Lifestyle Health Research Articles

More Adult Women than Men at High Cardiometabolic Risk Reported Worse Lifestyles and Self-Reported Health Status in the COVID-19 Lockdown.

The COVID-19 lockdown represented an immense impact on human health, which was characterized by lifestyle and dietary changes, social distancing and isolation at home. Some evidence suggests that these consequences mainly affected women and altered relevant ongoing clinical trials. The aim of this study was to evaluate the status and changes in diet, physical activity (PA), sleep and self-reported health status (SRH) as perceived by older adult men and women with metabolic syndrome during the COVID-19 lockdown. We analyzed data from 4681 Spanish adults with metabolic syndrome. We carried out a telephone survey during May and June 2020 to collect information on demographics, dietary habits, PA, sleep, SRH and anthropometric data. The mean age of participants was 64.9 years at recruitment, and 52% of participants were men. Most participants (64.1%) perceived a decrease in their PA during confinement. Regarding gender-specific differences, a higher proportion of women than men perceived a decrease in their PA (67.5% vs. 61.1%), Mediterranean diet adherence (20.9% vs. 16.8%), sleep hours (30.3% vs. 19.1%), sleep quality (31.6% vs. 18.2%) and SRH (25.9% vs. 11.9%) (all p < 0.001). The COVID-19 lockdown affected women more negatively, particularly their self-reported diet, PA, sleep and health status.

Children’s Health Lifestyles and the Perpetuation of Inequalities

Health lifestyles are a well-theorized mechanism perpetuating health and social inequalities, but empirical research has not yet documented crucial aspects: (1) health lifestyles’ collective nature or content beyond behaviors and (2) how people choose among available lifestyles in their social contexts. We conducted interviews, observations, and focus groups with families in two middle- to upper-middle-class communities. Contemporary class-privileged parenting involves constructing an individualized health lifestyle reliant on an expansive understanding of health and composed of parents’ identities and narratives, children’s health behaviors and identity expressions, and community norms. Children’s predominant health lifestyles in our sample vary by focus on parent versus child identity expression and on future achievements versus present well-being. Parents expect health lifestyles to influence future socioeconomic attainment and health inequalities. Understanding how health lifestyles encompass more than behaviors and are locally contextualized and how people choose them within structural constraints can inform research and policy.

Persuasive Systems Design Trends in Coronary Heart Disease Management: Scoping Review of Randomized Controlled Trials.

Behavior change support systems (BCSSs) have the potential to help people maintain healthy lifestyles and aid in the self-management of coronary heart disease (CHD). The Persuasive Systems Design (PSD) model is a framework for designing and evaluating systems designed to support lifestyle modifications and health behavior change using information and communication technology. However, evidence for the underlying design principles behind BCSSs for CHD has not been extensively reported in the literature. This scoping review aims to identify existing health BCSSs for CHD, report the characteristics of these systems, and describe the persuasion context and persuasive design principles of these systems based on the PSD framework. Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, 3 digital databases (Scopus, Web of Science, and MEDLINE) were searched between 2010 to 2022. The major inclusion criteria for studies were in accordance with the PICO (Population, Intervention, Comparison, and Outcome) approach. Searches conducted in the databases identified 1195 papers, among which 30 were identified as eligible for the review. The most interesting characteristics of the BCSSs were the predominant use of primary task support principles, followed by dialogue support and credibility support and the sparing use of social support principles. Theories of behavior change such as the Social Cognitive Theory and Self-Efficacy Theory were used often to underpin these systems. However, significant trends in the use of persuasive system features on par with behavior change theories could not be established from the reviewed studies. This points to the fact that there is still no theoretical consensus on how best to design interventions to promote behavior change in patients with CHD. Our results highlight key software features for designing BCSSs for the prevention and management of CHD. We encourage designers of behavior change interventions to evaluate the techniques that contributed to the success of the intervention. Future research should focus on evaluating the effectiveness of the interventions, persuasive design principles, and behavior change theories using research methodologies such as meta-analysis.

Sleep patterns and quality in university students: characteristics and associated factors

Background: Sleep is vital and influenced by factors such as age, lifestyle, and mental health. College students are always faced with challenges that negatively compromise their sleep and well-being. Objective: To evaluate sleep quality and associated factors among university students. Methods: This was a cross-sectional and quantitative study with 294 students from a public university in northeastern Brazil. Questionnaires on social and health characteristics, the Pittsburgh Sleep Quality Index, the Munich Chronotype Questionnaire, and the Perceived Stress Scale were used for data collection. Results: The study included 294 students with an average age of 21.5 years, 52.7% female, 43.7% from the health field, and 56% from the daytime shift. There was a prevalence of 76.5% of poor sleep quality, with the most impacted components being sleep latency, daytime dysfunction, sleep disturbances, and subjective sleep quality. The average sleep duration on school days was 416 min ± 88min, with 69.4% using an alarm clock. The students exhibited a slightly evening chronotype, correlating with greater social jetlag (r = 0.510; p &lt; 0.001). Students who engaged in physical exercise had better sleep quality (7.9±3.5 vs 9.2±3.9; p = 0.005) and lower stress levels (22±6.1 vs 24.6±6.7; p &lt; 0.001). Additionally, poor sleep quality was also correlated with higher stress (r = 0.326; p &lt; 0.001) and eveningness (r = 0.244; p &lt;0.01). Conclusion: The study highlights the high prevalence of poor sleep quality among university students, correlated with stress and eveningness. Physical exercise improves sleep quality and reduces stress, demonstrating its importance for student health.

Nailfold Capillaroscopy: A Comprehensive Review on Its Usefulness in Both Clinical Diagnosis and Improving Unhealthy Dietary Lifestyles.

Since the 1970s, the utility of nailfold capillaroscopy (NFC) in diagnosing rheumatological disorders such as systemic sclerosis has been well established. Further studies have also shown that NFC can detect non-rheumatic diseases such as diabetes, glaucoma, dermatitis, and Alzheimer disease. In the past decade, nailfold capillary morphological changes have also been reported as symptoms of unhealthy lifestyle habits such as poor diet, smoking, sleep deprivation, and even psychological stress, all of which contribute to slow blood flow. Therefore, studying the relationships between the morphology of nailfold capillaries and lifestyle habits has a high potential to indicate unhealthy states or even pre-disease conditions. Simple, inexpensive, and non-invasive methods such as NFC are important and useful for routine medical examinations. The present study began with a systematic literature search of the PubMed database followed by a summary of studies reporting the assessment of morphological changes detected by NFC, and a comprehensive review of NFC's utility in clinical diagnosis and improving unhealthy dietary lifestyles. It culminates in a summary of dietary and lifestyle health promotion strategy, assessed based on NFC and other related measurements that indicate healthy microvascular blood flow and endothelial function.

A Pilot Study of BRAIN BOOTCAMP, a Low-Intensity Intervention on Diet, Exercise, Cognitive Activity, and Social Interaction to Improve Older Adults’ Dementia Risk Scores

BackgroundLittle is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults.ObjectivesTo examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults.DesignSingle-group pre-post design.SettingCommunity-dwelling.ParticipantsA total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community.InterventionA 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults.MeasurementsThe ‘LIfestyle for BRAin health’ (LIBRA) index was used to assess participants’ modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index.ResultsProgram attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen’s d=0.59, p<0.001), increased dementia literacy and awareness (Cohen’s d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen’s d=0.25–0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction.ConclusionsImproving older adults’ motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.

2022 County-Level Population Changes in the United States Through the Lens of the Lifestyle Health Index.

2022 County-Level Population Changes in the United States Through the Lens of the Lifestyle Health Index.

Multidomain Dementia Risk Reduction in Primary Care is Feasible: A Proof-of-concept study.

Dementia risk reduction is a public health priority, but interventions that can be easily implemented in routine care are scarce. To evaluate the feasibility of integrating dementia risk reduction in regular consultations in primary care and the added value of a dedicated smartphone app ('MyBraincoach'). 188 participants (40-60 years), with modifiable dementia risk factors were included from ten Dutch general practices in a cluster-randomized trial (NL9773, 06/10/2021). Practices were randomly allocated (1 : 1) to provide a risk-reduction consultation only or to additionally provide the app. During the consultation, participants learned about dementia risk reduction and how to improve their risk profile. The app group received daily microteaching-notifications about their personally relevant risk factors. Feasibility was evaluated after 3 months using questionnaires assessing knowledge on dementia risk reduction and health behavior change. The primary outcome was change in the validated "LIfestyle for BRAin health" (LIBRA) score. In-depth interviews were conducted with participants and primary care providers (PCPs). The interventions were positively perceived, with 72.0% finding the consultation informative and 69.2% considering the app useful. Drop-out was low (6.9%). LIBRA improved similarly in both groups, as did Mediterranean diet adherence and body mass index. Knowledge of dementia risk reduction increased, but more in the app group. Interviews provided insight in participants' and PCPs' needs and wishes. Integrating dementia risk reduction in primary care, supported by a smartphone app, is a viable approach towards dementia risk reduction. Larger trials are needed to establish (cost-)effectiveness.

Association of parent-child health parameters and lifestyle habits - the “epi-family health” longitudinal study protocol

BackgroundLifestyle and habits, cardiovascular risk factors (CRF), bone and mental health, dietary habits, physical activity, among others are developed in childhood and adolescence. Family environment has shown to play an important role in these outcomes. However, whether the parent-child relationship lifestyle habits and health parameters can be influenced by physical activity patterns still unclear. The objective of this study will be to monitor and investigate the associations between lifestyle habits between parents and their children longitudinally, as well as verify whether in more active parents, the possible associations with lifestyle habits are different from those of parents considered less active.MethodsThe sample will consist of parents (father, mother, or both) and their children /adolescents. The participants will be recruited through public call by flyers spread across all the regions of the city and also through social media. The health parameters will include cardiovascular (cardiac autonomic modulation, blood pressure and resting heart rate), bone mineral density, anthropometric indices, handgrip strength, mental health (quality of life, anxiety and depression symptoms and stress), self-reported morbidities and musculoskeletal pain. Lifestyle habits will include physical activity levels, sedentary behavior, sleep parameters, eating patterns, smoking and alcohol consumption. Sociodemographic variables of age, sex, ethnicity and socioeconomic status will be considered as covariates. The follow-up visits of data collection will be scheduled after a period of 12 months from the baseline assessment during every twelve months.DiscussionThe family environment has great potential to determine lifestyle habits in children and adolescents. Based on the results presented in the present study, we hope that health promotion actions can be better designed in the family environment.

Acute effects on the psychological perception of university students after participation in the "RegulACTION" workshop for the improvement of emotional health and promotion of an active lifestyle.

Prospective research in Health Sciences and Sports Sciences warns of the need to design and implement educational program at the different stages of human development, that promote emotional competences, interpersonal competences, an adequate level of healthy physical activity as well as adherence to the Mediterranean diet and a more active lifestyle on a physical and social level. The main objective of the study was to design an intervention program on intra-and interpersonal competences together with emotional education, nutritional education and healthy physical activity, called 'RegulACTION'. The preliminary study sample consisted of 11 participants aged 21-28 years (M = 5.00, SD = 8.76) (8 female and 3 males) university students. An ad hoc questionnaire was elaborated to evaluate the participant's perception of the usefulness of the 'RegulACTION' experience and a semi-structured interview of 5 questions to assess their perception, identification of their emotions, awareness of their cognitions, emotions and behaviors in the different areas of their lives. The descriptive results show that the participants are receptive to continuing training in the regulation of cognitions (thoughts) and emotions to increase their satisfaction in different areas of their lives. Regarding the qualitative results, the participants' perception, collected verbatim, is that they feel the need to apply the knowledge about personal and social emotions, as well as healthy behavior in terms of nutrition and exercise, in their daily lives. The 'RegulACTION' program is designed based on the assessment of the prevalence of mental illness in the young adult and adult population, in line with the literature review in the area of knowledge of the theory of emotions, motivational theories and on the occasion of the development of a workshop organized.

Lifestyle Medicine in Focus: A Cross-Sectional Study Comparing Domestic and International Students.

This study investigated lifestyle factors among Hungarian and international students, utilizing lifestyle medicine principles to enhance overall well-being. Conducted at the University of Debrecen through a cross-sectional survey, we examined selected lifestyle factors, more specifically sleep patterns, weight management, nutrition, physical activity, mental well-being, and alcohol use. Hungarian (N = 122) and international (N = 139) students were compared, revealing significant differences. Hungarian students slept less (p = 0.041), desired weight loss (p = 0.040), ate more fruits and vegetables (p = 0.014), exercised longer (p = 0.002), and reported higher purpose and social support (p = 0.009), with higher alcohol use (p < 0.001). These findings highlight distinct experiences and challenges faced by these student groups including variations in sleep, weight management, diet, exercise, and social support. Targeted interventions and tailored support are essential to address their specific needs. To promote the well-being of both Hungarian and international students, educational programs addressing various facets of a healthy lifestyle are crucial. This study offers valuable insights into lifestyle factors and health outcomes among Hungarian and international students and underscores the importance of addressing the unique needs of each group through tailored interventions.

Measuring the consumer’s choice for edible cutlery: A sustainable lifestyle perspective

Edible cutlery is a safe alternative that, if adopted, can act as a panacea to plastic pollution. Consumers who believe in a lifestyle of health and sustainability (LOHAS) can motivate others by taking the lead in this direction. This study has explored the psychological variables associated with LOHAS consumers in conjunction with the product attributes of edible cutlery to check whether these variables can influence lifestyle of health and sustainability (LOHAS) consumers to adopt edible cutlery. An empirical study on 210 LOHAS consumers using Partial Least Squares Structure Equation Modelling (PLS-SEM) and Importance Performance Matrix Analyses (IPMA) showed that social consciousness and subjective norms motivate them to adopt edible cutlery in restaurants. This finding has an implication for hospitality businesses using edible cutlery that can target LOHAS consumers with strategies that affect their social consciousness and subjective norm belief for better adoption intentions.

Self-efficacy beliefs as key ingredients to healthy and sustainable lifestyles. A five-year longitudinal study on diet and physical activity habits of newly diagnosed patients with acute coronary syndrome.

Cardiovascular diseases represent a significant cause of morbidity and mortality worldwide, and an unhealthy lifestyle notoriously accounts for a large percentage of their risk. Identifying resources to stimulate lifestyle changes is an essential goal of primary and secondary cardiovascular prevention. Self-efficacy beliefs are among the major psychological factors proven to impact health status and lifestyle. This study aimed to confirm the role of self-efficacy beliefs by investigating their associations over 5 years of adherence to healthy lifestyles in terms of diet and physical activity in a sample of 275 newly diagnosed patients with acute coronary syndrome. Longitudinal profiles of lifestyles and self-efficacy beliefs in their improvement were identified through latent class growth analysis. Correlations were then performed to explore the associations between lifestyles and self-efficacy trajectories. Results showed a positive association between virtuous lifestyle profiles and high self-efficacy in implementing behavioural change. Finally, two logistic regressions were performed to test the hypothesis that a high self-efficacy profile would predict better lifestyles 5 years after the coronary event. This hypothesis was confirmed for diet. Overall, current findings confirm the importance of implementing repeated psychological interventions that promote patients' efficacy beliefs in self-regulating their behaviour changes over time.

Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals.

Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks.

Factors associated with intrinsic capacity impairment in hospitalized older adults: a latent class analysis

BackgroundIntrinsic capacity (IC) is proposed by the World Health Organization (WHO) to promote healthy aging. Although some studies have examined the factors influencing IC, few studies have comprehensively confirmed lifestyle factors on IC, especially IC impairment patterns. The present study aimed to identify the patterns of IC impairment and explore the lifestyle and other factors associated with different patterns of IC impairment.MethodsThis cross-sectional study was conducted in a Chinese geriatric hospital. IC was evaluated in five domains according to the recommendations of WHO: cognition, locomotion, vitality, sensory and psychological domains. The sociodemographic and health-related characteristics of participants were assessed.The health promoting lifestyle was evaluated using the Health-Promoting Lifestyle Profile-II scale, including nutrition, health responsibility, interpersonal relationships, physical activity, spiritual growth and stress management. We applied latent class analysis to identify IC impairment patterns and compared basic activities of daily living, instrumental activities of daily living, frailty, quality of life and falls among different IC impairment patterns. Multinomial logistic regression analysis was conducted to identify factors influencing the IC impairment patterns.ResultsAmong 237 participants included, the latent class analysis identified three patterns of IC impairment: 44.7% high IC (Class 1), 31.2% intermediate IC mainly locomotor impairment (Class 2) and 24.1% low IC mainly cognitive impairment (Class 3). Older adults in class 1 had the best function ability and quality of life, while class 3 had the highest levels of disability and frailty, the poorest quality of life and a higher prevalence of falls. Compared with class 1, older adults with advanced age (OR = 22.046, 95%CI:1.735-280.149), osteoporosis (OR = 3.377, 95%CI:1.161–9.825), and lower scores in physical activity (OR = 0.842, 95%CI:0.749–0.945), stress management (OR = 0.762, 95%CI:0.585–0.993) and social support (OR = 0.897, 95%CI:0.833–0.965) were more likely to belong to the class 2. Simultaneously, compared with class 1, older adults with advanced age (OR = 104.435, 95%CI:6.038-1806.410), stroke (OR = 3.877, 95%CI:1.172–12.823) and lower scores in physical activity (OR = 0.784, 95%CI:0.667–0.922) and social support (OR = 0.909, 95%CI:0.828–0.998) were more likely to be class 3. In addition, compared with class 2, older adults with a lower score in nutrition (OR = 0.764, 95%CI:0.615–0.950) were more likely to belong to the class 3.ConclusionsThis study provides evidence that there are heterogeneous IC impairment patterns in older adults and identifies various associated factors in each pattern, including age, stroke, osteoporosis, social support and lifestyle behaviors such as nutrition, physical activity and stress management. It informs stakeholders on which modifiable factors should be targeted through public health policy or early intervention to promote IC and healthy aging in older adults.

Multimodal dementia identification using lifestyle and brain lesions, a machine learning approach

Dementia diagnosis often relies on expensive and invasive neuroimaging techniques that limit access to early screening. This study proposes an innovative approach for facilitating early dementia screening by estimating diffusion tensor imaging (DTI) measures using accessible lifestyle and brain imaging factors. Conventional DTI analysis, though effective, is often hindered by high costs and limited accessibility. To address this challenge, fuzzy subtractive clustering identified 14 influential variables from the Lifestyle for Brain Health and Brain Atrophy and Lesion Index frameworks, encompassing demographics, medical conditions, lifestyle factors, and structural brain markers. A multilayer perceptron (MLP) neural network was developed using these selected variables to predict fractional anisotropy (FA), a DTI metric reflecting white matter integrity and cognitive function. The MLP model achieved promising results, with a mean squared error of 0.000 878 on the test set for FA prediction, demonstrating its potential for accurate DTI estimation without costly neuroimaging techniques. The FA values in the dataset ranged from 0 to 1, with higher values indicating greater white matter integrity. Thus, a mean squared error of 0.000 878 suggests that the model’s predictions were highly accurate compared to the observed FA values. This multifactorial approach aligns with the current understanding of dementia’s complex etiology influenced by various biological, environmental, and lifestyle factors. By integrating readily available data into a predictive model, this method enables widespread, cost-effective screening for early dementia risk assessment. The proposed accessible screening tool could facilitate timely interventions, preventive strategies, and efficient resource allocation in public health programs, ultimately improving patient outcomes and caregiver burden.

Factors Influencing COVID-19 Vaccination among Primary Healthcare Nurses in the Pandemic and Post-Pandemic Period: Cross-Sectional Study.

The decision to vaccinate against COVID-19 is primarily a personal choice influenced by numerous factors. Vaccine acceptance and a positive attitude towards vaccination among nurses have an impact on patients' willingness to vaccinate. To assess COVID-19 vaccination coverage among primary healthcare nurses and to associate socio-demographic factors, comorbidity, self-rated health, and unhealthy lifestyle with the decision to be vaccinated, we conducted an online cross-sectional study from March to May 2023 using a self-administrated questionnaire. Probability sampling was used to select 32 health centers and nurses were invited via email. Among the 560 participants who completed survey, 78.3% and 50.8% received the primary two-dose course and at least one booster dose of COVID-19 vaccine, respectively. Primary care nurses who were ≥41 years of age, physically less active, and those who were overweight opted statistically significantly more often for the primary vaccination scheme (p = 0.00, 0.015 and 0.017, respectively). Education and the living environments of primary care nurses did not significantly influence the decision to receive two primary COVID-19 doses. Likewise, good self-rated health and comorbidity did not contribute significantly to the vaccination decision. Nurses that were vaccinated with booster doses were significantly more often overweight (p = 0.034) and ≥41 year of age (p = 0.000).

Diet Quality and Resilience through Adulthood: A Cross-Sectional Analysis of the WELL for Life Study.

Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords' WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0-120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18-24), late young (25-34), middle (35-49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p < 0.001)) and within each age group (early young (β = 1.1 ± sd: 0.3, p < 0.001); late young (β = 1.2 ± sd: 0.3, p < 0.001); middle (β = 0.9 ± sd: 0.3, p < 0.001); and late adulthood (β = 1.0 ± sd: 0.3, p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults.

Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants.

Body adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants. 10,370 CAD patients (mean age ∼65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health). During ∼10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI ∼27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25-30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95%CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level. CAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.

The Cardiovascular Risk Awareness and Health Lifestyle of Italian Women.

Background: Cardiovascular (CV) disease is the leading cause of death in women, but few of them are aware of the CV risks (CVRs). Most women are not aware of all the CV risk factorsand their knowledge often still does not improve their lifestyle. Methods: The Carin Women is a survey conducted among Italian women by filling out a questionnaire in the waiting rooms of clinics. The aim was to determine the level of awareness of women's cardiovascular risk, knowledge of risk factors, and lifestyle. A total of 5590 questionnaires were completed in two different periods. Results: Median age was 56 (IQR 46-65); BMI was 25 (IQR 22-29). Schooling, marital status, and rate of risk conditions were assessed; 311 women (5.57%) had already suffered a cardiovascular event. The relationship between the CV events and the number of traditional risk factors was significant. A similar curve, but without significant differences, was reported for non-traditional risk factors. From the total number of women, 23% with a high CVR and 62% with a very high CVR underestimated thei risk regardless of their level of education. Up to 43% of women underestimated female CV risk compared to male risk. Women showed a good knowledge of traditional risk factors, but only a few of them had a healthy lifestyle: 21.86% were smokers, only 45.88% performed sufficient physical activity, 27.55% did not recognize they were overweight, and only 30.4% consumed more than two daily portions of fruit and vegetables. Most women (86%) need more information about CVR. Conclusions: Italian women underestimate female CVRs and their own CVR.