Long-term trends in the body mass index and obesity risk in Estonia: an age-period-cohort approach

Weight, weight gain and behavioural risk factors in women attending a breast cancer family history, risk and prevention clinic: an observational study

BACKGROUND

Weight and health behaviours impact on breast cancer risk. We describe trends in weight and health behaviours in women at entry to a specialist breast cancer family history clinic in Manchester, UK, and changes after clinic entry.

METHODS

Questionnaires were completed at clinic entry (1987-2019, n = 10,920), and updated in 2010-11 (n = 3283). Clinic entry characteristics were compared between joining periods 1989-98, 1999-2008 and 2009-18. Partial Least Squares analysis characterised trends in weight, smoking and alcohol intake by age at entry, year of entry and birth year. Weight changes were compared over time, between joining periods.

RESULTS

Obesity at clinic entry increased from 10.6% in 1989-98 to 20.5% in 2009-18. Alcohol intake above recommendations and smoking prevalence decreased from 20.1% to 13.8% and 33.5% to 16.1% respectively. Weight gain was median 9.7 (IQR 1.4-20.6) % between age 20 and clinic entry (mean duration 11.9 ± 5.6 years) and a further 4.5 (0.0-12.5) % between clinic entry and 2010-11 (31.1 ± 10.4 years). Weight gain between age 20 and clinic entry was highest in the most recent joining period.

CONCLUSIONS

Obesity and weight gain are common in women attending a breast cancer family history clinic suggesting a need for weight management advice and support.

An age-period-cohort approach to studying long-term trends in obesity and overweight in England (1992-2019)

OBJECTIVE

This study aims to understand long-term trends in obesity and overweight in England by estimating life-course transitions as well as historical and birth cohort trends for both children and adults.

METHODS

Data on individuals aged 5 to 85 years old from the Health Survey for England were used, covering the period 1992 to 2019 and birth cohorts born between 1909 and 2013. Individual BMI values were classified as healthy weight, overweight, or obesity. Trends were compared, and an age-period-cohort model was estimated using logistic regression and categorical age, period, and cohort groups.

RESULTS

There was significant variation in age trajectories by birth cohorts for healthy weight and obesity prevalence. The odds of having obesity compared with a healthy weight increased consistently with age, increased throughout the study period (but faster between 1992 and 2001), and were higher for birth cohorts born between 1989 and 2008. The odds of having overweight showed an inverted U-shape among children, increased through adulthood, have been stable since 2012, and were considerably higher for the youngest birth cohort (2009-2013).

CONCLUSIONS

Younger generations with higher overweight prevalence coupled with increasing obesity prevalence with age suggest that obesity should remain a high priority for public health policy makers in England.

Association of Impulsivity With Food, Nutrients, and Fitness in a Longitudinal Birth Cohort Study

BACKGROUND

Impulsivity is a psychiatric vulnerability factor strongly associated with substance abuse but also with unhealthy diet. Whether these associations extend to specific nutrients is largely unknown. Therefore, we investigated the longitudinal association between diet, cardiorespiratory fitness, and 2 impulsivity dimensions in a representative sample of south Estonian adolescents and young adults. Impulsivity and dietary intake were measured 3 times in 2 birth cohorts at regular intervals in individuals aged 15 to 33 years.

METHODS

The sample included 2 birth cohorts of the longitudinal Estonian Children Personality Behaviour and Health Study. The analytic sample size consisted of 2883 observations (56.4% females). The primary outcomes were adaptive and maladaptive impulsivity scores measured by an original 24-item Likert-type questionnaire. Impulsivity scores were predicted from the food diaries data converted into nutrient categories. A linear mixed-effects approach was used to model the time dependence between observations.

RESULTS

Lower maladaptive impulsivity was associated with higher cardiorespiratory fitness (β = -.07; 95% CI = -0.12; -0.03). Higher maladaptive impulsivity was associated with lower dietary intake of zinc (β = -.10; -0.15; -0.06) and vegetables (β = -.04; -0.07; -0.01) and higher intake of sodium (β = .06; 0.02; 0.10). Vitamin B6 was positively associated with adaptive impulsivity (β = .04; 0.01; 0.07). Additionally, some of the adjusted models showed significant but weak associations with selenium, alcohol, fish, and cereal products.

CONCLUSIONS

Food choice may affect the neurochemistry and therefore regulate the manifestations of impulsivity. We identified associations between several (micro)nutrients and maladaptive impulsivity.

Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke

Background and aims

The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries.

Methods

This study includes ischemic stroke patients aged 18-54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed.

Results

A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8-8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1-3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8-21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2-6), stroke was more severe in men (p = .05).

Conclusions

Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.