Higher Risk Of Chronic Disease Research Articles

Vivere con la malattia e la disabilità. Anziani, differenze sociali e di genere, tipologie familiari

Through the analysis of the Istat Multipurpose Survey data 2012-2013, this paper investigates how the differences in gender, social position, and family composition affect the elderly population with respect to certain specific diseases and to loss of self-sufficiency. A multivariate analysis reveals that women and the less educated parts of the population are subject to higher risk of chronic diseases and to loss of self-sufficiency. The risk of loneliness is particularly high in the women, especially in the extremely old ones, even in case of longterm care requirements. Thus social and healthcare policies sustaining the elder parts of the population with respect to long term care have a crucial role not only for the poorest segments of the society but especially for the women.

Role of the macrophage in HIV-associated neurocognitive disorders and other comorbidities in patients on effective antiretroviral treatment.

Combination antiretroviral therapy (ART) has altered the outcomes of HIV infection in treated populations by greatly reducing the incidence of opportunistic infections, cancer, and HIV-associated dementia. Despite these benefits, treated patients remain at high risk of chronic diseases affecting the peripheral organs and brain. Generally, these morbidities are attributed to persistence of latent HIV in resting T cells, chronic inflammation, and metabolic effects of ART. This review makes the case that monocytes/macrophages warrant attention as persistent reservoirs of HIV under ART, source of systemic and brain inflammation, and important targets for HIV eradication to control chronic HIV diseases.

Nutritional Knowledge of NCAA Division III Football Players

There is increased recognition of the role that nutrition plays in optimal athletic performance as well as the long-term health of athletes. While many NCAA Division I football programs have at least a part-time registered dietitian/nutritionist (RDN) on staff, the resources available at Division III schools are much more limited. In particular, football players may be at a higher risk for chronic diseases later in life that could be prevented by proper nutrition. PURPOSE: The purpose of this study was to evaluate the nutritional knowledge and sources of information of NCAA Division III football players. METHODS: The study was a cross-sectional design. Eighty-eight new and returning male collegiate football players completed a nutrition knowledge quiz to assess adequate nutrition knowledge (ANK) and a questionnaire that included questions on sources of nutrition information. Data was collected at the beginning of the fall 2014 training camp. An independent t-test compared nutrition knowledge between subjects who had taken a college nutrition course versus those who had not. RESULTS: Nutrition quiz performance was 55.2±16.3%, with only 12.5% of subjects demonstrating ANK (defined as a quiz score of ≥75%). Mean scores for subjects who had taken a nutrition course in college compared to those who had not were significantly higher (71.2% vs. 53.6% respectively; t=-7.38, df = 85, p<0.001). The top four sources of nutrition information were coaches, websites, athletic trainers (ATs), and physicians. The highest percentage of subjects felt comfortable discussing their nutritional needs with ATs (29%), then coaches (27%), dietitians/nutritionists (18%), and physicians (15%). Subjects ranked the adequacy of nutritional knowledge of these sources in the same order—ATs being the highest. CONCLUSION: Most NCAA Division III football players have inadequate nutrition knowledge and are relying primarily on ATs and coaches to provide knowledgeable nutrition advice. Since funding for RDNs at Division III is limited, steps should be taken to ensure that ATs and coaches are adequately trained to provide basic nutritional advice with the understanding of the limits within their scopes of practice.

Nutritional Practices of NCAA Division III Football Linemen

Football linemen have been shown to be at greater risk of chronic diseases (e.g. cardiovascular disease) later in life compared to other position players. Linemen encounter pressure to maintain high body mass, which may influence dietary choices. Previous research on this topic has largely focused on professional or Division I levels, with little study on Division III athletes. PURPOSE: The purpose of this study was to evaluate the dietary practices of NCAA Division III linemen. METHODS: In this cross-sectional study, 9 linemen (height=182.8±6.3cm, weight =113.9±10.2kg, years in college=2.7±1.4) completed a 3-day diet log. Diet logs were analyzed for macronutrient and micronutrient intake and compared to US Dietary Reference Intakes (DRI) and MyPlate recommendations for a male with the average weight, height, and age of the subjects. Separate 1-sample t-tests for each category were used (alpha=0.05). RESULTS: Average intake of nutrients and food groups with comparisons to recommendations are shown in Table 1. CONCLUSION: Excess consumption of total fats, saturated fats, and sodium and a low intake of essential fats and fiber may put NCAA Division III linemen at a higher risk of chronic disease and should be considered when providing nutrition counseling.Table 1: Average Nutrient and Food Group Intake of Linemen Compared to DRI and MyPlate Recommendations.Significantly different than recommendations (* <0.05; ♯ <0.001); SD = standard deviation; DRI = Dietary Reference Intake; MUFA = monounsaturated fatty acids; PUFA = polyunsaturated fatty acids

Physical activity as a determinant of fasting and 2-h post-challenge glucose: a prospective cohort analysis of the NAVIGATOR trial.

To investigate whether previous physical activity levels are associated with blood glucose levels in individuals with impaired glucose tolerance in the context of an international pharmaceutical trial. Data were analysed from the NAVIGATOR trial, which involved 9306 individuals with impaired glucose tolerance and high cardiovascular risk from 40 different countries, recruited in the period 2002-2004. Fasting glucose, 2-h post-challenge glucose and physical activity (pedometer) were assessed annually. A longitudinal regression analysis was used to determine whether physical activity levels 2years (t-2 ) and 1year (t-1 ) previously were associated withlevels of glucose, after adjusting for previous glucose levels and other patient characteristics. Those participants with four consecutive annual measures of glucose and two consecutive measures of physical activity were included in the analysis. The analysis included 3964 individuals. Change in physical activity from t-2 to t-1 and activity levels at t-2 were both associated with 2-h glucose levels after adjustment for previous glucose levels and baseline characteristics; however, the associations were weak: a 100% increase in physical activity was associated with a 0.9% reduction in 2-h glucose levels. In addition, previous physical activity only explained an additional 0.05% of the variance in 2-h glucose over the variance explained by the history of 2-h glucose alone (R(2) =0.3473 vs. 0.3468). There was no association with fasting glucose. In the context of a large international clinical trial, previous physical activity levels did not meaningfully influence glucose levels in those with a high risk of chronic disease, after taking into account participants' previous trajectory of glucose control.

Linking social and built environmental factors to the health of public housing residents: a focus group study

BackgroundPublic housing residents have a high risk of chronic disease, which may be related to neighborhood environmental factors. Our objective was to understand how public housing residents perceive that the social and built environments might influence their health and wellbeing.MethodsWe conducted focus groups of residents from a low-income public housing community in Baltimore, MD to assess their perceptions of health and neighborhood attributes, resources, and social structure. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently coded transcripts for thematic content using editing style analysis technique.ResultsTwenty-eight residents participated in six focus groups. All were African American and the majority were women. Most had lived in public housing for more than 5 years. We identified four themes: public housing’s unhealthy physical environment limits health and wellbeing, the city environment limits opportunities for healthy lifestyle choices, lack of trust in relationships contributes to social isolation, and increased neighborhood social capital could improve wellbeing.ConclusionsChanges in housing and city policies might lead to improved environmental health conditions for public housing residents. Policymakers and researchers may consider promoting community cohesiveness to attempt to empower residents in facilitating neighborhood change.

A Web-based health promotion program for older workers: randomized controlled trial.

BackgroundRecent evidence supports the efficacy of programs that promote improvements in the health practices of workers 50 years and older who are at higher risk for chronic diseases than younger workers are. Internet-based programs that promote healthy practices have also shown promise and, therefore, should be especially appropriate for workers aged 50 years and older.ObjectiveThe purpose of the research was to evaluate the effectiveness of HealthyPast50, a fully automated Web-based health promotion program based on social cognitive theory and aimed specifically at workers 50 years and older.MethodsThe randomized controlled trial was conducted across multiple US offices of a large global information technology company. The sample included 278 employees aged 50 to 68 who were recruited online and randomly assigned to the Web-based HealthyPast50 program or to a wait-list control condition. Self-report measures of diet, physical activity, stress, and tobacco use were collected online before and 3 months after the program group was given access to the program. Use data included number of log-ins and number of pages accessed. The primary analysis was multiple linear regression, following intent-to-treat principles with multiple imputation using the Markov chain Monte Carlo (MCMC) approach for nonmonotone missing data. Potential moderators from demographic characteristics and program dosage effects were assessed using multiple linear regression models. Additional analyses were conducted on complete (nonimputed) cases, excluding program participants who used the program for less than 30 minutes.ResultsRetention rates were good for both groups: 80.4% (111/138) for the program group and 94.3% (132/140) for the control group. Program group participants spent a mean of 102.26 minutes in the program (SD 148.32), logged in a mean of 4.33 times (SD 4.28), and viewed a mean of 11.04 pages (SD 20.08). In the analysis of the imputed dataset, the program group performed significantly better than the control group on diet behavioral change self-efficacy (estimated adjusted difference [Δ]=0.16, P=.048), planning healthy eating (Δ=0.17, P=.03), and mild exercise (Δ=1.03, P=.01). Moderator and dosage analyses of the dataset found no significant program effects. Analyses of the nonimputed dataset comparing program users with controls found additional significant program effects on eating practices (Δ=0.09, P=.03), exercise self-efficacy (Δ=0.12, P=.03), exercise planning (Δ=0.18, P=.03), and aging beliefs (Δ=0.17, P=.01). Moderator analysis of this dataset also found significant moderator effects of gender on multiple measures of exercise.ConclusionsA Web-based health promotion program showed promise for making a significant contribution to the short-term dietary and exercise practices of older working adults. Gender effects suggest that the program effects on exercise are due mainly to improvements among women.

EHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults.

BackgroundBaby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information.ObjectiveThe intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults.MethodsA random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information.ResultsAlmost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t 217.60=−2.98, P=.003. Younger age (b=−0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R 2 =.17, R 2adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information.ConclusionsBeing younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.

Effects of Legume-Enriched Diet on Cardiometabolic Risk Factors among Individuals at Risk for Diabetes: A Crossover Study

Aims: First-degree relatives of patients with diabetes are at high risk for chronic diseases, including type 2 diabetes and obesity. Our purpose was to determine the effects of consuming 4 servings of legumes per week on lipid profiles, glycemic indices, and blood pressure of participants with family history of diabetes over 6 weeks of intervention.Methods: A total of 26 first-degree relatives of patients with diabetes (14 women and 12 men) participated in this randomized crossover clinical trial study. Participants were randomly assigned to a legume-enriched diet or habitual diet for 6 weeks. Paired t test and repeated measures analysis of variance were used to compare data for the 2 experimental diets.Results: The mean ± SE of legumes intake during the legume phase was 111.12 ± 10.53 g/day that was significantly higher (p < 0.001) than the amounts of legumes during habitual diet (50.73 ± 7.10 g/d). Percentage changes for cardiovascular disease risk factors did not change significantly following 6 weeks of legume consumption.Conclusions: Consumption of 4 servings of legumes per week had no significant effect on anthropometric measurements, glycemic indices, and lipid profiles of participants with family history of diabetes, though it could reduce systolic and diastolic blood pressure at a marginally significant level.

Living arrangements, chronic diseases, and prescription drug expenditures among Korean elderly: vulnerability to potential medication underuse.

BackgroundInsufficient social security combined with family structure changes has resulted in a poverty of the elderly. The objective of this study was to examine an association of living arrangements of the elderly with chronic disease prevalence and prescription drug use.Methods2008 Korea Health Panel Survey (KHPS) data were used in this study. Information on living arrangements, socio-demographics, health behaviors, chronic disease prevalence and healthcare expenditures including out-of-pocket (OOP) prescription drug expenditures for elderly aged 65 or older were collected from self-reported diaries and receipts. OOP prescription drug expenditure as a total cost that subject paid to a pharmacy for prescription drugs was examined. Logistic regression was used to identify differences in major chronic disease prevalence by living arrangements. The association of living arrangements with prescription drug use was analyzed using generalized linear model with a log link and a gamma variance distribution.ResultsProportions of elderly living alone, elderly living with a spouse only, and elderly living with adults aged 20–64 were 14.5%, 48.3%, and 37.2%, respectively. Elderly living alone showed 2.43 odds ratio (OR) (95% confidence interval (CI) = 1.66-3.56) for having major chronic diseases prevalence compared to elderly living with adults. Despite a higher major chronic disease prevalence, elderly living alone showed lower OOP prescription drug expenditures (Cost Ratio = 0.80, 95% CI = 0.67-0.97) after adjusting for the number of major chronic diseases. Total OOP prescription drug expenditures were significantly lower in patients with a low income level versus high income level.ConclusionsEven though elderly living alone had a higher risk of chronic disease, they spent less on OOP prescription drug expenditures. Optimal drug use is important for elderly with chronic diseases to achieve good health outcomes and quality of life. Public health policies should be supplemented to optimize medical treatment for vulnerable elderly living alone.

Anthropometric indicators of obesity in policemen: a systematic review of observational studies.

The aim of this paper was to summarize scientific literature on obesity in policemen through a systematic review of observational studies. For this purpose the following electronic databases were selected: Medline by Pubmed, CINAHL, and Scopus; and a manual search of the referenced studies concerning this topic was performed. There were no restrictions with respect to the year or language of the publication. Twenty-three studies were identified and 9 articles, considered as potentially relevant, were included. The labor time, shift and career progression promoted changes in body composition. Most of the policemen taking part in the studies included in this paper were overweight (BMI: 25.2-29.3), obese (body fat ≥ 25%), had increased waist (90.4-102 cm) and abdominal perimeters (18.9-90.5 cm), and had a higher risk of chronic disease, which is associated with depression and stress development. Interventional studies are needed for the purpose of proposing preventive and rehabilitation programs, which would result in providing physical and mental well-being, improvement of life quality and, especially, prevention of obesity related to police work.

Sexual dimorphism in epigenomic responses of stem cells to extreme fetal growth.

Extreme fetal growth is associated with increased susceptibility to a range of adult diseases through an unknown mechanism of cellular memory. We tested whether heritable epigenetic processes in long-lived CD34+ hematopoietic stem/progenitor cells (HSPCs) showed evidence for re-programming associated with the extremes of fetal growth. Here we show that both fetal growth restriction and over-growth are associated with global shifts towards DNA hypermethylation, targeting cis-regulatory elements in proximity to genes involved in glucose homeostasis and stem cell function. We find a sexually dimorphic response; intrauterine growth restriction (IUGR) is associated with substantially greater epigenetic dysregulation in males, whereas large for gestational age (LGA) growth predominantly affects females. The findings are consistent with extreme fetal growth interacting with variable fetal susceptibility to influence cellular aging and metabolic characteristics through epigenetic mechanisms, potentially generating biomarkers that could identify infants at higher risk for chronic disease later in life.

Tooth loss and its association with dietary intake and diet quality in American adults

ObjectivesTo investigate associations between the number of natural teeth and energy intake, nutrient intake, and diet quality in adults. MethodsEligible adults who participated in the National Health and Nutrition Examination Survey during 2005–2008 were included in the present study (n=9140). Participants were classified into three groups depending on the total number of natural teeth (excluding third molars): full dentition (28 teeth), moderate dentition (21–27 teeth), and poor dentition (20 teeth or less). Dietary intake and diet quality were estimated from the first 24-h dietary recall data. ResultsParticipants in the poor dentition group had significantly lower energy intake than those with moderate dentition (P<0.05), however, both groups did not significantly differ from those who had full dentition. Adjusting for sociodemographic characteristics, physical activity, smoking status, and energy intake, the intake of protein as well as most vitamins and minerals were positively associated with the total number of natural teeth (P<0.05); an inverse association was observed for carbohydrate intake (P<0.001). Diet quality, as measured by the Healthy Eating Index 2005, was inversely associated with tooth loss (P<0.001). ConclusionsTooth loss in adults is associated with lower diet quality and reduced intake of most nutrients; this may partly explain for the higher risk of chronic diseases in this population. Clinical significancePeople with missing teeth are recommended to monitor their dietary intake to avoid nutrient deficiency and to improve their diet quality for better health.

Fetal Origin of Adult Disease

ABSTRACT Fetal origins of adult disease, a concept first popularized by Dr David Barker, has subsequently led to many studies which have provided the evidence that certain diseases do have links pointing to fetal origins—adverse influences early in development, and particularly during intrauterine life, can result in permanent changes in physiology and metabolism, which result in increased disease risk in adulthood. Links that are well-established are—reduced birth weight and increased risk of coronary heart disease, hypertension and stroke in adulthood. The concept of a fetal origin of adult disease have been extended well-beyond coronary heart disease and being a risk factor for coronary heart disease, and now includes investigations of the development of the central nervous system, early origins of adult mental health and cognitive function. By understanding fetal origin of adult disease, health care professionals and policy makers will make this issue a high health care priority and implement preventive measures and treatment for those at higher risk for chronic diseases. How to cite this article Malhotra N, Malhotra J, Bora NM, Bora R, Malhotra K. Fetal Origin of Adult Disease. Donald School J Ultrasound Obstet Gynecol 2014;8(2):164-177.

Perinatal growth restriction decreases diuretic action of furosemide in adult rats

Perinatal growth restriction programs higher risk for chronic disease during adulthood via morphological and physiological changes in organ systems. Perinatal growth restriction is highly correlated with a decreased nephron number, altered renal function and subsequent hypertension. We hypothesize that such renal maladaptations result in altered pharmacologic patterns for life. Maternal protein restriction during gestation and lactation was used to induce perinatal growth restriction in the current study. The diuretic response of furosemide (2mg/kg single i.p. dose) in perinatally growth restricted rats during adulthood was investigated. Diuresis, natriuresis and renal excretion of furosemide were significantly reduced relative to controls, indicative of decreased efficacy. While a modest 12% decrease in diuresis was observed in males, females experienced 26% reduction. It is important to note that the baseline urine output and natriuresis were similar between treatment groups. The in vitro renal and hepatic metabolism of furosemide, the in vivo urinary excretion of the metabolite, and the expression of renal drug transporters were unaltered. Creatinine clearance was significantly reduced by 15% and 19% in perinatally growth restricted male and female rats, respectively. Further evidence of renal insufficiency was suggested by decreased uric acid clearance. Renal protein expression of sodium–potassium–chloride cotransporter, a pharmacodynamic target, was unaltered. In summary, perinatal growth restriction could permanently imprint pharmacokinetic processes affecting drug response.

Effects of an aquatic physical exercise program on glycemic control and perinatal outcomes of gestational diabetes: study protocol for a randomized controlled trial

BackgroundGestational diabetes mellitus (GDM) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child. Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes. However, there are no randomized controlled trials (RCT) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes.Methods/DesignAn RCT will be conducted at Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Brazil. A total of 72 pregnant women will be studied; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool, 3 times per week over 2 months. The primary endpoint will be glucose level control and use of insulin; secondary endpoints will be the following maternal and fetal outcomes: weight gain during pregnancy, blood pressure, pre-eclampsia diagnosis, intrauterus growth restriction, preterm birth, Cesarean section, macrosomia and maternal or neonatal intensive care admission. Endpoints between intervention and control group will analyzed by t test for unpaired data and χ2 test, and the level of significance will set at <0.05.DiscussionThe physical proprieties of water make aquatic exercises ideal for pregnant women. An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance. It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control.Trial registrationClinicalTrial.gov, NCT01940003.

Variation of serum metabolites related to habitual diet: a targeted metabolomic approach in EPIC-Potsdam

Serum metabolites have been linked to higher risk of chronic diseases but determinants of serum metabolites are not clear. We aimed to investigate the association between habitual diet as a modifiable risk factor and relevant serum metabolites. This cross-sectional study comprised 2380 EPIC-Potsdam participants. Intake of 45 food groups was assessed by food frequency questionnaire and concentrations of 127 serum metabolites were measured by targeted metabolomics. Reduced rank regression was used to find dietary patterns that explain the maximum variation of metabolites. In the multivariable-adjusted model, the proportion of explained variation by habitual diet was ranked as follows: acyl-alkyl-phosphatidylcholines (5.7%), sphingomyelins (5.1%), diacyl-phosphatidylcholines (4.4%), lyso-phosphatidylcholines (4.1%), acylcarnitines (3.5%), amino acids (2.2%) and hexose (1.6%). A pattern with high intake of butter and low intake of margarine was related to acylcarnitines, acyl-alkyl-phosphatidylcholines, lyso-phosphatidylcholines and hydroxy-sphingomyelins, particularly with saturated and monounsaturated fatty acid side chains. A pattern with high intake of red meat and fish and low intake of whole-grain bread and tea was related to hexose and phosphatidylcholines. A pattern consisting of high intake of potatoes, dairy products and cornflakes particularly explained methionine and branched chain amino acids. Dietary patterns related to type 2 diabetes-relevant metabolites included high intake of red meat and low intake of whole-grain bread, tea, coffee, cake and cookies, canned fruits and fish. Dietary patterns characterized by intakes of red meat, whole-grain bread, tea and coffee were linked to relevant metabolites and could be potential targets for chronic disease prevention.

The role of the temporal environment in shaping Dominican women's food routines in New York City and the Santo Domingo, D.R.

In the US, foreign born individuals adopt food behaviors that are associated with higher risk of chronic disease. However, the mechanism of change in food behaviors is not well understood. The purpose of this research was to explore food behaviors in Dominican women living in New York City (NYC) and Santo Domingo (SD) in order to better understand the process of change. Qualitative interviews addressed social, cultural, environmental and personal influences on food behavior in twelve Dominican women. Study findings revealed that women constructed food routines that characterized the way in which they procured, prepared and consumed food. Household temporal environment, which is the perceived time available to procure, prepare and consume food, shaped food routines. In SD, the day was structured around the main meal, allowing for a leisurely food routine. In NYC, temporal environment varied and women developed a range of food routines including, a) maintenance of home cooked family meals, b) reliance on fast food and maintenance of family meals c) abandonment of cooking and family meals. While Latino neighborhoods may provide access to traditional foods, the temporal environment may necessitate dietary change. It is important for health professionals to consider the temporal environment when planning policies and interventions. Supported by Cornell University DNS, LALSP, GSGrant Funding Source: Cornell University DNS, LALSP, Grad School

Are non-attenders a concern for primary care practice?

The article by Eshel et al. describes major differences, in terms of demography and health status, between elderly patients who did and those who did not visit primary care physicians for general health check-ups. The authors conclude that non-attenders are not at risk for developing health conditions.While this study by Eshel et al. provides a better understanding of the primary care population, the conclusion (no need for reaching out to the non-attenders) should be viewed with caution. In this study, non-attenders ‘have a higher probability of being women, older, not married and from a lower socio-economic’ segment of the population, a population that is known to be at higher risk for chronic disease. In addition, outreach programs in primary care would be key in providing essential preventive measures for this vulnerable population (e.g., osteoporosis prevention, vaccination, lifestyle, etc.).This is a commentary on http://www.ijhpr.org/content/2/1/7.

Associations of Circadian Disruption of Sleep and Nutritional Factors with Risk of Cancer

Background: Daily entrainment of the human circadian clock is important for good human health. In previous studies, shift work has been linked to higher risk of chronic diseases, including certain types of cancers. Exposure to light at night suppresses the physiologic production of melatonin, a hormone that has antiproliferative effects on intestinal cancers. In the present review, we examine the available evidence on sleep disruption, changes in nutrient intake and nutritional factors and risk of cancers. Methods: Internet search of PubMed and discussion with colleagues. Results: Recent studies indicate that night shift work appears to have independent influence on the function of the endocrine system, gastrointestinal tract and circadian brain function. Sleep disruption enhances cortisol secretion and ghrelin release from the stomach and decreases melatonin and leptin which interfere with functioning of beta cells of pancreas. Apart from biological dysfunctions, behavioral changes, increased intake of refined carbohydrates, w-6 fats and low w-3 fats, physical inactivity, excess of tobacco and alcoholism appear to be common among night shift workers. Leptin signals the brain to feel satiety whereas ghrelin, produced in the stomach, signals hunger. Recent studies also indicate that sleep-deprived individuals with hormonal changes have greater cravings for sweet and fatty foods. Apart from this, stress hormone cortisol, which increases with sleep deprivation also contribute to hunger. In addition to altered hormone levels, late night awakening provides greater opportunity to eat, smoke and drink alcohol and eating often includes high-caloric foods. Epidemiological studies indicate that sleep disruption may be associated with obesity and other chronic diseases including cancers. Since electric light at night has adverse effects among night shift workers compared to day shift workers, it has been proposed that a portion of the high and rising risk of breast and prostate cancer worldwide may be because of night shift work. The suppression of melatonin by exposure to light at night may be one reason for the higher rates of breast, prostate and colorectal cancers in the developed world. Suppression of nocturnal melatonin by exposure to light at night results in lack of protection by melatonin on cancer cell receptor sites which allows the uptake of linoleic acid (LA) which in turn enhances the growth of cancer cells. Melatonin is a protective, oncostatic hormone and strong antioxidant having evolved in all plants and animals over the millennia. It is possible that rotating night shift at least three nights per month for 15 or more years may increase the risk of colorectal cancer and other cancers. Conclusions: Experimental evidence and limited human evidence allowed the International Agency for Research on Cancer (IARC) to classify circadian disruption of sleep, as a probable human carcinogen, group 2A. Behavioral changes, intake of fast foods, physical inactivity, excess of tobacco and alcoholism are common among night shift workers which may also apart from deficiency of melatonin.