Modifiable Lifestyle Risk Factors Research Articles

The MARVIN Hypothesis: Linking Unhealthy Lifestyles to Intracranial Aneurysm Rupture Risk and Clinical Prognosis

Background and Objectives: The rising incidence of modifiable lifestyle risk factors and cardiovascular diseases, driven by poor diet, inactivity, excessive alcohol use, and smoking, may influence the development and rupture of intracranial aneurysms (IA). This study aimed to examine the impact of lifestyle-related and cardiovascular risk factors on IA rupture and patient outcomes. Materials and Methods: We developed the “MARVIN” (Metabolic and Adverse Risk Factors and Vices Influencing Intracranial Aneurysms) model and conducted a retrospective analysis of 303 patients with 517 IAs, treated between 2007 and 2020. Of these, 225 patients were analyzed for rupture status and 221 for clinical outcomes. The analysis focused on hypertension, diabetes, hypercholesterolemia, vascular diseases, nicotine and alcohol abuse, obesity, aneurysm rupture status, and clinical outcomes. Logistic regression was used to evaluate the impact of these risk factors. Results: Among those with risk factors, 24.9% (56/225) and 25.3% (56/221) had one, 32.0% (72/225) and 30.8% (68/221) had two, 20.0% (45/225) and 20.4% (45/221) had three, 12.0% (27/225) and 12.2% (27/221) had four, 4.0% (9/225) and 4.1% (9/221) had five, 0.9% (2/225) had six in both groups, and 0.4% (1/225) and 0.5% (1/221) had seven risk factors, respectively. Strong relationships were found between lifestyle-related vascular risk factors, indicating multiple comorbidities in patients with unhealthy habits. Smokers with ruptured aneurysms had higher WFNS (World Federation of Neurosurgical Societies) scores, but nicotine abuse did not affect long-term outcomes. The most significant predictors for poor outcomes were WFNS score and age, while age and a history of vascular diseases were protective against rupture. Despite the high prevalence of modifiable risk factors, they did not significantly influence rupture risk. Conclusions: The findings suggest a need for multifactorial risk assessment strategies in managing IA patients. Future studies with larger cohorts are required to confirm these results and better understand IA progression.

Impact of addressing modifiable risk factors on the 10-year risk of cardiovascular disease in individuals with familial hypercholesterolemia: a causal analysis utilising UK biobank

Abstract Background Familial hypercholesterolemia (FH) is a prevalent autosomal dominant disorder characterised by elevated low-density lipoprotein cholesterol (LDL-C) levels from birth. These elevated LDL-C levels significantly amplify the lifetime risk of cardiovascular disease (CVD). While the impact of early and effective initiation of lipid-lowering medication (LLM) on CVD risk is well documented in genetically confirmed FH, the additional impact of addressing modifiable lifestyle risk factors (MLRF) in that patient population remains largely unquantified. Methods This study quantified the potential effects of successfully managing 4 MLRF (smoking, obesity, alcohol consumption, and low physical activity) on the 10-year incidence of a first CVD diagnosis in adults with genetically confirmed FH treated with LLM within the UK Biobank. The synthesised causal estimates of these 4 MLF were obtained using two recent causal analysis frameworks, namely the doWhy causal calculus framework and the Causal Forest Double Machine Learning Method. Results In 660 FH individuals (mean age 56±8 years; 60.15% women), smoking cessation and reducing body mass index below 30 kg/m2 delivered the most substantial risk reductions (pooled estimates, adjusted for the 3 other MLRF: -6.5% and -3.2%, respectively; both p<0.001), followed by initiating moderate or high physical activity (-1.7%; p<0.001; Figure). Notably, cessation of alcohol consumption significantly increased CVD risk (+2.5%; p<0.001), aligning with existing literature. Conclusion In over 10 years, reductions in CVD risk ranging from 1.7% to 6.5% were achievable through smoking cessation, BMI reduction, and enhanced physical activity in FH individuals. Leveraging causal inference methodologies facilitates the discernment of which risk factors offer the most pronounced additional benefits beyond lipid-lowering interventions in this high-risk population.Forest Plot of Causal Effect Estimates

Examining Lifestyle Risk Factor Clusters and Mental Health in Adults

Abstract Background Lifestyle risk factors often cluster, impacting both physical and mental health. Studies reveal bidirectional relationships between lifestyle factors and health. The aim of this study is to examine the relationship between mental health problems, self-reported depression, and lifestyle risk factors in a sample of the adult population in Turkey. Methods 2022 Turkey Health Survey (THS) data were used. The sample group was made using cross-sectional data of approximately 22742 individuals in the adult population over 15 years of age. Two-stage clustering method was used to determine vital risk factor clusters. Regression analysis was used to determine the relationship between vital risk factor clusters and self-reported depression and mental health problems. Results Lifestyle risk factors were grouped into 4 clusters. It was observed that unhealthy diet, inadequate physical activity, and smoking, which are modifiable lifestyle risk factors, were together in the clusters. It was also observed that self-reported depression and mental problems were more associated with clusters with more than one lifestyle risk factor. In addition, women, married individuals, and individuals over 65 years of age were more associated with mental problems. Conclusions As a result of the findings, there was an association between people with mental problems and lifestyle risk factors such as smoking, unhealthy diet, and insufficient physical activity. These findings may help to plan and implement more effective health policies and individual interventions targeting groups with multiple lifestyle risk factors in the future. Key messages • The target group was determined to improve community mental health and to make necessary interventions. • Since inadequate physical activity, which is one of the vital risk factors, and unhealthy nutrition and smoking tend to cluster together, it was determined that these problems should be prioritised

Lifestyle changes and patient-reported outcomes over five years in a sample of people with multiple sclerosis after a single multimodal intensive lifestyle education workshop.

Modifiable lifestyle risk factors for progression of multiple sclerosis (MS) have been increasingly studied. This study employed a single-group design involving a one-off intensive live-in educational workshop on lifestyle modification for people with MS. We aimed to examine changes in a range of clinical and lifestyle variables and quality of life, self-efficacy, physical impact of MS and disability from baseline to 3- and 5-years post-intervention. 95 participants completed the baseline survey. Data included lifestyle risk factors of diet quality, meat and dairy consumption, omega 3 and vitamin D supplementation, physical activity, stress reducing activities, and smoking status, and use of disease-modifying therapies (DMTs). Patient-reported outcomes included health-related quality of life, self-efficacy, physical impact of MS and disability. Generalised estimating equation models were used to account for within-participant correlation over time. Sixty participants (63.2%) provided data at 3- and 5-years. Significant improvements in diet quality, omega 3 supplementation, and non-smoking were seen at both timepoints. Use of DMTs and disability remained unchanged. Mental (8.8- and 6.9-point) and physical (10.5- and 7.3-point) quality of life, and self-efficacy (2.4- and 1.9-point) improved significantly at 3- and 5-years, respectively. Physical impact of MS reduced from baseline to 3-years (-3.7 points) with a trend towards reduction at 5-years (-2.9 points; p = 0.079). Education on lifestyle modification can lead to lifestyle modification and short and long-term improvements in mental and physical wellbeing outcomes. Results suggest potential value in lifestyle modification as an adjunctive component to standard therapy for MS.

Do modifiable patient factors increase the risk of postoperative complications after total joint arthroplasty?

Numerous studies demonstrate that modifiable lifestyle risk factors can influence patient outcomes including survivability, quality of life, and postoperative complications following orthopaedic surgery. The purpose of this study was to determine the impact of modifiable lifestyle risk factors on postoperative medical and surgical complications following a total joint arthroplasty (TJA) in a large national healthcare system. A retrospective chart review of a large national health system database was performed to identify patients who underwent TJA between 2017 and 2021. TJA included total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty. Modifiable lifestyle risk factors were defined as tobacco use, narcotic drug abuse, hypertension, and diabetes mellitus. Postoperative medical complications and postoperative surgical complications were collected. Logistic regression and odds ratio point estimate analysis were conducted to assess for associations between postoperative complications and modifiable lifestyle risk factors. Of the 16,940 patients identified, the mean age was 71 years, mean BMI was 29.7kg/m2, and 62% were women. We found that 3.5% had used narcotics, 8.7% were past or current smokers, 24% had diabetes, and 61% had hypertension; in addition, 5.4% experienced postoperative medical complications and 6.4% experienced postoperative surgical complications. Patients who used narcotics were 90% more likely to have postoperative complications (p < 0.0001) and 105% more likely to experience prosthetic complications (p < 0.0001). Similarly, patients with tobacco use were 65% more likely to have postoperative complications (p < 0.0001) and 27% more likely to experience prosthetic complications. Our results demonstrate critical rates of increased postoperative medical and surgical complications after TJA for patients with narcotic abuse, tobacco use, or diabetes mellitus. Furthermore, adopting preoperative interventions and optimization programs informed by our findings on specific modifiable risk factors could aid orthopaedic surgeons in optimizing patient health. III; Retrospective study.

Ranking of Modifiable Lifestyle Risk Factors for Breast Cancer in Saudi Women: Population Attributable Risk and Nomogram.

Breast cancer is the most common cancer among women in the Saudi Arabia, and over 50% of the cases are detected at a late stage. This study aimed to estimate population attributable risk percentage (PAR%) of modifiable lifestyle risk factors for breast cancer in Saudi Arabia. A secondaryanalysis of previously published papers was performed . Relative risks (RR) and odds ratios (OR) were obtained from published international epidemiological studies, and the prevalence of each risk factor in Saudi Arabia was obtained from various sources (eg, national surveys and published literature) to calculate PAR%. A nomogram was used to visually translate the RRs/ORs and their prevalence into PAR% using a practical tool. Seven modifiable lifestyle risk factors for breast cancer were identified in Saudi Arabia. The identified risk factors included lack of physical activity (sedentary lifestyle), oral contraception (current use), obesity (postmenopausal), hormone replacement therapy (current use), passive smoking, age at first birth (≥ 35 years), and tobacco smoking (current or daily smoking). The PAR% for these risk factors ranged from 0.5% for tobacco smoking to 23.1% for a lack of physical activity. Few modifiable lifestyle risk factors were excluded from this study, due to limited nor unavailable data in Saudi Arabia (eg, alcohol consumption, breastfeeding patterns and childbearing patterns, obesity according to menopausal status, and night-shift work). Physical inactivity has the most significant modifiable health impact and is a major risk factor for breast cancer. Removing this risk factor would reduce the prevalence of breast cancer in the Saudi population by 23%. There is an immense need to prioritize cancer control strategies based on local needs, current data on cancer risk factors, and the disease burden.

Different modifiable risk factors for the development of non-advanced adenoma, advanced adenomatous lesion, and sessile serrated lesions, on screening colonoscopy

The development of premalignant colorectal polyps is significantly influenced by various lifestyle and modifiable risk factors. In our study, we used a large cohort of 9025 patients, who underwent screening colonoscopies at a university hospital, to assess the risk factors associated with the development of three different colorectal cancer precursor lesions: non-advanced adenomas (NAs), advanced adenomatous lesions (ADLs), and sessile serrated lesions (SSLs). Among the participants, 3641 had NAs, 836 had ADLs, and 533 had SSLs. We identified obesity, current smoking, and appendicular skeletal muscle mass as modifiable lifestyle risk factors that increase the development of NAs and ADLs (all P < 0.05). Furthermore, we found a positive correlation between the degree of obesity and an increased risk of developing NAs and ADLs (all P for trend < 0.001), while non-smoking was associated with a decreased risk (P for trend < 0.001 and 0.003, respectively). Smoking was the only modifiable risk factor for developing SSLs (adjusted odds ratio [aOR] 1.58; 95% confidence interval [CI] 1.20–2.07), and the risk was even higher in patients with metabolic syndrome (aOR 1.71; 95% CI 1.05–2.77). Addressing modifiable lifestyle factors such as smoking and obesity could play an important role in reducing the risk of both non-advanced and advanced adenomatous lesions. Smoking cessation is especially important as it is a significant modifiable risk factor for sessile serrated lesions.

Epidemiology, pathophysiology and clinical aspects of Hepatocellular Carcinoma in MAFLD patients.

Hepatocellular carcinoma (HCC) is undergoing a transformative shift, with metabolic-associated fatty liver disease (MAFLD) emerging as a dominant etiology. Diagnostic criteria for MAFLD involve hepatic steatosis and metabolic dysregulation. Globally, MAFLD prevalence stands at 38.77%, significantly linked to the escalating rates of obesity. Epidemiological data indicate a dynamic shift in the major etiologies of hepatocellular carcinoma (HCC), transitioning from viral to metabolic liver diseases. Besides the degree of liver fibrosis, several modifiable lifestyle risk factors, such as type 2 diabetes, obesity, alcohol use, smoking, and HBV, HCV infection contribute to the pathogenesis of HCC. Moreover gut microbiota and genetic variants maycontribute to HCCdevelopment.The pathophysiological link between MAFLD and HCC involves metabolic dysregulation, impairing glucose and lipid metabolism, inflammation and oxidative stress. Silent presentation poses challenges in early MAFLD-HCC diagnosis. Imaging, biopsy, and AI-assisted techniques aid diagnosis, while HCC surveillance in non-cirrhotic MAFLD patients remains debated.ITA.LI.CA. group proposes a survival-based algorithm for treatmentbased on Barcelona clinic liver cancer (BCLC) algorithm. Liver resection, transplantation, ablation, and locoregional therapies are applied based on the disease stage. Systemic treatments is promising, with initial immunotherapy results indicating a less favorable response in MAFLD-related HCC.Adopting lifestyle interventions and chemopreventive measures with medications, including aspirin, metformin, and statins, constitute promising approaches for the primary prevention of HCC.Prognosis is influenced by multiple factors, with MAFLD-HCC associated with prolonged survival. Emerging diagnostic biomarkers and epigenomic markers, show promising results for early HCC detection in the MAFLD population.

Modifiable Lifestyle Risk Factors in Adult Survivors of Childhood Cancer: A Nationally Representative Study.

Given the vulnerable health condition of adult childhood cancer survivors, it is essential that they develop positive health behaviors to minimize controllable health risks. Therefore, we evaluated if adult survivors of non-childhood cancer and childhood cancer differ in the odds of each modifiable risk factor compared with each other and compared with the general population. This nationally representative study leveraged the National Health Interview Survey (NHIS) sample from 2000 to 2018 and the Behavioral Risk Factor Surveillance System (BRFSS) sample from 2016 to 2021. Our study population included adults diagnosed with cancer when they were ≤14 years of age. Outcomes included physical activity, body mass index (BMI), current smoking, ever-smoking, alcohol use, and binge drinking. Insufficient physical activity was not statistically significant in the BRFSS, but in the NHIS, childhood cancer survivors had significantly more insufficient physical activity compared with non-childhood cancer survivors (aOR 1.29, P =0.038) and the general population (aOR 1.40, P =0.006). Childhood cancer survivors also had a higher likelihood of being significantly underweight (aOR 1.84, P =0.018) and having ever-smoked (aOR 1.42, P =0.001) compared with the general population in the NHIS. There was a significantly higher likelihood of smoking among childhood cancer survivors in the BRFSS (aOR 2.02, P =0.004). The likelihoods of many risky behaviors between adult childhood cancer survivors and general population controls were comparable, although rates of physical activity may be decreased, and rates of smoking may be increased among childhood cancer survivors. Targeted interventions are needed to promote healthy behaviors in this vulnerable population.

Reversal of Autism Symptoms among Dizygotic Twins through a Personalized Lifestyle and Environmental Modification Approach: A Case Report and Review of the Literature

The prevalence of autism has been increasing at an alarming rate. Even accounting for the expansion of autism spectrum disorder diagnostic (ASD) criteria throughout the 1990’s, there has been an over 300% increase in ASD prevalence since the year 2000. The often debilitating personal, familial, and societal sequelae of autism are generally believed to be lifelong. However, there have been several encouraging case reports demonstrating the reversal of autism diagnoses, with a therapeutic focus on addressing the environmental and modifiable lifestyle factors believed to be largely underlying the condition. This case report describes the reversal of autism symptoms among dizygotic, female twin toddlers and provides a review of related literature describing associations between modifiable lifestyle factors, environmental exposures, and various clinical approaches to treating autism. The twins were diagnosed with Level 3 severity ASD “requiring very substantial support” at approximately 20 months of age following concerns of limited verbal and non-verbal communication, repetitive behaviors, rigidity around transitions, and extensive gastrointestinal symptoms, among other common symptoms. A parent-driven, multidisciplinary, therapeutic intervention involving a variety of licensed clinicians focusing primarily on addressing environmental and modifiable lifestyle factors was personalized to each of the twin’s symptoms, labs, and other outcome measures. Dramatic improvements were noted within several months in most domains of the twins’ symptoms, which manifested in reductions of Autism Treatment Evaluation Checklist (ATEC) scores from 76 to 32 in one of the twins and from 43 to 4 in the other twin. The improvement in symptoms and ATEC scores has remained relatively stable for six months at last assessment. While prospective studies are required, this case offers further encouraging evidence of ASD reversal through a personalized, multidisciplinary approach focusing predominantly on addressing modifiable environmental and lifestyle risk factors.

Catheter Ablation for Atrial Fibrillation—Influence of Modifiable Risk Factors and Ablation Modality on Procedural Efficacy and Safety

Modifiable lifestyle risk factors, in particular obesity and related conditions, are important drivers of atrial fibrillation (AF), impacting the severity of symptoms and influence the efficacy and safety of treatment. The study aimed to assess the impact of modifiable lifestyle factors on the effectiveness and safety of AF ablation, and examine the procedural characteristics, efficacy, safety and cost outcomes of cryoballoon vs radiofrequency ablation, in a real-world clinical setting. Patients undergoing catheter ablation for AF (June 2017 to December 2020) were included in this retrospective analysis. Efficacy and safety outcomes were obtained from electronic medical records and state-wide databases. The primary outcome was successful isolation of the pulmonary veins and freedom from AF without repeat ablation or ongoing antiarrhythmic therapy at 12 months. The study included 141 patients (mean age 60±11 years, 57% male). The average body mass index (BMI) was 29.2±5.6 kg/m2. Ablation by cryoballoon was undertaken in 59% (radiofrequency 41%). Acutely successful pulmonary vein isolation was achieved in 92%, however, only 52% (n=74) met the primary outcome (successful isolation of the pulmonary veins and freedom from AF without repeat ablation or ongoing antiarrhythmic therapy) at 12 months. Successful management of AF was more likely in patients with lower BMI (p=0.006; particularly with BMI <27 kg/m2; p=0.004) and weight (p=0.003), and in those without obstructive sleep apnoea (p=0.032). The only independent predictor of the primary outcome was BMI (β=0.25, p=0.004). Over 75% of complications occurred in those with BMI ≥27 kg/m2. Catheter ablation for AF is more likely to be unsuccessful in patients with uncontrolled risk factors, particularly obesity. Risk factor optimisation may improve procedural success and reduce the risk of procedural complications.

Effect of modifiable lifestyle risk factors on the incidence and prevention of cancer in modern society: A review

Human society has been influenced by modernization, which has altered our pattern of living. It is believed that several environmental and lifestyle factors, including urbanization, employment linked to socioeconomic transition, increased affluence, and altered social and family structures, are partially to be blamed for cancer. Lifestyle changes associated with urbanization such as smoking, alcohol consumption, excessive body weight, and being physically inactive are well-known risk factors for cancer. Anxiety due to stressful events can increase the production of free radicals, which in turn causes oxidative damage and the emergence of cancer. Economic liberty provides more leisure time and inclination toward ready-to-eat food, more screen time, and sedentary habits to some extent. All these factors have a positive impact on cancer initiation and development. Hence, a healthy lifestyle, together with nutritious food and regular exercise should be prioritized for cancer prevention. A healthy lifestyle has been associated with a decreased risk of different types of cancer, involving the lungs, liver, colon, breast, endometrium, and kidney. To outline this review, searches were performed with PubMed and Scopus databases up to August 2022. The lifestyle risk factors for cancer have been described in this review, along with recommendations for improving lifestyle choices for human welfare.

Assessment of the Relationship between High Blood Pressure and the Risk of Prostate Cancer among Patients in South-West, Nigeria

Abstract Introduction: Prostate cancer is the sixth leading cause of death worldwide. Nonmodifiable and modifiable lifestyle risk factors have been implicated and associated to its development and progression. There is a need to assess and establish the relationship between blood pressure (BP) and the risk of prostate cancer. Materials and Methods: This was a multicenter, prospective cross-sectional study of 400 patients at four tertiary hospitals in South-West, Nigeria. Participants were recruited into four arms, namely freshly diagnosed prostate cancer, hypertensive, combined hypertensive with prostate cancer, and control. Anthropometric measurements, BP, and family history were extracted from the case files. Biochemical analyses of venous samples were performed. One-way analysis of variance followed by post hoc Duncan test was conducted to determine the difference in the mean BP levels among the four arms. Results: High-density lipoprotein cholesterol in hypertensive patients was significantly lower (P ≤ 0.035) when compared with the other arms. Plasma total cholesterol (P &lt; 0.074), low-density lipoprotein cholesterol (P &lt; 0.029), and the mean C-reactive protein (P &lt; 0.017) were significantly high in the hypertensive with prostate cancer group when compared with the other arms. The mean plasma testosterone concentration (P &lt; 0.041) and the plasma calcium levels (P &lt; 0.055) were significantly higher in the control group compared with other arms. Conclusion: Virtually, the same parameters were altered in hypertensive, prostate, and hypertensive prostate cancer patients, showing an association between hypertension and prostate cancer, which can be concluded that hypertension may be a predisposing factor to the development of prostate cancer.

Insulin resistance, combined with health-related lifestyles, psychological traits and adverse cardiometabolic profiles, is associated with cardiovascular diseases: findings from the BHMC study.

The triglyceride glucose (TyG) index is a reliable marker of insulin resistance; however, its combined impact with modifiable lifestyle risk factors and psychological traits on cardiovascular diseases (CVDs) remains unclear. The aim of this study was to explore the relationship between the TyG index, various behavioral factors, psychological traits, and CVDs. A total of 77 752 adults aged 18 and over from the baseline survey of the Beijing Health Management Cohort study were investigated. Associations of the TyG index, body roundness index (BRI), dietary habits, psychological traits, and sleep habits with CVDs were estimated using multivariable logistic regression models. Compared to the Q1 level, the Q4 level of the TyG index had an odds ratio (OR) and 95% confidence interval (CI) of 2.30 (1.98-2.68) for CVD risk in men and 2.12 (1.81-2.48) in women. Compared to a sleep duration of more than 7 hours, a sleep duration less than 5 hours had a 32% (8%-61%) higher risk in men and 22% (1%-48%) in women. The ORs (95% CIs) for fast eating compared to normal speed were 1.47 (1.23-1.76) in men and 1.17 (1.05-1.29) in women. Compared to individuals with a passive and depressed psychological trait, those who were positive and optimistic had a 47% (36%-56%) decreased risk in men and 43% (31%-53%) in women. In the age-stratified analysis, a higher BRI level showed a sex-differential effect on CVDs, which is potentially related to a lower risk of CVDs in elderly men. A high level of the TyG index combined with unhealthy lifestyle factors indicates a higher risk of CVDs, while maintaining a positive and optimistic psychological trait acts as a protective factor. These findings may be valuable for identifying high-risk populations for CVDs in community settings.

Ketogenic strategies for Alzheimer’s disease and other memory impairments: History, rationale, and 288 caregiver case reports

Glucose hypometabolism predates Alzheimer’s disease symptoms by at least one to two decades. Ketones are an alternative fuel to glucose and are taken up normally in affected regions of the Alzheimer’s brain and could address certain pathologies that are common in the aging brain and exaggerated in Alzheimer’s disease including insulin resistance, a brain-energy deficit, mitochondrial dysfunction, oxidative stress, and neuroinflammation. Ketones have also been shown to reduce formation of beta-amyloid plaques and neurofibrillary tangles in animal models. Experts have estimated that at least 30 percent of Alzheimer’s and other dementias could be avoided by adopting a healthy diet, increasing physical activity, and correcting other modifiable lifestyle risk factors. Mild to moderate ketosis can be achieved through consumption of a healthy whole food low-carbohydrate ketogenic diet, ketogenic oils containing medium-chain triglycerides, or exogenous ketone supplements as well as intermittent or overnight fasting, and moderately vigorous aerobic exercise. An analysis was performed of 288 anecdotal reports about people with Alzheimer’s, other dementias, Parkinson’s disease with dementia, mild cognitive impairment, and other diagnosed or subjective memory impairments consuming coconut oil and/or medium-chain triglyceride oil. Improvement was reported by 89.2 percent, no improvement by 7.3 percent, and no improvement but stabilization for at least 3 months by 2.4 percent. One or more improvements were reported in the areas of memory/cognition (65.3%), social/behavior/ mood/personality (32.6%), speech/language/conversation (33%), resumption of self-care/other activities (24.7%), physical symptoms (18.4%), sleep (3.5%), appetite (2.4%), vision (1.4%), and improvement that was otherwise unspecified (8%). Certain fatty acids found in medium-chain triglyceride oil and coconut oil are ketogenic but also have other important biological effects which, along with polyphenols and other bioactive substances in virgin coconut oil, could explain these results. Adopting a personalized ketogenic lifestyle plan using one or more ketogenic strategies could address certain pathological processes that occur in the aging brain while potentially improving symptoms in people with Alzheimer’s disease. In addition, this approach could possibly prevent or delay the onset of cognitive impairment during aging, though larger long-term studies would be needed to confirm this.

Lessons From The Glaucoma Foundation Think Tank 2023: A Patient-Centric Approach to Glaucoma.

The main takeaways also included that BIG DATA repositories and AI are important combinatory tools to foster novel strategies to prevent and stabilize glaucoma and, in the future, recover vision loss from the disease. To summarize the main topics discussed during the 28th Annual Glaucoma Foundation Think Tank Meeting "A Patient-Centric Approach to Glaucoma" held in New York on June 9 and 10, 2023. The highlights of the sessions on BIG DATA, genetics, modifiable lifestyle risk factors, female sex hormones, and neuroprotection in the field of primary open angle glaucoma (POAG) were summarized. The researchers discussed the importance of BIG DATA repositories available at national and international levels for POAG research, including the United Kingdom Biobank. Combining genotyped large cohorts worldwide, facilitated by artificial intelligence (AI) and machine-learning approaches, led to the milestone discovery of 312 genome-wide significant disease loci for POAG. While these loci could be combined into a polygenic risk score with clinical utility, Think Tank meeting participants also provided analytical epidemiological evidence that behavioral risk factors modify POAG polygenetic risk, citing specific examples related to caffeine and alcohol use. The impact of female sex hormones on POAG pathophysiology was discussed, as was neuroprotection and the potential use of AI to help mitigate specific challenges faced in clinical trials and speed approval of neuroprotective agents. The experts agreed on the importance of genetics in defining individual POAG risk and highlighted the additional crucial role of lifestyle, gender, blood pressure, and vascular risk factors. The main takeaways also included that BIG DATA repositories and AI are important combinatory tools to foster novel strategies to prevent and stabilize glaucoma and, in the future, recover vision loss from the disease.

Cancer cases attributable to modifiable lifestyle risk factors in Switzerland between 2015 and 2019.

Several modifiable lifestyle risk factors have been linked to higher cancer risk in the literature. Determining the proportion and number of cancer cases attributable to these risk factors is pivotal in informing effective cancer prevention and control plans that have the greatest effect on reducing cancer incidence. We aimed to estimate the proportion and number of incident cancer cases that were attributable to modifiable lifestyle risk factors (ie, tobacco smoking, high alcohol consumption, excess body weight, physical inactivity and unhealthy diet) in Switzerland between 2015 and 2019. The exposure prevalence of selected risk factors was estimated based on the representative national nutrition survey menuCH, the associated relative risks were obtained from systematic literature reviews and the numbers of incident cancer cases were provided by the National Institute for Cancer Epidemiology and Registration. The fractions and numbers of attributable cases were calculated overall, by sex and by the three major language regions of Switzerland. The investigated modifiable risk factors combined were linked to 25.2% of potentially preventable incident cancer cases in Switzerland between 2015 and 2019. The proportion and numbers were slightly larger in males (28.4%, 6945 cases per year) than in females (21.9%, 4493 cases per year), and variations were observed between language regions. Tobacco smoking, excess body weight and high alcohol consumption were the leading contributors to lifestyle-attributable cancer cases. The observed differences in the leading risk factors both within Switzerland and compared to other countries underline the need for regionally and nationally tailored cancer prevention and education strategies.

CAN‐THUMBS UP: Recruitment in the Virtual Era

AbstractBackgroundThe Brain Health Support Program (BHSP) of the CAN‐Thumbs Up Study is an online, interactive educational intervention designed to increase dementia literacy, self‐efficacy and address modifiable lifestyle risk factors. Recruiting for a virtual study presented both opportunities and challenges. This included the need to attract participants through means beyond referrals from medical clinics, as well as opportunities to reach geographically diverse Canadian population less feasible with in‐person evaluations.MethodsA comprehensive recruitment strategy for a virtual environment was implemented. A central website provided any interested candidate with study information, and a link to register and provide basic demographic information via a secure form. Potential participants were directed to the website via traditional recruitment through CCNA specialty clinics or existing cohorts, through geotargeting mailing to specific target populations throughout Canada, social medial advertising, partner organizations, and a coordinated National press release.ResultsThe study had an 8‐month open recruitment window. During this time 964 participants agreed to be contacted through our online portal. Of these, 18‐81 were consented to enroll in the study per month. A total of 7,569 geotargeted postcards were sent, with 153 individuals agreeing to be contacted for the study (2%). Social media advertising generated 974 clicks, with 6.8% subsequently agreeing to be contacted for more information. The majority of participants enrolled in the study came from existing clinical cohorts, CCNA clinical sites, and partner organizations. The recruitment cohort was from a diverse geographical location, 45% urban, 35% suburban, and 20% rural. Overall, the target cohort of 350 subjects was successfully enrolled by the end of the recruitment period.ConclusionRecruitment for the BHSP intervention demonstrates the value of relatively underutilized clinical trials recruitment strategies, such as geotargeted mailing, and social media advertising. We also show the value of a centralized web site for initial screening of interested participants. While traditional recruitment methods still directed the majority of participants to the recruitment website, geotargeted mailing, social advertising, partner organizations, and earned media can all be scaled up, and will likely play a major role in future recruitments efforts in the broader CAN‐Thumbs Up Study.

What are the most prevalent combinations of modifiable dementia risk factors that can be targeted in multidomain lifestyle intervention in Canada?

AbstractBackgroundNot all risk factors have the same weight in dementia development, and the combinations of common risk factors differs across individuals and populations. The goal of this study is to estimate the potential population impact of modifiable risk factors for dementia in Canada, and to identify the combinations of the modifiable risk factors that could prevent many dementia cases in Canadian adults.MethodThis is a secondary analysis of data from the Canadian Longitudinal Study on Aging Comprehensive Cohort (n = 30,009). The prevalence and population attributable fraction (PAF) of 12 modifiable lifestyle risk factors established in the Lancet Commission Report 2020 were calculated using baseline data. The prevalence of every possible dyad, triad, and tetrad combination of the risk factors was estimated. All analyses were stratified by 2 sex strata (male, female) and 4 age strata (45‐54, 55‐64, 65‐74, 75+).ResultThe combined PAF of the 12 lifestyle risk factors was 49% in the Canadian population. The single risk factors that contributed the most were physical inactivity (11.3%), hearing loss (6.9%), and obesity (6.9%) in Canada, whereas social isolation (0.4%), alcohol (1.1%), and smoking (1.4%) had substantially smaller effects (Table 1). The most prevalent risk factor dyad was physical inactivity and sleep disturbance (34%). Obesity, physical inactivity, and sleep disturbance was the most prevalent risk factor triad (14%). The tetrad of hearing loss, obesity, physical inactivity, and sleep disturbance had the highest prevalence (4.9%). The prevalent risk factor combinations were similar in the two younger age groups and both sexes, but not in the two older age groups (Table 2).ConclusionNearly 50% of dementia cases in Canada can be prevented by modifying 12 lifestyle risk factors. The most prevalent combinations of risk factors differ before and after the age of 65, but not by sex. The most prevalent risk factor combinations consist of physical inactivity, sleep disturbance and obesity in the two younger age groups, and hearing loss, sleep disturbance and obesity in the two older age groups. These findings may help strategically target tailoring multidomain dementia intervention programs to have the greatest impact in the Canadian population.

The Maintain Your Brain online multidomain intervention for dementia risk reduction: end‐user evaluations of what did and did not work and why

AbstractBackgroundDementia prevalence is increasing, and risk reduction is a priority. Online interventions that are useable and acceptable to people seeking to reduce their dementia risk are needed. We aimed to assess and explore end‐user perceptions of a large‐scale multidomain online intervention targeting modifiable lifestyle risk factors for dementia.MethodMixed methods evaluation involving Maintain Your Brain (MYB) randomised controlled trial participants 55‐77 years of age at baseline who engaged in assessments, brain training, nutrition and physical activity, and mental health modules across three years. Of 5,260 participants invited, 2,386 completed online surveys at trial conclusion of whom 1,589 offered free‐text comments. Of survey respondents, 248 agreed to be contacted for interviews, 70 were invited and 40 were interviewed. Survey respondents rated ease of use and overall experience with MYB, endorsed whether they would recommend MYB, and provided comments. Interview completers further rated satisfaction with support, expressed online or face‐to‐face setting preference, answered open‐ended questions about participation, activities and modules, and provided further comments. Data were summarised using descriptive statistics and explored using multiple qualitative methods.ResultRespondents found computer‐based activities easy to use (92.2%), were satisfied with their overall experience (87.4%) and would recommend MYB (82.7%). Survey free‐text and interview comments addressed topics including computer literacy, health literacy, resource access, motivations, expectations, social relationships, and significant events. Perspectives on activities and information varied. Many enjoyed and/or appreciated the challenge of completing activities and assessments and the potential for health benefits from these activities. Others were disappointed by their own performance in activities and assessments, found testing and reporting repetitious, stressful and/or time‐consuming, and found educational information unhelpful. Many respondents would have preferred to access applications on phones or tablet devices and suggested that interventions should be available across platforms. Respondents wanted researchers to know that flexible and adaptive individually tailored goals and activities and timely feedback are important.ConclusionThe MYB online multidomain dementia risk reduction program was useable and acceptable. Similar programs should be accessible, well‐supported, cross‐IT platforms, and incorporate adaptive, individually tailored activities and feedback that is responsive to the varied and changing needs of older adults.