Modifiable Health Risk Factors Research Articles

Correlates of axonal content in healthy adult span: Age, sex, myelin, and metabolic health

As the emerging treatments that target grey matter pathology in Alzheimer's Disease have limited effectiveness, there is a critical need to identify new neural targets for treatments. White matter's (WM) metabolic vulnerability makes it a promising candidate for new interventions. This study examined the age and sex differences in estimates of axonal content, as well the associations of with highly prevalent modifiable health risk factors such as metabolic syndrome and adiposity. We estimated intra-axonal volume fraction (ICVF) using the Neurite Orientation Dispersion and Density Imaging (NODDI) in a sample of 89 cognitively and neurologically healthy adults (20–79 years). We showed that ICVF correlated positively with age and estimates of myelin content. The ICVF was also lower in women than men, across all ages, which difference was accounted for by intracranial volume. Finally, we found no association of metabolic risk or adiposity scores with the current estimates of ICVF. In addition, the previously observed adiposity-myelin associations (Burzynska et al., 2023) were independent of ICVF. Although our findings confirm the vulnerability of axons to aging, they suggest that metabolic dysfunction may selectively affect myelin content, at least in cognitively and neurologically healthy adults with low metabolic risk, and when using the specific MRI techniques. Future studies need to revisit our findings using larger samples and different MRI approaches, and identify modifiable factors that accelerate axonal deterioration as well as mechanisms linking peripheral metabolism with the health of myelin.

An online, public health framework supporting behaviour change to reduce dementia risk: interim results from the ISLAND study linking ageing and neurodegenerative disease

BackgroundUnmanaged cardiometabolic health, low physical and cognitive activity, poor diet, obesity, smoking and excessive alcohol consumption are modifiable health risk factors for dementia and public health approaches to dementia prevention have been called for. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) is a dementia prevention public health study examining whether improving knowledge about modifiable dementia risk factors supports behaviour changes that reduce future dementia risk.MethodsResidents of Tasmania, Australia, aged 50 + years who joined the 10-year ISLAND study were asked to complete annual online surveys about their knowledge, motivations and behaviours related to modifiable dementia risk. ISLAND included two knowledge-based interventions: a personalised Dementia Risk Profile (DRP) report based on survey responses, and the option to do a 4-week Preventing Dementia Massive Open Online Course (PDMOOC). Longitudinal regression models assessed changes in the number and type of risk factors, with effects moderated by exposures to the DRP report and engagement with the PDMOOC. Knowledge and motivational factors related to dementia risk were examined as mediators of risk behaviour change.ResultsData collected between October 2019 and October 2022 (n = 3038, av. 63.7 years, 71.6% female) showed the mean number of modifiable dementia risk factors per participant (range 0 to 9) reduced from 2.17 (SD 1.24) to 1.66 (SD 1.11). This change was associated with the number of exposures to the DRP report (p = .042) and was stronger for PDMOOC participants (p = .001). The interaction between DRP and PDMOOC exposures yielded a significant improvement in risk scores (p = .004). The effect of PDMOOC engagement on behaviour change was partly mediated by increased knowledge (12%, p = .013). Self-efficacy enhanced the effect of knowledge on behaviour change, while perceived susceptibility to dementia mitigated this relationship.ConclusionsThe ISLAND framework and interventions, a personalised DRP report and the four-week PDMOOC, work independently and synergistically to increase dementia risk knowledge and stimulate health behaviour change for dementia risk reduction. ISLAND offers a feasible and scalable public health approach for redressing the rising prevalence of dementia.

Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data

Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.

Correlates of hearing loss among adults with schizophrenia.

Hearing loss (HL) is associated with adverse cognitive, mental, and physical health outcomes. There is evidence that across age groups HL is more prevalent in people with schizophrenia than the general population. Given that people with schizophrenia may already be vulnerable to cognitive and psychosocial disability, we sought to examine how hearing ability relates to concurrent levels of cognitive, mental and daily functioning. Community-dwelling adults with schizophrenia (N=84) ages 22-50 completed pure tone audiometry assessments. Hearing threshold (in decibels) was defined as the lowest detectable pure tone at 1000Hz. Pearson correlation was used to test the hypothesis that higher hearing thresholds (worse hearing) would be significantly associated with poorer performance on the Brief Assessment of Cognition in Schizophrenia (BACS). Additional analyses explored the relationships between audiometric threshold and functional capacity measured with the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) and symptoms severity rated on the Positive and Negative Syndrome Scale (PANSS). Hearing threshold was inversely and significantly correlated with the BACS composite score (r=-0.27, p=0.017). This relationship was reduced but remained significant after controlling for age (r=-0.23, p=0.04). Hearing threshold was not associated with VRFCAT or psychiatric symptom measures. While schizophrenia and HL are independently associated with cognitive impairment, the magnitude of impairment in this sample was greater among those with poorer hearing. Findings warrant further mechanistic study of the relationship between hearing impairment and cognition and have implications for addressing modifiable health risk factors for higher morbidity and mortality in this vulnerable population.

Alarming signals: Worsening obesity, physical inactivity and high perception of stress in first-year medical and dental students in Chile

The high prevalence of obesity, smoking, and physical inactivity in Chile despite government-sponsored measures and campaigns, along with others in the last 30 years, suggests additional reinforcement of these efforts at the primary care level. To determine if lifestyles and modifiable health risk factors in first-year students from the University of Chile Faculties of Medicine and Dentistry, potential future promoters of healthy lifestyles, show changes throughout their first academic year. In a randomized stratified sample of 388 students according to sex and chosen career weight, height, waist circumference, waist circumference-weight ratio, food consumption, smoking prevalence and dependence, alcohol use, perceived stress level, and physical activity were measured at the first week, 3 and 6 months after their admission. The Cochrane test assessed dichotomic variables, and the Friedman test was used for nonparametric values. 253 students (186 women) completed the follow-up. A significant worsening of obesity (general and abdominal) and physical inactivity, persistent moderate and high-stress perception, and smoking prevalence were documented throughout the study period. The progressive obesity and physical inactivity, high-stress perception, and persistent smoking prevalence in the first year of academic life suggest considering measures in the curricular academic structure that facilitate adjustments in the student's lifestyles. Future follow-up of this cohort, increasing participants, and assessing students' mental health are planned.

Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies

BackgroundThe preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes.MethodsMedline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5th of January 2023, a date limit was set [2012–2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle–Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables.ResultsThis review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight.ConclusionThe current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.

Changes in Social, Economic, and Health Risk Factors Across the Lifespan during the COVID-19 Pandemic: A Latent Transition Analysis.

The COVID-19 pandemic led to unique, pervasive, and changing global impacts. It is imperative to characterize groups of individuals based on modifiable factors, and to describe how groups have been impacted by the continuing pandemic in the United States to promote health and well-being and to inform preventive interventions. We used latent transition analysis to identify subgroups of modifiable psychosocial, economic, and health risk factors; to explore subgroup shifts across time; and to assess the prevalence of non-modifiable factors associated with subgroup membership. We recruited 450 participants 18 years and older living in the United States to complete a longitudinal survey exploring health during the pandemic. Participants completed three waves of data collection from April to November 2020. We used latent transition analysis to identify statuses, shifts in prevalence over three waves, and the relationships of non-modifiable covariates with each status. Five statuses were identified: high risk together, low risk together, high risk alone, low risk alone, and financial risk together. Statuses were relatively stable over time; the majority (60%–66%) of participants were in statuses categorized by multiple indicators of high modifiable risk, and the largest transitions were to lower risk subgroups. Increasing age, being male, and living in an urban area were the only non-modifiable covariates associated with status membership. It is imperative to continue to scale up targeted interventions aimed at promoting resilience, well-being, financial well-being, delays in healthcare use, food insecurity, and depression among individuals in higher-risk subgroups to promote health and well-being.

Health status of young adults with serious mental illness enrolled in integrated care.

People with serious mental illness (SMI) are more likely to develop chronic health conditions and die prematurely. Timely identification of modifiable health risk factors may enable early intervention. We aimed to describe the physical health characteristics and service utilization of young people with SMI. Young people with SMI enrolled in an integrated community mental health clinic (CMHC) and primary care program were assessed for physical and mental health history and past year service utilization. A total of 122 participants, ages 16-35 (m=27.0 ± 5.0 years), half male, 78.3% White were assessed. Half smoked cigarettes, half had obesity, almost half (47.5%, n=56) had hypertension, and about a third had laboratory metabolic abnormalities. The group averaged 10.7 ± 5.1 h of sedentary behavior per day. Obesity was associated with high blood pressure, prediabetes, poor self-rated health abilities, sedentary behavior and low health satisfaction. Over half had been to the emergency department (ED) for a medical reason (55.0%, n=66) and 24.6% had been hospitalized for a health condition in the past year. Over half had a lifetime cardiovascular risk score indicating a 50-67% chance of having a cardiovascular event; simply quitting smoking would reduce the number with this risk by almost half. Most physical health diagnoses were not recorded in the CMHC record. Young people with SMI newly enrolled in integrated care had high rates of smoking, obesity, hypertension, and other cardio-metabolic abnormalities contributing to high risk for future disease. Research is needed to examine appealing, scalable interventions to improve health, reduce unnecessary medical care, and prevent disparate chronic disease in this group.

Educating the masses to address a global public health priority: The Preventing Dementia Massive Open Online Course (MOOC).

Dementia is a global public health priority and risk reduction is an important pillar of the public health response. While 40% of cases are estimated to be attributable to modifiable health and lifestyle risk factors, public awareness of the evidence is low, limiting peoples’ opportunity to adopt risk-reducing behaviours. To address this gap, we designed, implemented, and evaluated an educational intervention, the Preventing Dementia Massive Open Online Course (PDMOOC). This mixed-methods study examined the reach and impact of the free and globally available PDMOOC, to assess its potential to provide effective dementia risk reduction education to a broad international audience. Over 100,000 individuals participated in the PDMOOC across seven iterations from 2016 to 2020, with 55,739 of these consenting to participate in research. Their mean age was 49 years (SD = 15), they came from 167 different countries, and the majority were female (86%), had completed post-secondary education (77%), lived in high-income countries (93%) and worked in health care and social assistance (63%). This demographic profile changed across time, with more men, people with higher education and people from low- and middle-income countries participating in recent course iterations. Two-thirds of participants completed the PDMOOC; completion was associated with being aged 50 to 70 years, residing in a high-income country, having tertiary education, and working in the health sector. Participants reported high levels of satisfaction with the PDMOOC, improved dementia risk reduction understanding and self-efficacy, increased motivation to maintain healthy lifestyles, and, importantly, application of their learning to health behaviour change with the potential to reduce their dementia risk. The PDMOOC educated a large global audience about dementia risk reduction, which contributed to participants making risk-reducing behaviour changes. This suggests MOOCs can be a successful public health strategy to improve dementia risk reduction understanding.

Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States

ObjectivesTo characterize objective sleep patterns among U.S. adults before and during the COVID-19 pandemic, and to assess for associations between adverse mental health symptoms and (1) sleep duration and (2) the consistency of sleep timing before and during the pandemic. DesignLongitudinal objective sleep-wake data during January-June 2020 were linked with mental health and substance use assessments conducted during June 2020 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative. SettingAdult users of WHOOP—a commercial, digital sleep wearable. ParticipantsAdults residing in the U.S. and actively using WHOOP wearable devices, recruited by WHOOP, Inc. InterventionThe COVID-19 pandemic and its mitigation. MeasurementsAnxiety or depression symptoms, burnout symptoms, and new or increased substance use to cope with stress or emotions. ResultsOf 4912 participants in the primary analytic sample (response rate, 14.9%), we observed acutely increased sleep duration (0.25 h or 15 m) and sleep consistency (3.51 points out of 100) and delayed sleep timing (onset, 18.7 m; offset, 36.6 m) during mid-March through mid-April 2020. Adjusting for demographic and lifestyle variables, participants with persistently insufficient sleep duration and inconsistent sleep timing had higher odds of adverse mental health symptoms and substance use in June 2020. ConclusionsU.S. adult wearable users displayed increased sleep duration, more consistent sleep timing, and delayed sleep onset and offset times after the COVID-19 pandemic onset, with subsample heterogeneity. Associations between adverse mental health symptoms and pre- and mid-pandemic short sleep duration and inconsistent sleep timing suggest that these characteristics warrant further investigation as potential modifiable mental health and substance use risk factors.

Health conditions that predict Alzheimer’s disease and vascular dementia: A phenome‐disease association study

AbstractBackgroundPoor health increases the risk of cognitive decline and dementia. Here, we examined medical records to determine health conditions that were most predictive of dementia at intervals prior to dementia diagnosis. This phenome‐disease association study (PheDAS) used ICD‐9 health code medical record data from participants in the Baltimore Longitudinal Study of Aging (BLSA).MethodsData were available for 347 Alzheimer’s disease (AD), 76 vascular dementia (VD), and 811 non‐demented control participants. Logistic regressions were performed associating ICD‐9 health codes with dementia status at 5 and 1 year(s) prior to dementia diagnosis and at the year of diagnosis, controlling for maximum age, sex and follow‐up length of medical record.ResultsIn AD, the earliest and most consistent predictors across all time points included depression, erectile dysfunction, gait abnormalities, hearing loss, and nervous and musculoskeletal symptoms. Cardiomegaly, disorders of esophageal motility and non‐epithelial skin cancer were not significant until 1 year before dementia diagnosis. In VD, the earliest and most consistent predictors across all time points included abnormal EKG, cardiac dysrhythmias, cerebrovascular disease, non‐epithelial skin cancer, depression, and hearing loss. Atrial fibrillation, occlusion of cerebral arteries, and abnormal reflexes were not significant until 1 year before dementia diagnosis.ConclusionsThese findings suggest that some health predictors of future dementia begin at least 5 years before dementia diagnosis and are consistently seen over time, while others only reach significance closer to the date of diagnosis. These results also show that there are both shared and distinctive health predictors for AD and VD. Together, this study reinforces the need for proper care and treatment of modifiable health risk factors throughout the lifespan. This work was supported by the Intramural Research Program of the NIH, National Institute on Aging.

Production losses due to mortality associated with modifiable health risk factors in Poland

BackgroundEpidemiological burden of modifiable mortality risk factors is recognized in literature; however, less is known on the economic losses due to a range of such risks.AimTo estimate production losses (indirect cost) of mortality associated with risk factors as classified in Global Burden of Disease 2019 Study in Poland in years 2000, 2010, and 2017.MethodsWe relied on the human capital method and societal perspective and used sex-, age-, region-, and risk-specific data on mortality due to modifiable risk factors and a set of socio-economic measures.ResultsThe production losses due to mortality attributable to all investigated risk factors accounted for 19.6–21.0 billion PLN (Polish zloty; 2017 exchange rate: 1€ = 4.26 PLN) and 1.44–2.45% of gross domestic product, depending on year. Behavioural factors were the most important contributor to overall burden (16.7–18.2 billion PLN), followed by metabolic factors (6.8–7.6 billion PLN) and environmental and occupational factors (3.0–3.5 billion PLN). Of disaggregated risks, alcohol and tobacco, high systolic blood pressure, and dietary risks proved to lead to the highest losses. Cost per death was greatest for child and maternal malnutrition, followed by intimate partner violence and childhood sexual abuse and bullying. Moreover, a notable regional variation of indirect cost was identified with losses ranging from 1.21 to 1.81% of regional gross domestic product in 2017.ConclusionOur findings provide economically hierarchised list of modifiable risk factors and they contribute to inform policy-makers in prioritizing programmes to improve health.

Estimating population-level of alcohol, tobacco and morphine use in a small Russian region using wastewater-based epidemiology.

Alcohol, tobacco and illicit drug use combined are the largest modifiable health risk factors. Wastewater-based epidemiology (WBE) is a complementary approach for monitoring substance use in the population. In this study we applied WBE technique to a community in the Moscow region to estimate population-level consumption of alcohol, tobacco and morphine. Wastewater sampling was carried out over 47 days, in 2018 and 2019, including the New Year period. Analysis of the samples for consumption biomarkers (ethyl sulphate, cotinine and morphine) were undertaken using liquid chromatography tandem mass spectrometry (LC-MS/MS). Daily consumption estimates were then compared with sales/production/prescription data and between different days of the week using Mann-Whitney U test. Alcohol consumption was significantly higher on Sundays and during the New Year and Russian Christmas period compared to weekdays and Saturdays. Tobacco consumption estimates were largely consistent throughout the week. Morphine was detected by WBE during the monitoring period but was inconsistent with prescription record data. This study provides evidence for the feasibility of conducting WBE in Russia. Estimates of alcohol consumption derived from WBE were higher than average alcohol sales data for the country. The estimated consumption of nicotine is generally consistent with the production data, with estimates higher than in most other countries. Our results also suggest potential illegal use of opioids (morphine-based) in the population. Given the considerable health and economic costs of substance use in Russia, more extensive WBE testing is recommended to inform and evaluate public health policies.

Prevalence and characteristics of campus-based employee wellness programs among United States accredited colleges and universities.

Employee wellness programs (EWPs) aim to support positive changes in employees' modifiable behavioral health risk factors for disease prevention and management. This study described the prevalence and characteristics of EWPs in US accredited college and university campuses. Identification of the prevalence of EWPs and programming activities offered in 3039 accredited higher education institutions/campuses, and characteristics of these institutions/campuses were conducted, mainly through searching the institution's web page. Overall, 36%of the institutions/campuses offered EWPs, with a significantly larger percentage of 4-year public colleges/universities providing EWPs and wellness programming activities than the 4-year private colleges/universities and community colleges. When limiting the institutions/campuses to 4-year colleges and universities with at least 500 employees, the percentage of these institutions/campuses offering EWPs increased to 57.7%, which was comparable to the findings in the literature. The percentage of the institutions/campuses offering wellness programming activities ranged from 18.1%for injury prevention and ergonomics to 30.2%for stress management. The percentage of institutions/campuses offering injury prevention and ergonomics was significantly lower than the percentage of institutions/campuses offering other typical wellness activities. The prevalence of EWPs offered in accredited college and university campuses do not meet the national goal of 75%, which was set by Healthy People 2010.

Inflammation, depression, and anxiety related to recognition memory in young adults

Previous research suggests that common modifiable health risk factors (e.g., depression, anxiety, metabolic illness, inflammation) may have an impact on memory. In the present study, we sought to investigate relationships between a number of these health risk factors and two components of recognition memory (recollection and familiarity). Data were analyzed for 96 healthy young adults between 17 and 25 years old. Recollection and familiarity were measured using an associative recognition procedure involving unitized and unrelated word pairs, and regression analyses were used to relate recognition memory performance to physical health (inflammation via plasma IL-6 levels, central obesity via waste-to-hip ratio, and heart rate variability) and mental health (depression via CESD-R, stress via PSS, and state and personality trait anxiety via STAI) measures of modifiable risk factors. Together, these health variables predicted an additional 19% of the variance in recollection beyond what was accounted for by familiarity, and 15% of the variance in familiarity beyond what was accounted for by recollection. These effects were primarily driven by inflammation, depression, and trait anxiety, which were each significant (p < .05) independent predictors of recognition. Higher levels of depression and inflammation were related to worse recollection yet better familiarity. Higher levels of trait anxiety were related to better recollection but were not related to familiarity. These findings demonstrate complex relationships between these modifiable health risk factors and recognition memory. Future longitudinal and cross-sectional research is needed to further explore these relationships and determine whether or not poor health causes these changes in recognition.

Clustering of multiple health risk factors among a sample of adolescents in Liberia: a latent class analysis

Non-communicable diseases (NCDs) are associated with modifiable health risk factors. There is a lack of evidence regarding clusters of health-related behaviours among school-going adolescents from sub-Saharan Africa. This study was conducted to identify clustering patterns of health risk factors (i.e. smoking tobacco, inadequate fruit intake, inadequate vegetable intake, physical inactivity, sedentary behaviour, anxiety and depression) and association with sociodemographic factors among school-going adolescents in Liberia. The 2017 Liberian Global School-based Student Health Survey on 2774 adolescents aged 11 years and above (52.5% females) sampled with a two-stage cluster sample design was used. Latent class analysis was used to generate the clusters and latent class regression assessed the associations between sociodemographic factors and the clusters. We identified three clusters labelled as (1) ‘low substance use, moderately active cluster’ (34.8%); (2) ‘inadequate fruit and vegetable cluster’ (48.9%) and (3) ‘risk taking cluster’ (16.3%)’. Compared to cluster 1, adolescent boys [AOR = 1.71, 1.29–2.27, p < 0.001], and those in grade 10–12 [AOR = 1.51, 1.13–2.02, p < 0.001] were more likely to belong to cluster 2. Participants aged 15 years and above [AOR = 0.60, 0.39–0.91, p = 0.018] were less likely to belong to cluster 2. Compared to cluster 1, adolescents aged 15 years and above [AOR = 3.58, 1.33–9.62, p = 0.011] and those with low socio-economic status [AOR = 1.83, 1.22–2.73, p = 0.003] were more likely to belong to cluster 3. These results underscore the need for interventions that address adolescent multiple health risk factors, especially considering sociodemographic differences.

Distinct phenotypic characteristics of normal-weight adults at risk of developing cardiovascular and metabolic diseases

The normal-weight BMI range (18.5-24.9 kg/m2) includes adults with body shape and cardiometabolic disease risk features of excess adiposity, although a distinct phenotype developed on a large and diverse sample is lacking. To identify demographic, behavioral, body composition, and health-risk biomarker characteristics of people in the normal-weight BMI range who are at increased risk of developing cardiovascular and metabolic diseases based on body shape. Six nationally representative waist circumference index (WCI, weight/height0.5) prediction formulas, with BMI and age as covariates, were developed using data from 17,359 non-Hispanic (NH) white, NH black, and Mexican-American NHANES 1999-2006 participants. These equations were then used to predict WCI in 5594 NHANES participants whose BMI was within the normal weight range. Men and women in each race/Hispanic-origin group were then separated into high, medium, and low tertiles based on the difference (residual) between measured and predicted WCI. Characteristics were compared across tertiles; P values for significance were adjusted for multiple comparisons. Men and women in the high WCI residual tertile, relative to their BMI and age-equivalent counterparts in the low tertile, had significantly lower activity levels; higher percent trunk and total body fat (e.g. NH white men, X±SE, 25.3±0.2% compared with 20.4±0.2%); lower percent appendicular lean mass (skeletal muscle) and bone mineral content; and higher plasma insulin and triglycerides, higher homeostatic model assessment of insulin resistance (e.g. NH white men, 1.45±0.07 compared with 1.08±0.06), and lower plasma HDL cholesterol. Percent leg fat was also significantly higher in men but lower in women. Similar patterns of variable statistical significance were present within sex and race/ethnic groups. Cardiometabolic disease risk related to body shape in people who are normal weight according to BMI is characterized by a distinct phenotype that includes potentially modifiable behavioral health risk factors.

Cardiorespiratory Fitness and Its Relationship with Health Risk Factors Among University Students: A Comparison Between Iran and Italy

Background: Cardiorespiratory Fitness (CRF) and its associated modifiable and non-modifiable health risk factors are very important in clinical studies. Objectives: This study aimed to compare health risk factors affecting CRF between Iranian and Italian male and female exercise science students. The correlation between VO2max and these factors was also evaluated. Methods: The sample consisted of 87 sport science students from the University of Milan (25 males and 17 females) and the University of Mazandaran (20 males and 25 females) aged 23.69 ± 1.95 years. The level of Physical Activity (PA) and body composition indices were obtained as health risk factors. Then, CRF was assessed by the Bruce test. Rate Pressure Product (RPP), blood pressure, and Heart Rate (HR) were measured before, in the end, and six minutes after the end of the test. Results: Statistical analyses revealed significant differences in RPP, Systolic Blood Pressure (SBP) during exercise, resting SBP, and Waist-to-Height Ratio (WHtR) between Iranian and Italian males and significant differences in Waist-to-Hip Ratio (WHR) and body fat percentage between Iranian and Italian females (P &lt; 0.05). The relationships between VO2max and resting RPP, resting HR, heart rate recovery, step counts, and vigorous PA were significant in all groups (P &lt; 0.05). Conclusions: As an assessment of VO2max, CRF is associated with hemodynamics and health risk factors. Age, sex, ethnicity, lifestyle, and culture of people in different geographical regions can affect health risk factors.

Registered nurses as role models for healthy lifestyles

Objective: The aim of this paper is to report on registered nurses’ adherence to current Australian health behaviour recommendations. Barriers and facilitators to healthy lifestyles, and their attitudes towards being role models and promoting healthy lifestyles to their patients. Background: It is widely accepted that a healthy diet, limiting alcohol consumption, abstinence from smoking and regular physical exercise are important components of healthy lifestyles and play a significant role in preventing chronic diseases. Nurses are well situated to contribute to providing health and patient education regarding modifiable health risk factors, however their own adherence to health behaviours may impact this. Study design and methods: The research is a mixed methods study of 123 registered nurses from both public and private organisations in Regional Queensland. Data for this paper were generated from an online survey which is the first of two phases in the broader study. Results: Four health risk factors were examined; diet, smoking, physical exercise and alcohol consumption. BMI was also calculated and considered as a fifth risk factor. Of this sample, 13% of participants met the guidelines for fruit and vegetable intake, 5.2% smoked, and only 24.2% exercised enough to be classed sufficiently active for their health. Of the 93.62% of participants whom consumed alcohol, 69.3% consumed more than 2 standard drinks/day. The most common barriers to adhering to healthy lifestyles were shift work, long working hours and family commitments. Conclusion: Many nurses are not adhering to healthy lifestyle recommendations. It is recommended that the health and wellbeing of our health professionals, especially nurses be considered. Providing support and resources to enable them to care for themselves, may in turn allow them to better care for patients. Implications for research, policy, and practice: Research is needed into strategies to enable registered nurses’ better work/life balance. To make a real difference to health outcomes, nurses own health and health education needs to be made a priority that is supported and implemented at multiple points: by policymakers, within nursing practice, nursing curriculum, and in healthcare institutions. Nurses need to be supported in the provision health education to their patients with better resources, education and time allocation. Future research should include studies conducted in different regions or ideally a large nationally representative sample.

Ten Modifiable Health Risk Factors and Employees' Medical Costs-An Update.

To estimate the relationship between employees' health risks and health-care costs to inform health promotion program design. An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. United States. The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.