Risk Factors For Non-communicable Diseases Research Articles

Lifestyle related health risk factors regarding non-communicable diseases among adults in Morang District

Introduction: Non-communicable diseases are the leading causes of disease burden worldwide. According to World Health Organization estimates, NCDs are responsible for 74% of all deaths globally, with around 77% of premature deaths from NCDs occurring in low- and middle-income countries. This study aims to assess the lifestyle related health risk factors of non-communicable diseases among adults in Nepal, in which two- third of annual deaths are attributable to non-communicable diseases. Methods: A cross sectional study was conducted among adults in Morang district, Nepal. Data collection involved the assessment of the risk factors of obesity, smoking, alcohol consumption, inadequate fruits and vegetable consumption, inadequate physical activity, are raising blood pressure. Ethnical approval was obtained. Results: Two hundred forty participants participated in the study, of which the most prevalent risk factor was obesity (58.3%). Out of total participants, 41.6% had consumed tobacco, 31.2% had consumed alcohol, 41.6% had consumed inadequate fruits and vegetables, 30.4% had inadequate physical activity, and 29.1% had raised blood pressure. Similarly, education is statistically associated with lifestyle risk factors. Male participants of age above 40 years were found to be statistically associated with current tobacco and alcohol consumption. Conclusion: Health related risk factors are causes of non-communicable disease. Most of the participants had two or more risk factors for non-communicable disease. Education is significantly associated with all the risk factors among the participants.

РЕГИОНАЛЬНЫЙ МОНИТОРИНГ ФАКТОРОВ РИСКА РАЗВИТИЯ ХРОНИЧЕСКИХ НЕИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ ПОСЛЕ ПЕРЕНЕСЕННОГО COVID-19

Annotation. Chronic non-communicable diseases (NCD) represent a major public health problem in recent decades. NCD kill 41 million people annually, accounting for 74% of all deaths worldwide. WHO predicts that the total number of deaths from NCD will rise to 55 million by 2030 unless drastic measures are taken. Cardiovascular disease, cancer, chronic respiratory disease and diabetes are the four leading causes of premature mortality among NCD. Multimorbidity affects 65% of people over 65 years of age, requiring more patient-centred and complex models of care. The aim of the study was to conduct regional monitoring of risk factors for chronic noncommunicable diseases in geriatric patients. Outpatient charts of 152 patients aged 60 years and older who had undergone COVID-9 and had undergone an in-depth adult check-up were used for the study. The average age of the patients who underwent the dispensary was 70.0±5.7 years. Questionnaire survey of 152 patients aged 65 years and older to identify NCD and senile asthenia showed that the highest proportion of patients had risk factors for cardiovascular diseases - 63.2%, osteoporosis - 40.8%, GI diseases - 28%, senile asthenia - 27% and polypragmasia - 20.4%. 32.2% of respondents noted a decrease in memory, perception of material, impaired comprehension, loss of ability to distribute time, 30.9% experienced a decrease in mood, loss of energy, depressive state, 24.3% each experienced vision and hearing problems that impair the quality of life, and 22.4% of persons over 65 experienced difficulty in walking. Based on the results of the study, data collection modules based on the STEPS system were identified for the step-by-step assessment of risk factors for the development of chronic non-communicable diseases, and a model for a comprehensive approach to improving the health of citizens aged 60 years and older, who have the highest risk of developing NCD, was proposed.

Artificial intelligence to predict estimates of physical activity in small geographic areas

Abstract Background Artificial intelligence (AI) predictive models have been used to estimate the risk of a certain outcome occurring, using all available variables. Methods Using AI methods we have developed a small area estimation (SAE) technique to estimate the prevalence of leisure-time physical activity (LTPA), or who practices 150 minutes of LTPA per week, in small areas, in Belo Horizonte, Brazil, between 2009 and 2018, by the usage of k-means clustering. The VIGITEL, national telephone survey of Risk Factors for non-communicable diseases, was the main source. We applied available data to estimate prevalence of LTPA in 3300 census tracts, aggregated in 150 Primary Health Care (PHC) areas. The prevalence of PA was analyzed between two time periods, due to the low number of census tract interviews. With the available data, we estimate vulnerability clusters, derived from a Health Vulnerability Index (IVS), for the city of Belo Horizonte, according to socioeconomic, sanitation and health indicators, which measure the percentage of the population living in areas of vulnerability in the city. The index main purpose is to support public policy implementation. Results Nine clusters were identified according to the Silhouette coefficient analysis, i.e.: low (LO-0, LO-1), medium (ME-0, ME-1), high (HI-0, HI-1, HI-2) and very high) vulnerability (VH-0, VH-1. The prevalence of physical activity ranged from 23.7% (worst prevalence), in area of high vulnerability cluster (VH-1) to 45.5% in a low-risk cluster (LO-1) in period from 2009 to 2014. The prevalence of physical activity increased to 31.4% (high vulnerability cluster) to 52.81% (low-risk cluster) from 2014 to 2018. Conclusions The use of AI to estimate the prevalence of physical activity in small areas proved to be effective and highlighted important differences in the city. Thus, national surveys, with a small number of interviews per census sector, can be used to predict risks and health outcomes for small areas. Key messages • The study highlights the importance of using artificial intelligence to predict estimates of risk factors for chronic non-communicable diseases in small geographic areas. • The study showed less physical activity (PA) in areas of greater vulnerability. This can support health promotion policies and programs that encourage PA.

Physical activity and sedentarism among non-binary gender identified university students

Abstract Background Physical inactivity (PA) and sedentary behavior (SB) are modifiable risk factors for non-communicable diseases (NCDs). Data indicates that non-binary gender identified people find it difficult to perform PA, this is a disadvantage for them to reach their full health potential. Methods Students were selected by convenience sampling to complete a survey between October-November 2023. A validated PA questionnaire was included. PA and SB were classified into 4 levels: Active but sedentary, extremely sedentary, physically active and discreetly active. Data were analyzed using Statistical Package for the Social Sciences (SPSS). Results Out of 32 students did not identified themselves as binary gender. In our sample, 28,1% (vs 12.9% binary students) don’t do PA. Of those doing PA, 52,2% don’t meet World Health Organization recommendations. Among those who perform PA, there no difference in the amount of minutes/week of moderate or intense physical activity performed. Regarding SB, 93,8% spend >6 hours/day in SB (vs 84.7% binary students, mean 7,82 vs 8,75, Sg. 0,032). When grouped into PA/SB categories 65,6% (vs 40,5%) were extremely sedentary in contrast to 1,4% physically active (vs 8.8%). Conclusions In Spain, 1 in 4 young people does not identify with the male/female categories. In our sample, physical inactivity and sedentarism are higher among those who do not identify as male/female. Once they commit to physical activity, there is no difference in the time spent between those who meet the WHO recommendations. More research is needed to understand the reasons for these differences and ensure barrier-free access to healthy lifestyle habits on campus. Key messages • Non-binary gender identified students are less physically active and more sedentary than their peers. • Once they commit to physical activity recommendations, there are no differences among their performance.

Empowerment and interprofessional collaboration in health promotion centre Murska Sobota

Abstract Background Health promotion centres (HPCs) were introduced in Slovenian primary health care centres to provide interventions against risk factors for noncommunicable diseases (NCDs). HPCs integrate a multidisciplinary and community-based primary care approach to the prevention of NCDs and provide free lifestyle intervention programmes. This study aims to explore the perspectives of health care professionals on promoting health of local community members, as well as their perceptions of interprofessional collaboration in HPCs. Methods Two group discussions were conducted with a total of 11 health care professionals at the HPC Murska Sobota. Data collection was accompanied by a dual role interpreter in accordance with the principles of cross-language qualitative research. The data was transcribed, semantically translated and thematically analysed. Results Health care professionals emphasize the importance of health-related empowerment of individuals for the success of health promotion activities and therefore for the improvement of individuals’ quality of life. This is based on shared decision-making, self-management and educational measures in a combination of population- and individual-based approaches. The need for efficient interprofessional communication, characterized by a flat hierarchy, is stressed. Structured cooperation with other health care facilities, as well as close collaboration with communities and local media, are described as crucial for reaching all individuals and promoting health equity. Conclusions Interprofessional collaboration, health-related empowerment of individuals and collaboration with local communities are fundamental for the success of health promotion activities, achieving health equity and preventing NCDs. Understanding how these activities are implemented from the health care professionals’ perspective can help other health facilities developing and improving local health promotion strategies. Key messages • Slovenian health care professionals see interprofessional collaboration as fundamental for the implementation of health-promotion strategies. • Health-related empowerment of individuals and collaboration with local communities play an important role in achieving health equity in health promotion activities.

Traditional medicine use to manage hypercholesterolemia, hyperglycaemia and hypertension in Ecuador

Abstract Background Although the use of traditional medicine (TM) to manage health issues is frequently reported, clinical guidelines often overlook this practice. This study aimed to describe the frequency of TM use to control 3 cardiometabolic risk factors for non-communicable diseases (arterial hypertension, hypercholesterolemia, and hyperglycaemia, collectively referred to as CMRF here); and associated sociodemographic, economic, and clinical characteristics. Methods Descriptive cross-sectional study with a representative population of two health districts in Ecuador, one urban in southern Quito and one in a forested rural area with diverse ethnic groups in Esmeraldas. We included 602 individuals with at least one CMRF and calculated the proportion of those who reported regular use of TM (herbal or traditional remedies) to control their CMRF. We used a multivariable logistic regression model to calculate Odds Ratios for TM use according to sociodemographic, economic, and clinical characteristics. Results TM was commonly used to control CMRF in both sociocultural contexts (39.4% Esmeraldas, 31.1% Quito), often in combination with conventional medicine (CM). A notable percentage of people (33.9% Esmeraldas, 39.0% Quito) did not take any treatment for their CMRF, and the rest used CM alone. In both settings, education was significantly associated with TM use. While in Quito people with higher education were more likely to use TM (aOR 2.04, 95%CI 1.03-3.90), in Esmeraldas, it was more common among people without formal schooling (aOR 3.76; 95%CI 1.59-8.88) as well as those of younger age (aOR per year 0.97; 95%CI 0.95-0.99) and from Afro-Ecudorian ethnicity (aOR 2.13; 95%CI 1.02-4.45). Conclusions Traditional medicine is used by a significant portion of Ecuador’s population, highlighting the need for a more accessible and intercultural approach to healthcare. Key messages • The use of traditional medicine to address hypertension, hypercholesterolemia, and hyperglycaemia appears to be widespread in different sociocultural and economic contexts of Ecuador. • To promote intercultural health, understanding the diverse sociocultural patterns associated with the use of traditional medicine, often combined with conventional medicine, is crucial.

9.C. Round table: The Global Oral Health Action Plan – Integrating Oral Health into the global health agenda

Abstract Oral diseases (OD) are a global public health problem affecting 3.5 billion people, with a global prevalence of 45%, higher than the prevalence of any other non-communicable disease (NCD). Recognizing the global public health importance, the 76th World Health Assembly (WHA) (May 2023) adopted the WHO’s Global Oral Health Action Plan (GOHAP) 2023-2030; a crucial step to bring momentum and mobilise all actors to address the burden of OD and common risk factors for all NCDs, while integrating oral health (OH) as part of general health and promoting cross-sectoral cooperation on good OH worldwide to reach UHC. Drawing insights from other successful global health action plans, this roundtable (RT) will explore key lessons learned in implementing effective strategies to improve OH outcomes at European and global levels, ensuring access to quality care for all. The objectives of the RT are: 1.To present the GOHAP 2023-2030, incl. challenges and opportunities; 2. To draw insights from other global health action plans; 3. To present good examples of civil society organization (CSO) actions supporting the GOHAP’s implementation - The Manifesto of the Platform for Better Oral Health, calling for policy actions by EU policymakers; 4. To present findings from the EU DELIVER (DELiberative ImproVEment of oRal care quality) and PRUDENT projects, funded by the European Commission, aiming to provide and implement a blueprint model for ensuring access to quality OH care for all; 5. To inform follow-up actions and collaboration across EUPHA sections, its strategy, as well as that of European Member States (MS), CSOs and other institutional partners, and to raise awareness across the European public and global health communities. The structure of the RT will include brief interactive presentations with real-time polling to maximize participant engagement and to consolidate key messages to present at the end of the session, incl. to inform follow-up actions across EUPHA. The first brief presentation on GOHAP will highlight the aims and evidence-informed actions, followed by: 1. Insights from other global health action plans, exploring lessons learned in implementing effective strategies, examining the approaches, opportunities, challenges and outcomes; 2. Good examples of actions taken by CSOs; 3. Preliminary findings from the EU DELIVER and EU PRUDENT will be presented, incl. key co-creation tools of deliberative dialogues and the development of a set of quality indicators for applicability on the practice, community and policy levels. Guided discussion will focus on opportunities and challenges in GOHAP implementation, with the targeted questions to panellists on: What can countries learn from other global health action plans? What should be the priorities of EU MS? What is the role the public health community can play? What are key steps needed to eliminate common NCD risk factors to drastically reduce the prevalence and burden of ODs? Key messages • There is an urgent need in the global and public health communities to better understand the processes involved in implementing the GOHAP, incl. challenges and opportunities. • Interdisciplinary and cross-sectoral collaboration is key to address the common risk factors of NCDs, to inform concerted action and evidence-informed policymaking to improve oral health care. Speakers/Panelists Pauline Vassallo European Association of Dental Public Health, Valletta, Malta Benoit Varenne Dental Officer, Prevention of Non Communicable Disease Department, WHO, Geneva, Switzerland Dympna Kavanagh Chief Dental Officer, Platform for Better Oral Health in Europe, Dublin, Ireland Neville Calleja Department of Health Information and Research, G’Mangia, Malta

Joining forces to accelerate cancer and NCD prevention in Europe

Abstract JA PreventNCD, a Joint Action to prevent cancer and other non-communicable diseases (NCDs) aims to assist authorities in prioritizing the most effective prevention strategies and policies to reduce the burden of cancer and NCDs, focusing on both personal and societal risk factors. A key objective is to tackle social inequalities by addressing the root causes of NCD risk factors and adopting a life-course approach. Recognizing that health is created by policies in several sectors is key when addressing health determinants, including social and commercial determinants of health. Consolidated efforts across countries will be required to tackle some of these determinants. To achieve the project’s objectives, the JA PreventNCD will build a comprehensive European infrastructure for monitoring risk factors, disease burden, and the impact of policies and interventions. Rigorous evaluation will ensure that the project’s deliverables will have an impact at local, national and EU levels. Three technical work packages address common risk factors for NCDs through actions ranging from policies and structural measures at societal level to interventions targeting individuals. Another set of cross-cutting work packages address monitoring, social inequalities, and health in all policies. More than 100 partners across 25 countries are involved, with almost 100 pilots to be conducted over the course of the project’s four years. One way of ensuring sustainability of the project’s outcomes is the building of a sustainable governance structure through the establishment of an EU Consortium on Cancer Prevention. Furthermore, as a mechanism to ensure high policy relevance of this JA, a Policy Decision Maker’s Forum will be established to engage policymakers and ensure feasibility of the project’s recommended actions. Speakers/Panelists Claudia Habl Austrian National Public Health Institute, Vienna, Austria Ane Fullaondo Biosistemak, Bilbao, Spain Arnfinn Helleve Norwegian Institute of Public Health, Oslo, Norway

Evaluation of university food environment and healthy space policy implementation at university

Abstract Issue/problem Unhealthy diets, along with factors like tobacco, alcohol, and inactivity, contribute significantly to non-communicable diseases (NCDs). Prevention strategies should prioritize reducing exposure to these risk factors. It’s also crucial to consider environmental well-being alongside promoting health. Description of the problem During 2023/2024, university cafeterias (UC) were evaluated for healthy eating standards compliance, resulting in a noticeable presence of unhealthy foods together with plastic use, alcohol and tobacco consumption. This led to the development of an accreditation program to boost UC as healthy spaces. Results The developed program includes 5 mandatory standards and 42 recommendations. Priority objectives are offering healthy food options like fruit, avoiding alcohol and sugary drink ads, banning tobacco, promoting physical activity, and reducing waste for example by encouraging unpackaged water consumption. Our policy emphasizes evaluation and monitoring, so accreditation is valid only for two years. Our goal is to establish UC as sustainable, healthy spaces. To encourage compliance, we offer institutional financial support and accreditation seals to UC, showcasing their commitment to community health. Implementation begins in the 2024/2025 academic year, with an initial evaluation scheduled at that time. Lessons Monitoring UC food offerings is crucial for ensuring healthier options. Cafeterias play a key role in promoting healthy habits. Creating environments with healthier options can mitigate non-communicable disease risk factors presence. Key messages • University cafeterias are pivotal in fostering a healthy lifestyle. • Prioritizing policies to address non-communicable diseases is crucial. Clear programs are essential for sustained effectiveness.

Challenges and solutions to banning the advertisement of unhealthy products: a qualitative study

Unhealthy products (food, alcohol, tobacco) are among the main risk factors of non-communicable diseases. To discourage the consumption of these products, Iran has passed a law banning the advertisement of unhealthy products in all media and for all age groups. The purpose of the present study was to identify the challenges of this approach and provide evidence to facilitate the enforcement process and the participation of stakeholders. In this qualitative study participants were selected from the policymakers and experts involved in the banning of advertisements on unhealthy products in Iran. Semi-structured interviews were conducted with 24 specialists and experts. The participants were selected through purposive and snowball sampling. Identified challenges and solutions were divided into three categories and nine themes: external (political, social, and economic); interorganizational (mission and communication); and internal (planning, organization, leadership, and control). Banning the advertisement of unhealthy products involves many challenges due to the existence of key players with different roles and missions. If these challenges are not managed effectively, they will hinder the enforcement and success of this law. Therefore, it is necessary for policymakers and health system managers to take the necessary measures to remove these obstacles.

Prevalence and Determinants of Ideal Cardiovascular Health in Kenya: A Cross-Sectional Study Using Data From the 2015 Kenya STEPwise Survey.

Kenya is experiencing a rising burden of cardiovascular diseases (CVDs) due to epidemiological and demographic shifts, along with increasing risk factors. Ideal cardiovascular health (iCVH), defined by the American Heart Association (AHA), encompasses eight metrics to evaluate cardiovascular well-being. This study assessed the prevalence and determinants of iCVH in Kenya. Data from the 2015 Kenya STEPwise survey on non-communicable disease risk factors, including 4,500 adults aged 18-69, were analysed. iCVH was assessed using 2022 AHA criteria based on seven factors: nicotine exposure, physical activity, diet, BMI, blood pressure, glucose, and lipid levels. A cardiovascular health (CVH) CVH score of ≥80% classified individuals as having iCVH. Multivariable binary and ordinal logistic regression identified factors associated with iCVH. The mean CVH score in Kenya was 78.6% (95% CI: 77.9,79.2%), higher in females (79.3%), rural areas (79.5%), and non-drinkers (79.6%) than in males (77.9%), urban residents (77.0%), and alcohol drinkers (75.4%), respectively. The prevalence of iCVH (CVH score ≥80%) was 45.6%, while 6.4% had poor CVH (CVH score <50%). Only 1.2% achieved the maximum CVH score. iCVH prevalence declined with age and was lower among married individuals (43.7%), alcohol drinkers (32.3%), and urban residents (39.7%). Older adults had 50-80% lower odds of iCVH compared to those under 30 years. Alcohol users (AOR 0.5; p < 0.001) and urban residents (AOR 0.6; p < 0.001) were less likely to have iCVH. Residents of Nairobi and Central regions had 40-60% lower odds of iCVH compared to those in Rift Valley. The Kalenjin (AOR 0.5; p = 0.027) and Turkana (AOR 0.3; p = 0.002) ethnic groups had lower odds of iCVH compared to the Kisii. Less than half of Kenyan adults have iCVH, with poorer CVH status among older adults, urban residents, and alcohol users. Targeted public health interventions could mitigate the CVD burden and enhance health outcomes in Kenya.

Sex differences in the prevalence of metabolic syndrome and associated factors in the general population of Mongolia: A nationwide study.

The prevalence and factors associated with metabolic syndrome (MetS) between men and women in Mongolia were compared using secondary data from the STEPwise approach to non-communicable disease risk factor surveillance conducted in 2019. In total, 5,695 participants (2,577 males and 3,118 females) aged 18-69 years old were enrolled in the study. The prevalence of MetS was 37.4% in total and the prevalence was significantly higher in women (39.2%) than men (35.2%, P = 0.002). The most prevalent MetS components were abdominal obesity in women (74.2%) and high blood glucose levels in men (58.7%). All of the 2,128 participants who were categorized into MetS met the criteria of abdominal obesity. Factors associated with MetS included being 30-69 years old compared to 18-29 years old, low and moderate physical activity levels compared to high levels, history of hypertension and diabetes mellitus, and a high body mass index (overweight and obesity) compared to a normal body mass index in both sexes. Additional factors included Buryat ethnicity compared to Khalkh ethnicity, living in Ulaanbaatar, no education compared to primary education, higher monthly income, and currently drinking in men; and smoking and sufficient fruit and vegetable intake in women. Significant differences were observed between men and women in terms of the prevalence of MetS, components of MetS, and factors associated with MetS. To reduce MetS prevalence in Mongolia, sex-specific programs should be designed to promote health behavior, such as reducing alcohol consumption in men and smoking in women.

The effect of results-based motivating system on metabolic risk factors of non-communicable diseases: A field trial study.

Non-communicable diseases can be controlled and managed by reducing their associated metabolic risk factors. In this study, a set of intervention packages were designed to reduce the prevalence of three common metabolic risk factors (hypertension, hyperlipidemia, and obesity and overweight) in the community by motivating non-physician health workers. A field trial study was conducted in 4 districts of Iran. Thirty-two community health centers were randomly selected. A survey of 30 to 70-year-old was conducted to measure baseline metabolic risk factors. The intervention packages focused on improving hypertension, hyperlipidemia, obesity and overweight. The interventions included goal-setting, evidence-based education, operational planning, and incentive payments for non-physician health workers. A second survey to measure the final metabolic risk factors was performed after one year. The difference-in-difference method was used to evaluate the effectiveness of the intervention packages. The average age of participants in both surveys was 49 years. The interventions had statistically significant effects only on decreasing the prevalence of overweight and obesity. The package with all the interventions except pay-for-performance decreased the odds of overweight and obesity to 0.57 (95% CI: 0.34, 0.95). Involving non-physician health workers and having action plans based on the health needs of the covered population can decrease obesity and overweight in the community. However, longer trials are needed to observe the effects on hypertension and hyperlipidemia.

The Role of Dietary Ingredients and Herbs in the Prevention of Non-Communicable Chronic Liver Disease

Background: Liver diseases are among the most commonly diagnosed conditions, with the main risk factors being inappropriate lifestyles, including poor diet, excessive alcohol consumption, low physical activity and smoking, including electronic cigarettes. Non-communicable chronic liver diseases also often develop as a result of accompanying overweight and obesity, as well as type 2 diabetes. Methods: The literature on risk factors for non-communicable chronic liver diseases, which show a high strong influence on their occurrence, was analysed. Results: Measures to prevent non-communicable chronic liver disease include the selection of suitable food ingredients that have proven protective effects on the liver. Such ingredients include dietary fibre, probiotics, herbs, various types of polyphenols and fatty acids (omega-3). Conclusions: Because of their liver-protective effects, nutritionists recommend consuming vegetables, fruits, herbs and spices that provide valuable ingredients with anti-inflammatory and anti-cancer effects. These components should be provided with food and, in the case of probiotics, supplementation appears to be important. As a preventive measure, a diet rich in these nutrients is therefore recommended, as well as one that prevents overweight and other diseases that can result in liver disease.

The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review

Background/Objectives: Low quality diets are a risk factor for non-communicable diseases; therefore, improving diet quality is a public health and policy priority in the UK and elsewhere. Reformulating food/beverage products to make them healthier may be an effective approach. Evidence suggests that fiscal interventions, notably taxes/levies on soft drinks, can lead to reformulation but the evidence for voluntary or mandated non-fiscal interventions is less clear. We aimed to review and synthesise contemporary evidence to determine whether non-fiscal policies/interventions result in the reformulation of food/beverage products Methods: In April 2023, we systematically searched ten international academic and nine grey literature databases. We included real-world study designs, all nutrients, in- and out-of-home sectors, and studies published from 2013, to ensure policy relevancy. We excluded modelling studies. Using the Synthesis Without Meta-Analysis method we conducted vote counting of studies based on the direction of effect and narrative synthesis by intervention type. Risk of bias was assessed using a tool developed by the EPPI-Centre and quality was assessed using GRADE. Results: We included 77 real-world studies from 19 countries, reporting 100 non-fiscal policies/interventions. Most commonly, these were reduction targets (n = 44), front-of-pack labels (n = 23), and advertising standards (n = 9). Most interventions were voluntary (n = 67), compared to mandatory (n = 33), and focused on the in-home sector (n = 63). The vote counting results showed non-fiscal policies/interventions overall led to improvements in reformulation in 60/63 studies with a valid direction of effect (95%, 95% CI 0.869, 0.984, p &lt; 0.001). Mandatory implementations were more successful than voluntary implementations with 15/15 showing an improvement (100%, 95% CI 0.796, 1], p &lt; 0.001), compared 40/43 showing an improvement (93%, 95% CI 0.814, 0.976, p &lt; 0.001). Most of the studies were of low quality, due to the observational nature of the studies. Sodium was the most commonly targeted nutrient (n = 56) and was found to be reformulated in most studies. Causation is difficult to establish from real-world studies, but evidence suggests that regulatory and multi-component strategies may be effective at driving reformulation. Conclusions: Non-fiscal policies/interventions can play an important role in driving reformulation, alongside fiscal measures. This work was funded by the National Institute for Health and Care Research PRP-PRU-02-15-Healthy Weight and registered on Open Science Framework.

Modifying Non-communicable Disease Behaviours through Effective Health Communication and Behaviour Change: A Systematic Review

Abstract Non-communicable diseases (NCD) account for 74% of global mortality. Approximately 86% of all premature deaths occur in low- and middle-income countries majorly attributed to lifestyle changes or behavioural risk factors. The theory-based behaviour change interventions (BCIs) appear promising, but their applicability is not explored within the national programmes. The current paper aims to review the effectiveness of theory-based BCI in modifying the NCD risk factors and provide insights into the national NCD programmes. Interventions conducted to evaluate theory-based BCIs between 2002 and 2022 in modifying behavioural risk factors for NCDs were identified from multiple databases (PubMed, Scopus, Google Scholar and Cochrane Library) for systematic review. The final analysis included 35 studies that used theories and models that broadly come under one of the four approaches, i.e. intrapersonal (targets inherent individual factors for behaviour change), interpersonal (targets the family or groups), community (target socio-cultural ecosystems) and integrated (combination of other three approaches). Twenty-seven studies showed significant results. The highest number of studies were of interpersonal approach using socio-cognitive theory and integrated (11 each), and strength of evidence was moderate for both. Twenty-six studies focused on physical inactivity and unhealthy diet. The review supports the effectiveness of behaviour change interventions for mitigating NCD risk factors. Further efforts, including implementation research study methods, should be directed to evaluate effects of these interventions on population health outcomes within specific cultural and social contexts.

Global obesity epidemic and rising incidence of early-onset cancers.

Incidence of early-onset cancers at multiple organ sites has increased worldwide in recent decades. We investigated whether such increasing trends could be explained by trends in obesity. We obtained incidence data for 21 common cancers among 25-49-year-olds during 2000-2012 in 42 countries from the Cancer Incidence in Five Continents database. Nine cancers we examined have been classified as obesity-related by the International Agency for Research on Cancer. Estimates of overweight and obesity prevalence came from the Non-communicable Disease Risk Factor Collaboration. Using country-level data, we examined whether changes in the prevalence of overweight and obesity combined were correlated with changes in cancer incidence, after accounting for various time lags (0-15 years) between exposure and cancer diagnosis. To test the validity of our approach, we conducted negative control analyses (using non-obesity-related cancers as the outcome variable, and per-capita gross national income as the exposure variable), and sensitivity and supplemental analyses using alternative data streams or processing. We found increased incidence for six of nine obesity-related and seven of twelve non-obesity-related cancers in 25-49-year-olds. These increases were more predominant in Western countries (particularly Australia, the USA, Canada, Norway, the Netherlands, and Lithuania). For four obesity-related cancers displaying increased incidence (colon, rectum, pancreas, kidney), changes in cancer incidence were positively correlated with changes in overweight and obesity prevalence. When accounting for a 15-year lag, the estimated correlation was 0.27 (95% confidence interval (CI) = -0.04, 0.53; P = 0.090) for colon cancer, 0.33 (95% CI = 0.02, 0.58; P = 0.036) for rectal cancer, 0.39 (95% CI = 0.08, 0.64; P = 0.018) for pancreatic cancer, and 0.22 (95% CI = -0.10, 0.50; P = 0.173) for kidney cancer. Similar correlations were found in the sensitivity and supplemental analyses. We did not find similar correlations with excess body weight for the non-obesity-related early-onset cancers, nor correlations with per-capita gross national income for any cancer types, in the negative control analyses. Worldwide increases in early-onset colon, rectal, pancreatic, and kidney cancers may have been partly driven by increases in excess body weight. The increases in other early-onset cancers, however, were likely driven by other factors deserving of further investigation.

Development and validation of an image-based questionnaire ARTROVIS to identify risk factors for the articular syndrome and related conditions

Background: The importance of timely diagnosis of rheumatic diseases is beyond any doubt. However, in the real practice the time from manifestation of the first symptoms to the assessment by a rheumatologist and treatment administration often exceeds the window of opportunity for disease control. At the moment, there has been no Russian-language questionnaire that would allow a primary care physician to suspect a rheumatic disease manifesting with an articular syndrome. Aim: To develop, validate and test a questionnaire to identify risk factors for joint disorders and related conditions. Methods: From November 2022 to April 2024, we performed the study on the image-based questionnaire on identification of the risk factors for joint syndromes and associated conditions (ARTROVIS), which we have developed for early detection of both joint syndromes, as well as comorbid conditions associated with elevated serum uric acid levels (hyperuricemia). The initial test version of the questionnaire was tested in a focus group of respondents (n = 20) who came for regular medical examination. Based on the results of this face validity assessment, we corrected the wording of 10 questionnaire items. At the second study step, we assessed the primary validity and reliability of the questionnaire in a group of 41 rheumatology patients. The third study step involved 828 respondents (408 men and 420 women, median age 19 [18,0; 20,0] years; 21% with joint syndromes), who came for routine medical examination. The reliability of the questionnaire, its face and discriminant validity, as well as sensitivity and specificity (the ROC analysis) were assessed from 827 questionnaires included in the final processing (one was excluded due to questionnaire completion defects). Results: The self-report questionnaire for patients (ARTROVIS) has 24 items aimed at collecting social and demographic data, identifying risk factors for non-communicable diseases, assessing genetic aspects, identifying complaints from various organ systems, providing information on medical treatments taken by the patient (non-steroid anti-inflammatory agents, diuretics, antihypertensives, glucocorticosteroids, chemotherapy and radiation therapy), as well as an additional question for women on current pregnancy pathology. The questionnaire contains visual aids (colored photos) that facilitate the detection of clinical signs of autoimmune (psoriatic arthritis, Reynolds’s syndrome) and inflammatory rheumatic disease (gout), as well as the differential diagnosis of the joint syndrome. The assessment of face validity of the questionnaire showed the total number of missed answers of 3.42%; 62.85% of the respondents gave their full answers to all items. Good discriminant validity was demonstrated. The ROC analysis showed high correlation between the questionnaire score and the presence of a joint syndrome: the area under the curve was 0.884. The Cronbach’s alfa was 0.798, which is sufficient for a medical questionnaire. Conclusion: We have performed the approbation and standardization of the questionnaire to identify risk factors for the joint syndrome and related comorbidities by assessing its validity and reliability. The ARTROVIS as a self-report questionnaire can be used in primary care as a tool enabling general practitioners and internists to decide on further patient routing to corresponding specialists.

Protocol of Randomized Controlled Community Trial (RCCT) for obesity management in Brazilian primary health care.

Obesity is a chronic disease characterized by excess body fat and is a risk factor for other chronic non-communicable diseases. Its multifactorial and complex nature makes its management a challenge for health services. This manuscript presents an investigation protocol that aims to analyze the effectiveness of collective nutritional interventions for obesity management applicable to primary health care. Randomized Controlled Community Trial (RCCT) in a representative sample of users of the Programa Academia de Saúde (PAS), in Belo Horizonte, Minas Gerais, Brazil, with obesity. The research consists of four phases: (1) Screening to identify the participants eligible for the nutritional interventions (individuals with obesity, readiness for change to lose body weight, and willingness and interest to participate in a group activity for six months or more); (2) Baseline to characterize the participants; (3) Implementation of collective nutritional interventions; (4) Reassessment of the participants. Participants in the control group (CG) will receive the usual health service care, and participants in the intervention group (IG) will participate in collective nutritional interventions based on Therapeutic Group 1 (TG1) or Therapeutic Group 2 (TG2) of the "Instructive of Collective Approach for the obesity management in SUS". The strengths of the study include its robust RCCT design, which allows for longitudinal analyses and is suitable for investigating causal hypotheses and applying strategies to improve adherence to interventions. Furthermore, the study included a representative sample of a public health service and aims to evaluate therapeutic proposals from the Brazilian Ministry of Health, which can contribute to implementation and extension in the national territory. RBR-3vzsyqq and RBR-6pg682m.

Trends and determinants of clustering for non-communicable disease risk factors in women of reproductive age in Nepal.

Understanding the clustering of two or more risk factors of non-communicable disease, such as smoking, overweight/obesity, and hypertension, among women of reproductive age could facilitate the design and implementation of strategies for prevention and control measures. This study examined the factors associated with smoking, overweight/obesity, and hypertension among Nepalese women of reproductive age (15-49 years). This study used the Nepal Demographic and Health Surveys (NDHS) 2016 (6,079 women for smoking and overweight/obesity, 6076 for hypertension) and 2022 (6,957 women for overweight/obesity and smoking status and 3,749 women for hypertension) for comparison of trends of NCD risk factors among women aged 15-49 years. Additionally, for each participant, risk factors score (range of 0 to 3) was created by summing individual risk factors. We assessed the determinants of risk factor clustering using multivariable Poisson regression models with robust sandwich variance estimator to calculate adjusted prevalence ratios using NDHS 2022. The national prevalence of overweight/obesity increased from 22.2% in 2016 to 29.2% in 2022 among women of reproductive age. In 2022, the prevalence for smoking, overweight/obesity, and hypertension were 3.8%, 29.2%, and 9.6%, respectively. More than one in four women (28.7%) had one NCD risk factor, while 6.5% had two such risk factors. Higher aged women (40-49 years) were more likely to have multiple NCD risk factors than those aged 15-29 years (APR: 3.19; 95% CI: 2.68-3.80). Those in the richest wealth quintile (APR: 1.52; 95% CI: 1.24-1.85), as well as married (APR: 3.02; 95% CI: 2.43-3.76) and widowed/divorced (APR: 2.85; 95% CI: 2.14-3.80) were more likely to have multiple NCD risk factors. Women from Koshi province (APR: 1.74; 95% CI: 1.41-2.15) had more NCD risk factors than those from the Sudurpaschim province. Working women also had a higher prevalence of NCD risk factors compared to non-working women (APR: 1.23; 95% CI: 1.06-1.43). Additionally, Hill Janajatis (APR: 1.44; 95% CI: 1.21-1.72) and Dalits (APR: 1.42; 95% CI: 1.15-1.75) women were more likely to have NCD risk factors compared to women of Brahmin hill origin. Clustering of two or more NCD risk factors was higher among women aged ≥30 years, those who are currently married or widowed/divorced/separated, working women, and individuals from the wealthiest socioeconomic groups. A higher burden of risk factors underscores the importance of targeted public health interventions, particularly among women from advantaged socio-economic groups, those of affluent regions, and in the workplace.