Modifiable Lifestyle Risk Factors Research Articles

Self-reported Metabolic Risk Factor Associations with Adenomatous, Sessile Serrated, and Synchronous Adenomatous and Sessile Serrated Polyps.

Studies have found a positive association between metabolic risk factors, such as obesity and diabetes, and adenomatous polyps (AP). However, fewer studies have assessed the association between sessile serrated polyps (SSP) or synchronous diagnosis of APs and SSPs (synch polyps). Study participants (N = 1,370; ages 40-85) undergoing screening colonoscopy were enrolled between August 2016 and February 2020. Self-reported metabolic risk factors, including diabetes, hypertension, hyperlipidemia, and overweight/obesity, were evaluated for associations with new diagnoses of APs, SSPs, and synch polyps at the present colonoscopy. Average participant age was 60.73 ± 8.63 (SD) years; 56.7% were female and 90.9% white. In an assessment of individual metabolic risk factors, adjusted for age, sex, race, and smoking status, increased body mass index (BMI; overweight or obese vs. normal BMI of <25 kg/m2) was associated with an increased odds for new onset of colon APs (P trend < 0.001) as was a diagnosis of diabetes [adjusted conditional OR (aCOR) = 1.59 (1.10-2.29)]. No associations were seen between the metabolic risk factors and onset of SSPs. Being obese or hypertensive each increased the odds of new onset of synch polyps with aCOR values of 2.09 (1.01-4.32) and 1.79 (1.06-3.02), respectively. Self-reported risk factors may help assess polyp type risk. Because SSPs and synch polyps are rare, larger studies are needed to improve our understanding of the contribution of these factors to polyp risk. These data lead us to hypothesize that differences in observed metabolic risk factors between polyp types reflect select metabolic impact on pathways to colorectal cancer. PREVENTION RELEVANCE: Self-reported medical history provides valuable insight into polyp risk, potentially enabling the use of larger retrospective studies of colonoscopy populations to assess knowledge gaps. More aggressive colonoscopy screening, critical to colorectal cancer prevention, may be considered in populations of individuals with metabolic risk factors and modifiable lifestyle risk factors.

Lifestyle risk factors and infectious disease mortality, including COVID-19, among middle aged and older adults: Evidence from a community-based cohort study in the United Kingdom

In this community-based cohort study, we investigated the relationship between combinations of modifiable lifestyle risk factors and infectious disease mortality. Participants were 468,569 men and women (56.5 ± 8.1, 54.6% women) residing in the United Kingdom. Lifestyle indexes included traditional and emerging lifestyle risk factors based on health guidelines and best practice recommendations for: physical activity, sedentary behaviour, sleep quality, diet quality, alcohol consumption, and smoking status. The main outcome was mortality from infectious diseases, including pneumonia, and coronavirus disease 2019 (COVID-19). Meeting public health guidelines or best practice recommendations among combinations of lifestyle risk factors was inversely associated with mortality. Hazard ratios ranged between 0.26 (0.23–0.30) to 0.69 (0.60–0.79) for infectious disease and pneumonia. Among participants with pre-existing cardiovascular disease or cancer, hazard ratios ranged between 0.30 (0.25–0.34) to 0.73 (0.60–0.89). COVID-19 mortality risk ranged between 0.42 (0.28–0.63) to 0.75 (0.49–1.13). We found a beneficial dose–response association with a higher lifestyle index against mortality that was consistent across sex, age, BMI, and socioeconomic status. There was limited evidence of synergistic interactions between most lifestyle behaviour pairs, suggesting that the dose–response relationship among different lifestyle behaviours is not greater than the sum of the risk induced by each behaviour. Improvements in lifestyle risk factors and meeting public health guidelines or best practice recommendations could be used as an ancillary measure to ameliorate infectious disease mortality.

PROLONGED OBSERVATION OF SEXUAL DISORDERS BY HYPERTONIC PATIENTS AFTER NURSING INTERVENTION

Objective: Objective of this prolonged work was to observe progress in severity of erectile dysfunction as an expression of endothelial damage) by hypertensive patients with or without cardiovascular organic changes after one year nursing intervention on modifiable lifestyle risk factors in half of recruited probands. Design and method: Method: The presence and severity of ED in the group of 200 hypertensive patients, aged 40–70 years, were studied in the beginning and after one year. With half of the enrolled patients was performed periodic targeted nursing intervention (one year duration), focused on respect of the life style principles. Questionnaire method was used for data collection at the beginning and at the end of the annual reporting period, as well as after next 4 years. Questionnaires were focused on antropometric dates, lifestyle, QoL and ED. Results: Results: The research results showed that by hypertensive patients with organic CV changes is a higher incidence of moderate and severe ED than in hypertensive patients without organ changes. Those result were similar at start, as well as on the end of monitoring after 4 years. At the same time, a higher incidence of ED in the group of patients with organic complications than without them. In groups without nursing intervention was an increase in the number of patients with severe ED by 18% (group without organic complications), respectively 37% (with organic complications). The severity of ED by groups without intervention increased also, bud less intensive. The differences have been statistically significant. After 4 years monitoring – worsening of ED was observed, more intensive (statistically significant) by group of patients with cardiovascular organic changes. Conclusions: Conclusions: The results confirmed the assumption of a positive effect of targeted and repeated nursing interventions aimed at compliance with healthy lifestyle and quality of life on ED by hypertensive patients. In the end, paper makes recommendations regarding the highlighting of motivational factors affecting the adoption of healthy lifestyle and explains the role of nurses in applying the principles of secondary prevention of CV disease.

Five-Year Change in Body Mass Index Predicts Conversion to Mild Cognitive Impairment or Dementia Only in APOE ɛ4 Allele Carriers.

Body mass index (BMI) has been identified as an important modifiable lifestyle risk factor for dementia, but less is known about how BMI might interact with Apolipoprotein E ɛ4 (APOE ɛ4) carrier status to predict conversion to mild cognitive impairment (MCI) and dementia. The aim of this study was to investigate the interaction between APOE ɛ4 status and baseline (bBMI) and five-year BMI change (ΔBMI) on conversion to MCI or dementia in initially cognitively healthy older adults. The associations between bBMI, ΔBMI, APOE ɛ4 status, and conversion to MCI or dementia were investigated among 1,289 cognitively healthy elders from the National Alzheimer's Coordinating Center (NACC) database. After five years, significantly more carriers (30.6%) converted to MCI or dementia than noncarriers (17.6%), p < 0.001, OR = 2.06. Neither bBMI (OR = 0.99, 95%CI = 0.96-1.02) nor the bBMI by APOE interaction (OR = 1.02, 95%CI = 0.96-1.08) predicted conversion. Although ΔBMI also did not significantly predict conversion (OR = 0.90, 95%CI = 0.78-1.04), the interaction between ΔBMI and carrier status was significant (OR = 0.72, 95%CI = 0.53-0.98). For carriers only, each one-unit decline in BMI over five years was associated with a 27%increase in the odds of conversion (OR = 0.73, 95%CI = 0.57-0.94). A decline in BMI over five years, but not bBMI, was strongly associated with conversion to MCI or dementia only for APOE ɛ4 carriers. Interventions and behaviors aimed at maintaining body mass may be important for long term cognitive health in older adults at genetic risk for AD.

Modifiable lifestyle risk factors for dry eye disease

PurposeTo examine the association between modifiable lifestyle factors and dry eye disease. MethodsThree hundred and twenty-two community residents (186 females, 136 males; mean ± SD age, 41 ± 22 years) with no major systemic or ophthalmic conditions (other than dry eye disease) were recruited in a cross-sectional study. A lifestyle factor questionnaire was administered, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the TFOS DEWS II reports. ResultsA total of 111 (34 %) participants fulfilled the TFOS DEWS II diagnostic criteria for dry eye disease. Multivariate regression analysis demonstrated that advancing age, female sex, East Asian ethnicity, and increased digital screen exposure time were positive risk factors for dry eye disease (all p < 0.05), while increased caffeine consumption was a protective factor (p = 0.04). ConclusionsIncreased digital screen exposure time and reduced caffeine consumption were modifiable lifestyle factors associated with higher odds of dry eye disease. These findings might contribute to informing the design of future prospective research investigating the efficacy of preventative intervention and risk factor modification strategies.

Mild cognitive impairment and its lifestyle-related risk factors in the elderly: A community-based cross-sectional study

Context: Alzheimer's dementia (AD), an irreversible condition is an important cause of disability in old age. Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia. Amnestic MCI (aMCI) is the precursor of AD. Identification of modifiable lifestyle risk factors help in the prevention of aMCI, and thereby in the prevention of AD. Aim: The purpose of this study was to determine the prevalence of aMCI and different lifestyle factors associated with types of MCI. Methods: This cross-sectional study was conducted amongst the elderly (≥60 years). A sample of 576 persons was selected using a multistage sampling technique. Vernacular adaptation of Hindi Mini-Mental State Examination tool was used to screen dementia and MCI. Geriatric Depression Scale-15 was used for screening depression. Data were collected using a pre-designed and pretested schedule and SPSS was used for data entry and analysis. Results: The prevalence of MCI was found to be 22.4% among the elderly. Out of all MCI cases, the prevalence of aMCI was 38.8% in this study. The lack of social and leisure engagement was found to be significantly associated with the type of MCI. Conclusion: The comparatively higher prevalence of aMCI is just the tip of the iceberg. Lack of social and leisure engagement is a highly predictive risk factor.

Proteomic Signatures of Lifestyle Risk Factors for Cardiovascular Disease: A Cross-Sectional Analysis of the Plasma Proteome in the Framingham Heart Study.

BackgroundProteomic biomarkers related to cardiovascular disease risk factors may offer insights into the pathogenesis of cardiovascular disease. We investigated whether modifiable lifestyle risk factors for cardiovascular disease are associated with distinctive proteomic signatures.Methods and ResultsWe analyzed 1305 circulating plasma proteomic biomarkers (assayed using the SomaLogic platform) in 897 FHS (Framingham Heart Study) Generation 3 participants (mean age 46±8 years; 56% women; discovery sample) and 1121 FOS (Framingham Offspring Study) participants (mean age 52 years; 54% women; validation sample). Participants were free of hypertension, diabetes mellitus, and clinical cardiovascular disease. We used linear mixed effects models (adjusting for age, sex, body mass index, and family structure) to relate levels of each inverse‐log transformed protein to 3 lifestyle factors (ie, smoking, alcohol consumption, and physical activity). A Bonferroni‐adjusted P value indicated statistical significance (based on number of proteins and traits tested, P<4.2×10−6 in the discovery sample; P<6.85×10−4 in the validation sample). We observed statistically significant associations of 60 proteins with smoking (37/40 top proteins validated in FOS), 30 proteins with alcohol consumption (23/30 proteins validated), and 5 proteins with physical activity (2/3 proteins associated with the physical activity index validated). We assessed the associations of protein concentrations with previously identified genetic variants (protein quantitative trait loci) linked to lifestyle‐related disease traits in the genome‐wide‐association study catalogue. The protein quantitative trait loci were associated with coronary artery disease, inflammation, and age‐related mortality.ConclusionsOur cross‐sectional study from a community‐based sample elucidated distinctive sets of proteins associated with 3 key lifestyle factors.

Latent Class Analysis of Lifestyle Risk Factors and Association with Overweight and/or Obesity in Children and Adolescents: Systematic Review.

Background: Multiple modifiable lifestyle factors are well-known contributors to many health problems. Objectives: This study aims to determine the association between latent class analysis (LCA) of modifiable lifestyle risk factors with being overweight and/or obese for children and/or adolescents. Methods: Articles were selected from six databases, without limitation regarding language or date. The review included studies that identify latent classes of modifiable lifestyle risk factors [e.g., physical activity (PA), diet, sedentary behavior (SB), and/or unhealthy behavior] by LCA to determine the association between latent classes with being overweight and/or obese. The methodology of the selected studies was evaluated using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Owing to the heterogeneity between latent classes of modifiable lifestyle risk factors with obesity and/or being overweight, the results are described narratively. Results: Using a selection process in two phases, nine articles were included. All of the included studies were of high methodological quality. The studies were conducted in six different countries: the USA, Brazil, Canada, Portugal, Italy, and Australia. Sample sizes ranged from 166 to 18.587 children and adolescents, and in terms of age (range 5-19 years). Across study clusters characterized by low consumption of fruit and vegetables, and high consumption of fatty foods, sugar snack foods, sweets, chips and fries, low PA (<1 hour each day), and high SB (screen time and TV >2 hours/day), sleep time (<10 hours/day) were positively associated with being overweight and/or obese. Conclusion: Overall there is good evidence to support that the modifiable lifestyle risk factors clustered together by LCA should be novel targets for the treatment of obesity and its associated comorbidities.

Factors affecting egg consumption in young consumers

Factors affecting egg consumption in young consumers

Life-style and occupational risk factors for early onset dementia in an Italian community

Abstract Background Early onset dementia (EOD) is defined as dementia with symptoms onset before 65 years, deeply impacting on patients' employment and income, as well as on their families. Little is known about role of occupational and life-style risk factors, we aimed at assessing their role in disease etiology. Methods Using a case-control study design, we recruited all EOD cases resident in Modena province from October, 2016 to October, 2019, and a referent population drawn from patients' care-givers. We investigated residential, life-style history, and occupational and environmental exposures to toxics through a self-administered questionnaire. We used a multivariate unconditional logistic regression model adjusted for sex, age, and education to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of EOD risk for exposed vs. non-exposed subjects. Results Overall, fifty-eight EOD cases and fifty-four controls agreed to participate. Possible life-style risk factors are to be widowed (10.3% of cases vs. 2% of controls), and to have a lower educational attainment. Also smoking (OR 1.3, 95% CI 0.6-2.9), playing football (OR 2.2, 95% CI 0.5-9.3) or cycling (OR 2.3, 95% CI 0.4-13.4) were associated with higher EOD risk, although overall sport practice appeared to be a powerful protective factor (OR 0.4, 95% CI 0.2-0.9), particularly swimming (OR 0.2, 95% CI 0.0-0.8). Among occupational factors, disease risk was associated with exposure to aluminum (OR 2.6, 95% CI 0.4-15.7), pesticides (OR 2.3, 95% CI 0.7-7.8), and dyes, paints or thinners (OR 1.7, 95% CI 0.6-5.0). Finally, disease risk was not associate to overall history of any trauma, while head trauma and especially upper arm trauma showed positive association. Conclusions Despite the study limitations, our results appear to support a role of modifiable risk factors in EOD etiology, particularly of some chemical exposures and professional sports, while overall sports practice may have a beneficial effect. Key messages Some modifiable environmental, occupational and life-style risk factors seem associated with EOD onset. Awareness of EOD environmental and occupational risk factors, as well as life-style ones, is advisable on a public health perspective.

Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms.

An estimated 30-40% of cancers can be prevented through changes in modifiable lifestyle and environmental risk factors known to be associated with cancer incidence. Despite this knowledge, there remains limited awareness that these associations exist. The purpose of this review article was to summarize the epidemiologic evidence concerning the contribution of physical activity, sedentary behavior, and obesity to cancer etiology and to provide an overview of the biologic mechanisms that may be operative between these factors and cancer incidence. Strong and consistent evidence exists that higher levels of physical activity reduce the risk of six different cancer sites (bladder, breast, colon, endometrial, esophageal adenocarcinoma, gastric cardia), whereas moderate evidence inversely associates physical activity with lung, ovarian, pancreatic and renal cancer, and limited evidence inversely correlates physical activity with prostate cancer. Sedentary behavior, independent of physical activity, has been shown to increase the risk of colon, endometrial, and lung cancers. Obesity is an established risk factor for 13 different cancer sites (endometrial, postmenopausal breast, colorectal, esophageal, renal/kidneys, meningioma, pancreatic, gastric cardia, liver, multiple myeloma, ovarian, gallbladder, and thyroid). The main biologic mechanisms whereby physical activity, sedentary behavior, and obesity are related to cancer incidence include an effect on endogenous sex steroids and metabolic hormones, insulin sensitivity, and chronic inflammation. Several emerging pathways related to oxidative stress, DNA methylation, telomere length, immune function, and gut microbiome are presented. Key recommendations for future research in both the epidemiology and biology of the associations between physical activity, sedentary behavior, obesity, and cancer risk are also provided.

Feasibility and acceptability of a dietary intervention study to reduce salt intake and increase high-nitrate vegetable consumption among middle-aged and older Malaysian adults with elevated blood pressure: a study protocol.

IntroductionGlobal population ageing is one of the key factors linked to the projected rise of dementia incidence. Hence, there is a clear need to identify strategies to overcome this expected health burden and have a meaningful impact on populations’ health worldwide. Current evidence supports the role of modifiable dietary and lifestyle risk factors in reducing the risk of dementia. In South-East Asia, changes in eating and lifestyle patterns under the influence of westernised habits have resulted in significant increases in the prevalence of metabolic, cardiovascular and neurodegenerative non-communicable diseases (NCDs). Low vegetable consumption and high sodium intake have been identified as key contributors to the increased prevalence of NCDs in these countries. Therefore, nutritional and lifestyle strategies targeting these dietary risk factors are warranted. The overall objective of this randomised feasibility trial is to demonstrate the acceptability of a dietary intervention to increase the consumption of high-nitrate green leafy vegetables and reduce salt intake over 6 months among Malaysian adults with raised blood pressure.Methods and analysisPrimary outcomes focus on feasibility measures of recruitment, retention, implementation and acceptability of the intervention. Secondary outcomes will include blood pressure, cognitive function, body composition and physical function (including muscle strength and gait speed). Adherence to the dietary intervention will be assessed through collection of biological samples, 24-hour recall and Food Frequency Questionnaire. A subgroup of participants will also complete postintervention focus groups to further explore the feasibility considerations of executing a larger trial, the ability of these individuals to make dietary changes and the barriers and facilitators associated with implementing these changes.Ethics and disseminationEthical approval has been obtained from Monash University Human Research Ethics Committee and Medical Research and Ethics Committee of Malaysia. Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.ISRCTN47562685; Pre-results.

Maternal lifestyle characteristics and Wilms tumor risk in the offspring: A systematic review and meta-analysis

BackgroundLittle is known about the etiology of childhood Wilms tumor (WT) and potentially modifiable maternal risk factors, in particular. MethodsUnpublished data derived from the hospital-based, case-control study of the Greek Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) were included in an ad hoc conducted systematic literature review and meta-analyses examining the association between modifiable maternal lifestyle risk factors and WT. Eligible data were meta-analysed in separate strands regarding the associations of WT with (a) maternal folic acid and/or vitamins supplementation, (b) alcohol consumption and (c) smoking during pregnancy. The quality of eligible studies was evaluated using the Newcastle-Ottawa Scale. ResultsEffect estimates from 72 cases and 72 age- and sex-matched controls contributed by NARECHEM-ST were meta-analysed together with those of another 17, mainly medium size, studies of ecological, case-control and cohort design. Maternal intake of folic acid and/or other vitamins supplements during pregnancy was inversely associated with WT risk (6 studies, OR: 0.78; 95 %CI: 0.69–0.89, I2 = 5.4 %); of similar size was the association for folic acid intake alone (4 studies, OR: 0.79; 95 %CI: 0.69-0.91, I2 = 0.0 %), derived mainly from ecological studies. In the Greek study a positive association (OR: 5.31; 95 %CI: 2.00–14.10) was found for mothers who consumed alcohol only before pregnancy vs. never drinkers whereas in the meta-analysis of the four homogeneous studies examining the effect of alcohol consumption during pregnancy the respective overall result showed an OR: 1.60 (4 studies, 95 %CI: 1.28–2.01, I2 = 0.0 %). Lastly, no association was seen with maternal smoking during pregnancy (14 studies, OR: 0.93; 95 %CI: 0.80–1.09, I2 = 0.0 %). ConclusionsIn the largest to-date meta-analysis, there was an inverse association of maternal folic acid or vitamins supplementation with WT risk in the offspring, derived mainly from ecological studies. The association with maternal alcohol consumption found in our study needs to be further explored whereas no association with maternal smoking was detected. Given the proven benefits for other health conditions, recommendations regarding folic acid supplementation as well as smoking and alcohol cessation should apply. The maternal alcohol consumption associations, however, should be further explored given the inherent limitations in the assessment of exposures of the published studies.

Preconceptional Maternal Vegetable Intake and Paternal Smoking Are Associated with Pre-implantation Embryo Quality

Inadequate nutrition and lifestyle behaviors, particularly during the periconception period, are associated with a negative impact on embryonic and subsequent fetal development. We investigated the associations between parental nutritional and lifestyle factors and pre-implantation embryo development. A total of 113 women and 41 partners, with a corresponding 490 embryos, who underwent intracytoplasmic sperm injection (ICSI) treatment subscribed to the mHealth coaching platform “Smarter Pregnancy.” At baseline, nutrition and lifestyle behaviors (intake of fruits, vegetables, folic acid, and smoking and alcohol use) were identified and risk scores were calculated. A lower risk score represents healthier behavior. As outcome measure, a time-lapse morphokinetic selection algorithm (KIDScore) was used to rank pre-implantation embryo quality on a scale from 1 (poor) to 5 (good) after being cultured in the Embryoscope™ time-lapse incubator until embryonic day 3. To study the association between the nutritional and lifestyle risk scores and the KIDScore in men and women, we used a proportional odds model. In women, the dietary risk score (DRS), a combination of the risk score of fruits, vegetables, and folic acid, was negatively associated with the KIDScore (OR 0.86 (95% CI 0.76 to 0.98), p = 0.02). This could mainly be attributed to an inadequate vegetable intake (OR 0.76 (95% CI 0.59 to 0.96), p = 0.02). In men, smoking was negatively associated with the KIDscore (OR 0.53 (95% CI 0.33 to 0.85), p < 0.01). We conclude that inadequate periconceptional maternal vegetable intake and paternal smoking significantly reduce the implantation potential of embryos after ICSI treatment. Identifying modifiable lifestyle risk factors can contribute to directed, personalized, and individual recommendations that can potentially increase the chance of a healthy pregnancy.

Development and Validation of the Chronic Disease Population Risk Tool (CDPoRT) to Predict Incidence of Adult Chronic Disease

Predicting chronic disease incidence for the population provides a comprehensive picture to health policy makers of their jurisdictions' overall future chronic disease burden. However, no population-based risk algorithm exists for estimating the risk of first major chronic disease. To develop and validate the Chronic Disease Population Risk Tool (CDPoRT), a population risk algorithm that predicts the 10-year incidence of the first major chronic disease in the adult population. In this cohort study, CDPoRT was developed and validated with 6 cycles of the Canadian Community Health Survey, linked to administrative data from January 2000 to December 2014. Development and internal validation (bootstrap and split sample) of CDPoRT occurred in Ontario, Canada, from June 2018 to April 2019 followed by external validation in Manitoba from May 2019 to July 2019. The study cohorts included 133 991 adults (≥20 years) representative of the Ontario and Manitoba populations who did not have a history of major chronic disease. Predictors were routinely collected risk factors from the Canadian Community Health Survey, such as sociodemographic factors (eg, age), modifiable lifestyle risk factors (ie, alcohol consumption, cigarette smoking, unhealthy diet, and physical inactivity), and other health-related factors (eg, body mass index). Six major chronic diseases were considered, as follows: congestive heart failure, chronic obstructive pulmonary disease, diabetes, myocardial infarction, lung cancer, and stroke. Sex-specific CDPoRT algorithms were developed with a Weibull model. Model performance was evaluated with measures of overall predictive performance (eg, Brier score), discrimination (eg, Harrell C index), and calibration (eg, calibration curves). The Ontario cohort (n = 118 747) was younger (mean [SD] age, 45.6 [16.1] vs 46.3 [16.4] years), had more immigrants (23 808 [20.0%] vs 1417 [10.7%]), and had a lower mean (SD) body mass index (26.9 [5.1] vs 27.7 [5.4]) than the Manitoba cohort (n = 13 244). During development, the full and parsimonious CDPoRT models had similar Brier scores (women, 0.087; men, 0.091), Harrell C index values (women, 0.779; men, 0.783), and calibration curves. A simple version consisting of cigarette smoking, age, and body mass index performed slightly worse than the other versions (eg, Brier score for women, 0.088; for men, 0.092). Internal validation showed consistent performance across models, and CDPoRT performed well during external validation. For example, the female parsimonious version had C index values for bootstrap, split sample, and external validation of 0.778, 0.776, and 0.752, respectively. In this study, CDPoRT provided accurate, population-based risk estimates for the first major chronic disease.

The Impact of obesity and diabetes mellitus on pancreatic cancer: Molecular mechanisms and clinical perspectives.

The incidence of obesity and type 2 diabetes (T2DM) in the Western world has increased dramatically during the recent decades. According to the American Cancer Society, pancreatic cancer (PC) is the fourth leading cause of cancer‐related death in the United States. The relationship among obesity, T2DM and PC is complex. Due to increase in obesity, diabetes, alcohol consumption and sedentary lifestyle, the mortality due to PC is expected to rise significantly by year 2040. The underlying mechanisms by which diabetes and obesity contribute to pancreatic tumorigenesis are not well understood. Furthermore, metabolism and microenvironment within the pancreas can also modulate pancreatic carcinogenesis. The risk of PC on a population level may be reduced by modifiable lifestyle risk factors. In this review, the interactions of diabetes and obesity to PC development were summarized, and novel strategies for the prevention and treatment of diabetes and PC were discussed.

Randomized controlled trial on the efficacy of a multilevel non-pharmacologic intervention in older adults with subjective memory decline: design and baseline findings of the E.Mu.N.I. study

Alzheimer's Disease (AD) is a multifactorial disorder driven by genetic and modifiable lifestyle risk factors. Lifestyle primary prevention initiatives may reduce the prevalence and incidence of dementia in older adults. The E.Mu.N.I study is a randomized controlled trial investigating the effect of multilevel non-pharmacologic interventions on cognitive performances (primary outcome) and structural and vascular brain MRI markers (secondary outcome), as well as markers of brain functional connectivity change (exploratory outcome), in older adults with subjective memory decline (SMD). Here, we present the study design and the baseline features of the sample. Cognitively intact older adults with SMD, enrolled between February 2016 and June 2017, were randomly assigned to one of the 3 interventions for 1year: Active Control Intervention (ACI), i.e., educational lessons; Partial Intervention (PI), i.e., homotaurine administration (100mg/die) and lessons on the Mediterranean diet; Multilevel Intervention (MI), i.e., PI plus computerized cognitive training and physical exercise training. One-hundred and twenty-eight eligible participants were enrolled (66% female; age: 68 ± 5years). Eighty-two percent of the sample was composed of volunteers with SMD from the community. Participants were randomly allocated to the interventions as follows: ACI (N = 40), PI (N = 44), MI (N = 44). No significant differences among groups emerged on socio-demographic, clinical-neuropsychological variables and MRI markers at baseline. The outcomes obtained from the E.Mu.N.I. study will clarify the efficacy of multilevel non-pharmacologic interventions on cognitive and neuroimaging markers in SMD individuals. This is a crucial step forward for the development of cost-effective non-pharmacologic primary prevention initiatives for AD.

Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment).

PurposePeople with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting.DesignSingle arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention.MethodPeople with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise.ResultsForty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks.ConclusionsA brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors.Clinical Trial RegistrationThe trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)—U1111-1211-4009.

Queensland Cardiovascular Data Linkage (QCard): A population-based cohort study

Queensland is Australia's hotspot for cardiovascular disease (CVD). Critically, beyond modifiable lifestyle risk factors; socio-demographic differences and environmental factors account for significant variations in healthcare use and outcomes among cardiac patients across the country. To better understand the impacts of these factors on the health of cardiac patients, there is a need for a comprehensive and robust longitudinal cohort study that can unpack the underlying dynamics. This paper describes the protocol for the Queensland Cardiovascular Linkage (QCard) Study. The QCard is a longitudinal linkage cohort study of cardiac patients who were first hospitalised with any cardiac condition in 2010, with follow up hospitalisations until December 2015. The primary aim of the QCard is to identify and characterise the nature and impact of socio-demographic inequality among those presenting for the first time with the most common form of CVD in Australia (heart disease) in Queensland from 2010 with minimum 5-years follow-up of subsequent healthcare utilisation and outcomes. A secondary aim is to undertake an exploration of the impact of environmental and specific health service factors on healthcare use and survival time in the same QCard cohort. Administrative public and private hospital inpatient, outpatient and emergency department data for all of Queensland will be linked with individual primary care data and pharmaceutical data. These data will also be linked to regional socio-demographic data and environmental data, as well as data that describes the features of each hospital in the region. The findings from the study will provide critical information for cardiac patients, clinicians and health policymakers. Such information ranges from identifying most vulnerable cardiac patients who may require targeted needs to providing estimates for cost-effective ways of evaluating healthcare interventions that seek to improve the health of cardiac patients.

Association of Maternal depression with diet: A systematic review.

This review was conducted to explore the bi-directional association of maternal depression with diet. This link is hypothesized because the mental health of pregnant women may adversely affect their nutritional intake; or inversely, that poor nutritional intake during pregnancy may cause mental health issues. Seven electronic databases were searched to retrieve relevant peer-reviewed articles published during 2000-2018. Primary research studies published in English that evaluated the relationship between maternal antenatal and postnatal depression with dietary intake were selected. We screened 1585 articles, of which 13 met the inclusion criteria. These included five cohort studies (including two birth cohorts) and eight cross-sectional studies representing a total of 12,742 participants altogether. Studies were divided into five groups depending on whether they analyzed all nutrients, micronutrients, dietary patterns, dietary behavior or intake of fish and vegetables. The studies exploring the association of depression with dietary patterns found a protective association of "Health Conscious", "Healthy" and "Brazilian" diet patterns with maternal depression. The group of studies which analyzed all nutrients, found an inverse relationship of the "Healthy Eating Index" with maternal depression. Deficiency of calcium, iron, and folate were also associated with maternal depression. Prenatal and early postpartum eating attitudes and BMI were found as predictors of depressive symptoms in the late post-partum period in a diet behavior study. It is important to identify modifiable lifestyle risk factors which may contribute to maternal depression. A limitations of our review is the absence of meta-analysis which was not possible due to heterogeneity of the studies.