Strategies For Prevention Of Chronic Diseases Research Articles

Diet quality in young adulthood and sleep at midlife: a prospective analysis in the Bogalusa Heart Study

BackgroundDiet and sleep are both established risk factors for cardiometabolic diseases. Prior evidence suggests a potential link between these behaviors, though longitudinal evidence for how diet associates with sleep is scarce. This study aimed to determine the prospective association between diet quality in young adulthood and multiple sleep outcomes at midlife in the Bogalusa Heart Study (BHS).MethodsThis prospective study included 593 BHS subjects with dietary assessment at the 2001–2002 visit and sleep questionnaire responses from the 2013–2016 visit, after an average of 12.7 years (baseline mean age: 36 years, 36% male, 70%/30% White and Black persons). A culturally tailored, validated food frequency questionnaire assessed usual diet. Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015, and the alternate Mediterranean (aMed) dietary score. Robust Poisson regression with log-link function estimated risk ratios (RR) for insomnia symptoms, high sleep apnea score, and having a healthy sleep pattern by quintile and per standard deviation (SD) increase in dietary patterns. Models adjusted for potential confounders including multi-level socioeconomic factors, depression, and body mass index. Trends across quintiles and effect modification by sex, race, and education were tested.ResultsHigher diet quality in young adulthood, measured by both AHEI and HEI, was associated with lower probability of having insomnia symptoms at midlife. In the adjusted model, each SD-increase in AHEI (7.8 points; 7% of score range) conferred 15% lower probability of insomnia symptoms at follow-up (RR [95% confidence interval CI]: 0.85 [0.77, 0.93]), those in Q5 of AHEI had 0.54 times the probability as those in Q1 (95% CI: 0.39, 0.75), and there was a significant trend across quintiles (trend p = 0.001). There were no significant associations between young adult diet quality and having a high sleep apnea risk or a healthy sleep pattern at follow-up.ConclusionsA healthy diet was associated with a lower probability of future insomnia symptoms. If replicated, these findings could have implications for chronic disease prevention strategies incorporating the lifestyle behaviors of sleep and diet.

Effect of community-based public health service on health-related quality of life among middle-aged and older adults with chronic diseases in China

BackgroundThe growing prevalence of non-communicable chronic diseases poses a significant public health challenge globally, particularly impacting the well-being of aging populations. This study aims to assess the impact of community-based public health service (PHS) on the health-related quality of life (HRQoL) among middle-aged and older adults with chronic diseases in China.MethodsUtilizing data from the China Health and Retirement Longitudinal Study, we constructed a novel scale based on the 36-Item Short Form Health Survey (SF-36) to measure the HRQoL of middle-aged and older patients with hypertension and/or type-2 diabetes. Multivariate linear regression models with Instrument Variables and Propensity Score Matching techniques were applied to examine the effect of PHS on the HRQoL of identified chronic disease patients.ResultsAmong 8,403 hypertensive and/or diabetic patients, only 10.98% had received PHS. After adjusting for covariates, PHS exhibited a significant association with an elevated overall SF-36 score (β = 3.539, p < 0.001). Similar effects were observed in the physical and mental component summary scores, with increases of 1.982 (p < 0.001) and 5.095 (p < 0.001), respectively. Sensitive analysis affirmed the robustness of these findings. Heterogeneity analysis revealed significant HRQoL improvements among males, females, those aged 70 and older, patients with comorbidities, and urban residents, while the effect was less pronounced in the middle-aged, those without comorbidities, or rural dwellers.ConclusionCommunity-based PHS has exerted a positive impact on both the physiological and psychological aspects of HRQoL among middle-aged and older chronic disease patients, with effects varying among individuals with different characteristics. Our findings advocate for enhancing the delivery and utilization of government-funded PHS, increasing health literacy, and promoting early prevention strategies for chronic diseases. Furthermore, targeted health management initiatives for patients with comorbidities and enhancements in the quality of community healthcare services, particularly in rural areas, are deemed necessary.

Evaluating Oral and Dental Health and the RelatedFactors regarding the Elderly in Aliabad City of Golestan Province in 2022

&#x0D; &#x0D; &#x0D; Introduction: Considering the increasing growth of the elderly population, the importance of their life quality e, and the impact of oral and dental health on their quality of life, this study was conducted with the aim of evaluating oral and dental health and the factors affecting it in the elderly of Aliabad city, Golestan province, in 1400.&#x0D; Methods: This was a descriptive and analytical cross-sectional study. The research population consisted of 216 elderly of over 60 living in Aliabad city of Golestan province in 2022; they were selected through cluster random sampling method. 128 people (59/3 percent) were women and 88 people (40/ 7 percent) were men. This study was conducted from May to September 2022. To collect data, demographic information questionnaire and Geriatric Oral Health Assessment Index (GOHAI) were used, whose Persian version was valid and reliable. In addition, the last dental visit, the number of times the mouth was washed, the need for dental treatment, and personal assessment of the individual's oral and dental health status were among the items that were collected and recorded in the form of dental information regarding the elderly. After completing the questionnaires, data were entered into SPSS version 20 software and the analysis was done through descriptive statistics (frequency distribution calculation and central and dispersion indices), one way ANOVA, and t-test.&#x0D; Results: In the present study, the score of oral and dental health questionnaire regarding the elderly was 49/51±8/67, which was considered satisfactory. This variable had a statistically significant relationship with the number of mouth washes (p=0/02) , personal evaluation of mouth condition (p=0/01), and the number of teeth (p&lt;0/001). While there was no significant relationship regarding education level (p=0/26), place of residence (p=0/072), gender (p=0/56), employment status (p=0/63), income level (p=0/062), smoking (p=0/23) and the last dental visit (p=0/28),and the presence or absence of dentures (p=0/62) did not show a significant difference.&#x0D; Conclusion: Although the quality of life score related to the oral health of the elderly in Aliabad city was satisfactory, there is still roome to improve this score. Prevention strategies for chronic diseases and high blood pressure, re-emphasizing oral and dental hygiene, and improving related health behaviors should be considered as the most important future programs in this city. Integrating oral and dental health program in the country's public health program and creating a team to promote oral and dental health at primary care level are considered effective and low-cost solutions.&#x0D; &#x0D; &#x0D;

Prevalence of concomitant hypertension and diabetes among adults and elderly living in rural riverside areas in the Amazon.

Considering the scarcity of information on the assessment of chronic diseases in traditional Amazonian populations, as well as public health policies focused on their specificities, this study aimed to estimate the prevalence of at least one of the chronic diseases (systemic arterial hypertension (SAH) or diabetes mellitus (DM)) and their concomitant occurrence in a rural riverside population of the Amazon, and determine the associated factors. A household-based cross-sectional survey was conducted with a sample of adults and elderly people living in rural riverside locations along the left bank of the Negro River, in the municipality of Manaus, Amazonas, Brazil. The outcomes evaluated were the presence of at least one of the evaluated chronic diseases and the concomitant occurrence, based on the self-reported medical diagnosis of SAH and DM. Analysis of associated factors (sociodemographic, behavioral, and access to health services variables) was performed by Poisson regression with robust variance. The sample consisted of 495 individuals (young adults (n=257; 51.9%), middle-aged (n=132; 26.7%), and elderly (n=106; 21.4%)), of whom 51.5% were women (n=255), mean age 43.3&plusmn;17.1 years. The monthly household income was on average R$1100&plusmn;902 (A$345&plusmn;283). The diagnosis of any chronic disease was reported by 18.8% of the sample, with a preponderance of SAH (17.4%). The occurrence of at least one of the chronic diseases was associated with higher average age and worse health self-assessment. Regarding concomitant occurrence of SAH and DM, prevalent in 4.4% of the sample, the same associations were observed. The data for the occurrence of chronic diseases in the studied Amazon rural riverside populations are worrying, because these people live in areas of socioeconomic vulnerability, with a lack of basic sanitation infrastructure, difficult geographic access, and limited access to health care. Health policies fail to recognize the specificities of these populations, which implies deficiencies in the provision of necessary regular care. The findings also reinforce the need to strengthen health promotion and chronic disease prevention strategies in the context of primary care.

Is early age at menarche associated with multimorbidity? Findings from the Azar Cohort study

AimsThis study aimed to assess the association of age at menarche (AAM) with multimorbidity and chronic diseases. MethodsWe used data regarding the reproductive history of 8,294 female participants of the Azar Cohort Study. A questionnaire assessed the participants’ demographic information, reproductive history, personal behaviors, smoking status, socioeconomic status, activity status, and wealth score index. ResultsAmong 8,286 women included in the analysis, the AAM was < 12 years (early) in 648 (7.8%), 12–14 years (normal) in 4,911 (59.3%), and > 14 years (late) in 2,727 (32.9%) individuals. Early menarche was associated with a high risk of diabetes, obesity, and high WHR. On the other hand, late menarche was associated with higher rates of hypertension, stroke, and diabetes but a lower risk of MM, rheumatoid disease, obesity, abdominal obesity, and WHtR. ConclusionChanges in AAM have significant health implications. Factors predisposing individuals to early menarche and its consequences should be considered in chronic disease prevention strategies for adolescents and young adults.

Understanding Historical Trauma Among Urban Indigenous Adults at Risk for Diabetes.

Historical trauma has been posited as a key framework for conceptualizing and addressing health equity in Indigenous populations. Using a community-based participatory approach, this study aimed to examine historical trauma and key psycho-social correlates among urban Indigenous adults at risk for diabetes to inform diabetes and other chronic disease prevention strategies. Indigenous adult participants (n=207) were recruited from an urban area in California and were asked to identify whether their Indigenous heritage was from a group in the United States, Canada, or Latin America. Historical trauma was assessed using the Historical Loss (HLS) and Historical Loss Associated Symptoms (HLAS) scales. Nearly half (49%) of Indigenous participants from the United States or Canada endorsed thinking about one or more historical losses weekly, daily, or several times a day, compared to 32% for Indigenous participants from Mexico, Central America, and South America. Most participants (62%) reported experiencing one or more historical loss-associated symptoms, such as depression and anger, sometimes, often, or always. Ancestry from the United States or Canada, depression, and participation in cultural activities were associated with greater HLS and HLAS scores, indicating a greater number of losses and associated symptoms. Results suggest a need to consider historical trauma when designing diabetes prevention interventions and the need to further consider ancestry differences. As preventive efforts for Indigenous adults expand in urban environments, behavioral interventions must incorporate strategies that address community-identified barriers in order to succeed.

A Scoping Review of Technologies and Their Applicability for Exposome-Based Risk Assessment in the Oil and Gas Industry.

Oil and gas workers have been shown to be at increased risk of chronic diseases including cancer, asthma, chronic obstructive pulmonary disease, and hearing loss, among others. Technological advances may be used to assess the external (e.g. personal sensors, smartphone apps and online platforms, exposure models) and internal exposome (e.g. physiologically based kinetic modeling (PBK), biomonitoring, omics), offering numerous possibilities for chronic disease prevention strategies and risk management measures. The objective of this study was to review the literature on these technologies, by focusing on: (i) evaluating their applicability for exposome research in the oil and gas industry, and (ii) identifying key challenges that may hamper the successful application of such technologies in the oil and gas industry. A scoping review was conducted by identifying peer-reviewed literature with searches in MEDLINE/PubMed and SciVerse Scopus. Two assessors trained on the search strategy screened retrieved articles on title and abstract. The inclusion criteria used for this review were: application of the aforementioned technologies at a workplace in the oil and gas industry or, application of these technologies for an exposure relevant to the oil and gas industry but in another occupational sector, English language and publication period 2005-end of 2019. In total, 72 articles were included in this scoping review with most articles focused on omics and bioinformatics (N = 22), followed by biomonitoring and biomarkers (N = 20), external exposure modeling (N = 11), PBK modeling (N = 10), and personal sensors (N = 9). Several studies were identified in the oil and gas industry on the application of PBK models and biomarkers, mainly focusing on workers exposed to benzene. The application of personal sensors, new types of exposure models, and omics technology are still in their infancy with respect to the oil and gas industry. Nevertheless, applications of these technologies in other occupational sectors showed the potential for application in this sector. New exposome technologies offer great promise for personal monitoring of workers in the oil and gas industry, but more applied research is needed in collaboration with the industry. Current challenges hindering a successful application of such technologies include (i) the technological readiness of sensors, (ii) the availability of data, (iii) the absence of standardized and validated methods, and (iv) the need for new study designs to study the development of disease during working life.

Understanding perceptions of health, lifestyle risks and chronic disease in middle age.

The aim of this paper is to explore the perceptions, attitudes and beliefs of middle-aged Australians around their health, lifestyle risks and chronic disease. Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. A qualitative descriptive study using semi-structured interviews. Reporting was guided by the COREQ checklist. Thirty-four participants aged 40-65years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi-structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. Understanding the perceptions of health of middle-aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person-centred health promotion and chronic disease prevention strategies in this age group.

Dietary intake and nutritional status of Korean children and adolescents: a review of national survey data.

In Korea, several national cross-sectional surveys monitor the diet, nutritional status, and health status of children. This continual dedicated national surveillance system contributes to the identification of nutritional and health issues, establishment of public health policies, and development of nutrition recommendations. This paper provides recent information about the Korea National Health and Nutrition Examination Survey and the Korean Youth Risk Behavior Web-based Survey and describes key nationwide survey findings published in the last 5 years on infant feeding practices and the dietary intake and nutritional status of Korean infants, children, and adolescents. There have been increasing trends in children, and teenagers who skip breakfast, eat fast food, consume sugary drinks, have vitamin D deficiency, and are obese. This review will inform pediatricians, nutritionists, and other health care practitioners who track children’s growth and development. It may also help researchers and policymakers identify diet-related policies and strategies for chronic disease prevention in Korean infants, children, and adolescents.

Positive Attitudes and Reasons for Consuming Legumes Are Associated with Legume Intake Among Adults in Puerto Rico

Abstract Objectives Legumes are a healthy staple of the traditional Puerto Rican diet. Emphasizing legume intake could be a culturally acceptable strategy for chronic disease prevention in Puerto Rico. This study aimed to investigate attitudes, reasons, intentions, and expectations about legume consumption in Puerto Rico and associations with dietary intake. Methods This study includes adult participants (30–75y) from the Puerto Rico Assessment of Diet, Lifestyle and Diseases, who completed a validated food frequency questionnaire and a legumes questionnaire (n = 206). Attitudes and reasons were assessed with a Likert scale and assigned 0 points for disagree, 1 point for neutral, and 2 points for agree. Scores were computed by summing the points for 12 attitudes or 12 reasons; higher scores indicate more positive attitudes and stronger reasons for consuming legumes. Adjusted linear regression models examined associations between each score and bean intake, rice intake, and ratio of bean to rice intake. Adjusted logistic regression models tested the associations between specific intentions and expectations about legume consumption and bean intake. Results Most participants were female (70%), Puerto Rican (80%), and lived in urban areas (90%). Participants reported consuming a median of 0.47 servings/d of beans and 0.57 servings/d of rice. After adjusting for sociodemographic and lifestyle factors, each additional positive attitude was associated with a 0.08 (95% CI: 0.04, 0.1) servings/d higher bean intake and 0.66 (95% CI: 0.04, 1.28) higher ratio of bean to rice intake. Each additional reason to consume legumes was associated with a 0.04 (95% CI: 0.004, 0.06) servings/d higher bean intake. No other significant associations were observed for the attitudes or reasons scores, nor for expectations or intentions to consume legumes. Conclusions Having positive attitudes and more reasons for consuming legumes are associated with higher bean intake. Positive attitudes are also associated with a higher ratio of bean to rice intake. Interventions aiming to increase legume intake to prevent cardiometabolic disease in Puerto Rico should emphasize building positive attitudes and reasons for consuming legumes. Funding Sources Anonymous donations; Northarvest Bean Growers Association; FDI Clinical Research; and National Institutes of Health.

A Rapid Review of Evaluation Capacity-Building Strategies for Chronic Disease Prevention

Abstract: There has yet, it seems, to be a review of the literature specifically exploring evaluation capacity building (ECB) for chronic disease prevention (CDP). To guide efforts to build evaluation capacity for CDP, a rapid review of the literature was undertaken using systematic methods. A search was conducted of the grey and academic literature to explore ECB strategies in CDP, and 14 articles were retained. CDP ECB strategies were similar to general public health ECB efforts (multi-strategy, context-specific, experiential). Articles included a focus on how to maintain ECB over long periods and in light of staff turnover, both of which were described as being prevalent in the CDP context. Evaluating influence at multiple levels (individual, organizational, system) is also important. There is room for more clarity about the “how” of ECB strategies, and about specificity to CDP.

Addressing Challenges to Coordinating the Implementation of Place-Based Chronic Disease Prevention Interventions in Los Angeles.

Chronic disease prevention initiatives have traditionally been structured to address a single disease, potentially limiting the scope of health impacts. In the past decade, initiatives have increasingly adopted a coordinated approach, in which multiple interventions are intended to work synergistically-often in a bounded geographic area-to address interrelated risk factors and diseases. However, despite increased interest in this coordinated approach, few examples exist of how coordination has been operationalized in local public health practice. In 2014, the Los Angeles County Department of Public Health launched the 4-year Chronic Disease Prevention Strategy (CDPS). Through CDPS, the Los Angeles County Department of Public Health implemented a range of environmental, lifestyle change, and health system interventions intended to collectively reduce chronic disease among adults in Los Angeles, with concentrated implementation occurring in 1 high-need neighborhood. This case study examined the activities undertaken to coordinate across CDPS interventions and documented challenges to these efforts. Data were collected via a document review of programmatic materials and structured conversations with staff leading implementation of CDPS interventions. Document review and structured conversations with staff identified 3 primary coordination activities: (1) collaborating on outreach materials to unify messaging, (2) developing a network of common partners, and (3) investing in shared data collection. Operational challenges identified were disparate short-term objectives across interventions, minimal alignment between clinical practice and CDPS goals, restrictions around bidirectional referrals between organizations, and limited bandwidth among new partners to engage with multiple CDPS interventions. Contextual challenges identified were competing social and political issues, and geographic fluidity regarding where community members sought health resources. Developing an initiative-specific coordination plan prior to implementation may help reduce challenges to coordination. Modifications in how health initiatives are funded and structured may be needed: greater flexibility in how funding is administered, and the inclusion of coordination-specific metrics, may enable more robust coordination.

A survey of the prevalence of modifiable health risk behaviours among carers of people with a mental illness

BackgroundFamily carers provide significant support to people with a mental illness; yet may experience poor mental and physical health themselves. Among limited research addressing the physical health of carers, studies of carers of people with dementia and young people with psychosis suggest increased risk of chronic diseases in conjunction with higher levels of potentially modifiable lifestyle risk behaviours. This exploratory study, conducted with carers of people with various mental illnesses, aimed to determine: carer prevalence of health risk behaviours (inadequate fruit and vegetable consumption, inadequate physical activity, harmful alcohol consumption, and tobacco smoking); interest in changing ‘at risk’ behaviours; and potential associations of socio-demographic characteristics with risk status and interest in change.MethodsA cross-sectional survey was conducted among family carers of people with a mental illness (N = 144) residing in New South Wales, Australia. Analyses explored risk behaviour prevalence and interest in change, and associations with socio-demographic variables.ResultsInadequate fruit and vegetable consumption was most prevalent (74.8%), followed by engaging in inadequate amounts of physical activity (57.6%); harmful alcohol consumption (36.3%) and smoking (11.8%). The majority of carers were interested in improving ‘at risk’ behaviours (56.3–89.2%), with the exception of alcohol consumption (41.5%). Previously or never married participants were more likely to consume inadequate amounts of fruits and/or vegetables compared to those married or cohabiting (Odds Ratio [OR]: 4.1, 95% Confidence Interval [CI]: 1.3–12.9, p = .02). Carers in the workforce were more likely to be engaging in inadequate physical activity (OR: 2.6, 95% CI: 1.2–5.7, p = .02); and male participants were more likely to engage in harmful alcohol consumption (OR: 2.9, 95% CI: 1.1–7.9, p = .03). Working carers were approximately five times more likely to report interest in improving their alcohol consumption (OR: 5.1, 95% CI: 1.3–20.5, p = .02) compared to those not currently in the workforce.ConclusionsResults suggest high engagement in health risk behaviours among carers of people with a mental illness, particularly with regards to harmful alcohol consumption. Findings suggest a need to develop and implement chronic disease prevention strategies. Further research with larger representative samples is needed to confirm findings.

Setting strategy for system change: using concept mapping to prioritise national action for chronic disease prevention

BackgroundChronic diseases are a serious and urgent problem, requiring at-scale, multi-component, multi-stakeholder action and cooperation. Despite numerous national frameworks and agenda-setting documents to coordinate prevention efforts, Australia, like many countries internationally, is yet to substantively impact the burden from chronic disease. Improved evidence on effective strategies for the prevention of chronic disease is required. This research sought to articulate a priority set of important and feasible action domains to inform future discussion and debate regarding priority areas for chronic disease prevention policy and strategy.MethodsUsing concept mapping, a mixed-methods approach to making use of the best available tacit knowledge of recognised, diverse and well-experienced actors, and national actions to improve the prevention of chronic disease in Australia were identified and then mapped. Participants (ranging from 58 to 78 in the various stages of the research) included a national sample of academics, policymakers and practitioners. Data collection involved the generation and sorting of statements by participants. A series of visual representations of the data were then developed.ResultsA total of 95 statements were distilled into 12 clusters for action, namely Inter-Sectoral Partnerships; Systems Perspective/Action; Governance; Roles and Responsibilities; Evidence, Feedback and Learning; Funding and Incentive; Creating Demand; Primary Prevention; Social Determinants and Equity; Healthy Environments; Food and Nutrition; and Regulation and Policy. Specific areas for more immediate national action included refocusing the health system to prevention over cure, raising the profile of public health with health decision-makers, funding policy- and practice-relevant research, improving communication about prevention, learning from both global best-practice and domestic successes and failures, increasing the focus on primary prevention, and developing a long-term prevention strategy with an explicit funding commitment.ConclusionsPreventing chronic diseases and their risk factors will require at-scale, multi-component, multi-stakeholder action and cooperation. The concept mapping procedures used in this research have enabled the synthesis of views across different stakeholders, bringing both divergent and convergent perspectives to light, and collectively creating signals for where to prioritise national action. Previous national strategies for chronic disease prevention have not collated the tacit knowledge of diverse actors in the prevention of chronic disease in this structured way.

Association between prepregnancy obesity and metabolic risk in Chilean premenopausal women 10 y postpartum

One of every four pregnant women in Chile is obese. Gestational obesity is associated with maternal metabolic complications in pregnancy (e.g., gestational diabetes, preeclampsia), but to our knowledge, there is little evidence on relationships with future metabolic risk. The aim of this study was to evaluate the association between prepregnancy obesity (prepregnancy body mass index ≥30kg/m2) or excessive gestational weight gain (GWG; according to the 2009 recommendations from the Institute of Medicine), and maternal metabolic complications 10y postpartum in premenopausal Chilean women. A prospective study was conducted. In 2006, 1067 Chilean mothers of children born in 2002-participants of the GOCS (Growth and Obesity Cohort Study)-were recruited. Mothers completed a questionnaire concerning sociodemographic, anthropometric, and pregnancy characteristics. Of the sample, 402 women were randomly selected to participate in a study related to the determinants of breast cancer risk in 2012. At follow-up, anthropometry, blood pressure, and fasting labs were measured. Complete data was available for 366 women. Thirty-two percent of mothers had prepregnancy overweight/obesity and 39.1% had excessive GWG. In adjusted models, prepregnancy obesity was positively associated with increased insulin resistance (odds ratio [OR], 18; 95% confidence interval [CI], 5.2-62.7), metabolic syndrome (OR, 3.3; 95% CI, 1.3-8.3), and hyperglycemia (OR, 3; 95% CI, 1.1-8.6). Prepregnancy overweight/obesity was associated with increased risk for insulin resistance, metabolic syndrome, abdominal obesity, low high-density lipoprotein cholesterol, and hypertriglyceridemia (P<0.05). Excessive GWG was not associated with metabolic risk in the main model but was found to be positively associated in models with correction of weight by possible recall bias. Gestational obesity was associated with maternal metabolic alterations 10y postpartum. Prevention strategies for chronic diseases should consider prepregnancy obesity as a modifiable risk factor for future metabolic health.

Quantitative estimates of dietary intake with special emphasis on snacking pattern and nutritional status of free living adults in urban slums of Delhi: impact of nutrition transition.

BackgroundThe nutritional landscape of India is experiencing the fallout of urbanization and globalization. The changes are manifest in dietary patterns as well as health outcomes. The study aimed at assessing household dietary intake pattern with special emphasis on snacking pattern, anthropometric and lipid profiles in low socio-economic status households in an urban slum of Delhi.MethodsCommunity based cross-sectional study in 260 households of a purposively selected urban slum in North-East district of Delhi, India. Family dietary surveys including consumption pattern of commercial food products rich in Partially Hydrogenated Vegetable Oils (PHVOs), 24 h dietary recall and assessment of dietary diversity using Household Diet Diversity Scores (HDDS) were done. Assessment of nutritional status using anthropometric and lipid profile on a subsample (n =130) were also conducted.ResultsMedian energy and fat intake were adequate. Micronutrient intake was found to be inadequate for vitamin A, riboflavin, calcium and folate. PHVO usage was low (<20 % households). Milk (39 %), green leafy vegetables (25 %) and fruits (25 %) intake were below recommendations. Mean HDDS was 7.87. Prevalence of overweight/obesity was high (66.7 %). Lipid profile showed mean HDL-C levels lower than recommendations for females.ConclusionCommunity based awareness programs for prevention of non-communicable diseases should incorporate healthy diet and lifestyle practices with emphasis on quantity and quality of nutrient intake. This must be considered as an integral part of chronic disease prevention strategy for underprivileged communities in urban India.

Rising trend of life expectancy in Shanghai, China: quantitative analysis of changes by mortalities in different age groups and specific diseases

Objective: Life expectancy had increased from 73.16 to 79.82 years in men and 77.74 to 84.44 years in women during 1990-2010 in Shanghai. The elevating rate was faster than that of most developed countries. This study is to access life expectancy increasedin Shanghai by different age groups and specific diseases.Methods: Arriaga’s decomposition methods were applied to life tables and mortality data (1990-2010) to estimate changes in life expectancy.Results: The largest contributions lied on elderly population (60 years old &amp; above) (4.79-year in men and 4.90-year in women). During 1990-2000, reductions in mortality of respiratory system diseases, especially in chronic obstructive pulmonary disease (COPD), contributed 1.36-year increase in men and 1.16-year increase in women. During 2000-2010, reductions in mortality of circulatory system diseases, especially in cerebrovascular disease (CVD), contributed 0.82-year increase in men and 1.08-year increase in women.Conclusions: Rapid increases in life expectancy were mostly achieved by declining mortality in aged population and chronic noncommunicable diseases (CND), nevertheless CND were still the main causes of death in Shanghai, which implicated that the prevention strategies for chronic diseases was effective and should be persevered for a long time in the future.

A pragmatic randomised controlled trial of an implementation intervention to increase healthy eating and physical activity-promoting policies, and practices in centre-based childcare services: study protocol

BackgroundPromotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy. Centre-based childcare services represent a promising setting to provide children with...

Exploration of Strategies for Chronic Disease Prevention and Control and Relevant System Development in China

Chronic non-communicable diseases have become a major threat to humanity. International studies have shown that of 57 million deaths worldwide in 2008, 36 million (63%) were caused by chronic non-communic- able diseases; of these, 29 million (80%) occurred in low and middle income countries. The WHO predicts that if the current trend continues, the annual number of deaths due to chronic non-communicable diseases will increase to 55 million by 2030. Due to acceleration of industrialization and urbanization, along with population aging and rapid changes of people's lifestyle, the morbidity and mortality from chronic diseases are rapidly increasing in China. Therefore, dealing with the prevalence of chronic non- communicable diseases has become one of the current major health issues for China to address. On the basis of summarizing the status of major chronic diseases in China, analyzing the key issues and key factors in chronic disease prevention and control, and reviewing and summarizing the experience from the previous projects, this paper proposes the following recommendations as strategies for chronic disease prevention and control and development of relevant system, which China should adopt. All relevant government departments should formulate corresponding policies; establish a coordinated and efficient work system with rational structure and clear division of tasks and responsibilities within the system. Implementation and development of integrated medicine in system is necessary. Work norms and requirements will then improve the performance and efficiency in chronic disease preven- tion and control in China. of the 57 million deaths in the world in 2008, 36 million (63%) died of non-communicable chronic diseases. These chronic diseases include cardiovascular disease (48%), cancer (21%), chronic respiratory disease (12%) and diabetes (3.5%). Among the deaths from chronic non- communicable diseases, 29 million (80%) occurred in low and middle-income countries. In these countries, 48% of deaths are premature deaths (death before 70 years old); this is much higher than the 26% in high-income countries. According to WHO estimates, the deaths caused by non- communicable chronic diseases will increase to 55 million by 2030 if the current trend continues (The 66th World Health Assembly, 2013; The World Health Organization, 2013). Therefore, responding to the epidemic of chronic non-communicable diseases is an issue the developing world must urgently address.

Testing the boundaries of recommended carbohydrate intakes: Macronutrient exchanges, carbohydrate quality and nutritional adequacy

AbstractAim: The aim of this study was to explore the relationships between dietary carbohydrate, other macronutrients, carbohydrate quality and nutritional adequacy in the diets of free‐living Australian teenagers, and to consider the implications for total carbohydrate recommendations.Methods: Using the Children's Nutrition and Physical Activity Survey (2007) database, the nutrient intakes of boys and girls aged 14–16 years were assessed by quintile of carbohydrate intake.Results: Carbohydrate intake was inversely associated with intakes of saturated fat, polyunsaturated fat, long‐chain omega 3, monounsaturated fat and protein (for each association, P for trend &lt;0.001). Carbohydrate intake was associated with increased intake of fibre in boys (P for trend &lt;0.05) but not girls, the association being nonlinear. As carbohydrate intake increased, the densities of fibre, vitamin C, folate, thiamin and β‐carotene declined and the density of sugar increased, implying a decline in carbohydrate quality. Nutritional adequacy was generally compatible with a wide range of carbohydrate intakes.Conclusions: In combination, the exchanges of carbohydrate for polyunsaturated fat, long‐chain omega 3, monounsaturated fat and protein would be expected to increase coronary disease risk via several mechanisms. This implies that there may be a progressive increase in coronary risk as carbohydrate intakes increase across the Acceptable Macronutrient Distribution Range (AMDR), as the exchange of carbohydrate for saturated fat is now considered to be neutral for coronary risk. There is a case for lowering the upper and lower boundaries of the AMDR for carbohydrate intake as a strategy for chronic disease prevention. Lower boundaries would be unlikely to increase the risk for obesity or nutrient inadequacy.