Physical Activity and Lipid Profile in the ELSA- Brasil Study

Changes in cardiovascular-health blood biomarkers in response to exercise intervention among older adults with cognitive frailty: A scoping review

Introduction: Cardiovascular health contributes significantly to the incidence of cognitive impairment. Prior to conducting exercise-related intervention, it is crucial to explore cardiovascular health blood parameters that have been commonly used as guidance for the purpose of monitoring. Information on the effectiveness of exercise on cardiovascular-related biomarkers is lacking, especially among older adults with cognitive frailty. Therefore, we aimed to review existing evidence on cardiovascular-related blood parameters and their changes following exercise intervention among older adults with cognitive frailty. Methods: A systematic search was conducted on PubMed, Cochrane, and Scopus databases. Related studies involving only human and full text in either English or Malay language were selected. Types of impairment were limited to cognitive impairment, frailty, and cognitive frailty. Studies were restricted to randomized controlled trial and clinical trial design studies. For charting purposes, all variables were extracted and tabulated. Trends in types of parameters studied were explored. Results: A total of 607 articles were screened, and the final 16 were included in this review. Four cardiovascular-related blood parameter categories were extracted: inflammatory, glucose homeostasis, lipid profile, and hemostatic biomarkers. The common parameters monitored were IGF-1 and HbA1c, glucose, and insulin sensitivity in some studies. Out of the nine studies on inflammatory biomarkers, exercise interventions showed a reduction in pro-inflammatory markers, namely, IL-6, TNF-α, IL-15, leptin, and C-reactive protein and an increase in anti-inflammatory markers, namely, IFN-γ and IL-10. Similarly, in all eight studies, glucose homeostasis-related biomarkers had improved with exercise intervention. The lipid profile was tested in five studies, with four studies showing improvements with exercise intervention via a decrease in total cholesterol, triglycerides, and low-density lipoprotein and an increase in high-density lipoprotein. A decrease in pro-inflammatory biomarkers and an increase in anti-inflammatory biomarkers were demonstrated with multicomponent exercise, including aerobic exercise in six studies and aerobic exercise on its own in the remaining two studies. Meanwhile, four out of six studies that yielded improvements in glucose homeostasis biomarkers involved only aerobic exercise and the remaining two studies involved multicomponent with aerobic exercise. Conclusion: The most consistent blood parameters studied were glucose homeostasis and inflammatory biomarkers. These parameters have been shown to improve with multicomponent exercise programs, particularly with the inclusion of aerobic exercise.

Consumption of Omega-3 and Maintenance and Incidence of Depressive Episodes: The ELSA-Brasil Study

Depression affects 264 million persons in the world, accounting for some 4.3% of the global burden of disease. Current studies indicate that the decrease in the consumption of omega-3 food sources is associated with the increasing incidence of depression. The study aims to assess the association between the consumption of omega-3 and the maintenance and incidence of depressive episodes in adults (39−64 years) and elderly adults (>65 years). This was a longitudinal study using data from the baseline and first follow-up wave of the Longitudinal Study of Adult Health (ELSA-Brasil). Depressive episodes were obtained with the Clinical Interview Schedule Revised (CIS-R), and food consumption was measured with the Food Frequency Questionnaire (FFQ). Logistic regression was used to analyze associations between the consumption of omega-3 and depressive episodes. Fatty acids from the omega-3 family showed a protective effect against the maintenance of depressive episodes. In relation to incidence, the estimates suggest that the higher the consumption of omega-3 acids, the lower the risk of developing depressive episodes, and significant associations were found between the consumption of omega-3 and alpha-linolenic acid. Dietary consumption of omega-3, DHA, EPA, DPA, and alpha linolenic fatty acids may have a protective effect against the maintenance and incidence of depressive episodes.

Adherence to a Healthy Lifestyle and the Risk of All-Cause Mortality and Cardiovascular Events in Individuals With Diabetes: The ARIC Study

Objective: The relationship between combined healthy lifestyle and cardiovascular (CV) events in diabetes is unclear. We aim to investigate the association between a healthy lifestyle score (HLS) and the risk of mortality and CV events in diabetes.

Methods: We examined the associations of six lifestyle factors scores (including healthy diet, moderate alcohol and regular coffee intakes, never smoking, physical activity, and normal weight) with diabetes in the Atherosclerosis Risk in Communities (ARIC) study of 3,804 participants with diabetes from the United States at baseline. Primary outcomes included all-cause mortality, CV mortality, and composite CV events (heart failure hospitalizations, myocardial infarction, fatal coronary heart disease, and stroke).

Results: Among these diabetic participants, 1,881 (49.4%), 683 (18.0%), and 1,600 (42.0%) cases of all-cause mortality, CV mortality, and CV events were documented, respectively, during the 26 years of follow-up. Further, the prevalence of these adverse events became lower with the increase of HLS (all P < 0.001). In the risk-factors adjusted Cox regression model, compared to participants with HLS of 0, participants with HLS of 2 had significant lower risk of all-cause mortality (HR = 0.811, 95% CI: 0.687–0.957, P = 0.013), CV mortality (HR = 0.744, 95% CI: 0.576–0.962, P = 0.024), and CV events (HR = 0.789, 95% CI: 0.661–0.943, P = 0.009). The association of HLS with CV events was stronger for women than men (P for interaction <0.05).

Conclusion: Adherence to a healthy lifestyle was associated with a lower risk of CV events and mortality in diabetics. Our findings suggest that the promotion of a healthy lifestyle would help reduce the increasing healthcare burden of diabetes.

Clinical Trial Registration:https://clinicaltrials.gov, Identifier: NCT00005131.

The fit-active profile to better reflect the benefits of a lifelong vigorous physical activity participation: mini-review of literature and population data

Physical activity is favourably considered for its effect on metabolic fitness and body composition. This observation is generally supported by observational studies and is concordant with endurance-trained individuals' metabolic and morphological profiles. However, in some contexts, the measurement of physical activity habits may not provide an adequate representation of its benefits. In this paper, we review relevant literature on the respective effects of fitness and physical activity on anthropometric and metabolic variables and the informative potential of a classification based on aerobic fitness and activity indicators. The relevance to defining a profile based on both fitness and activity is reinforced by data from the Quebec Family Study showing that, in both men and women, "fit-active" individuals displayed a much more favourable morphological and metabolic profile than "unfit-inactive" individuals. Moreover, these benefits seemed to be more related to variations in fitness than in physical activity. In summary, evidence suggests that a profile combining information on aerobic fitness and physical activity may better reflect the lifelong impact of physical activity on body composition and health. Novelty: The fit-active profile better reflects the long-term benefits of vigorous physical activity participation on health. The reported benefits seem to be more related to variations in aerobic fitness than to those in physical activity.

Additional Metabolic Effects of Bariatric Surgery in Patients with a Poor Mid-Term Weight Loss Response: A 5-Year Follow-Up Study

To ascertain the 5-year metabolic effects of bariatric surgery in poor weight loss (WL) responders and establish associated factors. Methods: Retrospective analysis of a non-randomised prospective cohort of bariatric surgery patients completing a 5-year follow-up. Mid-term poor WL was considered when 5-year excess weight loss was <50%. Results: Forty-three (20.3%) of the 212 included patients were mid-term poor WL responders. They showed an improvement in all metabolic markers at 2 years, except for total cholesterol. This improvement with respect to baseline was maintained at 5 years for plasma glucose, HbA1c, HOMA, HDL and diastolic blood pressure; however, LDL cholesterol, triglycerides and systolic blood pressure were similar to presurgical values. Comorbidity remission rates were comparable to those obtained in the good WL group except for hypercholesterolaemia (45.8% vs. poor WL, p = 0.005). On multivariate analysis, lower baseline HDL cholesterol levels, advanced age and lower preoperative weight loss were independently associated with poor mid-term WL. Conclusions: Although that 1 in 5 patients presented suboptimal WL 5 years after bariatric surgery, other important metabolic benefits were maintained.

A healthy lifestyle pattern and the risk of symptomatic gallstone disease: results from 2 prospective cohort studies

BACKGROUND

Symptomatic gallstones cause high financial and disease burden for public health systems. The combined role of diet and other lifestyle factors has not been studied so far.

OBJECTIVES

We aimed to investigate the association between an a priori defined healthy lifestyle score (HLS, including healthy diet, moderate alcohol and regular coffee intakes, never smoking, physical activity, and normal weight) and the risk of symptomatic gallstone disease, and to estimate the proportion of cases potentially preventable by lifestyle modification.

METHODS

We followed 60,768 women from the Nurses' Health Study (NHS) and 40,744 men from the Health Professionals Follow-up Study (HPFS), both ongoing prospective cohort studies, from baseline (1986) until 2012. Symptomatic gallstone disease was self-reported and validated by review of medical records. The association between the HLS and the risk of symptomatic gallstone disease was investigated using Cox proportional hazards regression.

RESULTS

During 1,156,079 and 769,287 person-years of follow-up, respectively, 6946 women and 2513 men reported symptomatic gallstone disease. Comparing 6 with 0 points of the HLS, the multivariable HR of symptomatic gallstone disease was 0.26 (95% CI: 0.15, 0.45) for women, and 0.17 (95% CI: 0.07, 0.43) for men. For individual lifestyle factors, multivariable and mutually adjusted partial population attributable risks (women and men) were 33% and 23% for BMI <25 kg/m2, 10% and 18% for ≥2 cups of coffee per day, 13% and 7% for moderate alcohol intake, 8% and 11% for a high Alternate Healthy Eating Index 2010, 9% and 5% for being physically active, and 1% and 5% for never smoking. The full population attributable risk percentage for all factors combined was 62% and 74%, respectively.

CONCLUSIONS

Findings from these large prospective studies indicate that adopting a healthy lifestyle, especially maintaining a healthy weight, can help to prevent a considerable proportion of symptomatic gallstone diseases.

Physical Activity Modulating Lipid Metabolism in Gallbladder Diseases

Physical activity encompasses a series of overall benefits on cardiovascular health and metabolic disorders. Research has recently focused on the hepatobiliary tract, as an additional target of the health-related outcomes of different types of physical exercise. Here, we focus on the global features of physical activity with respect to exercise modality and intensity, and on studies linking physical activity to lipid metabolism, gallbladder diseases (gallstones, symptoms, complications and health-related quality of life), gallbladder motor-function, enterohepatic circulation of bile acids, and systemic metabolic inflammation. Additional studies need to unravel the pathophysiological mechanisms involved in both beneficial and harmful effects of physical activity in populations with different metabolic conditions.

Altered composition and functional profile of high-density lipoprotein in leprosy patients

The changes in host lipid metabolism during leprosy have been correlated to fatty acid alterations in serum and with high-density lipoprotein (HDL) dysfunctionality. This is most evident in multibacillary leprosy patients (Mb), who present an accumulation of host lipids in Schwann cells and macrophages. This accumulation in host peripheral tissues should be withdrawn by HDL, but it is unclear why this lipoprotein from Mb patients loses this function. To investigate HDL metabolism changes during the course of leprosy, HDL composition and functionality of Mb, Pb patients (paucibacillary) pre- or post-multidrug therapy (MDT) and HC (healthy controls) were analyzed. Mb pre-MDT patients presented lower levels of HDL-cholesterol compared to HC. Moreover, Ultra Performance Liquid Chromatography-Mass Spectrometry lipidomics of HDL showed an altered lipid profile of Mb pre-MDT compared to HC and Pb patients. In functional tests, HDL from Mb pre-MDT patients showed impaired anti-inflammatory and anti-oxidative stress activities and a lower cholesterol acceptor capacity compared to other groups. Mb pre-MDT showed lower concentrations of ApoA-I (apolipoprotein A-I), the major HDL protein, when compared to HC, with a post-MDT recovery. Changes in ApoA-I expression could also be observed in M. leprae-infected hepatic cells. The presence of bacilli in the liver of a Mb patient, along with cell damage, indicated hepatic involvement during leprosy, which may reflect on ApoA-I expression. Together, altered compositional and functional profiles observed on HDL of Mb patients can explain metabolic and physiological changes observed in Mb leprosy, contributing to a better understanding of its pathogenesis.

Could Omega 3 Fatty Acids Preserve Muscle Health in Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a high prevalence of death due to cardiometabolic diseases. As observed during the aging process, several comorbidities, such as cardiovascular disorders (CVD), insulin resistance, metabolic syndrome and sarcopenia, are frequently associated to RA. These abnormalities could be closely linked to alterations in lipid metabolism. Indeed, RA patients exhibit a lipid paradox, defined by reduced levels of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol whereas the CVD risk is increased. Moreover, the accumulation of toxic lipid mediators (i.e., lipotoxicity) in skeletal muscles can induce mitochondrial dysfunctions and insulin resistance, which are both crucial determinants of CVD and sarcopenia. The prevention or reversion of these biological perturbations in RA patients could contribute to the maintenance of muscle health and thus be protective against the increased risk for cardiometabolic diseases, dysmobility and mortality. Yet, several studies have shown that omega 3 fatty acids (FA) could prevent the development of RA, improve muscle metabolism and limit muscle atrophy in obese and insulin-resistant subjects. Thereby, dietary supplementation with omega 3 FA should be a promising strategy to counteract muscle lipotoxicity and for the prevention of comorbidities in RA patients.

The Lifestyle Characteristics in Non-Alcoholic Fatty Liver Disease in the PERSIAN Guilan Cohort Study

BACKGROUND:

Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease worldwide. Since the effect and safety of pharmacotherapy for NAFLD are unknown, the proper management of lifestyle is crucial.

AIM:

The present study was conducted to determine the status of food, Physical Activity (PA), and sleep in patients with and without NAFLD.

METHODS:

In this analytical- cross-sectional study, 630 clients with 36-60 years old who referred to the PERSIAN Guilan cohort study were included through simple non-random sampling. The developed questionnaire and lifestyle characteristics, including the status of nutrition, physical activity, and sleep, were completed for all samples. BMI was also calculated by determining weight and height, and fatty liver was confirmed based on abdominal ultrasound.

RESULTS:

The prevalence of NAFLD in this study was by 43.7% (275 / 630). Smoking, alcohol consumption, BMI, and weight loss over the past six months, regular exercise and exercise intensity, sedentary living, speed of eating, consuming fatty food, red meat, sweets beverages, and use of saturated fatty acid (SFA), and consuming fruits and vegetables were associated with presence of NAFLD (all p < 0.05). However, no significant relationship was observed between the parameters of sleep duration, the interval between dinner and night sleep, consuming breakfast and snack during the day and NAFLD (All p > 0.05).

CONCLUSION:

The onset and progression of NAFLD are associated with lifestyle. Therefore, dietary therapy solutions, physical activity, and sleep and rest situations should be paid attention for people with or at risk of NAFLD.

[Alcohol consumption and lipid profile in participants of the Longitudinal Study of Adult Health (ELSA-BRASIL)]

Introduction

Introduction: dyslipidemias are commonly defined by low levels of HDL-c and high levels of triglycerides and LDL-c as an alteration in the functioning of lipoproteins. Several factors are related to this pathogenesis, and one of them is the consumption of alcohol, presenting divergences between the amount and the type of alcoholic drink that must be consumed to find effects of association with the lipid parameters. Objective: to investigate the relationship between alcohol consumption and the type of alcoholic beverage with HDL-c and triglycerides in participants of the Longitudinal Study of Adult Health (ELSA-Brazil). Methods: observational, cross-sectional study, developed from baseline data from the ELSA-Brazil (2008-2010). The consumption of alcoholic beverages was estimated in doses/week and categorized in tertiles (1-7, 7-14 and > 14 doses/week) and by type of alcoholic beverage (beer, wine and distillates). Lipid parameters were used as continuous data. Linear regression models were performed for each type of alcoholic beverage. The confidence level was 5%. Results: HDL-c and triglycerides increased with the increase in the number of doses/week of beer. The consumption of wine between 1-7 and 7-14 doses/week raises HDL-c. Conversely, triglycerides tend to decrease when consumption is 1-7 doses/week. Consumption of distillates > 14 doses/week increase HDL-c. Conclusion: HDL-c increased plasma levels directly with the consumption of all types of alcoholic beverages. Conversely, triglycerides decrease with wine consumption.

Separate and combined associations of physical activity and obesity with lipid-related indices in non-diabetic and diabetic patients

BACKGROUND

This study evaluated the separate and combined associations of physical activity and obesity with blood lipids in Chinese adults with and without diabetes.

METHODS

Data of 17,535 participants aged 18 to 78 years old were collected. Physical activity was categorized as inactive (low) or active (moderate or high) according to the International Physical Activity Questionnaire. Linear and logistic regression analyses were performed to investigate the associations of physical activity and obesity with lipid-related indices.

RESULTS

Compared with physically active participants, inactive participants had higher triglyceride (TG) level, lower high-density lipoprotein cholesterol (HDL-C) level, and higher odds ratios for abnormal TG and HDL-C. Compared with non-obese participants, obese participants had higher levels of total cholesterol (TC), TG and low-density lipoprotein cholesterol (LDL-C), lower HDL-C level, and higher odds ratios for the four abnormal lipid indices. Inactive obese participants had highest levels of TC, TG and LDL-C, lowest HDL-C level, and highest odds ratios compared to the other groups. No significant associations were found between obesity and TC, LDL-C in patients with diabetes.

CONCLUSIONS

Irrespective of diabetes, physical inactivity and obesity were associated with the presences of abnormal TG and HDL-C. Moreover, there were additive effects on blood lipids when physical inactivity and obesity co-occur.

Analysis of the PPARD Gene Expression Level Changes in Football Players in Response to the Training Cycle

The PPARD gene codes protein that belongs to the peroxisome proliferator-activated receptor (PPAR) family engaged in a variety of biological processes, including lipid metabolism in muscle cells. In this study, we assess the relationship between PPARD gene expression lipid metabolism parameters and the variation of the PPARD gene expression before (T₁) and after 12 hours of training (T₂) sessions in a group of football players. Peripheral blood lymphocytes were obtained from 22 football players (17.5±0.7 years, 178±0.7 cm, 68.05±9.18 kg). The PPARD gene expression, analyzed by quantitative polymerase chain reaction (qPCR), was significantly higher after T₂ (p = 0.0006). Moreover, at the end of the training cycle, there was a significant decrease in relative fat tissue (FAT) (%) (p = 0.01) and absolute FAT (kg) (p = 0.01). A negative correlation was observed between absolute FAT (kg) and PPARD gene expression level in T₂ (p = 0.03). The levels of cholesterol and triglyceride (TG) fractions were not significantly different (p >0.05) before and after training. No significant relationship between PPARD expression and cholesterol or TG levels was found. We found that physical training affects PPARD expression. Moreover, the negative correlation between PPARD expression and absolute FAT (kg) level may be indicative of the contribution of PPARD in metabolic adaptation to increased lipid uptake that can be used to control the body composition of athletes.

HDL and associated factors stratified by sex and menopausal status: results from a community-based survey in Taiwan

Aim

To investigate factors, especially modifiable factors associated with high-density lipoprotein (HDL) in Taiwanese based on sex and menopausal status.

Materials and Methods

Participants comprised 2022 men and 2392 women (1267 menopausal and 1125 non-menopausal) aged ≥30 years who resided in Pingzhen district, Taoyuan from 2006-2011. Their data, obtained through questionnaires and measurements were retrieved from the Li-Shin Hospital.

Results

Higher HDL was associated with total cholesterol, underweight, and alcohol drinking in both men and women. It was also associated with education, blood group B, and marital status in men as well as with age in women. Moreover, it was associated with total cholesterol, underweight, and age in both menopausal and non-menopausal women. Furthermore, it was associated with marital status in non-menopausal women and alcohol drinking in menopausal women. Lower HDL was associated with triglycerides, low-density lipoprotein (LDL), overweight, obesity, waist-hip ratio (WHR), uric acid, and smoking in both men and women and with coffee drinking in only women. It was also associated with uric acid, triglycerides, LDL, overweight, obesity, WHR, and body fat in both menopausal and non-menopausal women. Moreover, it was associated with coffee drinking in menopausal women.

Conclusion

Modifiable factors associated with HDL differ according to sex and menopausal status. Sex and menopausal status should be considered when implementing lifestyle changes to raise HDL. For example, both men and women should maintain a normal weight as well as quit smoking.

The Association of Ideal Cardiovascular Health and Atherogenic Index of Plasma in Rural Population: A Cross-Sectional Study from Northeast China

In 2010, the American Heart Association has proposed a new concept “ideal cardiovascular health” (CVH) based on seven CVH metrics: smoking, body mass index, physical activity, diet score, total cholesterol, blood pressure, and fasting plasma glucose. We aimed to determine the association of CVH with atherogenic index of plasma (AIP), a strong marker for atherosclerosis (AS). This cross-sectional study was conducted in the rural areas of northeast China and 11,113 middle-aged subjects were enrolled. Seven CVH metrics were classified into ideal, intermediate, and poor groups. AIP was calculated as log (TG/HDL) (triglycerides/high-density lipoprotein cholesterol). AIP > 0.21 was classified into the high AIP group and served as dependent variable. All seven CVH metrics were correlated with AIP. A gradient relationship between the number of poor CVH metrics and the prevalence of high AIP existed. Log binomial regression analysis showed that compared to those with five to seven ideal CVH metrics, individuals with four, three, two, one, and no ideal CVH metrics had 1.67, 2.66, 4.00, 5.30 and 6.50 times higher prevalence for high AIP. The subjects with poor CVH status had 2.73 times higher prevalence for high AIP. We found an inversely gradient relationship between the number of ideal CVH metrics and lower prevalence of high AIP.