Unhealthy Lifestyle Research Articles

Plasma metabolites, systolic blood pressure, lifestyle, and stroke risk: A prospective cohort study.

To estimate the associations of stroke risk with plasma metabolites, metabolic risk score (MRS), the combinations of MRS with hypertension or lifestyle, and lifestyle-related metabolic signature. To assess the improvement of the stroke risk prediction model through the incorporation of MRS. A total of 77,315 participants from the UK Biobank were included in this study. Xgboost and LASSO-Cox regression were used to select metabolites and construct MRS. Elastic net regression was utilized to construct the lifestyle-related metabolic signature. Multivariate Cox regression was used to estimate the associations between metabolites, MRS, the combinations of MRS with hypertension or lifestyle, lifestyle-related metabolic signature, and stroke risk. We identified 48, 63, 39, and 4 metabolites associated with the risk of stroke, ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), respectively. High MRS significantly increased the risk of stroke (HR = 2.65 (95% confidence interval (CI): 2.09-3.35)), IS (HR = 2.45 (95% CI: 1.89-3.17)), ICH (HR = 2.74 (95% CI: 1.55-4.85)), and SAH (HR = 4.64 (95% CI: 2.25-9.56)). In the combination analyses, compared with normal systolic blood pressure (SBP) and low MRS, normal/high SBP, and high MRS significantly increased stroke risk (HR = 5.80 (95% CI: 2.75-12.27)/6.37 (95% CI: 3.22-12.62)). A favorable/unfavorable lifestyle and high MRS also significantly increased stroke risk (HR = 2.38 (95% CI: 1.73-3.28)/3.86 (95% CI: 2.63-5.67)) compared with a favorable lifestyle and low MRS. Incorporating MRS into the 15-year stroke and IS risk prediction model increased the areas under the curves (AUCs) from 0.746 to 0.766 and from 0.771 to 0.811, respectively. The metabolic signature was correlated with adherence to a healthy lifestyle (r = 0.414; P = 2.22e-16) and inversely associated with stroke risk (HR = 0.80 (95% CI: 0.73-0.86)). Various metabolites and MRS were significantly associated with the risk of stroke, IS, ICH, and SAH. Individuals with a high MRS may face an elevated stroke risk among populations with high SBP or unhealthy lifestyle, even those with normal SBP or healthy lifestyle. MRS provided modest improvement to the stroke risk prediction model. The lifestyle-related metabolic signature could reduce 20% stroke risk.

Unhealthy Lifestyle Contributes to Negative Mental Health and Poor Quality of Life in Young University Students

Background: A negative lifestyle is reported to be related to poor mental health and quality of life (QOL). However, there is little information on this in university students. The objective of the present study was to investigate the association between mental health (i.e., anxiety, depression symptoms and stress), QOL, SWLS and lifestyle parameters (i.e., PA, sleep duration, ST and food habits) among Chilean university students and then to determine the differences in mental health, QOL, SWLS and lifestyle parameters according to gender. Methods: This cross-sectional study included a total of 211 university students (128 females and 83 males) aged 18–28 years. Mental health, QOL and lifestyle were measured through validated questionnaires. Results: Bad food habits (lowest score in the food survey) were linked to anxiety (2.3 [0.22–4.36], p = 0.03), depressive symptoms (3.75 [1.54–5.9], p = 0.001) and stress (2.24 [0.31–4.17], p = 0.023). Furthermore, <6 h of sleep was related to poorer mental health (13.5 [7.6–19.5], p = 0.001), anxiety (4.2 [2.0–6.4], p < 0.001), depressive symptoms (5.5 [3.2–7.9], p < 0.001) and stress (3.8 [1.8–5.9], p < 0.001). In addition, ≥4 h of ST was linked positively to negative mental health (8.3 [2.86–13.7], p = 0.003), depressive symptoms (3.45 [1.47–5.4], p = 0.001) and anxiety (3.2 [1.05–5.4], p = 0.004). Non-physical activity was related to the scores for anxiety (2.6 [0.20–5.0], p = 0.030), depression (2.7 [0.009–5.3], p = 0.049) and stress (2.4 [0.12–4.7], p = 0.039). Conclusions: this study showed that unhealthy lifestyle factors (i.e., insufficient sleep, lack of PA and prolonged ST) were strongly associated with poorer mental health and QOL in university students. These findings highlight the importance of addressing these aspects of lifestyle in intervention and health promotion programs aimed at young university students in order to improve their mental health and overall QOL.

Perceived lack of behavioral control is a barrier to a healthy lifestyle in post-menopause: a qualitative study.

Menopause is a natural phase in a woman's life, but the quality of life and health of postmenopausal women are often compromised by unhealthy lifestyles. Therefore, it is crucial to identify the factors that influence their well-being. The main objective of this study is to explore the barriers to a healthy lifestyle among Iranian postmenopausal women. Qualitative exploratory research was conducted among postmenopausal women aged 45-65 years in three different health centers located in urban areas with varying economic level in a central city of Iran. These areas represented upscale, downtown, and downscale areas with different economic statuses (wealthy, relatively wealthy, and less wealthy). Nine focus group discussions were held, focusing on managing menopausal symptoms, physical activity, and healthy nutrition. Each topic was discussed separately in a different health center, with 10 women participating in each session. Data analysis was conducted using Graneheim and Lundman's method. The study revealed a prominent theme, "perceived lack of behavioral control as a barrier to a healthy lifestyle in post-menopause." Two categories, "False attitudes" and "Perceived inability to engage in behavior," were derived from 26 codes related to managing menopausal symptoms. Furthermore, a category, "Perceived inability to engage in behavior," was formed from 11 to 13 codes related to physical activity and healthy nutrition, respectively. The theme highlighted that the perceived lack of behavioral control prevented the women from adopting a healthy lifestyle. Improving perceived behavioral control through the modification of attitudes and abilities is essential for maintaining a healthy postmenopausal lifestyle.

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.

A healthy lifestyle is prospectively associated with lower onset of metabolic dysfunction-associated steatotic liver disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an unhealthy lifestyle. However, there is limited prospective evidence regarding the association between combined lifestyle factors and MASLD. This study aims to test the association of a combination of lifestyle components, expressed as a healthy lifestyle index (HLI), and unhealthful eating behavior habits with MASLD, insulin resistance (IR), liver fibrosis, and metabolic dysfunction-associated steatohepatitis. A prospective cohort study was conducted among participants of metabolic and hepatic screening surveys. MASLD was evaluated by ultrasonography or controlled attenuation parameter at 2 time points to assess new-onset, persistence, or remission, and IR was estimated by homeostasis model assessment. Presumed liver fibrosis and metabolic dysfunction-associated steatohepatitis were evaluated using FibroMax biomarkers. The HLI was calculated as the sum of 4 lifestyle components: nonsmoking, healthy weight, healthy diet, and physical activity. The final cohort included 315 subjects with 6.7 years of follow-up, 40-70 years old. In multivariable analyses, a favorable lifestyle (≥3 components) was independently associated with lower odds of new-onset MASLD (OR = 0.42; 95% CI: 0.19-0.90). Similarly, a favorable lifestyle was associated with lower odds of new-onset/persistent (vs. never/remission) MASLD and IR, respectively (OR = 0.49; 95% CI: 0.30-0.80; OR = 0.40; 95% CI: 0.24-0.66). There was a dose-response association between HLI and new-onset/persistent MASLD and IR. A favorable lifestyle was associated with lower odds of new-onset metabolic dysfunction-associated steatohepatitis (OR = 0.50; 95% CI: 0.27-0.95). Adjusting for HLI, unhealthful eating behavior habits were associated with higher odds of MASLD prevalence (OR = 1.81; 95% CI: 1.07-3.06). Adherence to a healthy lifestyle is prospectively associated with lower odds of MASLD, markers of liver damage, and IR. A holistic approach that considers overall lifestyle and eating behavior may be useful for preventing MASLD.

All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study

AimsThe rise in one-person households is a global trend. We aimed to investigate mortality risk in individuals with diabetes living alone (IDLA) using a large-scale population-based database. MethodsA total of 2,447,557 adults with type 2 diabetes were identified from the Korean National Health Information Database. One-person households were defined based on the number of registered family members. The risks of all-cause and cause-specific mortalities were estimated using a multivariable Cox proportional hazards regression model. ResultsDuring a median follow-up period of 6.0 years, 191,084 deaths (7.8 %) occurred. IDLA had a higher risk of mortality compared to those not living alone after adjusting for potential confounders (HR 1.20, 95 % CI: 1.18–1.22). This association was more prominent in younger individuals, men, and those with low income, and it was dependent on the duration of living alone. The risks of cause-specific mortality were all significantly higher in the IDLA group compared with the non-IDLA group. Adherence to favorable lifestyle behaviors was associated with a significant reduction in all-cause mortality, particularly in IDLA. ConclusionsThe elevated risk of mortality in IDLA highlights the need for tailored medical interventions and social assistance, particularly for those with unhealthy lifestyles or low income.

Blood pressure management protocol based on transtheoretical model effectiveness on self- care: A systematic review

Background: Hypertension is a prevalent medical condition associated with cardiovascular and kidney diseases, leading to premature death and disability. Despite medication use, hypertension continues to rise due to unhealthy lifestyles. Self-care strategies play crucial roles in effectively treating hypertension. We aimed to evaluate the effectiveness of interventions based on the transtheoretical model (TTM) in improving self-care, self-efficacy, and health-related quality of life (HRQOL) in hypertensive adults. Methods: A comprehensive search was performed in multiple databases using appropriate search strategies. Two independent reviewers screened articles, and assessed their adherence to the inclusion and exclusion criteria. The risk of bias in randomized controlled trials was assessed by the Cochrane Collaboration tool and quasi-experimental studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Quasi-Experimental Studies. Results: The review included 24 studies with a total of 6553 participants. Most interventions aimed to encourage a healthier lifestyle and improve diet and physical activity. The message was delivered through various methods such as slide/tape messages, individual education/counseling sessions, telephone-delivered interventions, and multimedia training software based on the TTM. Control groups received physician visits or attended lifestyle lectures but did not receive specific behavior change programs like the intervention groups. Conclusion: Our results indicated that the TTM and stage of change model can be an appropriate framework for delivering educational messages to patients.

The lifestyle factors of medical doctors in academic hospitals, Bloemfontein, Free State.

Lifestyle factors of medical doctors are essential to their health and well-being. Previous studies omitted factors that constituted a healthy lifestyle and did not differentiate between various medical specialties or level of seniority which may expose doctors to different stress levels, workload and responsibility. The study assessed the lifestyle factors of medical doctors and compared them between departments, levels of seniority, years of experience and gender according to globally recognised health standards. This descriptive cross-sectional study collected data using a questionnaire created by the researchers based on healthy lifestyle factors and was administered online. Access was given to all doctors from four large departments, employed at two academic hospitals in Bloemfontein, Free State who agreed to participate in the study. Consultants from paediatrics, with 6+ years in medical practice, had the healthiest lifestyles. Registrars and interns from surgical disciplines such as obstetrics and gynaecology and surgery, with 1-5 years of medical practice, showed unhealthy lifestyles with inadequate sleep and exercise. The challenge remains how medical doctors can live a healthy lifestyle while managing a demanding schedule. This may impact on the management of their patients and the doctors' overall health and well-being. We recommend improving the working conditions by providing healthy meals on-site at hospitals with adequate breaks, reducing the heavy workload and providing exercise facilities.Contribution:The findings from this article may help improve the lifestyles of the identified groups of at-risk doctors and assist them in seeking ways to improve upon this.

Gambaran Sedentary Behavior Mahasiswa Universitas Negeri Padang

College can be a difficult time for many students because during this time they face a lot of pressure and challenges that can cause various threats to the physical, social and emotional. Such times make them more susceptible to stress and health problems due to unhealthy lifestyles, one of which is sedentary behavior. This study aims to determine the description of the sedentary behavior of Padang State University students. This study uses a quantitative method using descriptive statistical analysis. The population in this study were Padang State University students in the 2018-2020 intake with a total of 4,166 people. Sampling in the study used the consecutive sampling technique using the Slovin formula with a 10% error tolerance so that a total of 98 respondents were obtained. This study used the Sedentary behavior questionnaire scale by Rosenberg et al (2010) which was adapted into Indonesian and distributed via gform. Based on the results, the mean was 37.3 and SD 23.5. This means that the sedentary behavior of Padang State University students tends to be high.

Interaction of polychlorinated biphenyls exposure, lifestyle and genetic risk in dyslipidemia

Abstract Background Polychlorinated biphenyls (PCBs) are endocrine-disrupting chemicals that have been associated with various adverse health conditions. However, the interaction effects between PCBs, lifestyle, and/or genetic susceptibility on dyslipidemias are still unknown. Methods Six serum PCBs including PCB-28, 101, 118, 138, 153, and 180 were determined in 3,845 participants from the Wuhan-Zhuhai cohort. Dyslipidemias, including hyper-total cholesterol (HyperTC), hyper-triglyceride (HyperTG), hyper-low density lipoprotein cholesterol (HyperLDL-C), and hypo-high density lipoprotein cholesterol (HypoHDL-C) were classified based on serum lipids levels, which were examined by an automatic biochemical analyzer. Besides, we constructed lipid-specific polygenic risk scores (PRS) and healthy lifestyle scores, and used Logistic regression models to explore the relationships of serum PCBs, lifestyle, and PRS with dyslipidemias. Results We observed that all six PCB congeners were positively associated with the prevalence of dyslipidemias to varying degrees. In particular, dose-response manners were observed between ΣPCB levels and odds ratios (ORs) of HyperTC, HyperTG, and HyperLDL-C, respectively. Besides, we found that PRSs and unhealthy lifestyles were both positively associated with dyslipidemias. For the combined effect of ΣPCB, lifestyle, and PRS, participants with high ΣPCB, unfavorable lifestyle, and high genetic risk had the highest odds of HyperTC (2.285; 1.533, 3.417), HyperTG (7.944; 5.169, 12.329), and HyperLDL-C (3.523; 2.311, 5.394) when compared with those with low ΣPCB, healthy lifestyle, and low genetic risk. Conclusions Our study provided evidence that PCB exposure potentially increases the prevalence of dyslipidemias, which may be exacerbated by genetic susceptibility and unhealthy lifestyles. Key messages • Our results highlighted the importance of reducing PCB exposure, adopting healthy lifestyles for the prevention of dyslipidemia. • Our work might facilitate the emergence of reducing or regulating PCB pollution to control blood lipids and the resultant dyslipidemia epidemic.

Linking health-related behaviours to quality of life in older adults: A latent class analysis

Abstract Background Life expectancy and healthy life years diverge considerably in Austria, and quality of life (QoL) varies widely among older people. Identifying the factors most relevant to QoL in older people is crucial. We aimed to investigate the association between health behaviour, including lifestyle and preventive behaviour, and QoL in this population. Methods Cross-sectional data from the Austrian Health Interview Survey (2019) were used, including 3,995 individuals aged 65 years and older. We performed latent class analysis (LCA) to identify patterns of health behaviours. Variables were selected based on the WHO framework of Active Ageing including factors related to lifestyle (physical exercise, fruit/vegetable intake, BMI, oral health, smoking, alcohol use) and the health care system (satisfaction, unmet needs, participation in screening, health checks and vaccination). Domain scores of the WHOQOL-BREF were used for QoL assessment. Class differences were assessed by survey regressions. Results In the LCA, four different behavioural classes emerged among the older-aged Austrian population, including (class 1) ‘best preventive behaviour and very good lifestyle’ (17.7%), (class 2) ‘worst lifestyle and worst preventive behaviour, high unmet healthcare needs and unsatisfied with the system’ (16.5%), (class 3) ‘very good preventive behaviour and best lifestyle, but worst vaccination probability’ (24.8%) and (class 4) ‘poor preventive behaviour, good lifestyle, but no physical activity’ (41.0%). The classes with unhealthy lifestyles (classes 2 and 4) had worse QoL in all domains compared to the classes with healthy lifestyles (classes 1 and 3). The four classes differ on demographic, socio-economic and health characteristics. Conclusions To improve the QoL of the older population, policies and interventions need to be tailored to the specific characteristics and needs of each behavioural class. Key messages • This study explores the relationship between health behaviour and QoL in older Austrians. • Findings support the development of differentiated interventions targeting different types of behaviour.

Changes in opinions on health insurance benefits deservingness in the Netherlands between 2013-2023

Abstract Background In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. Although people are generally highly supportive of collectively financed healthcare services, some groups are considered more deserving of health insurance benefits than others. Increasing knowledge of the health risks of certain lifestyle choices and pressure on healthcare systems may result in changing opinions on the allocation of resources. Our study looks into changes in citizen’s opinions on the deservingness of different groups between 2013 and 2023. Methods Questionnaires were sent out to samples of 1.500 members of the Dutch Health Care Consumer Panel in 2013, 2015, 2017, 2019, 2021, and 2023. Response rates varied between 42% (2015) and 56% (2021). Deservingness was studied by asking respondents about their opinions on the amount of health insurance premium for different, opposing groups, for example older and younger people and those with a healthy and unhealthy lifestyle (group A should pay more, both groups should pay the same amount, or group B should pay more). Multinominal logistic regression models were used to examine changes in deservingness opinions over time. Results Our study showed year-to-year fluctuations in opinions on the premium amount for health insurance for different, opposing groups. However, no distinct increases or decreases were observed over the whole time period. This applies to both the general population and to people who do and do not belong to the different groups. Conclusions Although there are differences in the degree to which groups are considered deserving of health insurance benefits, deservingness opinions were found to be fairly stable in the Netherlands between 2013 and 2023. Our results do not point to increasing support for premium differentiation based on personal characteristics. This suggests that support for solidarity in healthcare financing is not in decline. Key messages • Opinions on the deservingness of health insurance benefits of different groups were found to be fairly stable in the Netherlands between 2013 and 2023. • No evidence of increasing support for premium differentiation based on personal characteristics was found.

Breastfeeding duration, children’s diet and physical activity in immigrant children living in Lisbon

Abstract Background In 2023, 25% of children born in the Lisbon metropolitan area were from foreign mothers. Children of immigrant parents often face an unbalanced diet and unhealthy lifestyle, preventing them from reaching their full potential. The aim of this study was to analyse the associations between migrant status and breastfeeding duration, fruit and vegetable consumption and physical activity in children living in the Lisbon metropolitan area, Portugal. Methods Cross-sequential cohort study in Lisbon Region. Between May 2022 and April 2024, 729 children (49.4% immigrants) born in 2018 and 2020 were enrolled in the study. Data were collected in a face-to-face interview with the parents using a structured questionnaire with information on children’s diet (fruit and vegetable consumption) and physical activity. We used X2, Mann-Whitney U and t-tests to compare immigrant and non-immigrant children. Adjusted odds ratios (aOR) with a 5% level were estimated by logistic regression. Results Immigrant children (49.4%) live in socio-economically disadvantaged families. Breastfeeding practices are more common among migrant mothers with a higher median duration of exclusive breastfeeding (6 versus 4 months, p < 0.001) and a higher median duration of breastfeeding (14 versus 8 months, p < 0.001). Parental migration background is associated with the frequency of fruit (p = 0.039) and vegetable (p < 0.01) consumption and with the practice of physical activity (p < 0.01). The odds of consuming three or more portions of fruit are 1.37 times higher for non-immigrant children, and the odds of consuming two portions of vegetables are higher for non-immigrants than immigrants (aOR=2.04, p < 0.01). Practicing sports is most frequent in non-immigrants (aOR =2.25; p < 0.01). Conclusions Migrant status was associated with a less healthy lifestyle in childhood for children living in the Lisbon metropolitan area. Key messages • Breastfeeding is an essential source of nutrition for children, especially in socio-economically disadvantaged families. • The migrant status is often associated with inequalities in childhood, challenging immigrant children to achieve their full potential.

Youth Health Trends in Northern Portugal: Analyzing Diet, Physical Activity, and Body Image

(1) Background: In the face of global concerns regarding unhealthy lifestyles among youths, understanding dietary habits, physical activity, and weight management strategies among third-cycle students in Portugal becomes essential. This study aims to evaluate the extent to which middle school students adhere to the Mediterranean diet and assess their physical activity habits and overall weight perceptions. (2) Methods: This study is a cross-sectional observational study. Using self-reported data from a sample of 232 students aged between 12 and 18, this study delved into their dietary patterns, engagement in physical activities, perceptions of weight, and weight management approaches, measured by the KIDMED and YRB questionnaires. (3) The results demonstrated that adolescents engaged in a varied diet, and 65.5% had recently engaged in physical activity. However, 25% reported exercise-related injuries, suggesting potential safety gaps. Extreme weight management practices were minimal, but a disparity in weight perception and weight loss desire emerged, hinting at underlying societal and media influences. Gender differences in certain habits were minimal. (4) Conclusions: While students were generally inclined towards healthy habits, there are evident areas of concern, particularly regarding safety in physical activities and weight perceptions. In the future, interventions should be implemented to increase students’ literacy and raise awareness of the Mediterranean diet and physical well-being.

UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS: the DELICIOUS project

Abstract Over the last decades, the abandonment of traditional dietary patterns and engagement in unhealthy lifestyles (including poor physical activity, prolonged screen time, poor sleep behaviours) in children and adolescents has been considered an important threat for the future health of the younger generations living in the Mediterranean area and the safeguard of the environment. The DELICIOUS project aims to promote healthy lifestyles among children and adolescents by implementing activities and tools to increase the adherence to the Mediterranean diet with an attention to the environmental impacts of dietary habits. The DELICIOUS project as a single-arm, uncontrolled behavioral intervention program providing formal and non-formal education activities, development of new snacks and recipe reformulation, web/mobile app development, and physical activities to school children and adolescents in five European countries. Over 2000 families joined a preliminary survey to investigate potential determinants of adherence to a healthy diet. Children and adolescents recruited from schools in the parterns’ countries are now currently being recruited to participate to the intervention activities. A web application for school canteen and a mobile application for parents have been developed to help both schools and families to track and provide healthy and sustainable meals. The project aims to increase awareness of the nutritional benefits and the sustainability aspects of the Mediterranean Diet and to promote consumers’ empowerment through an online platform for sustainable and healthy meal planning in the school canteen.

Intersectional inequality through economic difficulties and lifestyle on body mass index in Sweden

Abstract Background A high body mass index (BMI) is listed among the top five risk factors for the Swedish population. Socially disadvantaged groups, including women, low-educated, and immigrants, are even at higher risk of a high BMI who may also face economic constraints, physical inactivity, and poor-quality diets. However, complex intersectional transmission of inequalities to BMI remains unexplored. Therefore, we aimed to examine intersectional inequalities in BMI mediated by economic strain and lifestyle in the Swedish population. Methods By using the Health on Equal Terms cross-sectional surveys in 2016, 2018, 2020, and 2021 in the Swedish population (n = 44,177 inhabitants aged 24 and over), we performed an intersectional mediation analysis to estimate how inequalities across intersectional strata, by gender (women or men), education (primary, secondary or university), and migration status (Swedish native or migrant), may be sequentially transmitted through economic strain (yes or not in the last 12 months) and unhealthy lifestyle (physical inactivity or inadequate fruit/vegetables consumption) to BMI (continuous). Results Compared with high-educated native men, socially disadvantaged strata experienced more economic strain, which in turn led to poorer health-related lifestyles and ultimately to a higher BMI. Some strata such as high-educated women, despite having a lower BMI, still experienced more pronounced transmissions of inequality on BMI through economic difficulties. Conclusions Not only inequalities in BMI, but also the material and behavioral pathways underpinning the inequalities, act by intersectional patterns. Public health interventions should ensure adequate economic resources to access healthy food and physical activity across all social strata groups. Key messages • Intersectional inequalities in BMI were driven by economic strain and lifestyle. • Economic strain and poorer lifestyles were not only more prevalent in lower stratus but also more detrimental.

Factors associated with major adverse cardiovascular events among Arabs and Jews in Israel: a population-based cohort study

Abstract Introduction Arabs in Israel are at higher risk of cardiovascular mortality; however, there are no data on factors associated with disparities in major adverse cardiovascular events (MACE) incidence among Arabs and Jews. Purpose To study factors associated with MACE incidence among Arabs and Jews in Israel. Materials and Methods This is a cohort study carried out in urban localities of Hadera District in Israel. The study sample included 1,100 participants, stratified in equal numbers by ethnicity (Arab and Jewish), sex, and five 10-year age group (mean age: 51 years, range: 26-77). Data collected via in-person interviews conducted between 2001-2006 included socio-demographic characteristics and health-related behaviors (smoking, physical activity, and diet). Data on baseline diabetes, hypertension, dyslipidemia, and cardiovascular disease were collected from interviews and participants' health records. Information on MACE occurring during follow-up was determined based on hospital discharge diagnoses, recorded in the Israel Ministry of Health hospital admission database. MACE was defined as an acute coronary, cerebrovascular or peripheral artery event, or invasive procedure for its treatment. Factors associated with the time to first MACE were tested in Cox proportional hazards models. Sensitivity analysis included death from any cause as a competing risk, using Fine and Gray’s model. Results During a median follow-up period of 20 years, there were 221 first MACE during follow-up; 91 among Jewish participants and 130 among Arab participants, hazard ratio (HR) Arab vs. Jewish: 1.59; 95% confidence interval (CI) 1.22, 2.09, adjusted for age and sex. Arab ethnicity was no longer significantly associated with MACE, following further adjustment for years of education; HR: 1.32; 95%CI 0.95, 1.84. The HR (95%CI) associated with ethnicity after additional adjustment for health-related behaviors, body weight and baseline chronic morbidity was 1.02 (95%CI: 0.73, 1.42). A subgroup analysis among 950 participants, who did not have a baseline diagnosis of cardiovascular disease, produced similar results. These participants experience 147 first MACE during follow-up. The age and sex-adjusted HR (95%CI) associated with Arab ethnicity was 1.72 (1.23, 2.40), compared to 1.08 (0.72, 1.64) in a fully adjusted model. Competing risk analysis did not materially change these results. Conclusions Arabs in Israel are at higher risk for MACE. Lower socioeconomic position and higher prevalence of unhealthy lifestyle and cardiovascular risk factors may explain the excess risk of MACE among Arabs. Improving cardiovascular health among Arabs should consider social determinants of health and cultural aspects.

Relationship between Lifestyle and Stress Levels in Hypertension Patients

Hypertension is a disease that often occurs with increasing age. Hypertension can be influenced by lifestyle factors and stress. This study aims to see the relationship between lifestyle and stress levels in hypertensive patients. The research method used a cross-sectional design with 70 samples in hypertensive patients at KRMT Wongsonegoro Hospital Semarang. Data were collected using a questionnaire. Data analysis used the Spearman rank correlation test to determine how the two variables relate. The results showed a significant relationship between lifestyle and stress levels in hypertensive patients (r = - 0.263, p <0.028). In this study, there were respondents whose unhealthy lifestyles tended to cause blood pressure to rise, causing stress.

Beyond the change: exploring age of menopause, lifestyle, and cardiovascular risk in women

Abstract Background Premature/early menopause increases the risk of future cardiovascular disease (CVD); however, whether lifestyle can offset this risk is unknown. Purpose Investigate the association between premature/early menopause and incident CVD and whether a healthy lifestyle modifies this association. Methods The 45 and Up Study prospectively recruited participants aged ≥45 years (n=267,357) between 2005-2009. Our study included women without prior CVD and those reporting menopausal age at baseline. Primary outcome was incident CVD (self-reported heart disease/stroke) based on survey data1 at Wave 2 (2012-2015) and/or Wave 3 (2018-2020). Logistic regression models assessed associations of premature (age <40 years) and early (age 40-44 years) menopause with CVD, compared to standard menopause (age 50-52 years), adjusting for sociodemographic and clinical variables. Healthy lifestyle adherence was assessed using a score of five factors: smoking, physical activity, sitting, sleep, and diet. Interaction effects were analysed between menopause and healthy lifestyle adherence on CVD. Results We included 46,273 women (mean age 62.1±8.2 years), with 5,425(11.7%) incident CVD over 15-year follow-up. After adjustment, the CVD risk was higher in women with premature menopause (odds ratio (OR): 1.36, 95% confidence intervals (CI), 1.17-1.59; p<0.0001) and early menopause (OR: 1.15, 95% CI, 1.03-1.28; p=0.013) compared to standard menopause. Among all menopausal women, high versus low healthy-lifestyle adherence led to 20% lower CVD risk (OR: 0.80, 95% CI, 0.71-0.90; p=0.0003). In the subset of high-risk women with premature menopause, high versus low healthy lifestyle adherence led to 50% lower risk of CVD (OR: 0.50, 95% CI, 0.31-0.80, p=0.0040). The healthy lifestyle effect was not significantly different across menopause groups (p=0.71). Conclusion Early and premature menopause were independently associated with increased CVD risk. Healthy versus unhealthy lifestyle significantly attenuated the risk of CVD in all menopausal women, particularly in the highest risk group of women with premature menopause, reducing this risk by 50%. 1 Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE).

An observational study in Roma women in Greece: measuring health factors in an understudied group

Abstract Background The Roma have always been one of the most vulnerable and at the same time understudied minority groups in Europe, living under difficult conditions and experiencing discrimination. The aim of the present work was to summarize the health and lifestyle profile of Roma women living in various regions of Greece. Methods A multi-center, observational study was implemented in April-June 2022, in the context of a national program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach”. Roma women, living in 5 areas of Greece, and health professionals working with Roma groups were considered as eligible to participate. A two-step, methodological approach was followed: a. qualitative study with Focus Groups and b. questionnaire-based survey. Results In total, n = 41 participants in FGs, and n = 99 responders in survey were recorded. 40% of participants were smokers (>10-15 cigarettes/day). Main quitting reasons, were “to set a good example and cost’. Increased consumption of ultra-processed foods and beverages, low plant-based foods intake, frequent breakfast omission and eating-out were reported by the vast majority of participants. Only 15% of responders had undergone typical, gynecological, screening tests while 1 in 5 responders used contraception. Regarding vaccinations, even if about 8 in 10 women seemed to comply with the obligatory vaccines for their children, a high vaccination reluctancy in 70% of the study sample was recorded in case of vaccination in adulthood. Conclusions This study stands one of the very few that underscore the vulnerability of Roma women in terms of poor health literacy, unhealthy lifestyle behaviours and low motivation to typical preventive measures. Improving access to primary health care services and tailored, culturally sensitive training is crucial. Key messages • Social inclusion of the increasing population of Roma women is crucial. • Health promotion, taking into consideration Roma women’s special needs, shall be a decisive factor of this process.