Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort

Clusters and associations of adverse neonatal events with adult risk of multimorbidity: A secondary analysis of birth cohort data

OBJECTIVE

To investigate associations between clustered adverse neonatal events and later-life multimorbidity.

DESIGN

Secondary analysis of birth cohort data.

SETTING

Prospective birth cohort study of individuals born in Britain in one week of 1970.

POPULATION

Respondents provided data at birth (n = 17,196), age 34 (n = 11,261), age 38 (n = 9,665), age 42 (n = 9,840), and age 46 (n = 8,580).

METHODS

Mixed components analysis determined included factors, 'Birthweight'; 'Neonatal cyanosis'; 'Neonatal cerebral signs'; 'Neonatal illnesses'; 'Neonatal breathing difficulties'; and 'Prolonged duration to establishment of respiratory rate at birth', within the composite adverse neonatal event score. Log-binomial regression quantified the unadjusted and covariate-adjusted (paternal employment status and social class; maternal smoking status; maternal age; parity; cohort member smoking status and Body Mass Index) associations between the adverse neonatal event score and risk of multimorbidity in adulthood.

OUTCOME MEASURES

Multimorbidity at each adult data sweep, defined as the presence of two or more Long-Term Conditions (LTCs).

RESULTS

13.7% of respondents experienced one or more adverse neonatal event(s) at birth. The percentage reporting multimorbidity increased steadily from 14.6% at age 34 to 25.5% at age 46. A significant association was only observed at the 38 years sweep; those who had experienced two or more adverse neonatal events had a 41.0% (95% CI: 1.05 - 1.88) increased risk of multimorbidity, compared to those who had not suffered any adverse neonatal events at birth. This association was maintained following adjustment for parental confounders and adult smoking status.

CONCLUSIONS

Adverse neonatal events at birth may be independently associated with the development of midlife multimorbidity. Programmes and policies aimed at tackling the growing public health burden of multimorbidity may also need to consider interventions to reduce adverse neonatal events at birth.

Prevalence and risk factors of the most common multimorbidity among Canadian adults

BACKGROUND

The number of persons living with multimorbidity-defined as the co-occurrence of at least two chronic conditions in the same individual-is growing globally, especially in developed countries. Traditionally, this increase has been attributed to a growing aging population, sedentary lifestyle, obesity, low socioeconomic status, and individual genetic susceptibility.

OBJECTIVE

To investigate the prevalence and associated risk factors of the most common multimorbidity (MCM) among Canadian middle-aged and older adults.

METHOD

Relevant data on all 30,097 middle-aged and older Canadian adults (aged 45 to 85 years) from the Canadian Longitudinal Study on Aging were used for this study. To identify the specific sociodemographic risk factors associated with the MCM, we used survey-specific logistic regression.

FINDINGS

Overall, co-occurrence of osteoarthritis and hypertension was identified as the MCM among Canadian adults aged 45+ with an estimated prevalence of 16.5%. The results from multivariate analysis showed that seven factors were significantly associated with increased odds of the MCM, which included increasing age, being retired from work (retired vs not retired), poorer rating of perceived health, (very good, good, poor vs excellent), increasing problems with sleep quality (satisfied, dissatisfied vs neutral), and abnormal body-mass index (underweight, overweight, obese vs normal). Also, residents in other urban centres had significantly lower odds than those in urban core. Persons living in Atlantic Canada, Ontario and Quebec were at increased odds of having the MCM compared to those in British Columbia. The odds of the MCM associated with increasing age was significantly higher among Females (OR = 1.12, 95% CI = 1.11-1.13) than Males (OR = 1.08, 95% CI = 1.07-1.10).

CONCLUSION

Multimorbidity is a common feature among Canadian adults. The identification of the most prevalent patterns and associated risk factors in this study provides fresh insights into the etiology, progression, and possible prevention of the MCM among Canadian adults.

Cohort profile: creation of the SAIL MELD-B e-cohort (SMC) and SAIL MELD-B children and young adult e-cohort (SMYC) to investigate the lived experience of the 'burdensomeness' of multimorbidity

PURPOSE

We have established the SAIL MELD-B electronic cohort (e-cohort SMC) and the SAIL MELD-B children and Young adults e-cohort (SMYC) as a part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) project. Each cohort has been created to investigate and develop a deeper understanding of the lived experience of the 'burdensomeness' of multimorbidity by identifying new clusters of burdensomeness concepts, exploring early life risk factors of multimorbidity and modelling hypothetical prevention scenarios.

PARTICIPANTS

The SMC and SMYC are longitudinal e-cohorts created from routinely collected individual-level population-scale anonymised data sources available within the Secure Anonymised Information Linkage (SAIL) Databank. They include individuals with available records from linked health and demographic data sources in SAIL at any time between 1 January 2000 and 31 December 2022. The SMYC e-cohort is a subset of the SMC, including only individuals born on or after the cohort start date.

FINDINGS TO DATE

The SMC and SMYC cohorts include 5 180 602 (50.3% female and 49.7% male) and 896 155 (48.7% female and 51.3% male) individuals, respectively. Considering both primary and secondary care health data, the five most common long-term conditions for individuals in SMC are 'Depression', affecting 21.6% of the cohort, 'Anxiety' (21.1%), 'Asthma' (17.5%), 'Hypertension' (16.2%) and 'Atopic Eczema' (14.1%) and the five most common conditions for individuals in SMYC are 'Atopic Eczema' (21.2%), 'Asthma' (11.6%), 'Anxiety' (6.0%), 'Deafness' (4.6%) and 'Depression' (4.3%).

FUTURE PLANS

The SMC and SMYC e-cohorts have been developed using a reproducible, maintainable concept curation pipeline, which allows for the cohorts to be updated dynamically over time and manages for the request and processing of further approved long-term conditions and burdensomeness concepts extraction. Best practices from the MELD-B project can be utilised across other projects, accessing similar data with population-scale data sources and trusted research environments.

Effect of different forms of high-intensity interval training on V̇O2max, strength, flexibility, and body fat percentage among middle-aged males

BACKGROUND

High-intensity interval training (HIIT) has become a popular exercise approach due to its potential to elicit significant physiological adaptations. However, limited research has compared the effects of different HIIT modalities on fitness parameters in middle-aged males. This study aimed to determine the effect of different HIIT on V̇O2max, strength, flexibility, and body fat percentage among middle-aged males.

METHODS

Thirty sedentary males aged 40-50 years were randomly assigned to HIIT-Weight Training Circuit (WTC), HIIT-Shuttle Run (SR), or HIIT-Bodyweight Exercise (BWE) groups. Training consisted of 20 sessions over 5 weeks of 4×4 minutes at 90-95% HRmax with 3 minutes recovery at 70% HRmax between intervals. Outcome measures including V̇O2max, strength, flexibility, and body fat percentage were assessed pre- and postintervention.

RESULTS

The result for the Two-Way Mixed ANOVA indicated there was no significant interaction effect between the three training groups. There was no significant main effect for the three training groups, whereas there was a significant effect for the repeated measure time existed. A significant improvement in V̇O2max, strength, flexibility has been shown between post-test and pre-test for the HIIT-SR, HIIT-WTC, and HIIT-BWE group. Whereas A significant decrease has been shown between post and pretest for all the groups in body fat percentage.

CONCLUSIONS

This research findings suggested that different forms of HIIT can elicit differential adaptation in middle-aged males. Incorporating different form of HIIT as HITT-SR, HITT-WTC, and HITT-BWE into exercise program may be an effective way to systematically improve V̇O2max, strength, flexibility, and body composition in middle-age male population. These findings provide guidance on HIIT prescription according to fitness goals.

Mapping domains of early life determinants of future multimorbidity across three UK longitudinal cohort studies

Many studies use a reductionist approach to isolate the influence of one factor in childhood on multimorbidity rather than consider the combined effect of wider determinants. We explored how potential multiple early life determinants of multimorbidity can be characterised across three UK cohort studies. We used the National Child Development Study (NCDS), the 1970 British Cohort Study (BCS70), and the Aberdeen Children of the 1950s Study (ACONF) to identified early life variables that fit into 12 conceptualised domains of early life determinants of multimorbidity. Variables were assigned into 12 domains; principal component analysis reduced the dimensionality of the data and structured variables into subgroups. The data audit identified 7 domains in ACONF, 10 domains in NCDS and 12 domains in BCS70. Dominant components included maternal fertility histories within the prenatal, antenatal and birth domain, long-term illnesses within the child health domain, educational ability within the child education and health literacy domain, ethnicity within the demography domain, parental health behaviours within the transgenerational domain, housing within the socioeconomic domain and parental-child interactions within the parental-family domain. We demonstrated that if multiple large scale longitudinal studies are used, there is enough data available for researchers to consider conceptualising early life risk factors of multimorbidity across groups or domains. Such conceptualisation can help challenge the existing understanding of disease aetiology and develop new ideas for prevention of multimorbidity.

Midlife health in Britain and the United States: a comparison of two nationally representative cohorts

BACKGROUND

Older adults in the USA have worse health and wider socioeconomic inequalities in health compared with those in Britain. Less is known about how health in the two countries compares in mid-life, a time of emerging health decline, including inequalities in health.

METHODS

We compare measures of current regular smoking status, obesity, self-rated health, cholesterol, blood pressure and glycated haemoglobin using population-weighted modified Poisson regression in the 1970 British Cohort Study (BCS70) in Britain (N = 9665) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the USA (N = 12 300), when cohort members were aged 34-46 and 33-43, respectively. We test whether associations vary by early- and mid-life socioeconomic position.

RESULTS

US adults had higher levels of obesity, high blood pressure and high cholesterol. Prevalence of poor self-rated health and current regular smoking was worse in Britain. We found smaller socioeconomic inequalities in mid-life health in Britain compared with the USA. For some outcomes (e.g. smoking), the most socioeconomically advantaged group in the USA was healthier than the equivalent group in Britain. For other outcomes (hypertension and cholesterol), the most advantaged US group fared equal to or worse than the most disadvantaged groups in Britain.

CONCLUSIONS

US adults have worse cardiometabolic health than British counterparts, even in early mid-life. The smaller socioeconomic inequalities and better overall health in Britain may reflect differences in access to health care, welfare systems or other environmental risk factors.

"Spine to the future"-A narrative review of anatomy engagement

Anatomy has been integral to medical and health education for centuries, it has also had a significant role in wider public life, as an educational resource, a link to their health, and also as a darker deterrent. Historically, public engagement in anatomy is hallmarked by public dissections of convicted criminals across the globe. Artists, specifically non-medical men, such as Leonardo da Vinci, are reported to have participated in public dissection. Dissection would later rekindle public interest in anatomy as graverobbing led to the reform and regulation of anatomy in many countries. In recent years, there has been growing interest from the public in learning more about their bodies as health and well-being become of paramount importance, particularly following the COVID-19 pandemic. Anatomy sits in a prime position to direct and instigate conversations around health, well-being, and body image. Every human on earth possesses a perfect resource to look at and learn about. Models, art-based anatomical activities, and crafts provide active learning opportunities for the wider public around anatomy. Most recently, apps, games, and extended reality provide novel and insightful learning opportunities for the public relating to the body. Finally, training and resources must also be made available from institutions and professional bodies to anatomists to enable them to deliver engagement in an already congested and educationally heavy schedule. This resurgence of interest in anatomical public engagement sees anatomy re-enter the public spotlight, with more appropriate resources and educational settings to offer engagement with the aim of benefiting the public.

Longitudinal analysis of the Alternative Healthy Eating Index-2010 and incident non-communicable diseases over 15 years in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health

In studies that contain repeated measures of variables, longitudinal analysis accounting for time-varying covariates is one of the options. We aimed to explore longitudinal association between diet quality (DQ) and non-communicable diseases (NCDs). Participants from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were included, if they; responded to survey 3 (S3, 2003, aged 25-30 years) and at least one survey between survey 4 (S4, 2006) and survey 8 (S8, 2018), were free of NCDs at or before S3, and provided dietary data at S3 or S5. Outcomes were coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), diabetes mellitus (DM), depression and/or anxiety, and multimorbidity (MM). Longitudinal modelling using generalised estimation equation (GEE) approach with time-invariant (S4), time-varying (S4-S8) and lagged (S3-S7) covariates were performed. The mean (± standard deviation) of Alternative Healthy Eating Index-2010 (AHEI-2010) of participants (n = 8022) was 51·6 ± 11·0 (range: 19-91). Compared to women with the lowest DQ (AHEI-2010 quintile 1), those in quintile 5 had reduced odds of NCDs in time-invariant model (asthma: OR (95 % CI): 0·77 (0·62-0·96), time-varying model (HT: 0·71 (0·50-0·99); asthma: 0·62 (0·51-0·76); and MM: 0·75 (0·58-0·97) and lagged model (HT: 0·67 (0·49-0·91); and asthma: 0·70 (0·57-0·85). Temporal associations between diet and some NCDs were more prominent in lagged GEE analyses. Evidence of diet as NCD prevention in women aged 25-45 years is evolving, and more studies that consider different longitudinal analyses are needed.

Early growth, stress, and socioeconomic factors as predictors of the rate of multimorbidity accumulation across the life course: a longitudinal birth cohort study

BACKGROUND

Early growth, stress, and socioeconomic factors are associated with future risk of individual chronic diseases. It is uncertain whether they also affect the rate of multimorbidity accumulation later in life. This study aimed to explore whether early life factors are associated with the rate at which chronic diseases are accumulated across older age.

METHODS

In this national birth cohort study, we studied people born at Helsinki University Central Hospital, Helsinki, Finland between Jan 1, 1934, and Dec 31, 1944, who attended child welfare clinics in the city, and were living in Finland in 1971. Individuals who had died or emigrated from Finland before 1987 were excluded, alongside participants without any registry data and who died before the end of the registry follow-up on Dec 31, 2017. Early anthropometry, growth, wartime parental separation, and socioeconomic factors were recorded from birth, child welfare clinic, or school health-care records, and Finnish National Archives. International Classification of Diseases codes of diagnoses for chronic diseases were obtained from the Care Register for Health Care starting from 1987 (when participants were aged 42-53 years) until 2017. Linear mixed models were used to study the association between early-life factors and the rate of change in the number of chronic diseases over 10-year periods.

FINDINGS

From Jan 1, 1934, to Dec 31, 2017, 11 689 people (6064 [51·9%] men and 5625 [48·1%] women) were included in the study. Individuals born to mothers younger than 25 years (β 0·09; 95% CI 0·06-0·12), mothers with a BMI of 25-30 kg/m2 (0·08; 0·05-0·10), and mothers with a BMI more than 30 kg/m2 (0·26; 0·21-0·31) in late pregnancy accumulated chronic diseases faster than those born to older mothers (25-30 years) and those with a BMI of less than 25 kg/m2. Individuals with a birthweight less than 2·5 kg (0·17; 0·10-0·25) and those with a rapid growth in height and weight from birth until age 11 years accumulated chronic diseases faster during their life course. Additionally, paternal occupational class (manual workers vs upper-middle class 0·27; 0·23-0·30) and wartime parental separation (0·24; 0·19-0·29 for boys; 0·31; 0·25-0·36 for girls) were associated with a faster rate of chronic disease accumulation.

INTERPRETATION

Our findings suggest that the foundation for accumulating chronic diseases is established early in life. Early interventions might be needed for vulnerable populations, including war evacuee children and children with lower socioeconomic status.

FUNDING

Finska Läkaresällskapet, Liv och Hälsa rf, the Finnish Pediatric Research Foundation, and Folkhälsan Research Center.

TRANSLATIONS

For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

Midlife Health in Britain and the US: A comparison of Two Nationally Representative Cohorts

Background

Older adults in the United States (US) have worse health and wider socioeconomic inequalities in health compared to Britain. Less is known about how health in the two countries compares in midlife, a time of emerging health decline, including inequalities in health.

Methods

We compare measures of smoking status, alcohol consumption, obesity, self-rated health, cholesterol, blood pressure, and glycated haemoglobin using population-weighted modified Poisson regression in the 1970 British Cohort Study (BCS70) in Britain (N= 9,665) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the US (N=12,297), when cohort members were aged 34-46 and 33-43, respectively. We test whether associations vary by early- and mid-life socioeconomic position.

Findings

US adults had higher levels of obesity, high blood pressure and high cholesterol. Prevalence of poor self-rated health, heavy drinking, and smoking was worse in Britain. We found smaller socioeconomic inequalities in midlife health in Britain compared to the US. For some outcomes (e.g., smoking), the most socioeconomically advantaged group in the US was healthier than the equivalent group in Britain. For other outcomes (hypertension and cholesterol), the most advantaged US group fared equal to or worse than the most disadvantaged groups in Britain.

Interpretation

US adults have worse cardiometabolic health than British counterparts, even in early midlife. The smaller socioeconomic inequalities and better overall health in Britain may reflect differences in access to health care, welfare systems, or other environmental risk factors.

Funding

ESRC, UKRI, MRC, NIH, European Research Council, Leverhulme Trust.

Risk factors for multimorbidity in adulthood: A systematic review

BACKGROUND

Multimorbidity, the coexistence of multiple chronic diseases in an individual, is highly prevalent and challenging for healthcare systems. However, its risk factors remain poorly understood.

OBJECTIVE

To systematically review studies reporting multimorbidity risk factors.

METHODS

A PRISMA-compliant systematic review was conducted, searching electronic databases (MEDLINE, EMBASE, Web of Science, Scopus). Inclusion criteria were studies addressing multimorbidity transitions, trajectories, continuous disease counts, and specific patterns. Non-human studies and participants under 18 were excluded. Associations between risk factors and multimorbidity onset were reported.

RESULTS

Of 20,806 identified studies, 68 were included, with participants aged 18-105 from 23 countries. Nine risk factor categories were identified, including demographic, socioeconomic, and behavioral factors. Older age, low education, obesity, hypertension, depression, low pysical function were generally positively associated with multimorbidity. Results for factors like smoking, alcohol consumption, and dietary patterns were inconsistent. Study quality was moderate, with 16.2% having low risk of bias.

CONCLUSIONS

Several risk factors seem to be consistently associated with an increased risk of accumulating chronic diseases over time. However, heterogeneity in settings, exposure and outcome, and baseline health of participants hampers robust conclusions.

Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study

This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.

Clustering of adverse health and educational outcomes in adolescence following early childhood disadvantage: population-based retrospective UK cohort study

BACKGROUND

Disadvantage in early childhood (ages 0-5 years) is associated with worse health and educational outcomes in adolescence. Evidence on the clustering of these adverse outcomes by household income is scarce in the generation of adolescents born since the turn of the millennium. We aimed to describe the association between household income in early childhood and physical health, psychological distress, smoking behaviour, obesity, and educational outcomes at age 17 years, including the patterning and clustering of these five outcomes by income quintiles.

METHODS

In this population-based, retrospective cohort study, we used data from the Millennium Cohort Study in which individuals born in the UK between Sept 1, 2000, and Jan 1, 2002, were followed up. We collected data on five adverse health and social outcomes in adolescents aged 17 years known to limit life chances: psychological distress, self-assessed ill health, smoking, obesity, and poor educational achievement. We compared how single and multiple outcomes were distributed across early childhood quintile groups of income, as an indicator of disadvantage, and modelled the potential effect of three income-shifting scenarios in early childhood for reducing adverse outcomes in adolescence.

FINDINGS

We included 15 245 adolescents aged 17 years, 7788 (51·1%) of whom were male and 7457 (48·9%) of whom were female. Adolescents in the lowest income quintile group in childhood were 12·7 (95% CI 6·4-25·1) times more likely than those in the highest quintile group to have four or five adverse adolescent outcomes, with poor educational achievement (risk ratio [RR] 4·6, 95% CI 4·2-5·0) and smoking (3·6, 3·0-4·2), showing the largest single risk ratios. Shifting up to the second lowest, middle, and highest income groups would reduce multiple adolescent adversities by 4·9% (95% CI -23·8 to 33·6), 32·3% (-2·7 to 67·3), and 83·9% (47·2 to 120·7), respectively. Adjusting for parental education and single parent status moderately attenuated these estimates.

INTERPRETATION

Early childhood disadvantage is more strongly correlated with multiple adolescent adversities than any of the five single adverse outcomes. However, shifting children from the lowest income quintile group to the next lowest group is ineffective. Tackling multiple adolescent adversities requires managing early childhood disadvantage across the social gradient, with income redistribution as a central element of coordinated cross-sectoral action.

FUNDING

UK Prevention Research Partnership.

Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) - protocol for a research collaboration

Background

Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as 'early onset'). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled 'MELD-B' to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions.

Aim

Our aim is to identify critical periods in the lifecourse for prevention of early-onset, burdensome MLTC-M, identified through the analysis of birth cohorts and electronic health records, including artificial intelligence (AI)-enhanced analyses.

Design

We will develop deeper understanding of 'burdensomeness' and 'complexity' through a qualitative evidence synthesis and a consensus study. Using safe data environments for analyses across large, representative routine healthcare datasets and birth cohorts, we will apply AI methods to identify early-onset, burdensome MLTC-M clusters and sentinel conditions, develop semi-supervised learning to match individuals across datasets, identify determinants of burdensome clusters, and model trajectories of LTC and burden accrual. We will characterise early-life (under 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions. Finally, using AI and causal inference modelling, we will model potential 'preventable moments', defined as time periods in the life course where there is an opportunity for intervention on risk factors and early determinants to prevent the development of MLTC-M. Patient and public involvement is integrated throughout.

A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity

Objective

Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity.

Method

This work was conducted as part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) study. The conceptualisation of multimorbidity lifecourse determinant domains was shaped by a review of existing research evidence and policy, and co-produced with public involvement via two workshops.

Results

Early-life risk factors incorporate personal, social, economic, behavioural and environmental factors, and the key domains discussed in research evidence, policy, and with public contributors included adverse childhood experiences, socioeconomics, the social and physical environment, and education. Policy recommendations more often focused on individual-level factors as opposed to the wider determinants of health discussed within the research evidence. Some domains highlighted through our co-production process with public contributors, such as religion and spirituality, health screening and check-ups, and diet, were not adequately considered within the research evidence or policy.

Conclusions

This co-produced conceptualisation can inform research directions using primary and secondary data to investigate the early-life characteristics of population groups at risk of future multimorbidity, as well as policy directions to target public health prevention scenarios of early-onset multimorbidity.

Alternative Healthy Eating Index-2010 and Incident Non-Communicable Diseases: Findings from a 15-Year follow up of Women from the 1973–78 Cohort of the Australian Longitudinal Study on Women’s Health

Non-communicable diseases (NCDs) and multimorbidity (≥two chronic conditions), are increasing globally. Diet is a risk factor for some NCDs. We aimed to investigate the association between diet quality (DQ) and incident NCDs. Participants were from the Australian Longitudinal Study on Women’s Health 1973–78 cohort with no NCD and completed dietary data at survey 3 (2003, aged 25–30 years) who responded to at least one survey between survey 4 (2006) and survey 8 (2018). DQ was measured by the Alternative Healthy Eating Index-2010 (AHEI-2010). Outcomes included coronary heart disease (CHD), hypertension (HT), asthma, cancer (excluding skin cancer), diabetes mellitus (DM), depression and/or anxiety, multimorbidity, and all-cause mortality. Repeated cross-sectional multivariate logistic regressions were performed to investigate the association between baseline DQ and NCDs over 15 years. The AHEI-2010 mean (±sd) for participants (n = 8017) was 51.6 ± 11.0 (range: 19–91). There was an inverse association between AHEI-2010 and incident asthma at survey 4 (OR_Q5–Q1: 0.75, 95% CI: 0.57, 0.99). Baseline DQ did not predict the occurrence of any NCDs or multimorbidity between the ages of 25–45 years. Further well-planned, large prospective studies conducted in young women are needed to explore dietary risk factors before the establishment of NCDs.

The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group

Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.

Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study

OBJECTIVES

The prevalence of multiple long-term condition (LTC) multimorbidity is increasing with younger onset among socioeconomically deprived populations. Research on life course trajectories towards multimorbidity is limited and early-onset multimorbidity poorly characterised. Understanding sentinel conditions (the first LTC occurring in the life course), the sequence of LTC accrual and the permanency of the reporting of LTCs may help identify time points for prevention efforts. We used a longitudinal birth cohort to estimate the prevalence of a common three-condition early-onset multimorbidity (multiple long-term condition multimorbidity (MLTC-M)) group at midlife, describe the frequency of sentinel conditions, the sequence of LTC accrual and explore the permanency of one of these conditions: psychological distress.

SETTING

1970 British Cohort Study (BCS70).

PARTICIPANTS

17 196 cohort members born in 1970.

OUTCOME MEASURES

Prevalence of the most common three-condition multimorbidity group at age 46. The nature and timing of sentinel conditions, the sequencing patterns of subsequent LTC accrual and the permanency of the reporting of psychological distress.

RESULTS

At age 46 high blood pressure, psychological distress and back pain were the most common three-condition MLTC-M group, (4.3%, n=370). A subgroup of 164 (44.3%) people provided complete information on LTC across all time points. Psychological distress measured by the Malaise Index was the most common sentinel condition, occurring in 25.0% (n=41), followed by back pain (22%, n=36). At age 26, 45.1% (75/164) reported their sentinel condition. The most common sequence of LTC accrual was the co-reporting of psychological distress and back pain followed by high blood pressure. Almost one-third (30.5%, n=50) reported a variation of psychological distress across the adult life course.

CONCLUSION

In these exploratory analyses, psychological distress and back pain were the most common sentinel conditions, and along with high blood pressure these three conditions represented the most common three-condition MLTC-M group. These analyses suggest that birth cohorts, like the BCS70, may usefully inform life course-multimorbidity research.

Sport Participation and Subjective Outcomes of Health in Middle-Aged Men: A Scoping Review

Although sport participation is intrinsically motivating and improves the physical health of middle-aged men, its influence on subjective health measures, such as health-related quality of life, self-rated health, or well-being is unclear. The purpose of this scoping review was to describe the existing literature that has assessed male sport participants and their subjective health. MEDLINE, Embase, Emcare, PsycInfo, SPORTDiscus, Cochrane Library, and Web of Science were searched, and reference lists of included studies were pearled. Included were original peer-reviewed studies reporting a marker of subjective health in males, 35 to 54 years (average), who participated in sport. The search identified 21 eligible articles, 18 quantitative, 2 mixed-methods, and 1 qualitative, from 13 different countries. Eighteen studies were cross-sectional. A broad range of outcomes were assessed, with the most common being quality of life/health-related quality of life (n = 6) and self-rated health (n = 6). Most studies assessing quality of life, health-related quality of life, or self-rated health demonstrated a positive association with sport participation, while sport participation was not related to measures of life satisfaction, flourishing, happiness or global well-being; however, limited studies examined these latter outcomes. Sport participation appears to be related to better select subjective health outcomes in middle-aged men. However, most available data are cross-sectional and thus causation cannot be determined. Randomized intervention trials are required to determine whether sport participation improves the subjective health of middle-aged men.Open Science Framework registration: https://osf.io/zypds.

Microbiome–Gut Dissociation: Investigating the Origins of Obesity

The reduction of excessive weight remains a major public health challenge, with control currently limited to a calorie reduction strategy. Currently, attempts are being made at revisiting the fibre hypothesis based on the African studies of Denis Burkitt, that the lack of dietary fibre in the modern diet was responsible for the occurrence of obesity and many of the other non-communicable diseases of what he called “Western civilization”. However, the dilemma is that Burkitt himself stressed that other peoples of his day, such as the Maasai, remained healthy without consuming such high fibre diets. Equally, the present obesity epidemic is accompanied by diseases of a malfunctioning immune system and of poor mental health that do not seem to be adequately explained simply by a deficiency of dietary fibre. Though unknown in Burkitt’s day, an increasing degradation of a mutualistic intestinal microbiome would offer a better fit to the observed epidemiology, especially if the microbiome is not effectively passed on from mother to child at birth. Taking the broader view, in this article we posit a view of the microbiome as a cofactor of mammalian evolution, in which a maternal microbial inheritance complements the parental genetic inheritance of the animal, both engaging epigenetic processes. As this would require the microbiome to be fully integrated with the animal as it develops into an adult, so we have a meaningful evolutionary role for the microbiome–gut–brain axis. By a failure to correctly establish a microbiome–gut interface, the inhibition of maternal microbial inheritance sets the scene for the future development of non-communicable disease: compromised immune system function on the one hand and dysfunctional gut–brain communication on the other. The basic principle is that the fully functioning, diverse, microbiome achieves interkingdom communication by the generation of messenger chemicals, semiochemicals. It is envisaged that the in situ detection of these as yet ill-defined chemical entities by means of an ingestible sensor would indicate the severity of disease and provide a guide as to its amelioration.

Principles of Researching Health Disparities in Longitudinal Cohort Studies Enrolling Children

Health disparities are defined on the basis of specific populations that, when compared to the general population, have a significant disparity on the rate of disease incidence, prevalence, morbidity, mortality, or survival. People that experience health disparities can be defined by multiple criteria. As the diversity of the United States broadens and increases, research on the origins and causes of health disparities becomes more important to support a healthy general population. Children are particularly sensitive to and vulnerable to health disparities due to the potentially life long consequences of events during periods of critical organ, intellectual and social development. The concept of health justice whereby each individual has the opportunity to realize their full health potential can only be realized with proper understanding and relevant data to frame practice, policy and actions. The National Children's Study (NCS) was a longitudinal birth cohort study designed to incorporate the principles of the Federal Collaboration on Health Disparities Research in consultation with subject matter experts, community representatives, and ongoing evaluation to ensure high quality and relevant data on factors that impact health outcomes. The NCS developed and tested a model of enrolling a diverse population, capturing and integrating data using a life course framework, constructing individual profiles, then aggregating individuals into groups based on profiles and outcomes. This approach is applicable to other longitudinal cohort studies.