Modifiable Lifestyle Behaviors Research Articles

Associations of lifestyle behaviors with mental health in a nationwide cross-sectional survey of 152,860 Brazilian students.

To evaluate the association between modifiable lifestyle behaviors and mental health indicators in Brazilian adolescents. This cross-sectional study used data from the 2019 National Survey of School Health including 152,860 students. The lifestyle behaviors and mental health indicators were obtained from a self-reported questionnaire. Logistic regression analyses were used to examine the association between lifestyle behaviors and mental health indicators. Infrequent healthy eating (OR 1.22; 95%CI 1.14-1.31), being inactive (OR 1.82; 95%CI 1.65-2.01), smoking (OR 1.24; 95%CI 1.10-1.40), and irregular school attendance (OR 1.31; 95%CI 1.22-1.40) were associated with not having close friends. Additionally, not having close friends was also associated with unhealthy eating (OR 0.86; 95%CI 0.81-0.92) and alcohol consumption (OR 0.81; 95%CI 0.75-0.87). Infrequent healthy eating (OR 1.29; 95%CI 1.24-1.33), frequent unhealthy eating (OR 1.39; 95%CI 1.35-1.43), being inactive (OR 1.12; 95%CI 1.07-1.18), excessive screen time and sitting (OR 1.10; 95%CI 1.07-1.14 and OR 1.68; 95%CI 1.63-1.73, respectively), smoking (OR 1.26; 95%CI 1.19-1.34), alcohol (OR 1.33; 95%CI 1.28-1.37), drugs (OR 1.13; 95%CI 1.05-1.22), and irregular school attendance (OR 1.53; 95%CI 1.48-1.59) were associated with worse self-rated mental health. Various lifestyle behaviors are associated with different indicators of mental health.

Healthy Lifestyle Behaviors Attenuate the Effect of Poor Sleep Patterns on Chronic Kidney Disease Risk: A Prospective Study from the UK Biobank.

This study aimed to assess the impact of modifiable lifestyle behaviors on the association between sleep patterns and chronic kidney disease (CKD) risk. This study included 294,215 UK Biobank participants initially without CKD, followed until 13 October 2023. Sleep patterns were derived from five sleep factors, including sleep duration, chronotype, insomnia, snoring, and daytime dozing. The healthy lifestyle score (HLS) was newly calculated based on smoking status, physical activity, diet, body mass index, and mental health. Cox's proportional hazards models were used to assess the associations between sleep patterns, HLS, and CKD risk. A total of 17,357 incident CKD cases were identified during a median follow-up of 14.5 (interquartile range: 13.7-15.3) years. Both sleep patterns and HLS were independently associated with increased CKD risk (p-trend < 0.001). Importantly, the HLS was found to modify the association between sleep patterns and CKD risk (p-interaction = 0.026). Among participants with a low HLS, medium (HR = 1.12; 95% CI 1.05-1.19) and poor sleep patterns (HR = 1.23; 95% CI 1.17-1.30) increased CKD risk to varying degrees, whereas no significant association was observed for a high HLS. Moreover, the combination of a low HLS and poor sleep pattern significantly increased the risk of incident CKD (HR = 2.19; 95% CI 2.00-2.40). A high HLS may significantly reduce CKD risk associated with poor sleep, whereas a low HLS may exacerbate this risk. These findings underscore the critical importance of lifestyle interventions as a primary prevention strategy for CKD.

Diabetes, Prediabetes, and Brain Aging: The Role of Healthy Lifestyle.

Diabetes is a well-known risk factor for dementia. We investigated the association between (pre)diabetes and older brain age and whether this can be attenuated by modifiable lifestyle behaviors. The study included 31,229 dementia-free adults from the UK Biobank between the ages of 40 and 70 years. Glycemic status (normoglycemia, prediabetes, or diabetes) was ascertained based on medical history, medication use, and HbA1c measured at baseline. Information on cardiometabolic risk factors (obesity, hypertension, low HDL, and high triglycerides) and lifestyle behaviors (smoking, drinking, and physical activity) was also collected at baseline. Participants underwent up to two brain MRI scans over 11 years of follow-up. Brain age was estimated using a machine learning model based on 1,079 brain MRI phenotypes and used to calculate brain age gap (BAG; i.e., brain age minus chronological age). At baseline, 13,518 participants (43.3%) had prediabetes and 1,149 (3.7%) had diabetes. Prediabetes (β = 0.22 [95% CI 0.10, 0.34]) and diabetes (2.01 [1.70, 2.32]) were both associated with significantly higher BAG, and diabetes was further associated with significant increase in BAG over time (0.27 [0.01, 0.53]). The association between (pre)diabetes and higher BAG was more pronounced in men and in people with two or more cardiometabolic risk factors. In joint exposure analysis, having a healthy lifestyle (i.e., no smoking, no heavy drinking, and high physical activity) significantly attenuated the diabetes-BAG association. Diabetes and even prediabetes are associated with accelerated brain aging, especially among men and people with poor cardiometabolic health. However, a healthy lifestyle may counteract this.

Leisure time activities of children: Inequalities, determinants, and inter-relations

More studies should adopt a combined approach to modifiable lifestyle behaviors because of their potential synergistic effects on health. This study aims to observe how boys and girls allocate their time on different activities, during week and weekend days, investigate the time inter-relations between different leisure activities, and analyze how child and familial characteristics are associated with children’s time use in multiple activities. In 2016/17, a validated questionnaire collected data from 3-10-year-old Portuguese children (n = 8,472). Parents reported their children’s time use in different behaviors: sleep, study, screen media use, indoor and outdoor play, and school commute, as well as children’s participation in sports, and socio-economic characteristics of the family. A combination of statistical analysis (e.g., t-tests, pairwise correlations and multiple linear regression) revealed that: boys reportedly have higher screen time than girls, but they also accumulate more time in outdoor play; the time spent in different activities was determined by a set of family sociodemographic factors, such as urbanization and parental employment; and exists some inter-relation between leisure activities with high screen time being significantly associated with less sport participation and less sleep duration. Identifying time spent in multiple activities that differ by sex (and associated determinants) is critical for the development of activity promotion strategies, and may help to inform evidence-based policies designed to increase physical activity and decrease sedentary behavior in young children. Present findings highlight the growing importance of electronic media in children’s life and how they can displace other leisure activities.

Preventive healthcare practice by allied health professionals: Results from a cross-sectional survey in rural and regional Victoria

ObjectivesTo describe the frequency of preventive healthcare practice (assess, advice, refer for support) provided by allied health professionals (AHPs) practicing in regional and rural healthcare settings to address smoking, diet and physical inactivity. To identify factors that influence the delivery of preventive healthcare practice. MethodsAHPs working in public healthcare services in the Loddon Mallee region of Victoria were surveyed. Clinicians reported on the proportion of clients where they had provided preventive care. Likert scale questions measured factors influencing preventive healthcare practice. ResultsIn total, 115 clinicians completed the survey. AHPs reported that they assess for smoking and physical activity behaviours but not diet. Preventive health practice that included providing advice or referrals for follow-on support was rarely undertaken. Availability of screening tools and automated referral letters increased the likelihood of preventive healthcare practice. ConclusionsGreater attention to addressing modifiable lifestyle behaviours by AHPs might be warranted to match the rates of risk factors in rural and regional Victoria. Integrating support systems, for example, embedding screening questions within clinical assessments can assist preventive healthcare practice. Implication for public healthMany AHPs are not promoting healthy behaviours to prevent poor health. We present some strategies that could potentially improve this.

An approach to persons who are not willing to engage in behavioural change.

With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling. The 5Rs MI approach holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but is best integrated within a theoretical behavioural change framework. Of the four health-related behavioural change theoretical frameworks that are frequently used, the transtheoretical stages of the change model are the most used. This continued professional development article provides a summary review of the literature on behavioural change theories as they apply to lifestyle health behaviour change and presents the 5Rs approach as a feasible and practical approach to manage patients who are unwilling to change or in the precontemplation stage. This offers a beacon of hope for improved patient outcomes in a PHC system saddled with high prevalence of modifiable unhealthy lifestyle behaviours.

Associations of 24-hour movement guidelines adherence with fruit and vegetable intake in university students.

Unhealthy eating habits, such as low vegetable and fruit intake, are associated with many health problems. 24-h movement behaviors have been reported to be positively associated with numerous health-related outcomes. Despite the importance of these two modifiable lifestyle behaviors in building healthy habits in university students, there is a paucity of relevant research in this population. Therefore, this study aims to examine the correlation between compliance with 24-h movement guideline (24-h MG) and intake of fruits and vegetables (IFV) in Chinese university students. This study investigated the relationship between the compliance with 24-h MG and IFV in 1,793 Chinese university students using a convenience sampling method online. Physical activity (PA) and sedentary behavior (SB) were assessed by the International Physical Activity Questionnaire-Short Form, while sleep was measured using the Pittsburgh Sleep Quality Index. The Chinese version of the Health Promoting Lifestyle Profile II was used to measure IFV. Generalized linear models were applied to examine the correlation between compliance with the 24-h MG and eating habits. The proportion of participants who routinely consumed vegetables and fruits was 24.6% and 43.1%, respectively, while the proportion of meeting the three 24-h MG and a combination of any two guidelines was 27.8% and 40.1%, respectively. Meeting all three guidelines was associated with a greater IFV intake compared to not meeting either guideline. Meeting all three guidelines (OR = 2.42 [1.63, 3.58]) and the combination of moderate to vigorous PA (MVPA) and sleep (OR = 2.06 [1.37, 3.10]) were positively associated with the frequency of vegetable consumption (p < 0.05). As well, meeting all three guidelines (OR = 2.06 [1.37, 3.10]), the combination of MVPA and sleep (OR = 1.72 [1.04, 2.84]), and sleep only (OR = 1.88 [1.21, 2.92]) were positively associated with fruits consumption (p < 0.05). Almost a third of the university students met the three 24-h MG, and compliance with all three guidelines was associated with a higher frequency of IFV. Furthermore, meeting the sleep guideline alone or in conjunction with the PA, and meeting the entire 24-h MG was associated with greater consumption of fruits.

Association between Depressive Symptoms, Physical Activity, and Health Factors in Hispanic Emerging Adults.

Physical activity is a modifiable lifestyle behavior known for reducing symptoms of and being a risk factor for depression and mental health disorders. However, emerging adults (ages 18-25) struggle to meet recommended amounts. In this study, we explore the association between physical activity, depressive symptoms, and health factors in 137 Hispanic emerging adults. Using a cross-sectional survey design, sociodemographic information, depressive symptoms (CES-D score), physical activity (IPAQ score), body composition, and blood pressure measures were obtained. Statistical analyses included correlation and regression analyses. More than half of the participants demonstrated depressive symptomology (59.1%) and body fat percentage greater than 25% (64.2%). Body fat percentage, lean body mass, stress, and heart rate demonstrated notable associations with depressive symptoms and physical activity. When measured continuously and categorically, IPAQ was not a significant predictor of depressive symptoms. When used as a binary variable with a cutoff of 600 MET min/week, IPAQ score revealed a negative relationship with CES-D score (β = -0.169, SE = 2.748, p = 0.034). Our results indicate that a threshold of physical activity, 600 MET min/week, may confer protective effects against depressive symptoms. Future research should investigate the context and quality of physical activity to address mental health disparities in this underrepresented population.

Early Prostate Cancer Deaths Among Men With Higher vs Lower Genetic Risk

Prostate cancer, a leading cause of cancer death among men, urgently requires new prevention strategies, which may involve targeting men with an underlying genetic susceptibility. To explore differences in risk of early prostate cancer death among men with higher vs lower genetic risk to inform prevention efforts. This cohort study used a combined analysis of genotyped men without prostate cancer at inclusion and with lifestyle data in 2 prospective cohort studies in Sweden and the US, the Malmö Diet and Cancer Study (MDCS) and the Health Professionals Follow-Up Study (HPFS), followed up from 1991 to 2019. Data were analyzed between April 2023 and April 2024. Men were categorized according to modifiable lifestyle behaviors and genetic risk. A polygenic risk score above the median or a family history of cancer defined men at higher genetic risk (67% of the study population); the remaining men were categorized as being at lower genetic risk. Prostate cancer death analyzed using time-to-event analysis estimating hazard ratios (HR), absolute risks, and preventable deaths by age. Among the 19 607 men included for analysis, the median (IQR) age at inclusion was 59.0 (53.0-64.7) years (MDCS) and 65.1 (58.0-71.8) years (HPFS). During follow-up, 107 early (by age 75 years) and 337 late (after age 75 years) prostate cancer deaths were observed. Compared with men at lower genetic risk, men at higher genetic risk had increased rates of both early (HR, 3.26; 95% CI, 1.82-5.84) and late (HR, 2.26; 95% CI, 1.70-3.01) prostate cancer death, and higher lifetime risks of prostate cancer death (3.1% vs 1.3% [MDCS] and 2.3% vs 0.6% [HPFS]). Men at higher genetic risk accounted for 94 of 107 early prostate cancer deaths (88%), of which 36% (95% CI, 12%-60%) were estimated to be preventable through adherence to behaviors associated with a healthy lifestyle (not smoking, healthy weight, high physical activity, and a healthy diet). In this 20-year follow-up study, men with a genetic predisposition accounted for the vast majority of early prostate cancer deaths, of which one-third were estimated to be preventable. This suggests that men at increased genetic risk should be targeted in prostate cancer prevention strategies.

MHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan.

Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully.

Efficacy of Self-Review of Lifestyle Behaviors with Once-Weekly Glycated Albumin Measurement in People with Type 2 Diabetes: A Randomized Pilot Study.

Lifestyle management, including appropriate modifications of nutrition, exercise, and medication behaviors, is essential for optimal glycemic control. The absence of appropriate monitoring methods to validate the lifestyle change may hinder the modification and continuation of behaviors. In this study, we evaluated whether once-weekly glycated albumin (GA) measurement received via a smartphone application could improve glycemia management in patients with type 2 diabetes mellitus by supporting self-review and modification of lifestyle behaviors. This open-label, randomized controlled, single-center study in Japan with an 8-week intervention period was conducted in individuals with type 2 diabetes mellitus and HbA1c levels between 7.0 and 9.0% (53‒75mmol/mol). The intervention was once-weekly home monitoring of GA with a daily self-review of lifestyle behaviors using a smartphone application, in addition to conventional treatment. A total of 98 participants (72.0% males; age 63.2 ± 11.4years; HbA1c 7.39 ± 0.39% [57.3 ± 4.3mmol/mol]) were randomly assigned to the intervention or control group. Significant decreases of the GA and HbA1c levels from the baseline to the last observation day were observed in the intervention group (- 1.71 ± 1.37% [- 39.1 ± 31.3mmol/mol] and - 0.32 ± 0.32% [- 3.5 ± 3.5mmol/mol], respectively). Significant decreases of the body weight, waist circumference, and caloric expenditure (p < 0.0001 and p = 0.0003, p = 0.0346, respectively), but not of the caloric intake (p = 0.678), were also observed in the intervention group as compared with the control group. Self-review of lifestyle behaviors in combination with once-weekly GA home testing received via a smartphone application might potentially benefit glycemic management in people with type 2 diabetes mellitus. jRCTs042220048.

Modifiable Lifestyle Behaviors and Depressive Symptoms in Emerging Hispanic Adults

Modifiable Lifestyle Behaviors and Depressive Symptoms in Emerging Hispanic Adults

Behind the Genetics: The Role of Epigenetics in Infertility-Related Testicular Dysfunction.

In recent decades, we have witnessed a progressive decline in male fertility. This is partly related to the increased prevalence of chronic diseases (e.g., obesity and diabetes mellitus) and risky lifestyle behaviors. These conditions alter male fertility through various non-genetic mechanisms. However, there is increasing evidence that they are also capable of causing sperm epigenetic alterations, which, in turn, can cause infertility. Furthermore, these modifications could be transmitted to offspring, altering their general and reproductive health. Therefore, these epigenetic modifications could represent one of the causes of the progressive decline in sperm count recorded in recent decades. This review focuses on highlighting epigenetic modifications at the sperm level induced by non-genetic causes of infertility. In detail, the effects on DNA methylation, histone modifications, and the expression profiles of non-coding RNAs are evaluated. Finally, a focus on the risk of transgenerational inheritance is presented. Our narrative review aims to demonstrate how certain conditions can alter gene expression, potentially leading to the transmission of anomalies to future generations. It emphasizes the importance of the early detection and treatment of reversible conditions (such as obesity and varicocele) and the modification of risky lifestyle behaviors. Addressing these issues is crucial for individual health, in preserving fertility, and in ensuring the well-being of future generations.

Gardening and cognitive ageing: Longitudinal findings from the Lothian Birth Cohort of 1921

Identifying modifiable lifestyle behaviours that facilitate healthy cognitive ageing is of major public interest for the prevention of cognitive decline and dementia. Gardening is associated with numerous health benefits, yet few studies have explored the significance of gardening activity in relation to cognitive ageing. Here, longitudinal cognitive data from 467 older adults (aged 79 ± 0.6) of the LBC1921 study were used to examine associations of self-reported gardening at age 79 with lifetime cognitive change (age 11 to 79), and cognitive level (age 79) and slope across later life (age 79 to 90). Cognitive function was assessed at age 11 and 79 using the Moray House Test (MHT), and a battery of psychometric tests assessed cognitive function at ages 79, 83, 87 and 90 (MHT, Raven's Matrices, Verbal Fluency, Logical Memory). Models controlled for individual-level socio-demographic, lifestyle and health covariates including overall physical activity. Higher frequency of gardening was significantly associated with greater lifetime cognitive gain from age 11 to 79 on the MHT (std β = 0.112 P = 0.024), higher general cognitive ability (g) level at age 79 (std β = 0.145, P = 0.001), and higher test-specific scores on the MHT (std β = 0.153, P = 0.001) and Raven's Matrices (std β = 0.102, P = 0.040). Gardening was not associated with subsequent cognitive slopes from age 79 to 90. Overall, these findings suggest that engaging in gardening activities may contribute modestly to healthy cognitive functioning up to the eighth decade of life. Although physical activity was higher in gardeners, it did not explain the gardening and cognitive function relationship.

The contribution of rare and common genetic variants to risk of prostate cancer and second primary cancer after prostate in the UK Biobank.

10604 Background: It has been estimated that up to 40% of prostate cancer may be attributed to inherited genetic susceptibility, yet very few variants have been consistently associated with risk and/or adverse outcomes after diagnosis. Moreover, because prostate cancer survival is generally good, risk of developing a second primary cancer (SPC) is an important concern. Identifying men at greater genetic risk of developing an SPC will lead to improved post-diagnostic cancer surveillance practices and lifestyle behavior modifications. Methods: The current investigation leverages genetic and phenotypical data from the UK Biobank (UKB) to examine inherited genetic factors, including rare pathogenic mutations (RPMs) and polygenic risk scores (PRS) with prostate cancer risk and SPC. The individual and joint contribution of (RPM in 26 cancer susceptibility genes and trans-ethnic PRS previously derived for 11 different cancer sites with both risk of prostate cancer and also SPCs among men diagnosed after primary prostate cancer. Cox regression models were used to estimate Hazard Ratio (HR) for prostate cancer, adjusted for age and ancestry. Cumulative incidence of SPC by person-year among prostate cancer patients was estimated from the age of diagnosis and compared with that in men without cancer. Results: Among 228,472 men in the UKB, 17,547 were diagnosed with prostate cancer. RPMs in five genes ( ATM, BRCA2, CHEK2, HOXB13 and PTEN) were significantly associated with prostate cancer risk. The rate of prostate cancer among RPM carriers was 15.59% compared with 7.72% in non-carriers (HR=2.26, 95% CI=1.97-2.59). The top decile of PRSProstate was associated with a 9.99-fold increase in risk of prostate cancer (95% CI=9.08-11). Having a diagnosis of prostate cancer had a significantly increased risk for two SPCs (bladder and kidney) and reduced risk for lung cancer, p&lt;0.001. Those that developed SPC of bladder cancer had significantly higher PRSBladder, p=5.91E-06. The number of RPM carriers (n=77) among SPC bladder cancers was prohibitively small to precisely estimate risk. Conclusions: In this large population-based cohort, both RPMs in largely DNA damage repair genes and PRS contribute to risk of prostate cancer and PRS with second primary bladder cancer among men with prostate cancer. These data both contribute to our understanding of the genetic susceptibility to prostate cancer and reinforce the need for refinement of genetic screening panels.

Comparison of health-related fitness and modifiable lifestyle behaviors between SWAT officers and professional firefighters: An exploratory study

Comparison of health-related fitness and modifiable lifestyle behaviors between SWAT officers and professional firefighters: An exploratory study

The relationship between modifiable lifestyle behaviours and self-reported health in children and adolescents in the United Kingdom.

Obesity, along with its associated health issues, is closely tied to lifestyle habits. While certain elements affecting childhood health, such as genetics and ethnicity, are beyond individuals' control, there exists modifiable lifestyle behaviours that can facilitate healthier living. This study employed multiple regression analysis to investigate the relationship between specific modifiable lifestyle behaviours and self-reported health. The independent variables considered included days of moderate to vigorous physical activity (MVPA), fruit and vegetable consumption, breakfast frequency, school night sleep duration, and non-school night sleep duration. These variables were chosen for their practical modifiability within participants' daily lives. The analysis revealed a highly significant overall model (F(13,11363) = 191.117, p < .001), explaining 17.9% of the variance in self-reported health. Notably, higher MVPA levels were associated with improved self-reported health (B = 0.136 to 0.730, p < .001). Additionally, regular breakfast consumption and increased fruit and vegetable intake exhibited positive associations with self-reported health (B = 0.113 to 0.377, p < .001), while girls reported lower self-reported health (B = -0.079, p < .001). School night sleep duration was positively linked to self-reported health (B = 0.071, p < .001). Furthermore, a dose-response relationship between MVPA, dietary habits, and health was identified. These findings hold substantial potential for public health campaigns to promote healthy behaviours and prevent chronic diseases in young individuals. It is imperative to emphasise that all the variables considered in this study are readily modifiable aspects of individuals' lives, offering a promising avenue for personal health and well-being enhancement.

Lifestyle and genetic risk of chronic liver disease in metabolically healthy and unhealthy individuals from the general population

Background & AimsIt is unclear to what extent lifestyle and genetic factors affect incidence of chronic liver disease (CLD) in a general population and if lifestyle affects CLD independently of underlying cardiometabolic perturbations and genetic predisposition. MethodsWe examined 27,991 men and women aged 44-73 years from the Malmö Diet and Cancer Study recruited between 1991-1996 and followed until end of 2020 using registry-linkage (median follow-up time 25.1 years; 382 incident first-time CLD events). Associations between cardiometabolic factors, polygenic risk scores (PRSs), and lifestyle factors in relation to CLD were examined using multivariable Cox proportional hazards regression models. ResultsIncidence of CLD increased with number of cardiometabolic risk factors (the hazard ratio (HR) per each additional cardiometabolic risk factor was 1.33 (95% CI: 1.21-1.45; p= 5.1 x 10-10). Two novel polygenic risk scores (PRS) for metabolic dysfunction-associated steatotic liver disease (MASLD) and a PRS for liver cirrhosis associated with higher risk of CLD but provided marginal predictive utility on top of other risk factors and compared to the PNPLA3 rs738409 genetic variant. An unhealthy lifestyle (high alcohol intake, current smoking, physical inactivity and unhealthy diet) markedly increased risk of CLD (HR=3.97, 95% CI: 2.59-6.10). Observed associations between examined lifestyle factors and CLD were largely independent of cardiometabolic perturbations and polygenic risk. ConclusionsWe confirmed the importance of cardiometabolic dysfunction in relation to risk of CLD in a general population. Lifestyle risk factors were shown to independently associate with CLD and added predictive information on top of cardiometabolic risk factors. Information on the polygenic risk of liver disease does not currently add to prediction of CLD in a general population. Lay summaryIn this large longitudinal study of a general population, we found that cardiometabolic, genetic and lifestyle risk factors all contribute to the development of chronic liver disease (CLD). Our results suggest that an unhealthy lifestyle, including alcohol consumption, smoking, physical inactivity, and an unhealthy diet, substantially increase risk of CLD independently of underlying genetic risk or cardiometabolic health. This suggest that a large proportion of CLD cases are potentially preventable through adoption of healthy lifestyle changes. Impact and implicationsThis large population-based prospective study suggests largely independent roles of cardiometabolic, lifestyle, and genetic risk factors in the development of chronic liver disease. Findings strengthen the evidence base for a beneficial effect of modification of high-risk lifestyle behaviors in the primary prevention of chronic liver disease in the general population.

Effectiveness of the Pasifika Women's Diabetes Wellness Program (PWDWP): Protocol for a Pilot Intervention and Feasibility Randomized Controlled Trial.

Type 2 diabetes poses public health challenges for Māori and Pasifika communities in Australia. The women of these communities face a greater burden from type 2 diabetes-related mortality and comorbidities. Lifestyle modification behaviors through previous women's wellness programs have been shown to reduce the risk of developing complications in established type 2 diabetes. The Pasifika Women's Diabetes Wellness Program (PWDWP) pilot study, co-designed with Māori and Pasifika communities, was aimed at addressing late hospital presentations from diabetes-related complications. This study (1) examines the efficacy of women with type 2 diabetes in the intervention group for improved glycated hemoglobin (HbA1c) clinical levels and diabetes self-management compared with the control group from baseline (T0) to week 12 (T1) and week 24 (T2; postintervention) and (2) assesses the cultural adaptability, acceptability, and feasibility of the pilot intervention for future studies. This study uses a quasiexperimental design that involves a 24-week intervention. We recruited 50 Māori and Pasifika women with type 2 diabetes (25 in the intervention group from the south side of Brisbane and 25 in the control group from the north side of Brisbane) using participatory talanoa methodologies. The intervention group participated in face-to-face and virtual whānau education workshops (5 weeks) and had access to individual coaching and virtual support delivered by trained Māori and Pasifika health professionals and community health workers. The control group received usual care with their identified health provider. Both groups received copies of the PWDWP journal, fact sheets, and a health check passbook with tailored motivational text messages. An advisory committee was set up to oversee the program implementation, including protocols of engagement, health checks, and data collection in community settings. The quantitative data were collected at T0, T1, and T2 with HbA1c as the primary outcome measure. Secondary outcomes measured changes in diabetes self-care and body composition (eg, BMI, waist circumference). Qualitative data will ascertain the program's feasibility and cultural adaptability using talanoa focus groups. This pilot study was approved by the Queensland University of Technology Human Ethic Research Committee (5609) and began in January 2023 after participant recruitment between July 2022 and December 2022. The final data collection including the health check, focus group, and survey data was completed in November 2023, and data analysis and reporting are expected to conclude in 2024. This study provides a blueprint for PWDWP. Collaborative partnerships with community organizations and stakeholders are crucial for program success and suggest a potential model for targeting diabetes management for Māori and Pasifika communities, emphasizing the need for culturally relevant interventions. The findings will have significant implications for policymakers and practitioners when developing and implementing public health initiatives, particularly for communities with unique cultural nuances. Australian New Zealand Clinical Trials Registry ACTRN12622001100785p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384470&isReview=true. DERR1-10.2196/55435.

Assessment of Violence during COVID-19 among Reproductive Age Women in Arsi Zone, South East Ethiopia.

Preventive measures, like staying at home during lockdown, are mandatory during the COVID-19 pandemic. Particularly as a result of staying at home, violence against women is beginning to increase in correlation with these measures. Therefore, the purpose of this study was to assess the prevalence of violence against women of reproductive age during the COVID-19 pandemic in the Arsi Zone. A community-based cross-sectional study design was employed from February 15 to March 30, 2021. A multistage sampling technique was used to recruit 1458 women aged 15-49 years old. Data entry was performed using Epi info-7 and exported to SPSS version 25 for analysis. A logistic regression analysis was employed to identify factors associated with violence against women at p value <0.05 and AOR values with 95% CI. The prevalence of violence against women during COVID-19 was 51.1% (95% CI 48.5-53.7%). Psychological violence (31.8%) and controlling behavior violence (29.3%) were the leading types of violence followed by economic (20.2%) and sexual violence (15.6%). Respondents who had monthly income of <1000 birr (AOR = 1.72; 95% CI, 1.18, 2.51), 1001-2000 birr (AOR = 2.22; 95% CI, 1.51, 3.27), 2001-3000 birr (AOR = 1.91; 95% CI, 1.26, 2.91), and 3001-4000 birr (AOR = 2.03; 95% CI, 1.31, 3.14), quarreled with their partner's family (AOR = 3.36; 95% CI: 2.14-5.30), witnessed chilhood family violence (AOR = 2.34; 95% CI: 1.81-3.02), and decisions made on the household issue by husband only (AOR = 2.62; 95% CI: 2.01-3.41) or wife only (AOR = 1.99; 95% CI: 1.33-2.98) were significantly associated with violence against women. In addition, we found that participants whose partners cannot read and write (AOR = 2.63; 95% CI: 1.19- 5.81), drink alcohol (AOR = 2.78; 95% CI: 2.10-3.76), chew chat (AOR = 3.27; 95% CI: 2.21-4.85), ever fighting or aggressive with other men (AOR = 2.73; 95% CI: 1.51-4.95), and partners' families taking part in the decision making (AOR = 2.32; 95% CI: 1.49-3.62) were also associated with violence against women. One in every two women was the victim of any form of violence in the study area. Hence, empowering women's economic status and enhancing community-based health education for males on behavioral lifestyle modification were required to prevent violence against women.