Important Lifestyle Changes Research Articles

Multiproxy bioarchaeological data reveals interplay between growth, diet and population dynamics across the transition to farming in the central Mediterranean

The transition to farming brought on a series of important changes in human society, lifestyle, diet and health. The human bioarchaeology of the agricultural transition has received much attention, however, relatively few studies have directly tested the interrelationship between individual lifestyle factors and their implications for understanding life history changes among the first farmers. We investigate the interplay between skeletal growth, diet, physical activity and population size across 30,000 years in the central Mediterranean through a ‘big data’ cross-analysis of osteological data related to stature (n = 361), body mass (n = 334) and long bone biomechanics (n = 481), carbon (δ13C) and nitrogen (δ15N) stable isotopes (n = 1986 human, n = 475 animal) and radiocarbon dates (n = 5263). We present the observed trends on a continuous timescale in order to avoid grouping our data into assigned ‘time periods’, thus achieving greater resolution and chronological control over our analysis. The results identify important changes in human life history strategies associated with the first farmers, but also highlight the long-term nature of these trends in the millennia either side of the agricultural transition. The integration of these different data is an important step towards disentangling the complex relationship between demography, diet and health, and reconstruct life history changes within a southern European context. We believe the methodological approach adopted here has broader global implications for bioarchaeological studies of human adaptation more generally.

Impact of Healthy Food Consumption Practice on Normal BMI among College Girls

Background: Food is considered a natural body defender against different diseases, and it keeps the body healthy. The lifestyles always have a great influence on both health and food consumption. College students represent a major segment of the young adult population. Young adults, in consideration of important lifestyle changes, are arranged to negatively modify their way of eating. Hence, this study aimed to predict of healthy eating Practice of college students with their Body Mass Index. Methods: A descriptive study conducted among students from nursing college, King Khalid university to evaluate the impact of healthy food consumption on normal BMI. Healthy eating practice questionnaire distributed via online self-reported by 135 study subjects, and their anthropometric measurement height, weight, hip, and waist circumferences were measured in the nursing laboratory. 7 items questionnaire consists of 5-point frequency ranges from ‘‘Less than 1time, 2-3 times, 4-5 times and 6 or more times per day’’. The total score was 35 of the healthy eating practice, which is categorized as good (26-35), fair 16- 25 and need improvement (7-15). The responses were analyzed using SPSS IBM version 21. A binary logistic regression was performed to predict the relationship between healthy food consumption practices and normal BMI. Results: Half of the study participants 50.37% were in normal BMI, BMI (body mass index) and WHR (waist hip ratio) was negatively correlated with healthy food practice score which infers that as Healthy food practice score increases BMI and WHR decreases. The consumption of sweetened beverages was 18.2%, Desserts was 23.3%, and Fried food/or packaged snacks was 17.6%. Meat/Fish/Beans consumption Frequency: < 1 time/ day category (P= 0.029); Sugar beverages: sodas, coffee, tea & energy sports drinks (P= 0.013) 6 or more times per day was significant predictors of keeping the body weight in normal BMI range. Conclusion: Healthy food consumption practice has a significant impact on keeping the body weight in Normal BMI range. Keywords: [BMI, Healthy eating practice, food practice, healthy food consumption]

Gut microbiome transitions across generations in different ethnicities in an urban setting—the HELIUS study

BackgroundDuring the course of history, various important lifestyle changes have caused profound transitions of the gut microbiome. These include the introduction of agriculture and animal husbandry, a shift from a nomadic to a more sedentary lifestyle, and recently increased levels of urbanization and a transition towards a more Western lifestyle. The latter is linked with shifts in the gut microbiome that have a reduced fermentative capability and which are commonly associated with diseases of affluence. In this study, in which 5193 subjects are included, we investigated the direction of microbiome shifts that occur in various ethnicities living in Amsterdam by comparing 1st and 2nd generation participants. We furthermore validated part of these findings with a cohort of subjects that moved from rural Thailand to the USA.ResultsThe abundance of the Prevotella cluster, which includes P. copri and the P. stercorea trophic network, diminished in the 2nd generation Moroccans and Turks but also in younger Dutch, whilst the Western-associated Bacteroides/Blautia/Bifidobacterium (BBB) cluster, which has an inverse correlation with α-diversity, increased. At the same time, the Christensenellaceae/Methanobrevibacter/Oscillibacter trophic network, which is positively associated with α-diversity and a healthy BMI, decreased in younger Turks and Dutch. Large compositional shifts were not observed in South-Asian and African Surinamese, in whom the BBB cluster is already dominant in the 1st generation, but ASV-level shifts towards certain species, associated amongst others with obesity, were observed.ConclusionThe Moroccan and Turkish populations, but also the Dutch population are transitioning towards a less complex and fermentative less capable configuration of the gut microbiota, which includes a higher abundance of the Western-associated BBB cluster. The Surinamese, whom have the highest prevalence of diabetes and other diseases of affluence, are already dominated by the BBB cluster. Given the continuous increase in diseases of affluence, this devolution towards low-diversity and fermentatively less capable gut microbiome compositions in urban environments is a worrying development.9koSLJh1fDbsjUtu7rD1NMVideo Graphical

A life cycle assessment method to support cities in their climate change mitigation strategies

National climate change mitigation objectives must be translated to the city level and to specific sectors, with locally-relevant policy measures. However, assessing the decarbonization value of these measures is a challenge for local policy makers and few local consumption assessment studies integrate a systemic vision. This research presents a multi-criteria city-scale Life Cycle Assessment method focusing on the three largest carbon-emitting sectors in cities: food, residential buildings and daily mobility, with an original combination of databases and models. For food, databases were used to evaluate environmental impacts based on socio-demographic characteristics. For building and mobility, modeling tools were used and adapted at different scales: with local spatial refinement for mobility and the creation of archetypes representing the city's most common residential buildings. A demonstration of this new cross-sectoral method was conducted on Montreuil city in the Parisian region, to (1) evaluate the current greenhouse gas emissions (GHG), and (2) test the possible reductions following different measures. The developed assessment framework provides various interpretation, with disaggregated contribution, mapping, and scenario analysis. For instance, the application of ambitious measures and important lifestyle changes reduced GHG in these sectors by 30%, far from the French government's ambitions of a 55% reduction by 2030.

Assessing Lifestyle Transformations and Their Systemic Effects in Energy-System and Integrated Assessment Models: A Review of Current Methods and Data

Achieving the ambitious climate targets required to limit global warming to 1.5 °C requires a deep transformation of the supply-and-demand side of energy–environmental–economic systems. Recent articles have shown that environmentally sustainable consumer behaviors driven by lifestyle changes can significantly contribute to climate-change mitigation and sustainable development goals. However, lifestyle changes are not adequately captured by scenarios developed with integrated assessment and energy-system models (IAMs/ESMs), which provide limited policy insights. This article conducts a systematic review of the IAM and ESM literature to identify the most important lifestyle changes in current mitigation pathways for the residential and transport sectors, review the employed state-of-the-art modeling approaches and scenario assumptions, and propose improvements to existing methodological frameworks. The review finds that mode shifts towards public transport and active transport modes, shared mobility, and eco-driving have the greatest impact in the transport sector, while actions that reduce space and water-heating requirements and the circular economy are the most effective practices in households. Common modeling approaches lack sophistication as they omit (1) the dynamics and costs of demand-side transitions, (2) the heterogenous responses of different consumer groups, and (3) the structural effects of lifestyles on the macro-economy. New approaches employing innovative methodologies combined with big data collected from users offer new avenues to overcome these challenges and improve the modeling of lifestyle changes in large-scale models.

Translation and psychometric validity of the Brazilian version of the European Organisation for Research and Treatment of Cancer-colorectal liver metastases module.

Patients with liver metastasis of colorectal cancer (CRC) experience important lifestyle changes that impair the quality of life (QoL). The use of instruments is important to assess the cancer patients’ QoL. To develop a Brazilian translation of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Colorectal Liver Metastases (QLQ-LMC21) questionnaire, and to investigate psychometric validity in patients with CRC with liver metastases, patients with liver metastasis from CRC answered the Brazilian versions of EORTC core Quality of Life Questionnaire-Core 30 (QLQ-C30) and the QLQ-LMC21 module, a demographic data questionnaire and a questionnaire to assess understanding against the translated QLQ-LMC21. Data collection was performed in three Southern hospitals in Brazil, from August 2017 to August 2019. Descriptive analyses and Spearman’s correlation tests were performed for construct and criterion validity. The Cronbach’s alpha test was performed to assess reliability. Significant values were p < 0.05. Ten patients participated in the study for the pilot test and 106 for validation, with a mean age of 58.2 + 12.4 years old. The translated questionnaire was easy to understand for the participants in the pilot test phase, with no need for modification. In the validation of the convergent construct, all the correlations were significant (p < 0.001) and with coefficients above 0.53. In the discriminant validity, among items of different scales, the values of the divergent correlations were pain scale (0.005 to 0.186) and fatigue (−0.01 to 0.186), all non-significant. In the criterion validation, the correlations were significant, p < 0.05, and higher among similar scales of the QLQ-LMC21 and QLQ-C30, p-value < 0.001. The total internal consistency of the questionnaire was adequate, with a Cronbach’s alpha value of 0.790. The Brazilian version of the QLQ LMC21 proved to be a valid reliable questionnaire to be used in conjunction with the QLQ-C30.

Can we improve dental treatment outcomes in patients with high-risk factors?

Aim The aim of the study was to identify best practice in relation to improving the periodontal conditions of patients and increasing the rate of treatment success, through the identification of risk factors and implementation of changes in lifestyle.Methods and materials The study used two search strategies to identify papers describing best practices and important lifestyle changes which improved periodontal conditions and treatment outcomes in patientsResults The study demonstrated that the two most important factors in terms of interventions to improve periodontal conditions and treatment outcomes were to improve the level of diabetes control and remove aggravating factors such as smoking.Conclusion Many studies have focused on improving treatment outcomes in patients with high-risk factors such as smoking and medical conditions. Strategies, guidelines and protocols that reflect the best practices and lifestyle changes to improve the level of treatment success in high-risk patients should be adapted within treatment planning and follow-up. Successful treatment outcomes are best achieved through controlling diseases affecting the oral cavity and supporting structures.

Patient experiences and perspectives on hypertension at a major referral hospital in rural southwestern Uganda: a qualitative analysis

ObjectivesNovel care models are needed to address the large burden of hypertension globally. We aimed to explore how patients in rural Uganda experience and perceive hypertension in order to understand...

77 Routine outpatients visits during SARS-CoV2 global pandemic

AimsThe inability to carry office visits was collateral damage caused by the Coronavirus (COVID-19) pandemic. Tele-health is a relatively new, and yet fundamental amid the current crisis, resource to bridge the gap between phisicians and patients.Methods and resultsWe report our experience with telemedicine and describe the major events occured in our patients. 121 consecutive adult patients with arterial hypertension (F/M: 56/65; mean age: 66.8 years) were enrolled. 33 patients (27%) had also diabetes, 94 (78%) were also affected from dyslipidemia and 11 (9%) had CAD. They all referred to our ambulatory of hypertension, in most of case for several years. Given the impossibility to continue routine outpatient visits during lockdown, they were all phone called by three residents in order to detect their state of health or any events they could have experienced over this period. They were all asked about their own blood pressure values, the occurrence of new symptoms and of new-onset both cardiovascular and non cardiovascular events. We also followed a self-made preset form. 31 of them (26%) experienced cardiovascular symptoms/events during this period: 11 had hypertensive peaks, in one case associated with nausea and vomiting while 2 of them had hypotensive episodes; 10 had typical angina and/or dyspnoea while 4 had atypical angina; 6 had palpitations; 1 of them developed new onset atrial fibrillation resolved with pharmacologic cardioversion during hospitalization; 1 had syncope; 1 patient reported new onset peripheral oedema; 2 patients died during lockdown for non cardiovascular causes. 17 of them also developed non cardiovascular symptoms, 7 of whom were severe anxiety and/or panic attacks. Almost all patients had important lifestyle changes, in 15 cases (12.3%) associated with weight increase.ConclusionThe impossibility to access to routine outpatient visits during lockdown due to global pandemic of SARS-CoV2, has brought out the risk of underestimating consequences of chronic disease, in absence of appropriate Follow-up. Nevertheless, the two deaths we report were not related to cardiovascular disease. The risk is that both the missing of cardiovascular control visit and the extension of the waiting list, could provoke serious complications in patients suffering from chronic cardiovascular disease.

Takayasu's Arteritis from the Patients' Perspectives: Measuring the Pulse to the Patient-Reported Outcomes

Patients with Takayasu's arteritis (TA) experience important changes in lifestyle, quality of life, and functional status due to ischemic symptoms or treatment toxicity. To describe the clinical characteristics and the patient-reported outcomes (PROs), such as quality of life, disability, fatigue, and perception/impact of the disease in Mexican patients with TA. Cross-sectional study including patients with established diagnosis of TA recruited at a tertiary care center. Demographics, comorbidities, clinical characteristics, laboratory, imaging, and treatment were retrieved. Disease activity (the Indian Takayasu Clinical Activity Score (ITAS) 2010), damage (Vasculitis Damage Index (VDI)), quality of life (Short Form 36 (SF-36)), disability (Health Assessment Questionnaire Disability Index (HAQ-DI)), fatigue (Multidimensional Fatigue Inventory-20), and patient's disease perceptions were assessed. Fifteen women were included, with a median age of 41years (interquartile range (IQR) 30-45) and disease duration of 108months (IQR 55-197). Median ITAS 2010 and VDI scores were 0 (IQR 0-2) and 3 points (IQR 2-6), respectively. Mean SF-36 score was 71.38±13.39, with mean physical and mental component summaries of 66.52±13.37 and 76.24±14.89, respectively. HAQ-DI mean score was 0.48±0.62, being grip the most affected domain. Among fatigue subscales, the higher scores were present in the physical fatigue (16.3±5.8). Correlations between the HAQ-DI and the VDI score (r=0.64, P=0.03); between the general fatigue, score, and disease duration (r=-0.71, P=0.01); and between the SF-36 total score and the HAQ-DI (r=-0.87, P=0.0004) were found. It is important to identify disease-specific outcomes of interest to the patients to develop tools that assess them with a holistic approach.

Regional Differential in Diet Diversity Consumption and its Association with Adult Nutrition Status in Urban Areas

Background: The demographic and economic transition that many developing countries are undergoing isproducing important changes in diet and lifestyle that greatly impact on diet related disease risks. Therefore,evaluating the association between diet diversity and obesity would be interesting for the adult populationof urban areas.Objective: This study deals with the consumption of different food items in the region of Maharashtra andits association with adult nutritional status.Material & Method: This study used the National Family Health Survey (NFHS -4) data which wascollected during 2015-16. Multiple logistic regression analysis has been done to fulfill the objective of thestudy using software STATA version 14.Result: The present study found that the overweight and obesity situation among the adults of urbanMaharashtra is alarming. This study also shows that the consumption of the Non-veg food (Fish, Eggs,chicken or meat) higher in Konkan and Pune region.Conclusion: Based on the study findings, it is essential to address the present scenario of its increasingprevalence of overweight/obesity not only in the state but also at the national level.

Crafting an effective narrative on the green transition

The ambitious carbon-reduction targets set out by the Paris Agreement, or by recent Green Deals such as the one launched by European Commission President Ursula von der Leyen, will require a high degree of engagement with the public. This is true not only as important changes in lifestyle are going to be needed from citizens, especially in developed economies, but also because top-down measures will need public approval to be put in place. This paper reviews literature from behavioural and environmental economics, cognitive sciences, (social) psychology, health policy, and marketing to condense key insights on how to make communication on the green transition more effective in terms of citizens’ engagement. In doing so, it distils six policy recommendations that can serve as building blocks for an impactful narrative accompanying decarbonisation strategies, in Europe and beyond. If used skilfully, an effective communication and consequent behavioural change holds the promise of complementing top-down financial and regulatory tools, accelerating the green transition.

Compliance the Dietary Approaches to Stop Hypertension (DASH) Among the People with Pre-hypertension

Introduction:pre-hypertension is a common worldwide disease in 30-50% of the studied population. Diet compliance among pre-hypertensions is one of the most important changes in lifestyle. This study aims to determine compliance dietary approaches to stop hypertension (DASH) among pre-hypertensions. Methods:This cross-sectional study in 2017, using a cluster sampling method, 165 pre-hypertensive patients referred to health centers of Ferdows were surveyed. The data gathering tool was a three-day food inventory questionnaire. Information about the nutrition program was obtained using N4 software and data was analyzed using SPSS software version 19 and descriptive and analytic tests. The diet was measured by using a three-day dietary questionnaire. In order to analyze the data the consumed food substances were converted into gram scale and then the N4 software rendered the data on diet. The obtained data were analyzed in SPSS using chi-square and covariance. Results: The average Dash diet compliance was 24.21 ± 4.4. The mean and standard deviation of systolic and diastolic blood pressure were Respectively 133 ± 9.8, 82 ± 11. Compliance with the diet was accompanied by an increase in the consumption of fruits, vegetables, low-fat dairy, whole grains, beans, Nuts and reduced sodium intake Sweet drinks, and red meat and processed. There was a significant difference between the components of the diet plan and the score of the diet plan. Conclusion: Considering the importance of following a diet plan to prevent high blood pressure and its moderate follow-up among pre-hypertensive individuals, it is suggested that theoretically-focused interventions be designed to increase compliance with the diet.

The impact of type of dietary protein, animal versus vegetable, in modifying cardiometabolic risk factors: A position paper from the International Lipid Expert Panel (ILEP).

Proteins play a crucial role in metabolism, in maintaining fluid and acid-base balance and antibody synthesis. Dietary proteins are important nutrients and are classified into: 1) animal proteins (meat, fish, poultry, eggs and dairy), and, 2) plant proteins (legumes, nuts and soy). Dietary modification is one of the most important lifestyle changes that has been shown to significantly decrease the risk of cardiovascular (CV) disease (CVD) by attenuating related risk factors. The CVD burden is reduced by optimum diet through replacement of unprocessed meat with low saturated fat, animal proteins and plant proteins. In view of the available evidence, it has become acceptable to emphasize the role of optimum nutrition to maintain arterial and CV health. Such healthy diets are thought to increase satiety, facilitate weight loss, and improve CV risk. Different studies have compared the benefits of omnivorous and vegetarian diets. Animal protein related risk has been suggested to be greater with red or processed meat over and above poultry, fish and nuts, which carry a lower risk for CVD. In contrast, others have shown no association of red meat intake with CVD. The aim of this expert opinion recommendation was to elucidate the different impact of animal vs vegetable protein on modifying cardiometabolic risk factors. Many observational and interventional studies confirmed that increasing protein intake, especially plant-based proteins and certain animal-based proteins (poultry, fish, unprocessed red meat low in saturated fats and low-fat dairy products) have a positive effect in modifying cardiometabolic risk factors. Red meat intake correlates with increased CVD risk, mainly because of its non-protein ingredients (saturated fats). However, the way red meat is cooked and preserved matters. Thus, it is recommended to substitute red meat with poultry or fish in order to lower CVD risk. Specific amino acids have favourable results in modifying major risk factors for CVD, such as hypertension. Apart from meat, other animal-source proteins, like those found in dairy products (especially whey protein) are inversely correlated to hypertension, obesity and insulin resistance.

A Study to Assess the Factors Affecting Adherence to Exercise in the Indian Population.

IntroductionAs proven by many previous studies, physical inactivity is associated with many diseases, including heart conditions and cancer. The elimination of physical inactivity helps increase life expectancy and reduce morbidity. Nonadherence to exercise is a common problem faced by many people. The goal of this study was to determine the percentage of people in the Indian population who regularly exercise. We also assessed factors for nonadherence, motivating factors, and the intensity of exercise usually performed and explored any association between adherence to exercise and demographic factors.Materials and methodsWe conducted an anonymous questionnaire-based, cross-sectional study in an adult Indian population (participants were older than 18 years) from rural and urban areas having no contraindication to at least some form of voluntary exercise. Data were collected via email by sending a questionnaire, and an appropriate statistical methodology was used to derive the results.ResultsThis study included 220 individuals older than 18 years, and most participants were aged 25 to 30 years (35.5%). Most participants (67.3%) were women, and 32.7% were men. Forty-one percent of the total population reported suffering from some medical condition. Nearly half (51.8%) of the subjects were involved in physical activity, and 48.2% were not involved in physical activity. The most common reason for not exercising was a lack of time followed by a lack of motivation. Maintenance of good health was the main reported benefit of physical exercise, with self-motivation being the main motivator. Low-intensity exercise was the preferred form of exercise for most of the participants; high-intensity exercise was preferred by younger participants, though less commonly than low-intensity exercise. Older participants (i.e., those aged > 40 years) preferred moderate-intensity exercise. Only half the study population were educated regarding physical activity by a healthcare professional. We found no statistically significant association between the presence of a medical condition, body mass index (BMI), or healthcare education and adherence to exercise.ConclusionThe inclusion of exercise in a daily routine is one of the more important lifestyle changes advised for all ailments and for improvements in patient quality of life. Nearly half the Indian population does not exercise daily. Because we found no statistical significance between demographic factors, health conditions, BMI, or general healthcare education, an individualized education and exercise plan may help improve exercise adherence.

Healthy Diet and Reduction of Chronic Disease Risks of Night Shift Workers.

The large increase in epidemiological studies on night shift work is due to the important effects of night shift work on workers' health and psychophysical wellbeing. The short-term effects-insomnia, difficulties in managing work and private life, lower work performance, and more work and extra-work accidents-are easily studied. However, there are several long-term effects that are difficult to study because of the need for detailed exposure assessment and the long latency periods of these diseases. The aim was to collect epidemiologic evidence of diseases in night shift workers, describing their biological pathways and a set of dietary guidelines. This is a review on diet and health effects in night shift workers. Significant increases in the rate ratios and hazard ratios of different diseases were associated with modified eating behaviours and poor eating habits among night shift workers. Night shift work is a risk factor for disruption of the circadian rhythms and for some genetic deregulation because it produces the inversion of the sleep/wake cycle and modifies the alternation between activity and rest. A healthy diet and improved dietary practices, together with other factors, can reduce shift workers' chronic disease risk. The literature showed the importance of eating behaviour in order to prevent diseases in these workers; therefore, educational programmes are necessary to encourage several important lifestyle changes. The target of our future research will be the role of food components in some dietetic habits for the prevention of disease in night shift workers.

Evaluation of an intervention targeting loneliness and isolation for older people in North Wales.

Age Cymru Gwynedd and Môn provided a service, Cadwyn Môn, which aimed to reduce loneliness and isolation of older people living on Anglesey, North Wales. It involved working with individuals to identify goals, beginning on a one-to-one basis, with the aim of integrating into a wider social setting. The aim of this study was evaluate the impact of Cadwyn Môn on those who received the service. The evaluation adopted a mixed-methods design. Standardized measures of loneliness, social isolation and well-being were obtained at baseline and follow-up time points, and a qualitative element explored client experiences further. Improvements were observed in all standardized measures. Qualitative interviews also revealed important psychological and lifestyle changes. Given the anticipated rise in loneliness and social isolation alongside an ageing population, this evaluation contributes to understanding the qualities required for interventions to be effective. The findings provide support for the importance of developing individualized interventions that aim to gradually re-integrate people into their communities.

Diabetes, adult neurogenesis and brain remodeling: New insights from rodent and zebrafish models.

The prevalence of diabetes rapidly increased during the last decades in association with important changes in lifestyle. Diabetes and hyperglycemia are well-known for inducing deleterious effects on physiologic processes, increasing for instance cardiovascular diseases, nephropathy, retinopathy and foot ulceration. Interestingly, diabetes also impairs brain morphology and functions such as (1) decreased neurogenesis (proliferation, differentiation and cell survival), (2) decreased brain volumes, (3) increased blood-brain barrier leakage, (4) increased cognitive impairments, as well as (5) increased stroke incidence and worse neurologic outcomes following stroke. Importantly, diabetes is positively associated with a higher risk to develop Alzheimer disease. In this context, we aim at reviewing the impact of diabetes on neural stem cell proliferation, newborn cell differentiation and survival in a homeostatic context or following stroke. We also report the effects of hyper- and hypoglycemia on the blood-brain barrier physiology through modifications of tight junctions and transporters. Finally, we discuss the implication of diabetes on cognition and behavior.

Metabolic Syndrome and Nephrolithiasis Risk: Should the Medical Management of Nephrolithiasis Include the Treatment of Metabolic Syndrome?

This article reviews the relationship between metabolic syndrome (MetS) and nephrolithiasis, as well as the clinical implications for patients with this dual diagnosis. MetS, estimated to affect 25% of adults in the United States, is associated with a fivefold increase in the risk of developing diabetes, a doubling of the risk of acquiring cardiovascular disease, and an increase in overall mortality. Defined as a syndrome, MetS is recognized clinically by numerous constitutive traits, including abdominal obesity, hypertension, dyslipidemia (elevated triglycerides, low high-density lipoprotein cholesterol), and hyperglycemia. Urologic complications of MetS include a 30% higher risk of nephrolithiasis, with an increased percentage of uric acid nephrolithiasis in the setting of hyperuricemia, hyperuricosuria, low urine pH, and low urinary volume. Current American Urological Association and European Association of Urology guidelines suggest investigating the etiology of nephrolithiasis in affected individuals; however, there is no specific goal of treating MetS as part of the medical management. Weight loss and exercise, the main lifestyle treatments of MetS, counter abdominal obesity and insulin resistance and reduce the incidence of cardiovascular events and the development of diabetes. These recommendations may offer a beneficial adjunctive treatment option for nephrolithiasis complicated by MetS. Although definitive therapeutic recommendations must await further studies, it seems both reasonable and justifiable for the urologist, as part of a multidisciplinary team, to recommend these important lifestyle changes to patients with both conditions. These recommendations should accompany the currently accepted management of nephrolithiasis.

SURGICAL AND NON-SURGICAL THERAPY OF OBSTRUCTIVE SLEEP APNEA SYNDROME IN CHILDREN.

Interventions of paediatric obstructive sleep apnea syndrome are complex, varied and multidisciplinary. The goal of the treatment is to restore optimal breathing during the night and to relieve associated symptoms. Evidence suggests that the surgical intervention with removal of the tonsils and adenoids will lead to significant improvements in the most incomplicated cases, as recently reported from a meta-analysis. However, post-operative persistence of this syndrome in paediatric population is more frequent than expected, which supports the idea of the complexity of this syndrome. Adenotomy alone may not be sufficient in children with OSAS, because it does not address oropharyngeal obstruction secondary to tonsillar hyperplasia. Continuous positive airway pressure can effectively treat this syndrome in selected groups of children, improving both nocturnal and daytime symptoms, but poor adherence is a limiting factor. For this reason, CPAP is not recommended as first-line therapy for OSAS when adenotonsillectomy is an option. It is now being investigated the incorporation of nonsurgical approaches for milder forms and for residual OSAS after surgical intervention. Althought adeno-tonsillar hypertrophy is the most common for OSAS in children; obesity is emerging as an equally important etiological factor. Therefore an intensive weight reduction program and adequate sleep hygiene are also important lifestyle changes that may be very effective in mitigating the symptoms of this syndrome. Pharmacological therapy (leukotriene antagonists, topical nasal steroids) is usually use for mild forms of OSAS and in children with associated allergic diseases. Special orthodontic treatment and oropharyngeal exercises are a relatively new and promising alternative therapeutic modality used in selected groups of children with OSAS.