Knowledge, attitude, and practice of body shape and fitness among university students in China

BACKGROUND

Body shape and fitness (BSF) is critical for overall well-being, while university students in China are subjected to stress, peer pressure, performance anxiety, busy schedules, and lack of sleep, which can easily lead to poor BSF. This study aimed to explore the knowledge, attitude, and practice of BSF and related factors among university students in China.

METHODS

This web-based cross-sectional study was conducted on students of 15 universities in China between September 1st and November 30th, 2022. The KAP scores were evaluated using a 38-item questionnaire, including social demography, knowledge, attitude, and practice. Univariable and multivariable regression analyses were performed to identify the factors associated with KAP.

RESULTS

A total of 995 valid questionnaires were collected. There were 431 (43.3%) males and 564 (56.7%) females. Most participants were sophomores (51.2%) and freshmen (36.3%). Most participants had a BMI of 18-24 kg/m2 (66.1%). The students scored highly on BSF-related knowledge (8.30 ± 1.49), moderately on attitude (37.20 ± 4.46), and low on practice (19.64 ± 4.62). Multivariate logistic regression analysis showed that attitude score (P = 0.001), sex (P = 0.001), grade (P = 0.011), body mass index (BMI) (P < 0.050), parent's education level (P = 0.005), monthly allowance (P < 0.050), and sleep quality and habits (P = 0.016) were independently associated with practice scores.

CONCLUSIONS

University students in China were found to have good knowledge, moderate attitude, and poor practice toward BSF. Attitude, sex, grade, BMI, parents' education, monthly living expenses, and sleep quality and habits affected their practice. More BSF-related courses or activities are required to motivate students, especially females.

Old age takes its toll: Long-run projections of health-related public expenditure in Luxembourg

This paper simulates long-term trends in Luxembourg's public expenditure on healthcare and on long-term care. We combine population projections with micro-simulations of individuals' health status that account for their demographic, socio-economic characteristics and their childhood circumstances. Model equations estimated on data from the SHARE survey and from several branches of Social Security provide a rich framework to study policy-relevant applications. We simulate public expenditure on healthcare and long-term care under different scenarios to evaluate the separate contributions of population ageing, costs of producing health-related services, and the distribution of health status across age cohorts. Results suggest that rising per capita expenditure on healthcare will mostly result from production costs, while rising expenditure on long-term care will mostly reflect population ageing.

Type D Personality and Health Behaviors in People Living with Obesity

BACKGROUND

Considering that health behaviors and personality traits play an important role in the formation of health attitudes, the main objective of this study was to evaluate the relations that occur between type D personality and health behaviors in a group of obese patients.

METHODS

443 adult patients with BMI ≥ 30 kg/m2, who had been hospitalized in selected hospital facilities in the Silesian Voivodeship (Poland), participated in the study. Respondents completed three standardized questionnaires-the Multidimensional Health Locus of Control Scale, version A (MHLC-A), the Inventory of Health Behaviors (IZZ), and the Type D Scale (DS-14).

RESULTS

Patients with type D personality were characterized by the least effective mental attitudes and preventive behaviors, and differed significantly from the other personality types (intermediate and non-type D). Type D personality increased the risk of initiating improper health behaviors by more than five times. Regarding the sense of health control, patients with type D personality had significantly lower scores for the Internal Dimension subscale (21.3 ± 3.1) and higher for the Powerful Others Dimension subscale (24.0 ± 2.6), compared to patients with intermediate and non-type D personality. Proper health behaviors correlated with an internal sense of health control; the strongest correlation, defined as a medium, was with Preventive Behaviors (R = 0.42; p < 0.0001).

CONCLUSIONS

Type D personality was associated with poorer attitudes towards health. Among obese respondents with a type D personality, there was a significantly higher prevalence of those who believed that their health status was a consequence of chance events.

Lifestyle choices mediate the association between educational attainment and BMI in older adults in China: A cross-sectional study

As the Chinese population ages, unhealthfully high body mass index (BMI) levels in older adults are becoming a public health concern as an unhealthfully high BMI is an ill-being condition and can contribute to the risk of disease. Education and lifestyle choices affect BMI; however, the evidence on the relationships and interactions among these factors remains unclear. This study aimed to investigate the mediating effect of lifestyle choices on educational attainment and BMI among older adults in China. Using the Chinese Family Panel Studies (CFPS) 2018 panel data, this study integrated personal- and family-level economic data libraries, including 7,359 adults aged ≥60 years. Lifestyle parameters included smoking amount and screen time. Height and weight values were used to calculate BMI. The chi-square test, binary logistic regression analysis, stepwise regression analysis, and bootstrapping mediating effect tests were used for data analysis. Single-factor chi-square test revealed differences in BMI levels among groups defined by sex, age, residence, marital status, per capita annual household income, education years, and lifestyle choices. Binary logistic regression showed that age, residence, education years, smoking amount, and screen time influenced BMI. Stepwise regression results showed that education years, smoking amount, and screen time were associated with BMI (t = 3.907, -4.902, 7.491, P < 0.001). The lifestyle variables had partial mediating effects on BMI. The mediating effect of lifestyle on BMI was 0.009, while smoking amount was 0.003, and screen time was 0.006. Unhealthfully high BMI levels are increasing among older adults in China and are affected by many factors. Lifestyle factors and educational attainment can interact, affecting BMI. Interventions should consider lifestyle factors and education attainment to help maintain healthy BMI and reduce unhealthfully high BMI incidence.

Prevalence and Clinical Conditions Related to Sarcopaenia among Older Persons Living in the Community

(1) Background: In health care and in society at large, sarcopaenia is a disorder of major importance that can lead to disability and other negative health-related events. Our study aim is to determine the prevalence of sarcopaenia among older people attended in primary care and to analyse the factors associated with this age-related clinical condition; (2) Methods: A multicentre cross-sectional study was conducted of 333 community-dwelling Spanish adults aged 65 years or more. Sociodemographic, clinical, functional, anthropometric, and pharmacological data were collected. Sarcopaenia was defined following European Working Group on Sarcopaenia in Older People (EWGSOP) criteria; (3) Results: Sarcopaenia was present in 20.4% of the study sample, and to a severe degree in 6%. The intensity of the association between sarcopaenia and frailty was weak-moderate (Cramer V = 0.45). According to the multinomial logistic regression model performed, sarcopaenia was positively associated with age and with the presence of psychopathology (OR = 2.72; 95% CI = 1.30–5.70) and was inversely correlated with body mass index (OR = 0.73, 95% CI = 0.67–0.80; (4) Conclusions: Sarcopaenia commonly affects community-dwelling older persons and may be associated with age, body mass index, and psychopathology. The latter factor may be modifiable or treatable and is therefore a possible target for intervention.

Glimpse into the Lifestyle of Doctors

Background

Lifestyle disorders are on rise world over. Also, the role of doctors as leaders in propagating healthy lifestyles needs to get a reality check. Aims and Objectives: This study aimed to investigate the prevalence of lifestyle disorders, eating habits, nutrition patterns, and lifestyle of doctors by assessing health-related behaviours considering gender and other relevant demographic parameters. The objectives of the present study are to find out the relationship of lifestyle disorders among doctors and to study lifestyle disorders and related behaviour among male and female doctors and other subgroups.

Materials and Methods

Online survey was conducted using Googledoc in June to August 2021. Descriptive statistical analysis has been carried out in the present study. The student's t-test (two tailed, independent) has been used.

Results

About 50% rated a happiness quotient of 7 and 8. Surgeons had more diabetes and hypertension than physicians. Prevalence of hypertension was more in self-employed males versus males in job. About two-third participants scored ≥ 80% on healthy lifestyle score.

Conclusion

Our results call for a well-thought strategy to overcome the financial and technological hindrances to accurately identify health risk factors and plan corrective interventions. A healthy lifestyle both in terms of diet and exercise should be incorporated into the schedules of doctors.

Prevalence of Obesity and Overweight among Adults in the Middle East Countries from 2000 to 2020: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity has become a significant public health issue worldwide, and it is a major risk factor for many noncommunicable diseases. This systematic review aimed to identify the prevalence of obesity and overweight in the Middle East region and different countries in this region.

MATERIALS AND METHODS

PubMed, Google Scholar, and MEDLINE databases were searched from 2000-2020 to identify relevant studies in the Middle East area. The survey was carried out using combinations of Medical Subject Headings (Mesh) keywords like "body mass index", "obesity", "overweight", "prevalence", "Middle-East", and "Countries in the Middle East area". Analysis of the data was done using STATA-14, and a random-effects model was used to estimate the pooled prevalence.

RESULTS

A total of 101 studies with 698905 participants have been identified that met inclusion criteria for this meta-analysis. The pooled estimates of the prevalence of obesity and overweight in the Middle East area were 21.17 (95% CI: 17.05-26.29) and 33.14 (95% CI: 26.87-40.87), respectively. The findings showed that obesity prevalence increased with age so that the highest prevalence of obesity and overweight was observed in people >40 years old. Obesity prevalence in the Middle East area remained steady between 2000-2006 and 2014-2020 (23%). During these time intervals, the prevalence of overweight decreased from 34.83 (95% CI: 32.40-37.45) to 32.85 (95% CI: 31.39-34.38).

CONCLUSIONS

Despite the relative stabilization of the overweight and obesity trend in the Middle East, current interventions to combat the overweight epidemic need to be maintained and strengthened because the prevalence of overweight and obesity in this region is still very high. The prevalence of obesity increases with age so that people over 40 have the highest percentage of obesity and overweight. Therefore, implementing intervention programs to prevent and control obesity and overweight in the Middle East is essential.

Association of central obesity and high body mass index with function and cognition in older adults

OBJECTIVE

To investigate the association of normal BMI with central obesity (CO), high BMI with CO, high BMI without CO, and normal BMI without CO, with function and cognition in older adults.

METHODS

Cross-sectional study involving 754 participants ≥ 65 years. Data collected include demographics, cognition, and physical measurements.

RESULTS

Females had a higher prevalence of high BMI with CO and a lower prevalence of high BMI without CO than males (61.0% vs 44.6% and 4.6% vs 15.0%, respectively). Within gender, CO groups, regardless of BMI, had lower mini-mental state examination (MMSE), handgrip strength (HGS), and longer timed-up-and-go (TUG) scores. Overall, the high BMI without CO group had the highest MMSE scores, HGS, and shortest TUG. Amongst males, HGS was significantly lower in the normal BMI with CO group (B -3.28, 95% CI -6.32 to -0.23, P = 0.04). CO, regardless of normal/high BMI, had significantly longer TUG time (B 2.65, 95% CI 0.45 to 4.84, P = 0.02; B 1.07, 95% CI 0.25 to 1.88, P = 0.01, respectively) than normal BMI without CO group. CO was associated with lower MMSE scores in both genders but significant only in males with normal BMI and CO (B -1.60, 95% CI -3.15 to -0.06, P = 0.04).

CONCLUSION

CO may be a better predictor of obesity and adverse outcomes in older adults. High BMI without CO was associated with better outcomes especially in males but require further validation. Prospective longitudinal studies are needed to ascertain the impact of BMI and/or CO on function, cognition, mortality, and gender differences.