Unfavorable Lifestyle Factors Research Articles

Possible determinants of physical fitness in Japanese school children: Across-sectional study.

Physical fitness is one of the most important health indicators in children. Although appropriate body composition or certain lifestyle factors such as frequent physical activity are thought to improve physical fitness, results of previous studies are inconsistent, and most studies were from Western countries. We investigated associations of body composition and modifiable lifestyle factors such as physical activity, screen time, diet and sleep duration with physical fitness in Japanese primary school children. 2308 children (age 10-12 years old) in 12 primary schools were analysed in this cross-sectional study. Physical fitness was evaluated by sports battery tests conducted routinely and annually at schools. The total score of sports battery tests, 20-m shuttle run (laps) and grip strength (kg) were selected as outcomes. Information about lifestyle factors was collected by two questionnaires. Associations between lifestyle factors and physical fitness were assessed by multivariable linear mixed models by sex. Frequent exercise was related to better overall physical fitness. Regarding the 20-m shuttle run, many unfavourable lifestyle factors such as higher BMI in boys (β -7.37, 95% confidence interval [CI] -8.39, -6.35) and girls (β -3.54, 95% CI -4.50,-2.58), longer screen time (β -4.31, 95% CI -7.29, -1.34) in boys and girls (β -5.65, 95% CI -9.01, -2.30); shortest (reference) versus longest, breakfast skipping in boys (β -5.24, 95% CI -8.71, -1.77) and girls (β -3.57, 95% CI -6.84, -0.30); consumers (reference) versus skippers were associated with worse performance. Better quality of diet was associated with better results in the 20-m shuttle run only in girls (β 2.58, 95% CI 0.24, 4.93); lowest (reference) versus highest. Frequent exercise was related to better physical fitness. Higher BMI and unfavourable lifestyle factors such as longer screen time and breakfast skipping were associated with worse results of the 20-m shuttle run.

Healthy lifestyle factors as predictors of the initiation of dialysis in people with and without diabetes.

To clarify the impact of Breslow's scores consisting of only lifestyle habits or American Heart Association's (AHA) Life's Simple 7 scores consisting of lifestyle habits and control targets on starting dialysis in people with or without diabetes mellitus (DM). To pursue the study aims, we examined a nationwide database on 294,647 individuals with and without DM aged 19-72y in Japan to pursue the study aims. Using multivariate Cox modeling, we evaluated and compared 5 risk factors based on the unfavorable lifestyle factors in Breslow's scores and the unfavorable lifestyle factors and clinical values in AHA Life's Simple 7 scores. DM increased the risk of the initiation of dialysis 5- to sixfold but that risk did not increase with worsening of Breslow risk factors. Compared with no risk factor, 5 risk factors derived from AHA's Life's Simple 7 presented 9.8-fold and 4.2-fold risks for the initiation of dialysis in non-DM and DM, respectively. In comparison with non-DM and no risk factor, risk of the initiation of dialysis dramatically increased up to 32.3 times according to the number of AHA risk factors in those with DM. DM and risk factors derived from AHA's Life's Simple 7 synergistically increased the risk of the initiation of dialysis. Factors similar to those used to predict cardiovascular disease would also be useful to predict the initiation of dialysis. These approaches might be helpful in clinical practice and patient education. The online version contains supplementary material available at 10.1007/s13340-024-00739-0.

Associations between a paternal healthy lifestyle score and its individual components with childhood overweight and obesity.

Maternal healthy lifestyle behaviors during pregnancy have been associated with reduced risk of offspring overweight and obesity (OWOB). However, there has been little investigation, in the context of the Paternal Origins of Health and Disease (POHaD) paradigm, of the potential influence of the paternal lifestyle on offspring OWOB. To describe paternal healthy lifestyle factors around pregnancy and investigate their associations, individually and combined, with offspring risk of OWOB during childhood. Participants included 295 father-child pairs from the Lifeways Cross-Generation Cohort Study. A composite paternal healthy lifestyle score (HLS) based on having a high dietary quality (top 40% of the Healthy Eating Index-2015), meeting physical activity guidelines (≥450 MET-min/week of moderate-to-vigorous physical activity), having a healthy body mass index (BMI) (18.5-24.9kg/m2 ), being a non-smoker, and having no/moderate alcohol intake, was calculated (range 0-5). Paternal HLS (and individual components) associations with child BMI and waist-to-height ratio (WHtR) at age 5 and 9 years were assessed using linear (BMI z-scores and WHtR) and logistic (IOTF categories) regression analyses, adjusted for sociodemographic characteristics. At age 5 and 9 years, 23.5% and 16.9% of children were classified as living with OWOB, respectively. Of the 160 pairs with a complete HLS, 45.0% of the fathers had unfavorable lifestyle factors, determined by a low HLS between 0 and 2 points. Although a low paternal HLS was not significantly associated with a higher risk of childhood OWOB measured using either BMI z-scores and IOTF categories, it was associated with a greater child WHtR, an indicator of central adiposity, at 9 years of age (β [95% CI]=0.04 [0.01,0.07]). Almost half of the fathers had unfavorable lifestyle factors around pregnancy. A low paternal HLS was associated with a greater child WHtR at 9 years but not with a higher risk of childhood OWOB when measured by BMI z-scores or IOTF categories.

Healthy lifestyle in the first 1000 days and childhood overweight and obesity in 4 European cohorts

Abstract Background The high prevalence of overweight and obesity in young children suggests the involvement of early life exposures. Based on the Developmental Origins of Health and Disease paradigm, we investigated associations of healthy lifestyle (HL) behaviours around the first 1000 days of life with adiposity and weight status throughout childhood. Methods Cohort-specific analyses were conducted in four European birth cohorts (EDEN, Elfe, France; Generation R, the Netherlands; Lifeways, Ireland), implementing a harmonized data and analysis approach. Composite HL scores were calculated during pregnancy (maternal/parental) and infancy periods based on parental diet quality, BMI, smoking status, alcohol consumption; and for infant score breastfeeding, age of solid food introduction and exposure to passive smoking. Associations with child BMI (measure of overweight and obesity) and waist-to-height ratio (WHtR, measure of abdominal obesity) at age 5 and 9 were assessed using linear (BMI z-scores and WHtR) and logistic regression (IOTF categories). Results Current results are based on the Lifeways data; other cohort-specific analyses are ongoing. Depending on the period, up to 50% of the sample had unfavourable lifestyle factors, determined by a HL score of less than half of the possible points. Lower maternal and parental pregnancy HL scores, indicating lower adherence to HL factors, were associated with a higher child BMI at age 5 and 9. Associations with WHtR were non-significant. A low infancy HL score was strongly and consistently associated with both a higher child BMI and WHtR at age 5 and 9. Conclusions A low adherence to HL factors around the first 1000 days of life was associated with a higher risk of childhood obesity. If confirmed in the other birth cohorts, these findings will inform the development of future early family-based lifestyle obesity prevention interventions. Key messages • Low adherence to healthy lifestyle behaviours around the first 1000 days of life is associated with a higher risk of childhood obesity and abdominal adiposity. • If confirmed in the other cohorts, these results call for further research exploring family and multi-behavioural approaches to prevention of childhood obesity.

551-P: Healthy Lifestyle Behaviors as Predictors of Initiation of Hemodialysis (HD) in People With and Without Diabetes Mellitus (DM)

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (never smoking, regular physical activity, moderate or no use of alcohol, 7-8 hours sleep regularly, maintaining proper weight, eating breakfast, and not eating between meals). Cardiovascular health metrics (CVHMs), defined by the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking, weight, physical activity, diet, cholesterol, blood pressure, and blood glucose). To clarify the impact of HPI or CVHMs on incident HD according to DM, we analyzed a nationwide claims-based database of 294,647 people included from 2008-16 (DM- 277,935, DM 16,712). Risk for HD were analyzed according to DM and HPI/CVHMs based on the number of unfavorable lifestyle factors in the HIP and unfavorable lifestyle factors and clinical values in the CVHM (Table). Multivariate Cox regression analysis showed that DM increased the risk of dialysis 5- to 6-fold and DM and CVHMs synergistically increased the risk of HD. Results indicated that factors similar to those used to predict cardiovascular disease would also be useful to predict HD. These approaches might be helpful in clinical practice and patient education. Disclosure T.Osawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. T.Sato: None. M.Kitazawa: None. Y.Matsubayashi: None. T.Yamada: None. S.Kodama: None.

Predictive risk markers in alcoholism.

The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.

Influence of early life risk factors and lifestyle on systemic vascular resistance in later adulthood: the cardiovascular risk in young Finns study

Purpose There are limited data available concerning the effects of lifetime risk factors and lifestyle on systemic hemodynamics, especially on systemic vascular resistance. The purpose of the study was to evaluate how lifetime cardiovascular risk factors (body mass index (BMI), high-density lipoprotein, low-density lipoprotein, triglycerides, systolic blood pressure, blood glucose) and lifestyle factors (vegetable consumption, fruit consumption, smoking and physical activity) predict systemic vascular resistance index (SVRI) and cardiac index (CI) assessed in adulthood. Materials and Methods Our study cohort comprised 1635 subjects of the Cardiovascular Risk in Young Finns Study followed up for 27 years since baseline (1980; aged 3–18 years, females 54.3%) who had risk factor and lifestyle data available since childhood. Systemic hemodynamics were measured in 2007 (aged 30–45 years) by whole-body impedance cardiography. Results In the multivariable regression analysis, independent predictors of the adulthood SVRI were childhood BMI, blood glucose, vegetable consumption, smoking, and physical activity (p ≤ .046 for all). Vegetable consumption, smoking, and physical activity remained significant when adjusted for corresponding adult data (p ≤ .036 for all). For the CI, independent predictors in childhood were BMI, systolic blood pressure, vegetable consumption, and physical activity (p ≤ .044 for all), and the findings remained significant after adjusting for corresponding adult data (p ≤ .046 for all). The number of childhood and adulthood risk factors and unfavourable lifestyle factors was directly associated with the SVRI (p < .001) in adulthood. A reduction in the number of risk factors and unfavourable lifestyle factors or a favourable change in BMI status from childhood to adulthood was associated with a lower SVRI in adulthood (p < .001). Conclusion Childhood BMI, blood glucose, vegetable consumption, smoking and physical activity independently predict systemic vascular resistance in adulthood. A favourable change in the number of risk factors or BMI from childhood to adulthood was associated with lower vascular resistance in adulthood.

Weight Gain After 20 Years of Age is Associated with Unfavorable Lifestyle and Increased Prevalence of Metabolic Disorders.

PurposeIt is unclear what kind of modifiable lifestyle factors are associated with long-time weight gain in adulthood. To clarify the lifestyle behavior related to body weight gain since the age of 20 years, we explored the lifestyle risk factor, independently associated with excessive weight gain after 20 years of age as compared to those in subjects with a stable weight, with matching of age, gender, and the current body mass index (BMI).Patients and MethodsFrom baseline data of a general population-based cohort study, we designed a cross-sectional analysis collecting individual data of medical health check-ups and a questionnaire related to lifestyle, including amount of sleep, frequency of eating breakfast, average times per day engaged in walking and sitting in the prior year, and smoking habits. These data were compared between the subjects with weight gain ≥10kg (n=3601) and <10kg (n=3601) after age 20, matched by a propensity score model which included current BMI, age and gender. We used multivariable logistic regressions to assess the lifestyle factor’s association with high weight gain.ResultsParticipants who gained ≥10 kg were significantly more likely to sleep <5 hours or ≥9 hours per night, skip breakfast, engage in walking <1 hour per day, and sit ≥5 hours per day than those who gained <10kg. Multivariable logistic regressions analyses showed that, with adjusting for potential confounder, the lifestyles with the positive association with high weight gain were skipping breakfast (OR 1.252; 95% CI 1.053–1.489, vs regularly), long sleeping duration (9 hours/day≤ OR 1.613; 95% CI 1.018–2.557 vs 5≤-<7 hours/day), and former smoker (OR 1.163; 95% CI 1.008–1.343 vs never smoker), while walking duration was negatively associated with high weight gain. Furthermore, despite similar current BMI, participants with weight gain ≥10kg had significantly higher values for waist circumference, blood pressure, HbA1c, LDL-C, triglycerides, and hepatic enzyme levels than those with weight gain <10kg. Similarly, the prevalence rates of hypertension, dyslipidemia, metabolic syndrome (MetS), and former smoker were higher in the participants with weight gain ≥10kg.ConclusionMajor weight gain after 20 years of age was associated with unfavorable lifestyle factors and greater waist circumference, possibly leading to elevated risk for MetS and other non-communicable diseases. These findings highlight the importance of maintaining both weight at age 20 and a favorable lifestyle throughout adulthood.

Unaffected Memory and Inhibitory Functioning Several Weeks Postpartum in Women with Pregnancy Complicated by Preeclampsia.

Several studies reported impaired cognitive functioning after pregnancy complicated by preeclampsia. The present study examined cognitive and executive functioning in women with preeclampsia at a time at which immediate effects of gestation have resolved, brain damage due to other risk factors have not yet manifested, and impairments may thus primarily occur as a result of the huge stress induced by the potentially life threatening condition. Verbal learning/memory (California Verbal Learning Test) and inhibitory functioning (Mittenecker Pointing Test) of 35 women with preeclampsia and 38 women with uncomplicated pregnancy were followed over five measurement time points during the period from 16 to 48 weeks postpartum. A further control group comprised 40 women with no history of recent pregnancy. The groups did not differ in their verbal learning/memory performance. Higher levels of currently experienced everyday-life stress were associated with poorer inhibitory control/greater stereotypy in responding, but this effect was not directly connected with pregnancy complications. Taken together, the findings do not indicate rapid-onset cognitive impairment after preeclampsia, brought about by its extremely stressful nature or other factors that take effect during gestation. Deficits observed in later life may develop on a long-term basis through late-diagnosed hypertension and unfavorable lifestyle factors. The large time window in which exaggerated cognitive decline can be prevented or mitigated should be utilized for the control of risk factors and interventions to improve lifestyle where appropriate.

Associations of lifestyles with major chronic diseases in Chinese adults: evidence from the China Kadoorie Biobank

Major chronic diseases, including cardiovascular disease, diabetes, cancer, and respiratory disease, cause substantial mortality and morbidity in China. Evidence from Western population showed that smoking, excessive alcohol intake, physical inactivity, unhealthful dietary habits and adiposity are independent risk factors for major chronic diseases. However, because of the vast differences in lifestyles and disease patterns, evidence from Western populations may not be generalizable to the Chinese population. Assessing the directions and magnitude of associations between lifestyles and major chronic diseases is crucial to evaluate the benefits yielded from lifestyle modifications, thus informing related guidelines. In recent years, prospective cohort studies in China, including the China Kadoorie Biobank (CKB), have shown relationships between unfavorable lifestyle factors and major chronic diseases. In particular, the CKB study has laid the evidence base for lifestyle factors (occupational physical activity) and diseases (hemorrhagic stroke, gastrointestinal cancers, and chronic obstructive pulmonary disease) unique to the Chinese population. This article aims to summarize the research findings on this topic.

Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study.

Aims: Conflicting data exist on whether an association exists between antidepressants and the risk of major adverse cardiovascular events (MACEs) in patients with depression. This may be due to the use of various study designs and residual or unmeasured confounding. We aimed to assess the association between antidepressant use and the risk of MACEs while considering various covariates, including severity of depression and the cardiovascular disease (CVD) risk score. Methods: Patients newly diagnosed with depression with no history of ischemic heart disease and stroke were followed-up from 2009 to 2015. We conducted Cox proportional hazard regression analysis to estimate hazard ratios (HRs) for each antidepressant for MACE risk. Result: We followed-up (median, 4.4 years) 31,830 matched patients with depression (15,915 antidepressant users and 15,915 non-users). In most patients (98.7%), low-dose tricyclic antidepressants (TCAs) were related with a significantly increased risk of MACEs [adjusted HR = 1.20, 95% confidence interval (CI) = 1.03–1.40]. Duration response relationship showed a gradually increasing HR from 1.15 (95% CI = 0.98–1.33; <30 days of use) to 1.84 (95% CI = 1.35–2.51; ≥365 days of use) (p for trend <0.01). High Korean atherosclerotic CVD risk score (≥7.5%) or unfavorable lifestyle factors (smoking, alcohol intake, and exercise) were significantly associated with MACEs. Conclusion: Even at low doses, TCA use was associated with MACEs during primary prevention. Longer duration of TCA use correlated with higher HR. Careful monitoring is needed with TCA use in patients with no known CVD history.

Mortality among Italian male workers in the construction industry: a census-based cohort study.

Advances in technologies, occupational hygiene and increased surveillance have reduced the excess mortality previously found in the construction industry. This study is aimed to evaluate cause-specific mortality in a recent cohort of construction workers. We carried out a record-linkage cohort study based on the 2011 Italian census and the mortality archives (2012-2015), including 1 068 653 construction workers. We estimated mortality rate ratios (MRR) using Poisson regression models including terms for age and geographic area. Compared with non-manual workers, construction workers showed an excess mortality from all causes (MRR: 1.34), all neoplasms (MRR: 1.30), head and neck (MRR: 2.05), stomach (MRR: 1.56), liver (MRR: 1.62), lung (MRR: 1.80), prostate (MRR: 1.24) and bladder (MRR: 1.60) cancers, respiratory (MRR: 1.41) and liver (MRR: 1.79) diseases, all external causes (MRR: 1.87), falls (MRR: 2.87) and suicide (MRR: 1.58). Compared with manual workers in other industries, construction workers showed excess mortality from prostate (MRR: 1.27) and non-melanoma skin cancers (MRR: 1.95), all external causes (MRR: 1.14), falls (MRR: 1.94) and suicide (MRR: 1.18). Most of this excess mortality disappeared after adjusting for education, with the exception of prostate and non-melanoma skin cancers, all external causes, falls and suicide. Construction workers are at high risk of dying from external causes, while the excess mortality found for several cancers, liver and respiratory diseases may be at least partially due to the high prevalence of low education and unfavorable lifestyle factors. The excess mortality from prostate cancer requires further evaluations.

Impacts of unfavourable lifestyle factors on biomarkers of liver function, inflammation and lipid status.

BackgroundAdopting a healthy lifestyle is associated with prolonged life expectancy. The main modifiable lifestyle-related risk factors are hazardous alcohol drinking, smoking, excess body weight and lack of physical activity. Our aim was to estimate the impact of unfavourable lifestyle factors on abnormalities in laboratory tests reflecting liver status, inflammation and lipid metabolism in a population-based cross-sectional study.MethodsThe study included 22,273 participants (10,561 men, 11,712 women) aged 25–74 years from the National FINRISK Study. Data on alcohol use, smoking, body weight, and physical activity were recorded from structured interviews. The risk scores for the various life style factors were established on a 0–8 scale and used to stratify the population in classes to allow estimates of their joint effects. Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques.ResultsConsistent dose-response relationships were observed between the number of unfavourable risk factors and serum levels of GGT, ALT, CRP, cholesterol, HDL, LDL and triglycerides (p < 0.0005 for linear trend in all comparisons). When compared with those with zero risk factors, the multivariable-adjusted odds ratios (ORs) for abnormalities in all biomarkers were significantly higher in those with a sum of risk score two or more. The most striking increases in ORs in the group with the highest numbers of risk factors were observed among men in serum GGT: 26.6 (12.4–57.0), ALT: 40.3 (5.3–307.8), CRP: 16.2 (7.8–33.7) and serum triglycerides: 14.4 (8.6–24.0).ConclusionsThe data support the view that the presence of unfavourable life style risk factors is associated with distinct abnormalities in laboratory tests for liver function, inflammation and lipid status. Such biomarkers may prove to be of value in the assessment of interventions aimed at reducing unfavourable risk factors and in helping individuals in long-term maintenance of lifestyle modifications.

Joint exposure to smoking, excessive weight, and physical inactivity and survival of ovarian cancer patients, evidence from the Ovarian Cancer Association Consortium.

Previous epidemiologic studies have shown that smoking, obesity, and physical inactivity are associated with poor survival following a diagnosis of ovarian cancer. Yet, the combined relationship of these unfavorable lifestyle factors on ovarian cancer survival has not been sufficiently investigated. Using data pooled from 13 studies, we examined the associations between combined exposures to smoking, overweight/obesity weight, and physical inactivity and overall survival (OS) as well as progression-free survival (PFS) among women diagnosed with invasive epithelial ovarian carcinoma (n = 7,022). Using age- and stage-adjusted Cox proportional hazards regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) associated with joint exposure to these factors. Combined exposure to current smoking, overweight/obesity, and physical inactivity prior to diagnosis was associated with a significantly increased risk of mortality compared to women who never smoked, had normal body mass index (BMI), and were physically active (HR = 1.37; 95% CI 1.10-1.70). The association for a joint exposure to these factors exceeded that of each exposure individually. In fact, exposure to both current smoking and overweight/obesity, and current smoking and physical inactivity was also associated with increased risk of death (HR = 1.28; 95% CI 1.08-1.52, and HR = 1.26; 95% CI 1.04-1.54, respectively). The associations were of a similar magnitude when former smoking was assessed in combination with the other exposures and when excessive weight was limited to obesity only. No significant associations were observed between joint exposure to any of these factors and PFS. Joint exposure to smoking, excessive weight, and physical inactivity may negatively impact survival of ovarian cancer patients. These results suggest the importance of examining the combined effect of lifestyle factors on ovarian cancer patients' survival.

Accelerated atherosclerosis, hyperlipoproteinemia and insulin resistance in long-term survivors of Hodgkin lymphoma during childhood and adolescence.

Long-term survivors of Hodgkin lymphoma during childhood or adolescence (HL survivors) are at high risk of developing treatment-related late cardiovascular sequelae. In our study we evaluated the presence of modifiable cardiovascular risk factors (hypertension, hyperlipoproteinemia, hyperinsulinemia, obesity), endothelial and inflammatory markers (E-selectin, PAI-1, hs-CRP) and atherosclerotic changes in the common carotid arteries. Assessment was performed in 80 young adult Hodgkin lymphoma long-term survivors at more than 10 years after the potentially cardiovascular toxic anticancer treatment (median age at evaluation 34.7 years; range 24.1-40.9 years). The HL survivors were compared with 83 age- and gender-matched healthy volunteers. The HL survivors showed unfavorable lipid profiles compared to those of healthy controls: triglycerides (p=0.01), total cholesterol (p=0.0004), low density lipoprotein cholesterol (p=0.005). In HL survivors, we found a higher prevalence of hypertension (p=0.004) and insulin resistance - HOMA-IR (p=0.0002). Ultrasonographic examination of both common carotid arteries revealed a higher prevalence of atherosclerotic plaques (p=0.0009) and higher carotid intima-media thickness (p<0.0001) in HL survivors. Markers of oxidative stress (advanced oxidation protein products, oxidized low-density lipoprotein), inflammation (hs-CRP) and endothelial dysfunction (E-selectin, PAI-1) were also higher in HL survivors (p<0.0001, p=0.0002, p=0.0031, p=0.0087, p=0.004, respectively). Adult survivors of Hodgkin lymphoma during childhood and adolescence need closer follow-up with screening of metabolic syndrome components, unfavorable lifestyle factors and early management of these risk factors.

Genetic Risk, Lifestyle Factors, and Type 2 Diabetes Among 550,000 Chinese Adults: Results from Two Independent Asian Cohorts

Background: Evidence from Caucasians showed that both genetic and lifestyle factors play important roles in the development of type 2 diabetes. However, the interaction between the genetic susceptibility and lifestyle factors to type 2 diabetes among Chinese remains unknown. Methods: We defined lifestyle score including body mass index, drinking, smoking, physical activities and diets in 461,030 participants from the China Kadoorie Biobank and 38,434 participants from the Singapore Chinese Health Study. Genetic risk score was calculated based on T2D loci in two cohorts. Cox proportional-hazard model was used to estimate the interaction between genetic and lifestyle factors on risk of incident T2D. Findings: The most unfavorable lifestyle was significantly associated with a higher risk of incident events (HR, 3*32; 95%CI, 3*08 to 3*58) than the most favorable lifestyle regardless of genetic risk. The risk of incident events was 90% higher among participants at the highest genetic risk than those at the lowest genetic risk (95% CI, 1*74 to 2*08). The standardized 10-year incidence at high genetic risk was 7*11% among those with unfavorable lifestyle, and 1*43% among those with low genetic risk and favorable lifestyle. However, there was no evidence of a statistically significant interaction between genetic risk and lifestyle factors. Interpretation: Our findings provide replicable evidence to show that unfavorable lifestyle and genetic factors were independently associated with increased risk of incident type 2 diabetes. Funding Statement: (UK Wellcome Trust and National Natural Science Foundation of China.) This work was supported by grants (2016YFC0900500, 2016YFC0900501, 2016YFC0900504) from the National Key R&D Program of China. The CKB baseline survey and the first re-survey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z), National Natural Science Foundation of China (81390540, 81390544, 81390541), and Chinese Ministry of Science and Technology (2011BAI09B01). The Singapore Chinese Health Study was supported by grants from the National Medical Research Council, Singapore (NMRC/CIRG/1456/2016), and the National Institutes of Health (R01 CA144034 and UM1 CA182876). W-P Koh was supported by National Medical Research Council, Singapore (NMRC/CSA/0055/2013). Declaration of Interests: The authors report: No conflicts of interest. Ethics Approval Statement: The Ethical Review Committee of the Chinese Center for Disease Control and Prevention (Beijing, China) and the Oxford Tropical Research Ethics Committee, University of Oxford (UK) approved the study.

Combined Impact of Known Lifestyle Factors on Total and Cause-Specific Mortality among Chinese Men: A Prospective Cohort Study

Impact of combined lifestyles on risk of mortality needs to be explored quantitatively. We aimed to evaluate the associations of combined lifestyle factors with total and cause-specific mortality in Chinese men. We used data from the Shanghai Men’s Health Study (2002–2013), an on-going population-based prospective cohort study of men (aged 40 to 74 years). Four traditional unfavorable lifestyle factors were included: smoking, heavy alcohol use, unhealthy diet and physical inactivity. Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Among about 61,480 men in the cohort, a total of 4,952 men died, of which 1,637 men died from cardiovascular diseases (CVD), 2,122 from cancer during a median of 9.29 years’ follow-up. The HRs of men with four risk practices comparing to those with zero were 2.92 (95%CI: 2.53, 3.38) for all-cause mortality, 3.15 (95%CI: 2.44, 4.05) for CVD mortality, and 3.18 (95%CI: 2.55, 3.97) for cancer mortality. The population attributable risks (PARs) were 0.41, 0.40 and 0.38 for total, CVD and cancer mortality, accordingly. As combined unhealthy lifestyle behaviors had substantial impact on total and cause-specific mortality, promotion of healthy lifestyle should be a public health priority.

Combined association of clinical and lifestyle factors with non-restorative sleep: The Nagahama Study.

BackgroundNon-restorative sleep (NRS) was suggested to be associated with cardiovascular outcomes. However, causative factors for NRS have not been fully elucidated. This study aimed to clarify factors and their relationships with NRS to better understand the clinical and epidemiological implications of NRS and to develop a score that can objectively evaluate NRS status.MethodsStudy subjects consisted of 9,788 community residents (age 53.6 ± 13.4 y). Subjective NRS as well as possible clinical and lifestyle factors for NRS were investigated by questionnaires. Other clinical parameters were obtained from personal records of information obtained at the baseline examination.ResultsA total of 3,261 participants complained of NRS. Factors independently associated with subjective NRS were younger age (odds ratio = 1.43), use of a hypnotic drug (2.04), irregular sleep schedule (2.02), short sleep duration (<5 h, 11.7; 5–6 h, 4.81; 6–7 h, 2.40), frequent sleepiness (2.33), routine stress (4.63), no habitual exercise (1.61), nocturia symptoms (1.43), symptoms of gastroesophageal reflux disease (1.44), and depression (1.46) (all P <0.001). The NRS score comprised of these 10 factors was linearly associated with the frequency of subjective NRS (Ptrend <0.001). Frequency of individuals with a high NRS score was greater in women (52.3%) than in men (42.1%, P<0.001), while no clear association was observed with common risk factors for cardiovascular diseases.ConclusionsNRS was a phenomenon representing various clinical and lifestyle features. Careful attention should be paid to individuals with a high NRS score who might be at risk for mental fatigue and have unfavorable lifestyle factors.

Interpersonal violence and overweight in adolescents: the HUNT Study.

Overweight and obesity in children and adolescents are major public health challenges associated with psychosocial adversity and unfavourable lifestyle. Exposure to interpersonal violence, such as sexual abuse, violence and bullying, could represent precursors, accelerating or sustaining factors. The Young-HUNT 3 study, 2006-2008, is a population-based, cross-sectional, cohort study of Norwegian youth that includes self-report data on exposure to interpersonal violence; pubertal status and timing; socioeconomic, psychosocial, and lifestyle factors; and clinical anthropometric measures. A cohort of 10,464 adolescents aged 12-20 years from Nord-Trøndelag County were invited to participate. Body mass index served as the outcome in the simple and multiple linear regression analyses. The response rate was 72.3% (7564), and 49.9% (3777) of the respondents were girls. A robust and significant relationship between interpersonal violence and increased BMI for both genders was found. Importantly, interpersonal violence remained significantly correlated with higher BMI following adjustment for pubertal development, socioeconomic and psychosocial adversity and unfavourable lifestyle factors in both genders, although most evident in girls. Adjusted regression coefficients (95% confidence intervals) for the relationship between interpersonal violence and BMI were 0.33 (0.01, 0.65) for 1 type and 0.89 (0.37, 1.41) for 2 types, compared to no exposure in girls, and 0.40 (0.09, 0.71) for 1 type and 0.35 (-0.09, 0.79) for 2 types of interpersonal violence in boys. The empirical evidence of consistent associations between interpersonal violence, related psychosocial and lifestyle factors, and body fatness, indicates that these features play important roles for adolescents struggling with overweight.

Design of the Saitama Cardiometabolic Disease and Organ Impairment Study (SCDOIS): A Multidisciplinary Observational Epidemiological Study

Background: In the past few decades, the incidence of cardiometabolic diseases and disorders of the liver, kidney, pancreas, heart, and lung, have been increasing in Western and Asian countries, including Japan. Numerous factors, including abnormal body weight (obesity, overweight, or underweight), infrequent exercise, and other unfavorable lifestyle factors (e.g., smoking and heavy alcohol drinking) have been proposed as risk factors for the development and the progression of diseases, such as type 2 diabetes, hypertension, and dyslipidemia, which ultimately lead to impaired organ function and possibly death. However, the mechanisms that link these risk factors with diseases are still poorly understood, and the potential treatments, including pharmacotherapy and diet, have not been fully evaluated. Methods: In 2011, we established a new collaborative research program, the Saitama Cardiometabolic Disease and Organ Impairment Study (SCDOIS). This multidisciplinary observational epidemiological research study was designed to cover several high-profile diseases and some traditional fields of internal medicine, as well as apparently unrelated fields and particular lifestyle factors, such as unhealthy eating behaviors. In a series of studies, apparently healthy subjects who underwent a regular medical checkup were retrospectively identified based on the results of their medical checkups. In this way, the incidence, prevalence, causality, and clinical relevance of specific conditions and diseases have been investigated in cross-sectional analyses of 100,000 - 200,000 adults, and in longitudinal studies of several thousand subjects who underwent medical checkups multiple times. Discussion: This article describes the background, rationale, purpose, and methods of the SCDOIS. Using data obtained from annual medical checkups, our goals are to 1) establish criteria or identify clinical features that would enable clinicians to detect the presence of abnormal conditions associated with cardiometabolic diseases and/or organ impairment much earlier in the disease course; and 2) determine the potential mechanisms and therapies for these conditions.