Lifestyle Modification Strategies Research Articles

The Ibadan Pregnancy Cohort Study (IbPCS), a Prospective Cohort Study Protocol

Maternal obesity is a neglected public health challenge in Nigeria, even though it's associated with adverse metabolic, pregnancy, postpartum outcomes and future risk of non-communicable diseases. The Ibadan Pregnancy Cohort Study (IbPCS) investigates maternal obesity, lifestyle factors and the associated pregnancy and postpartum outcomes in Ibadan, Nigeria. IbPCS is an ongoing prospective cohort study that enrolled 1745 pregnant women at ≤ 20 weeks gestation at their first antenatal visit from four health facilities in Ibadan. Maternal body mass index (BMI) and lifestyle characteristics (Physical Activity - PA and Dietary Pattern) were assessed during enrollment using the pregnancy physical activity questionnaire and a qualitative food frequency questionnaire. The follow-up of participants was at 24 -28 weeks, third trimester, delivery and the postpartum period. Biomarkers (blood glucose and lipids) were assessed during the Oral Glucose Tolerance Test conducted between 24 – 28 weeks' gestation after an overnight fast. Baseline characteristics were: age (29.8±5.3 years), BMI (26.2±7.1kg/m2), primigravida (32.4%) , married (94.2%) , and tertiary level education (68.3%). This study will provide the preventive tools and lifestyle modification strategies required to mitigate the adverse effect of maternal obesity on maternal and child health and a future epidemic of cardio-metabolic diseases in Nigeria

Cardiovascular disease risk factors and lifestyle modification strategies after pediatric kidney transplantation: what are we dealing with, and what can we target?

Kidney transplantation in pediatric patients can lead to partial improvement of some of the cardiometabolic parameters that increase the risk for cardiovascular disease (CVD) in patients with chronic kidney disease. However, even after restoration of kidney function, transplant recipients remain at risk for CVD due to the continual presence of traditional and non-traditional risk factors, including the side effects of immunosuppression and chronic inflammation. This educational review describes the prevalence of CVD risk factors in pediatric kidney transplant recipients and presents available evidence for therapeutic lifestyle changes and other non-pharmacologic strategies that can be used to improve traditional and modifiable CVD risk factors. Although trial-grade evidence for interventions that improve CVD in pediatric kidney transplant recipients is limited, potential strategies include lowering dietary sodium and saturated fat intake and increasing physical activity levels. Intensive follow-up may help patients achieve guideline-recommended goals for reducing their overall CVD risk.

A nurse-led cardiovascular disease prevention clinic

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Bayer Background Patients who present to our hospital with a vascular event receive appropriate preventative measures and are discharged to Primary Care without further specialist review. We have initiated a Cardiovascular Disease Prevention Clinic to provide specialist review for all patients at one year following their index event. Purpose This project was undertaken to assess the implementation of guideline-directed preventative treatment within our current patient pathway, thereby establishing the need for, and the likelihood of benefiting from a secondary care specialist clinic. Methods The medical notes of all patients on our angiography database over a 6 month period were scrutinised. This included the majority of patients diagnosed with acute coronary syndromes [ACS] and symptomatic coronary artery disease [CAD] over this period. Patients with confirmed atheromatous CAD were screened for clinical features that would put them at high risk of recurrent events. These risk factors were identified in recent landmark trials[1,2] and include: diabetes, eGFR <60, age >65 years, multi-vessel disease, recurrent events within 3 years, and heart failure. Of the high risk patients, those whose management was deemed suboptimal were invited to attend the clinic that is nurse led, protocol driven, with a Consultant available for advice. All appointments were conducted via telephone in view of COVID precautions. Patients were assessed according to guideline targets for cardiovascular risk factors[3,4,5]. Lifestyle habits were reviewed with appropriate guidance provided for the patient. Results 833 patients were screened, of which 175 patients fulfilled the above criteria and so invited to the clinic. 2 patients declined the appointment. Table 1 summarises the guideline targets not achieved by the high risk cohort. 132 patients (75.8%) met the criteria for consideration for DOAC[6]. Of these, 80 (60%) had a relative bleeding contraindication or declined therapy. 155 (88.6%) met the criteria for consideration for longer-term P2Y12i[7]. Of these 139 (89.7%) had relative bleeding contraindications or declined therapy. Interventions implemented at this clinic are summarised in Table 2. All patients were given advice with regard to lifestyle modification strategies. Conclusion The discharge pathway for patients diagnosed with ACS and symptomatic CAD includes cardiologist prescribing, cardiac rehabilitation nurse review and primary care follow-up. Despite this, we showed that a significant number of patients with CAD and at high risk of recurrent events failed to achieve secondary prevention targets at one year following their index event. A specialist CVD prevention follow-up clinic can result in significant improvements in patient management over and above the usual standard of care and we should anticipate a reduction in cardiovascular events as a result of this. A nurse led clinic with prescribing protocols based on current guidelines is a successful clinic model.

FC003: Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Hyperfiltration In Subjects with Prediabetes and Abdominal Obesity Without Evidence of Chronic Kidney Disease

Abstract BACKGROUND AND AIMS The newly defined metabolic dysfunction-associated fatty liver disease (MAFLD) [1] is a multifactorial state that could influence multiple extra-hepatic diseases. Glomerular hyperfiltration (GHF) is an important early determinant of diabetic kidney disease onset and progression in a subgroup of patients, and recently it was reported that prediabetes stage is an independent risk for incident GHF [2]. Currently, no data are available on the association between MAFLD and GHF. The aim of the study was to determine the prevalence of MAFLD and whether and to which extent it is associated with GHF in prediabetic subjects with abdominal obesity and without evidence of chronic kidney disease (CKD). METHOD Data from a total of 6697 civil servants, aged 18–65 years, with prediabetes (fasting plasma glucose ≥100 ≤ 125 mg/dL, American Diabetes Association criteria), abdominal obesity (waist circumference ≥94 cm for men and ≥80 cm for women, International Diabetes Federation criteria) and an estimated glomerular filtration rate (eGFR) ≥60 mL/min, belonging to a large Spanish database of routine occupational health visits (January 2008–December 2010), were included in the analyses. The presence of MAFLD was defined according to the criteria of an international expert consensus statement [1]. Liver steatosis, the first component of MAFLD, was determined by the validated fatty liver index (FLI) with a cut-off value of ≥603. An eGFR was calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [4], deindexed for body surface area (BSA) to avoid underestimation in patients with obesity [5]. Hyperfiltration was defined as an eGFR above the age- and gender-specific 95th percentile. The association between MAFLD and GHF was evaluated by multivariable logistic regression. RESULTS Overall, the prevalence of subjects with MAFLD was 62.9% (n = 4213). Hyperfiltering subjects (n = 330, 4.9%), as compared with non-hyperfiltering subjects, had a higher prevalence of MAFLD (86.4% versus 61.7%, P < .001), higher BMI, waist circumference for both genders, systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP), higher prevalence of arterial hypertension, lower total cholesterol and serum creatinine (P < .05 for all comparisons) (Table 1). In multivariable logistic regression, the presence of MAFLD was independently associated with GHF after adjusting for age, gender, obesity, MAP and smoking status (adjusted OR 3.36, 95% CI 2.33–4.84; P < .001) (Table 2). Receiving operator characteristic curve analysis confirmed the predictive power of MAFLD (area under the curve of 0.623, 95% CI 0.60–0.65; P < .001). CONCLUSION Prediabetic subjects with abdominal obesity are characterized by an increased prevalence of MAFLD that emerges as a possible early risk marker of GHF. This could help general practitioners to timely identify patients at high risk and to start weight loss with appropriate calorie restriction and lifestyle modification strategies. Longitudinal studies are needed to investigate whether MAFLD in prediabetes is associated with a later decline in eGFR.

MO446: The Prevalence of Mafld in Subjects With Normoglycaemia, Prediabetes and Type 2 Diabetes Without Evidence of Chronic Kidney Disease and its Association With Glomerular Hyperfiltration

Abstract BACKGROUND AND AIMS Whereas metabolic dysfunction-associated fatty liver disease (MAFLD) reflects multisystem disorders [1], many aspects of the association between MAFLD and extra-hepatic diseases are the issues to study. Glomerular hyperfiltration (GHF) is an early manifestation of kidney damage in diabetic patients and predicts its further progression. Recently it was reported that an initial increase of plasma glucose in subjects with prediabetes is an independent risk for incident GHF [2]. However, it remains unknown whether GHF could also occur in subjects with normoglycaemia and whether it is associated with MAFLD. The study aimed to compare the prevalence of MAFLD in subjects with normoglycaemia, prediabetes and type 2 diabetes mellitus without evidence of chronic kidney disease (CKD) and then explore its association with GHF in the study groups. METHOD A cohort of 125 070 people aged 18–65 years, without CKD [(estimated glomerular filtration rate (eGFR) ≥60 mL/min], belonging to a large Spanish database of routine occupational health visits (January 2008–December 2010), has been explored. Subjects were divided into three groups according to their fasting plasma glucose (FPG) levels—subjects with normoglycaemia (FPG < 100 mg/dL), prediabetes (FPG ≥ 100–≤125 mg/dL) and type 2 diabetes mellitus (FPG ≥ 126 mg/d or use of antidiabetic drugs), according to the American Diabetes Association criteria. The presence of MAFLD was defined according to the new criteria of an international expert consensus statement [1]. Liver steatosis was determined by the validated Fatty liver index (FLI) with a cut-off value of ≥ 60 [3]. eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [4], deindexed for body surface area (BSA) to avoid underestimation in patients with obesity [5]. Hyperfiltration was defined as an eGFR above the age- and gender-specific 95th percentile. The association between MAFLD and GHF was evaluated by multivariable logistic regression. RESULTS The overall prevalence of subjects with MAFLD was 19.3% (n = 24 112) and it significantly increased from 14.7% (n = 14 809) to 33.2% (n = 5697) and 48,9% (n = 3606), in subjects with normoglycaemia, prediabetes and diabetes, respectively (Table 1), (P < 0.001 between all paired groups). By definition, the overall presence of hyperfiltration was 5% (n = 6249) and it significantly increased from 4.5% (n = 4553) to 5.7% (n = 978) and 9.7% (n = 718) in subjects with normoglycaemia, prediabetes and diabetes, respectively (P < 0.001 between all paired groups). In multivariable logistic regressions, along with age, gender, overweight, obesity (common risk factors in the three groups), the presence of MAFLD was independently associated with GHF, ​after adjusting for the following confounding variables—age, gender, overweight, obesity, FPG, mean arterial pressure, triglycerides, gamma-glutamyl transferase, presence of arterial hypertension, drug therapy and smoking status: adjusted odds ratio (OR), 1.96; 95% confidence interval (CI), 1.78–2.15, P < 0.001; adjusted OR, 2.83; 95% CI, 2.31–3.47, P < 0.001 and adjusted OR, 2.05; 95% CI, 1.58–2.66, P < 0.001 for the subjects with normoglycaemia, prediabetes and diabetes, respectively (Table 2). CONCLUSION The increase of FPG levels in subjects with normoglycaemia, prediabetes and diabetes is accompanied by an increase of the prevalence of MAFLD, which in turn, raises a possible independent early risk marker of GHF in the three study groups, together with other metabolic risk factors. Timely identifying subjects with MAFLD might be helpful to early setup calorie restriction and lifestyle modification strategies. Longitudinal studies are needed to investigate whether and to which extent MAFLD is associated with an increased risk of a future kidney function decline among subjects with normoglycaemia and prediabetes.

Metabolic Syndrome and Its Associated Factors Among Faculty Members in a Tertiary Care Teaching Hospital, Puducherry: A Cross-Sectional Analytical Study.

Background: Settings-based approach has received lot of attention under WHO renewed strategy of health promotion. It advocates regular screening/health check-ups of employees to maintain a healthy workplace. This study aimed to assess prevalence of metabolic syndrome (MetS) among faculty members and its association with selected sociodemographic, behavioral and biochemical parameters, and to determine the 10-year fatal or nonfatal cardiovascular risk using WHO-ISH risk chart. Methodology: A cross-sectional study was conducted among 252 teaching faculty members using standardized international protocols to measure behavioral risk factors (smoking, alcohol consumption, diet pattern, physical activity, sleep, and stress), physical characteristics (weight, height, waist and hip circumferences, and blood pressure), and biochemical parameters (fasting glucose and lipid profile). Risk factor profiling was done using WHO/ISH risk prediction chart. Results: Among 252 participants (males: 172 and females: 80), 58 (24.1%) were with MetS. Prevalence was higher in males (24.6%) than females (22.6%). The younger doctors (≤40 years) had lesser prevalence of MetS compared with the elderly (>40 years) doctors (20.3% vs. 26%). Age and diet pattern were found to be independently associated with MetS. The risk of having a cardiovascular event in 10 years was <5% (low risk) for 87.5% of study participants. Conclusion: Although we included doctors who are probably the most health-conscious population, we have found that one in four have a chance of having MetS. There is a need for periodic screening program and lifestyle modification strategies to control the burden of MetS among doctors.

Composite Score of Healthy Lifestyle Factors and the Risk of Pancreatic Cancer in a Prospective Cohort Study.

While the associations between individual lifestyle factors and risk of pancreatic cancer were studied extensively, their combined impact has not been examined. We evaluated the association of a composite score of healthy lifestyle factors, including body mass index, cigarette smoking, the Alternative Healthy Eating Index-2010 (AHEI-2010), sleep duration, and physical activity with pancreatic cancer risk in the Singapore Chinese Health Study, an ongoing prospective cohort study of 63,257 Chinese aged 45 to 74 years at enrollment in 1993 to 1998 with up to 25 years of follow up. Cox proportional hazard regression method was used to estimate HR and its 95% confidence interval (CI) with adjustment for multiple potential confounders. We identified 316 incident pancreatic cancer cases among the cohort participants after a mean 17 years of follow up. Individuals with higher composite scores representing healthier lifestyle were at significantly lower risk of pancreatic cancer. The multivariate-adjusted HRs (95% CIs) of pancreatic cancer incidence for the composite scores 2, 3, 4, 5, 6 to 7 were 0.60 (0.50-0.91), 0.48 (0.32-0.71), 0.45 (0.31-0.67), 0.41 (0.27-0.62), and 0.38 (0.24-0.62), respectively, compared with the scores 0 to 1 (P trend < 0.0001). The inverse association was more apparent among participants without diabetes history and was robust in men and women as well as in alcohol drinkers and nondrinkers. In summary, the association for pancreatic cancer risk was stronger for the aggregated than individual healthy lifestyle factors. These findings suggest that a more comprehensive lifestyle modification strategy would be more effective for prevention of pancreatic cancer than the change of a single lifestyle factor. PREVENTION RELEVANCE: In this large prospective Asian study, we calculated a composite score of healthy lifestyle factors, including body mass index, cigarette smoking, the Alternative Healthy Eating Index-2010 (AHEI-2010), sleep duration, and physical activity and found this composite score was associated with a significant reduction in pancreatic cancer risk, by as much as 62%. This finding suggests that public health programs emphasizing comprehensive lifestyle modification strategy would be more effective for prevention of pancreatic cancer than the change of a single lifestyle factor.

Lifestyle interventions for preventing and ameliorating CKD in primary and secondary care.

Despite the growth in chronic kidney disease (CKD) epidemics, evidence-based lifestyle recommendations for primary prevention of CKD are limited by reliance on observational studies and predominantly pilot clinical trials. Emerging data have shown lifestyle modification strategies for primary CKD prevention with the most evidence favoring a healthy dietary pattern (rich in fruit, vegetables, potassium and have a higher plant-based to animal protein ratio), and diet low in sodium, being physically active, avoiding tobacco smoking, moderating alcohol consumption and maintaining a healthy body weight. The way these behavioral interventions can be implemented in practice should consider their synergistic benefit as well as mechanisms to facilitate long-term behavior change. Sustaining long-term behavior change remains a challenge in practice, particularly due to a lack of healthcare resources and behavior relapse. Some suggestions to mitigate this include ensuring adequate time is spent in intervention codesign and planning, utilizing adaptive trial/intervention designs with regular intervention tailoring for intervention dose, intensity, duration, and modality. A number of modifiable lifestyle behaviors consistently associate with developing CKD in the community. The current evidence base, despite its inherent limitations, may inform both public health recommendations and clinical practice.

Associations of Socioeconomic Status and Rurality With New-Onset Cardiovascular Disease in Cancer Survivors: A Population-Based Analysis.

Patients with cancer are predisposed to develop new-onset cardiovascular disease (CVD). We aimed to assess if rural residence and low socioeconomic status modify such a risk. Patients diagnosed with solid organ cancers without any baseline CVD and on a follow-up of at least 1 year in a large Canadian province from 2004 to 2017 were identified using the population-based registry. We performed logistic regression analyses to examine the associations of rural residence and low socioeconomic status with the development of CVD. We identified 81,418 patients eligible for the analysis. The median age was 62 years, and 54.3% were women. At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD diagnosis was 29 months. Rural patients (32.3% v 28.5%; P < .001) and those with low income (30.4% v 25.9%; P < .001) or low educational attainment (30.7% v 27.6%; P < .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio [OR], 1.07; 95% CI, 1.04 to 1.11; P < .001), low income (OR, 1.17; 95% CI, 1.12 to 1.21; P < .001), and low education (OR, 1.08; 95% CI, 1.04 to 1.11; P < .001) continued to be associated with higher odds of CVD. A multivariate Cox regression model showed that patients with low socioeconomic status were more likely to die, but patients residing rurally were not. Despite universal health care, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs for the growing number of cancer survivors.

Clinical impact of sexual dimorphism in non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis (NASH).

NAFLD/NASH is a sex-dimorphic disease, with a general higher prevalence in men. Women are at reduced risk of NAFLD compared to men in fertile age, whereas after menopause women have a comparable prevalence of NAFLD as men. Indeed, sexual category, sex hormones and gender habits interact with numerous NAFLD factors including cytokines, stress and environmental factors and alter the risk profiles and phenotypes of NAFLD. In the present review, we summarized the last findings about the influence of sex on epidemiology, pathogenesis, progression in cirrhosis, indication for liver transplantation and alternative therapies, including lifestyle modification and pharmacological strategies. We are confident that an appropriate consideration of sex, age, hormonal status and sociocultural gender differences will lead to a better understanding of sex differences in NAFLD risk, therapeutic targets and treatment responses and will aid in achieving sex-specific personalized therapies.

Composite Score of Healthy Lifestyle Factors and Risk of Hepatocellular Carcinoma: Findings from a Prospective Cohort Study.

While the associations between individual lifestyle factors and risk of hepatocellular carcinoma (HCC) have been described previously, their combined impact on HCC risk is unknown. The association of a composite score of healthy lifestyle factors, including body mass index, alcohol consumption, cigarette smoking, alternative Mediterranean diet, and sleep duration, and HCC risk was examined in the Singapore Chinese Health Study, an ongoing prospective cohort study of 63,257 Chinese men and women. Cox proportional hazard regression method was used to estimate HR and its 95% confidence interval (CI). Conditional logistic regression method was used to evaluate this composite lifestyle score-HCC risk association among a subset of individuals who tested negative for hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibody. After a mean follow-up of 17.7 years, 561 participants developed HCC. Individuals with higher composite scores representing healthier lifestyles (range 0-8) were at significantly lower risk of HCC. Compared with the lowest composite score category (0-4), the HRs (95% CIs) for the composite scores of 5, 6, 7, and 8 were 0.67 (0.62-0.85), 0.61 (0.48-0.77), 0.49 (0.37-0.65), and 0.13 (0.06-0.30), respectively (P trend < 0.0001). A similar inverse association was observed in participants with negative HBsAg and anti-hepatitis C virus (HCV)-negative serology (HR, 0.38; 95% CI, 0.19-0.79; for the highest vs. the lowest category of the composite scores; P trend = 0.001). Healthy lifestyles protect against HCC development, especially for individuals without hepatitis B virus and HCV infections. This study highlights the importance of a comprehensive lifestyle modification strategy for HCC primary prevention.

Cataract and systemic disease: A review.

We review the current literature regarding the risk factors for cataract and the association between cataract and systemic disease. Numerous epidemiologic studies have found that the risk factors for age-related cataract formation include age, sex, race and myopia. Modifiable risk factors include smoking, socioeconomic status and ultra-violet light exposure. Alcohol intake and nutritional status may play a role in cataract formation. Cataract has been associated with many systemic diseases mainly diabetes mellitus, hypertension, obesity, chronic kidney disease and autoimmune disease. Cataract is also a hallmark of many metabolic disorders and syndromes. These findings are important to help implement risk factor and lifestyle-modification strategies that can hopefully decrease the burden of global cataract blindness.

Psycho-social and behavioral impact of COVID-19 on middle-aged and elderly individuals: A qualitative study.

BACKGROUND:COVID-19 may seem to have an impact on middle-aged and elderly people. However, not much is known about the lived experiences of middle-aged and elderly people during this pandemic. The study aims to explore psychosocial and behavioral impact of COVID-19 on the lives of these individuals.MATERIALS AND METHODS:Three focus group discussions and seven in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive and snowball sampling techniques. Discussions were recorded and transcribed verbatim. Thematic analysis method was used to extract key conceptual themes.RESULTS:There were 12 male and 10 female participants included, with a mean age of 62.2 years. Five subcategories identified were: Fear and anxiety, household confinement, lifestyle modification, preventive practices, and coping strategies. These sub-categories formed three major categories-psychological, social, and behavioral which ultimately led to the emergence of the main theme that is, COVID-19 effects on the life of middle-aged and older individuals.CONCLUSION:Middle-aged and elderly people are affected in many ways due to COVID-19. Addressing the psycho-social and behavioral problems can help in the better adjustment to tide over the pandemic.

Lifestyle modification strategies practiced in management of hypertensive patients in Imenti North Sub County, Kenya

Lifestyle modification strategies practiced in management of hypertensive patients in Imenti North Sub County, Kenya

Factors affecting health seeking behaviour in hypertensive patients of Imenti North sub county, Kenya

Background: Prevalence of non-communicable diseases like hypertension is raising hence a burden to low resource countries like Kenya. Purpose of the study was to determine factors affecting health seeking behaviour in hypertensive patients in Imenti North sub county, Kenya.Methods: A cross-sectional study design and cluster random sampling method was used to select five health facilities for study. Purposive sampling was used to select total of 212 patients from selected health facility proportionally. Spearman’s Rho correlation and bivariate logistic regression was used to check for strength of associations.Results: Patients interviewed had an average of 51 years and higher proportions were above 40 years of age. Married and female patients were (66.5%), and 60% respectively. An average of (42%) had a secondary level of education. Knowledge on lifestyle modification strategies was above average (68%).Conclusions: Health education given during hypertensive clinics had positive influence. Slow service delivery, long queues and the long waiting times for laboratory investigation results influenced patients’ health seeking behavior negatively. The study recommends the government of Kenya to develop policies on implementation of support groups among hypertensive patients in all hospitals and intensify campaigns on importance of seeking medical attention early. This will empower the patients on knowledge of hypertension management. The study also recommends health care providers to ensure reduced waiting time for the patients.

Catheter ablation for atrial fibrillation: current indications and evolving technologies.

Catheter ablation for atrial fibrillation (AF) has emerged as an important rhythm-control strategy and is by far the most common cardiac ablation procedure performed worldwide. Current guidelines recommend the procedure in symptomatic patients with paroxysmal or persistent AF who are refractory or intolerant to antiarrhythmic drugs. The procedure might also be considered as a first-line approach in selected asymptomatic patients. Data from large registries indicate that AF ablation might reduce mortality and the risk of heart failure and stroke, but evidence from randomized controlled trials is mixed. Pulmonary vein isolation using point-by-point radiofrequency or with the cryoballoon remains the cornerstone technique in AF ablation. Additional atrial ablation can be performed in patients with persistent AF, but its benefits are largely unproven. Technological advances in the past decade have focused on achieving durable vein isolation, reducing procedure duration and improving safety. Numerous exciting new technologies are in various stages of development. In this Review, we discuss the relevant data to support the recommended and evolving indications for catheter ablation of AF, describe the different ablation techniques, and highlight the latest advances in technology that aim to improve its safety and efficacy. We also discuss lifestyle modification strategies to improve ablation outcomes.

Associations of rural residence and low socioeconomic status on the risk of new onset cardiovascular disease (CVD) in cancer patients.

90 Background: Cancer patients are predisposed to CVD due to cancer treatments and shared risk factors (smoking/physical inactivity). We aimed to assess if rural residence and low socioeconomic status (SES) modify the risk of developing CVD. Methods: Patients diagnosed with non-metastatic solid organ cancers without baseline CVD in a large Canadian province from 2004 to 2017 were identified using the population-based registry. Postal codes were linked with Census data to determine rural residence as well as neighborhood-level income and educational attainment. Low income was defined as &lt;46000 CAD/annum; low education was defined as a neighborhood in which &lt;80% attended high school. Myocardial infarction, congestive heart failure, arrythmias and cerebrovascular accident constituted as CVD.We performed logistic regression analyses to examine the associations of rural residence and low SES with the development of CVD, adjusting for measured confounding variables. Results: We identified 81,275 patients diagnosed with cancer without pre-existing CVD. The median age was 62 years and 54.2% were women. The most prevalent cancer types included breast (28.6%), prostate (23.1%), and colorectal (14.9%). At a median follow-up of 68 months, 29.4% were diagnosed with new CVD. The median time from cancer diagnosis to CVD was 29 months. Rural patients (32.3 vs 28.4%,P &lt; .001) and those with low income (30.4% vs 25.9%,P &lt; .001) or low educational attainment (30.7% vs 27.6%,P &lt; .001) experienced higher rates of CVD. After adjusting for baseline factors and treatment, rural residence (odds ratio[OR], 1.07; 95% confidence interval[CI], 1.04-1.11;P &lt; .001), low income (OR,1.17;95%CI,1.12-1.21;P &lt; .001) and low education (OR,1.08;95%CI,1.04-1.11;P &lt; .001) continued to associate with higher odds of CVD. Further, patients with colorectal cancer were more likely to develop CVD compared with other tumors (OR,1.12;95% CI,1.04-1.16;P = .001). A multivariate Cox regression model showed that patients with low SES were more likely to die, but patients residing rurally were not. Conclusions: Approximately one-third of cancer survivors develop CVD on follow-up. Despite universal healthcare, marginalized populations experience different CVD risk profiles that should be considered when operationalizing lifestyle modification strategies and cardiac surveillance programs. [Table: see text]

Abstract 2344: Composite score of healthy lifestyle factors and risk of hepatocellular carcinoma: Findings from a prospective cohort study

Abstract Background. While the associations between individual lifestyle factors and risk of hepatocellular carcinoma (HCC) were examined substantially, their combined impact on HCC risk has not been evaluated. Methods. The association of a composite score of healthy lifestyle factors, including body mass index, alcohol consumption, cigarette smoking, alternative Mediterranean Diet (aMED), and sleep duration, with the risk of developing HCC was examined in the Singapore Chinese Health Study (SCHS), an on-going prospective cohort of 63,257 Chinese men and women aged 45-74 at enrollment in 1993-1998 with up to 25 years of follow-up. Cox proportional hazard regression method was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) of HCC with the composite score after adjustment for multiple potential confounders. The unconditional logistic regression method was used to confirm the association between the composite lifestyle score and HCC risk among hepatitis B surface antigen (HBsAg) negative individuals to eliminate its potential confounding effect. Results. After a mean follow-up of 17.7 years, 561 participants of the SCHS developed HCC. Individuals with higher composite scores, which represented for healthier lifestyles, were at significantly lower risk of HCC. Compared with the lowest composite score (i.e., 0-4), the HRs (95% CIs) for 5, 6, 7 and 8 were 0.48 (0.36-0.64), 0.44 (0.34-0.67), 0.37 (0.28-0.48), and 0.26 (0.17-0.39), respectively (Ptrend&amp;lt;0.001). A similar inverse association was observed in participants with negative HBsAg serology; HR was 0.12 (95% CI: 0.04-0.38) for the highest versus the lowest category of the composite scores (Ptrend=0.01). Conclusion. Healthy lifestyles are protective against the development of HCC, especially for individuals without viral infection. This finding highlights the importance of a comprehensive lifestyle modification strategy for primary prevention of HCC. Funding: The Singapore Chinese Health Study was supported by the National Institutes of Health (NIH) of the United States (grants # R01 CA144034 and UM1 CA182876). Citation Format: Hung N. Luu, Renwei Wang, Jaideep Behari, Jennifer Adams-Haduch, Andrew O. Odegaard, George Goh Bee, Aizhen Jin, Woon-Puay Koh, Jian-Min Yuan. Composite score of healthy lifestyle factors and risk of hepatocellular carcinoma: Findings from a prospective cohort study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2344.

Joint and dose-dependent associations between aerobic and muscle-strengthening activity with depression: A cross-sectional study of 1.48 million adults between 2011 and 2017.

Research has shown that regular physical activity is key for the prevention and/or treatment of depression. However, epidemiological studies describing the associations between different physical activity modes (i.e., aerobic vs. muscle-strengthening exercise) with depression are limited. Cross-sectional analyses were conducted on pooled data from four U.S. health surveillance surveys (2011-2017). Validated survey items assessed self-reported moderate-to-vigorous-intensity physical activity (MVPA) and muscle-strengthening activity (MSA). Twenty groups were created, ranging from (a) "inactive" (0 MVPA min/week & MSA 0 times/week) to (xx) "most active" (≥300 MVPA min/week & MSA ≥4 times/week). Poisson regression with a robust error variance was used to assess prevalence ratios (PRs) of self-reported clinically diagnosed depression (outcome variable) across physical activity groups (exposure variables). The sample contained 1,477,981 adults (≥18 years), of which 286,325 (18.0%) had depression. Compared to the reference group (i.e., no MVPA and no MSA), almost all physical activity combinations were associated with lower depression prevalence. Lowest prevalence of depression was shown for those combining sufficient MVPA-MSA (MVPA ≧300 min/week and MSA ≥2 times/week; adjusted prevalence ratio range: 0.54-0.63). All associations remained after stratification and/or adjustment for sociodemographic (age, sex, income, education), lifestyle characteristics (body mass index, self-rated health, smoking, alcohol), comorbidities (e.g., arthritis, diabetes, hypertension), and year of survey. A physical activity routine that includes both aerobic and MSA is likely to be optimal for the prevention of depression. Public health approaches targeting depression should endorse joint aerobic and MSA as key lifestyle modification strategy.

Detecting Lifestyle Risk Factors for Chronic Kidney Disease With Comorbidities: Association Rule Mining Analysis of Web-Based Survey Data.

BackgroundThe rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease necessitating renal replacement therapy has placed a significant strain on health care. The rate of progression of CKD is influenced by both modifiable and unmodifiable risk factors. Identification of modifiable risk factors, such as lifestyle choices, is vital in informing strategies toward renoprotection. Modification of unhealthy lifestyle choices lessens the risk of CKD progression and associated comorbidities, although the lifestyle risk factors and modification strategies may vary with different comorbidities (eg, diabetes, hypertension). However, there are limited studies on suitable lifestyle interventions for CKD patients with comorbidities.ObjectiveThe objectives of our study are to (1) identify the lifestyle risk factors for CKD with common comorbid chronic conditions using a US nationwide survey in combination with literature mining, and (2) demonstrate the potential effectiveness of association rule mining (ARM) analysis for the aforementioned task, which can be generalized for similar tasks associated with noncommunicable diseases (NCDs).MethodsWe applied ARM to identify lifestyle risk factors for CKD progression with comorbidities (cardiovascular disease, chronic pulmonary disease, rheumatoid arthritis, diabetes, and cancer) using questionnaire data for 450,000 participants collected from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. The BRFSS is a Web-based resource, which includes demographic information, chronic health conditions, fruit and vegetable consumption, and sugar- or salt-related behavior. To enrich the BRFSS questionnaire, the Semantic MEDLINE Database was also mined to identify lifestyle risk factors.ResultsThe results suggest that lifestyle modification for CKD varies among different comorbidities. For example, the lifestyle modification of CKD with cardiovascular disease needs to focus on increasing aerobic capacity by improving muscle strength or functional ability. For CKD patients with chronic pulmonary disease or rheumatoid arthritis, lifestyle modification should be high dietary fiber intake and participation in moderate-intensity exercise. Meanwhile, the management of CKD patients with diabetes focuses on exercise and weight loss predominantly.ConclusionsWe have demonstrated the use of ARM to identify lifestyle risk factors for CKD with common comorbid chronic conditions using data from BRFSS 2017. Our methods can be generalized to advance chronic disease management with more focused and optimized lifestyle modification of NCDs.