1
|
Genovesi S, Vania A, Caroli M, Orlando A, Lieti G, Parati G, Giussani M. Non-Pharmacological Treatment for Cardiovascular Risk Prevention in Children and Adolescents with Obesity. Nutrients 2024; 16:2497. [PMID: 39125377 PMCID: PMC11314452 DOI: 10.3390/nu16152497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
In younger generations, excess weight has reached very alarming levels. Excess weight in adults is associated with increased mortality and morbidity from cardiovascular disease. However, it is not easy to distinguish to what extent these effects are the result of obesity itself or how much is due to the various cardiovascular risk factors that often accompany excess weight. Several risk factors, such as hypertension, dyslipidemia, hyperuricemia, glucose intolerance, and type 2 diabetes mellitus, are already present in pediatric age. Therefore, early intervention with the goal of correcting and/or eliminating them is particularly important. In the child and adolescent with obesity, the first approach to achieve weight reduction and correct the risk factors associated with severe excess weight should always be non-pharmacologic and based on changing poor eating habits and unhealthy lifestyles. The purpose of this review is to give an update on non-pharmacological interventions to be implemented for cardiovascular prevention in children and adolescents with obesity, and their effectiveness. In particular, interventions targeting each individual cardiovascular risk factor will be discussed.
Collapse
Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| | | | | | - Antonina Orlando
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| | - Giulia Lieti
- UO Nefrologia e Dialisi, ASST-Rhodense, 20024 Garbagnate Milanese, Italy;
| | - Gianfranco Parati
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy;
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| | - Marco Giussani
- Istituto Auxologico Italiano, IRCCS, 20145 Milano, Italy; (A.O.); (M.G.)
| |
Collapse
|
2
|
Poursalehi D, Lotfi K, Shahdadian F, Hajhashemy Z, Rouhani P, Saneei P. Dietary intake of methyl donor nutrients in relation to metabolic health status, serum levels of brain-derived neurotrophic factor and adropin. Clin Nutr 2024; 43:1353-1362. [PMID: 38677046 DOI: 10.1016/j.clnu.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/23/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND AND AIMS There is a lack of evidence on dietary intake of methyl donor nutrients with metabolic health status and related biomarkers. Thus, this study aimed to assess the relation between methyl donor nutrients intake and metabolic health status with regarding the interactive roles of brain-derived neurotrophic factor (BDNF) and adropin in Iranian adults. METHODS This cross-sectional survey was conducted among 527 Iranian adults (45.7% female) selected by multistage cluster random-sampling method. A validated food frequency questionnaire was used to evaluate participants' dietary intake. Metabolic unhealthy status was defined by Wildman criteria as having ≥ 2 of hyperglycemia, hypertriglyceridemia, hypo-HDL-cholesterolemia, hypertension, chronic inflammation, and insulin resistance. Concentrations of metabolic parameters, BDNF and adropin were determined using fasting blood samples. RESULTS An inverse association was found between methyl donor nutrients intake and metabolically unhealthy status in multivariable-adjusted model (ORT3 vs. T1 = 0.30; 95%CI: 0.12-0.75). This association was especially significant among overweight/obese adults and was stronger in women. Additionally, consumption of vitamin B6 and choline was separately related to reduced odds of metabolically unhealthy status. Methyl donor intake was not significantly related to low BDNF (ORT3 vs. T1 = 0.93; 95%CI: 0.60-1.44) and adropin (ORT3 vs. T1 = 0.71; 95%CI: 0.44-1.15). However, the interaction between high methyl donor nutrients intake and high BDNF was related to lower odds of metabolically unhealthy status in multivariable-adjusted model (ORMDNS∗BDNF = 0.27; 95%CI: 0.11-0.67). CONCLUSION Higher intake of methyl donor nutrients, alone and in interaction with BDNF levels, was associated with decreased odds of metabolically unhealthy status in Iranian adults.
Collapse
Affiliation(s)
- Donya Poursalehi
- Students' Scientific Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Keyhan Lotfi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Shahdadian
- Department of Clinical Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Hajhashemy
- Isfahan University of Medical Sciences, Isfahan, Iran; Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Rouhani
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
3
|
Kiærbech H, Broderstad AR, Silviken A, Lorem GF, Kristiansen RE, Spein AR. The association of religious factors with mental health-service utilisation and satisfaction in a mixed Sámi and Norwegian adult population: Adopting the SAMINOR 2 Questionnaire Survey. Int J Circumpolar Health 2023; 82:2223422. [PMID: 37331011 DOI: 10.1080/22423982.2023.2223422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
The Indigenous Sámi have poorer mental health than the majority population and fairly equal access to professional mental healthcare. Despite this condition, certain studies indicate that this group is underrepresented among the users of such services. Religion or spirituality (R/S) often influences mental health-service utilisation and satisfaction among other Indigenous peoples and ethnic minorities. Thus, this study examines the situation in Sámi-Norwegian areas. We utilised cross-sectional data from the population-based SAMINOR 2 Questionnaire Survey (2012; subsample n = 2,364; 71% non-Sámi) in mixed Sámi-Norwegian regions of Northern and Central Norway. We analysed the associations between R/S factors and past-year mental health-service utilisation and satisfaction among individuals reporting mental health problems, substance use, or addictive behaviours. Multivariable-adjusted regression models considering sociodemographic factors, including Sámi ethnicity, were applied. Religious attendance was significantly associated with infrequent past-year use of mental health services (OR = 0.77) and fewer mental health problems, indicating that the R/S fellowship may buffer mental distress and represent an alternative psychological support to professional services. R/S was not significantly associated with lifetime mental health-service satisfaction. We found no ethnic differences in service utilisation or satisfaction.
Collapse
Affiliation(s)
- Henrik Kiærbech
- Mental Health and Addiction Clinic, Nordland Hospital Trust, Bodø, Norway
- Mental Health and Addiction Clinic, Finnmark Hospital Trust, Alta, Norway
| | - Ann Ragnhild Broderstad
- Centre for Sámi Health Research, UiT - the Arctic University of Norway (UiT), Tromsø, Norway
| | - Anne Silviken
- Centre for Sámi Health Research, UiT - the Arctic University of Norway (UiT), Tromsø, Norway
- Sámi Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS), Finnmark Hospital Trust, Karasjok, Norway
| | | | - Roald E Kristiansen
- Department of Archaeology, History, Religious Studies, and Theology, UiT, Tromsø, Norway
| | - Anna Rita Spein
- Centre for Sámi Health Research, UiT - the Arctic University of Norway (UiT), Tromsø, Norway
- Sámi Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS), Finnmark Hospital Trust, Karasjok, Norway
| |
Collapse
|
4
|
Liu Y, Douglas PS, Lip GYH, Thabane L, Li L, Ye Z, Li G. Relationship between obesity severity, metabolic status and cardiovascular disease in obese adults. Eur J Clin Invest 2023; 53:e13912. [PMID: 36424669 DOI: 10.1111/eci.13912] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/06/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence about the associations between obesity severity, metabolic status and risk of incident cardiovascular disease (CVD) in adults with obesity remains limited. METHODS The study included 109,301 adults with obesity free of prior CVD based on the UK Biobank cohort. Metabolic status was categorized into metabolically healthy obesity (MHO; free of hypertension, hypercholesterolemia and diabetes) and metabolically unhealthy obesity (MUO). Obesity severity was classified into three levels: class I (body mass index of 30.0-34.9 kg/m2 ), II (35.0-39.9) and III (≥40.0). Cox proportional hazards models were used for analyses. RESULTS There were 8059 incident CVD events during a median follow-up of 8.1 years. MUO was significantly associated with a 74% increased CVD risk compared with MHO (HR = 1.74, 95% CI: 1.62-1.83). There was a significant interaction between obesity severity and metabolic status on an additive scale regarding CVD risk. When taking class I obesity as reference, class II was nonsignificantly associated with an increased risk of CVD in the MHO group (HR = 1.07, 95% CI: 0.90-1.27), while class III was significantly related to increased risks of CVD (HR = 1.48, 95% CI: 1.12-1.96). In the MUO group, both classes II and III were significantly related to increased risks of CVD. Significant subgroup effects of age (p = .009) and sex (p = .047) were observed among participants with MUO but not in the MHO group. CONCLUSIONS Both elevated obesity severity and MUO were significantly associated with increased risks of CVD in adults with obesity, while metabolic status could modify the relationship between obesity severity and CVD risk. More research is needed to further clarify the relationship.
Collapse
Affiliation(s)
- Yingxin Liu
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, North Carolina, Durham, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zebing Ye
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| |
Collapse
|
5
|
The effects of a 5-year physical activity on prescription (PAP) intervention in patients with metabolic risk factors. PLoS One 2022; 17:e0276868. [PMID: 36315564 PMCID: PMC9621409 DOI: 10.1371/journal.pone.0276868] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients' PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare. METHODS This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27-85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes. RESULTS The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary. CONCLUSION This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.
Collapse
|
6
|
Masi D, Risi R, Biagi F, Vasquez Barahona D, Watanabe M, Zilich R, Gabrielli G, Santin P, Mariani S, Lubrano C, Gnessi L. Application of a Machine Learning Technology in the Definition of Metabolically Healthy and Unhealthy Status: A Retrospective Study of 2567 Subjects Suffering from Obesity with or without Metabolic Syndrome. Nutrients 2022; 14:nu14020373. [PMID: 35057554 PMCID: PMC8779369 DOI: 10.3390/nu14020373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
The key factors playing a role in the pathogenesis of metabolic alterations observed in many patients with obesity have not been fully characterized. Their identification is crucial, and it would represent a fundamental step towards better management of this urgent public health issue. This aim could be accomplished by exploiting the potential of machine learning (ML) technology. In a single-centre study (n = 2567), we used an ML analysis to cluster patients with metabolically healthy (MHO) or metabolically unhealthy (MUO) obesity, based on several clinical and biochemical variables. The first model provided by ML was able to predict the presence/absence of MHO with an accuracy of 66.67% and 72.15%, respectively, and included the following parameters: HOMA-IR, upper body fat/lower body fat, glycosylated haemoglobin, red blood cells, age, alanine aminotransferase, uric acid, white blood cells, insulin-like growth factor 1 (IGF-1) and gamma-glutamyl transferase. For each of these parameters, ML provided threshold values identifying either MUO or MHO. A second model including IGF-1 zSDS, a surrogate marker of IGF-1 normalized by age and sex, was even more accurate with a 71.84% and 72.3% precision, respectively. Our results demonstrated high IGF-1 levels in MHO patients, thus highlighting a possible role of IGF-1 as a novel metabolic health parameter to effectively predict the development of MUO using ML technology.
Collapse
Affiliation(s)
- Davide Masi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
- Correspondence: ; Tel.: +39-06-499-707-16
| | - Renata Risi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
- MRC Metabolic Diseases Unit, MRC Institute of Metabolic Science, University of Cambridge, Cambridge CB2 1TN, UK
| | - Filippo Biagi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
| | - Daniel Vasquez Barahona
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
| | - Mikiko Watanabe
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
| | | | | | | | - Stefania Mariani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
| | - Carla Lubrano
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
| | - Lucio Gnessi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy; (R.R.); (F.B.); (D.V.B.); (M.W.); (S.M.); (C.L.); (L.G.)
| |
Collapse
|