Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries

The association between exposure to famine in early life and risks of diabetic complications in adult patients with type two diabetes

Background

In this study, we aimed to assess the associations between early exposure to famine and the risks of diabetic complications in adult patients with type two diabetes.

Methods

The participants in this study were selected from China National HbA1c Surveillance System (2009-13) and further stratified according to the birth year. The participants born between 1956-59, 1959-61, and 1962-64 were classified as foetal exposed group with 70 852, infant/toddler exposed group with 93 616, and unexposed group with 72 723 participants. The association between exposure to famine in early life and risks of diabetic complications were analysed by logistic regression. We assessed the attributing effects of the interaction between exposure to famine in early life and modifiable risk factors by the multiplicative and additive interactive models.

Results

After adjustments for sex, famine severity, economic status in adulthood, body mass index, blood pressure, low-density lipoprotein cholesterol, glycated haemoglobin, diabetes duration, and the use of antidiabetic agents, the increased risks of coronary heart disease (odds ratio (OR) = 1.31; 95% CI (confidence interval) = 1.26, 1.36), cerebrovascular disease (OR = 1.32; 95% CI = 1.24, 1.41), and diabetic retinopathy (OR = 1.06; 95% CI = 1.02, 1.10) were observed in patients with early-life exposure to famine. The reduced risk of diabetic kidney disease (OR = 0.94; 95% CI = 0.90, 0.99) was observed in patients with early-life exposure to famine compared with those without famine exposure. The interaction analyses indicated that obesity might exacerbate the increased risk of coronary heart disease (OR = 1.26; 95% CI = 1.22, 1.30), cerebrovascular disease (OR = 1.26; 95% CI = 1.21, 1.32), and diabetic retinopathy associated with early-life exposure to famine (OR = 1.09; 95% CI = 1.06, 1.12) in patients with type two diabetes. Moreover, high economic status in adulthood might also exacerbate the increased risk of coronary heart disease (OR = 1.35; 95% CI = 1.30, 1.40) and cerebrovascular disease (OR = 1.33; 95% CI = 1.23, 1.43) associated with early-life exposure to famine in patients with type two diabetes.

Conclusions

Early-life exposure to famine in patients with type two diabetes might be associated with increased risks of coronary heart disease, cerebrovascular disease, and diabetic retinopathy but a reduced risk of diabetic kidney disease in adulthood. Obesity and high economic status might further exacerbate the risk of diabetic complications associated with early-life exposure to famine. Improving early-life nutritional status may promote better risk prevention and management of diabetic complications in patients with type two diabetes.

Relationship between socioeconomic status and hypertension incidence among adults in southwest China: a population-based cohort study

PURPOSE

To investigate the correlation between socioeconomic status (SES) and the incidence of hypertension among adults aged 18 or above in southwest China.

METHODS

A multistage proportional stratified cluster sampling method was employed to recruited 9280 adult residents from 12 counties in southwest China, with all participants in the cohort tracked from 2016 to 2020. The questionnaire survey gathered information on demographics, lifestyle habits, and household income. The physical exam recorded height, weight, and blood pressure. Biochemical tests measured cholesterol levels. The chi-square test was employed to assess the statistical differences among categorical variables, while the Cox proportional hazards regression model was applied to evaluate the association between socioeconomic status (SES) and the incidence of hypertension.

RESULTS

The finally effective sample size for the cohort study was 3546 participants, after excluding 5734 people who met the exclusion criteria. Adults in the highest household income group had a significantly lower risk of hypertension compared to those in the lowest income group (HR = 0.636, 95% CI: 0.478-0.845). Besides, when compared to individuals in the illiterate population, the risk of hypertension among adults with elementary school, junior high school, senior high school and associate degree educational level decreased respectively by 34.4% (HR = 0.656, 95%CI: 0.533-0.807), 44.9% (HR = 0.551, 95%CI: 0.436-0.697), 44.9% (HR = 0.551, 95%CI: 0.405-0.750), 46.1% (HR = 0.539, 95%CI: 0. 340-0.854). After conducting a thorough analysis of socioeconomic status, compared with individuals with a score of 6 or less, the risk of hypertension in participants with scores of 8, 10, 11, 12, and greater than 12 decreased respectively by 23.9% (HR = 0.761, 95%CI: 0.598-0.969), 29.7% (HR = 0.703, 95%CI: 0.538-0.919), 34.0% (HR = 0.660, 95%CI: 0.492-0.885), 34.3% (HR = 0.657, 95%CI: 0.447-0.967), 43.9% (HR = 0.561, 95%CI: 0.409-0.769).

CONCLUSION

The findings indicate a negative correlation between socioeconomic status and hypertension incidence among adults in southwest China, suggesting that individuals with higher socioeconomic status are less likely to develop hypertension.

Health-related quality of life assessed by EQ-5D-5L and its determinants among rural adults: result from the Henan rural cohort study

OBJECTIVES

Evidence on the health-related quality of life (HRQoL) among Chinese rural populations and its influence factors were limited. This study aimed to describe the distribution of HRQoL assessed by EQ-5D-5L and its determinants among a Chinese rural population.

METHODS

A total of 23,510 eligible participants (9542 men and 13,968 women) from the Henan rural cohort study were included. Tobit regression and generalized linear models were performed to investigate the associations between demographic characteristics, lifestyle factors, common chronic diseases, and HRQoL.

RESULTS

Of all respondents, the most frequently reported problem was pain/discomfort dimension (23.05%), followed by mobility (12.72%), anxiety/depression (7.77%), and usual activities (6.45%), while the least reported was the self-care dimension (3.84%). The more problems reported in all dimensions with age increased except anxiety/depression. The mean (standard deviation) utility index and VAS score were 0.954 (0.111) and 78.34 (14.80), respectively. The regression analysis indicated that increasing age, former drinkers, poor sleep quality, and suffering from common chronic diseases were significantly associated with low HRQoL, while high education level, average monthly income, and physical activity were significantly associated with high HRQoL.

CONCLUSION

This study described the distribution of HRQoL and its influence factors among the Chinese rural population, which was helpful for medical institutions and policymakers to allocate medical resources and better understand HRQoL among the Chinese rural population.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China

BACKGROUND

High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM.

METHODS

Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels.

RESULTS

We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts.

CONCLUSIONS

Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

Life-course social disparities in body mass index trajectories across adulthood: cohort study evidence from China health and nutrition survey

BACKGROUND

The social disparities in obesity may originate in early life or in adulthood, and the associations of socioeconomic position (SEP) with obesity could alter over time. It is unclear how lifetime-specific and life-course SEP influence adult obesity development in China.

METHODS

Based on the China Health and Nutrition Survey (CHNS), three SEP-related indicators, including the father's occupational position and the participant's education and occupational position, were obtained. The life-course socioeconomic changes and a cumulative SEP score were established to represent the life-course SEP of the participants in the study. The growth mixture modeling was used to identify BMI trajectories in adulthood. Multinomial logistic regression was adopted to assess the associations between SEP and adult BMI trajectories.

RESULTS

A total of 3,138 participants were included in the study. A positive correlation was found between the paternal occupational position, the participants' occupational position, education, and obesity in males, whereas an inverse correlation was observed among females. Males who experienced social upward mobility or remained stable high SEP during the follow-up had 2.31 and 2.52-fold risks of progressive obesity compared to those with a stable-low SEP. Among females, stable high SEP in both childhood and adulthood was associated with lower risks of progressive obesity (OR = 0.63, 95% CI: 0.43-0.94). Higher risks of obesity were associated with the life-course cumulative SEP score among males, while the opposite relationship was observed among females.

CONCLUSIONS

The associations between life-course SEP and BMI development trajectories differed significantly by gender. Special emphasis should be placed on males experiencing upward and stable high socioeconomic change.

Physical attractiveness and cardiometabolic risk

OBJECTIVES

There is only limited evidence suggesting that physical attractiveness and individuals' actual health are causally linked. Past studies demonstrate that characteristics related to physical attractiveness are more likely to be present in healthy individuals, including those with better cardiovascular and metabolic health, yet many of these studies do not account for individuals' initial health and socioeconomic characteristics, which are related to both physical attractiveness and later life health.

METHODS

We use panel survey data from the National Longitudinal Study of Adolescent to Adult Health in the United States to examine the relationship between interviewer-rated in-person physical attractiveness and actual cardiometabolic risk (CMR) based on a set of relevant biomarkers: LDL cholesterol, glucose mg/dL, C-reactive protein, systolic and diastolic blood pressure, and resting heart rate.

RESULTS

We identify a robust relationship between individuals' physical attractiveness and 10-year follow up actual health measured by the levels of CMR. Individuals of above-average attractiveness appear to be noticeably healthier than those who are described as having average attractiveness. We find that individuals' gender and race/ethnicity do not have a major effect on the described relationship. The link between physical attractiveness and health is affected by interviewers' main demographic characteristics. We carefully address the possibility of confounders affecting our results including sociodemographic and socioeconomic characteristics, cognitive and personality traits, initial health problems and BMI.

CONCLUSION

Our findings are largely in line with the evolutionary perspective which assumes that physical attractiveness is linked to individuals' biological health. Being perceived as physically attractive might also imply, among other aspects, high levels of satisfaction with life, self-confidence and ease of finding intimate partners, all of which can positively affect individuals' health.

Nutrition Profile for Countries of the Eastern Mediterranean Region with Different Income Levels: An Analytical Review

The World Health Organization's (WHO) Eastern Mediterranean Region (EMR) is suffering from a double burden of malnutrition in which undernutrition coexists with rising rates of overweight and obesity. Although the countries of the EMR vary greatly in terms of income level, living conditions and health challenges, the nutrition status is often discussed only by using either regional or country-specific estimates. This analytical review studies the nutrition situation of the EMR during the past 20 years by dividing the region into four groups based on their income level-the low-income group (Afghanistan, Somalia, Sudan, Syria, and Yemen), the lower-middle-income group (Djibouti, Egypt, Iran, Morocco, Pakistan, Palestine, and Tunisia), the upper-middle-income group (Iraq, Jordan, Lebanon, and Libya) and the high-income group (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates)-and by comparing and describing the estimates of the most important nutrition indicators, including stunting, wasting, overweight, obesity, anaemia, and early initiation and exclusive breastfeeding. The findings reveal that the trends of stunting and wasting were decreasing in all EMR income groups, while the percentages of overweight and obesity predominantly increased in all age groups across the income groups, with the only exception in the low-income group where a decreasing trend among children under five years existed. The income level was directly associated with the prevalence rates of overweight and obesity among other age groups except children under five, while an inverse association was observed regarding stunting and anaemia. Upper-middle-income country group showed the highest prevalence rate of overweight among children under five. Most countries of the EMR revealed below-desired rates of early initiation and exclusive breastfeeding. Changes in dietary patterns, nutrition transition, global and local crises, and nutrition policies are among the major explanatory factors for the findings. The scarcity of updated data remains a challenge in the region. Countries need support in filling the data gaps and implementing recommended policies and programmes to address the double burden of malnutrition.

Re-examining the reversal hypothesis: A nationwide population-based study of the association between socioeconomic status, and NCDs and risk factors in China

Background

According to the reversal hypothesis, as a country's economic and social development progresses, the burden of NCDs and risk factors shifts from rich to poor. The aim of this research is to examine the reversal hypothesis in the Chinese setting.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, we explored whether the reversal hypothesis applies at the subnational level. Participants aged 45 years and older in 2015 were included. We examined five risk factors (smoking, heavy drinking, physical inactivity, overweight, and obesity) and three objectively measured NCDs (diabetes, hypertension, dyslipidemia). Binary logistic regressions were performed to examine outcomes across people of differing SES in provincial level, in urban and rural areas, and across generations.

Results

Nationally, SES is positively associated with heavy drinking, obesity, diabetes and dyslipidemia, whereas it is negatively associated with physical inactivity. The association between SES and smoking and hypertension was not statistically significant. Except in the cases of diabetes and dyslipidemia, we found that risk factors of all kinds were more concentrated among richer people in rural than in urban areas. Across provinces with increasing GDP per capita, a downward trend in risk factors among those with high SES compared to those with low SES could be interpreted, while the opposite trend could be interpreted with respect to the metabolic syndrome conditions. Obesity and overweight exhibited slight downward trends (in line with those for risk factors) and upward trends (in line with those for metabolic syndrome conditions), respectively.

Conclusion

We conclude that China is at a relatively early stage of 'reversal', visible with respect to risk factors. If these patterns persist over time, the trend will likely feed through to metabolic disorders which will increasingly become diseases of the poor.

Trends in associations between socioeconomic development and urban-rural disparity with high blood pressure in Chinese children and adolescents over two decades

This study aimed to assess the association between the trend of urban-rural disparity in high blood pressure (HBP) in Chinese children and adolescents and socioeconomic development. Data on 1,054,602 students aged 7-18 years were obtained from five successive national surveys administered in 29 Chinese provinces in 1995, 2000, 2005, 2010, and 2014. HBP was defined as average measured systolic BP and/or diastolic BP equal to or more than 95th percentile. The socioeconomic indicators at the provincial-level included gross domestic product (GDP) per capita, the Engel coefficient, and urbanization rates. From 1995 to 2014, HBP prevalence in Chinese children and adolescents fluctuated between 6.9% and 9.2%. Rural areas had a higher prevalence of HBP than urban areas, with a diminishing trend in urban-rural disparity from 1995 to 2010 with a reduced OR from 1.45 (95% CI: 1.40-150) in 1995 to 1.09 (1.05-1.12) in 2010, whereas a widening gap in 2014 with OR of 1.23 (1.19-1.26)). A positive association existed between the improvement of socioeconomic indicators and the increase in HBP, which was demonstrated obviously by the Engel coefficient strata. The increases in the urbanization rates were accompanied by a greater increase of HBP in urban than in rural areas. The large urban-rural disparity suggests a priority of HBP control in rural children due to their current and future HBP and cardiovascular disease risks. Socioeconomic development could affect the urban-rural disparity in HBP risk, reflecting the importance of effective policy responses for preventing HBP by avoiding unhealthy lifestyles brought about by rapid economic development.

Obesity Prevalence and Associated Socio-Demographic Characteristics and Health Behaviors in Russia and Norway

Associations between obesity and socio-demographic and behavioral characteristics vary between populations. Exploring such differences should throw light on factors related to obesity. We examined associations between general obesity (GO, defined by body mass index) and abdominal obesity (AO, defined by waist-to-hip ratio) and sex, age, socio-economic characteristics (education, financial situation, marital status), smoking and alcohol consumption in women and men aged 40–69 years from the Know Your Heart study (KYH, Russia, N = 4121, 2015–2018) and the seventh Tromsø Study (Tromsø7, Norway, N = 17,646, 2015–2016). Age-standardized prevalence of GO and AO was higher in KYH compared to Tromsø7 women (36.7 vs. 22.0% and 44.2 vs. 18.4%, respectively) and similar among men (26.0 vs. 25.7% and 74.8 vs. 72.2%, respectively). The positive association of age with GO and AO was stronger in KYH vs. Tromsø7 women and for AO it was stronger in men in Tromsø7 vs. KYH. Associations between GO and socio-economic characteristics were similar in KYH and Tromsø7, except for a stronger association with living with spouse/partner in KYH men. Smoking had a positive association with AO in men in Tromsø7 and in women in both studies. Frequent drinking was negatively associated with GO and AO in Tromsø7 participants and positively associated with GO in KYH men. We found similar obesity prevalence in Russian and Norwegian men but higher obesity prevalence in Russian compared to Norwegian women. Other results suggest that the stronger association of obesity with age in Russian women is the major driver of the higher obesity prevalence among them compared to women in Norway.

The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women

Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45-65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.

Intergenerational Transmission of Obesity from Mothers to Their Offspring: Trends and Associated Factors Derived from the Malaysian National Health and Morbidity Survey (NHMS)

Along with the increasing overweight and obesity trends among adults and children globally, numerous studies have suggested a strong association between maternal overweight and obesity among their offspring. We sought to report the prevalence and associated factors of intergenerational overweight and obesity among mother–child pairs in Malaysia from 2006 to 2015. Data were analysed from three waves of the Malaysian National Health and Morbidity Survey, a population-based cross-sectional study conducted in 2006, 2011 and 2015. A mother and the youngest child from each household formed ‘mother–child pairs’ and were grouped according to their body mass index categories. A multivariable logistic regression model was performed to determine the factors associated with overweight mother/overweight child pairs (OWM/OWC), with normal weight mother/normal weight child pairs (NWM/NWC) as the reference group. The prevalence of OWM/OWC increased from 15.3% to 21.7%, while the prevalence of NWM/NWC decreased from 28.4% to 23.8% between 2006 and 2015. Older maternal age and having primary and secondary education levels were positively associated with OWM/OWC. Conversely, older child age, Chinese ethnicity, large household size and low-income households were inversely associated with OWM/OWC. In conclusion, intergenerational weight gain is a worrisome trend in Malaysia. These findings may help in guiding priority setting for obesity prevention strategies in Malaysia.

Association of life-course socioeconomic status with allostatic load in Chinese middle-aged and older adults

AIM

To examine the association of life-course socioeconomic status (SES) and mobility with allostatic load (AL) in a large cohort of Chinese middle-aged and older adults.

METHODS

Drawing on data from 17 552 middle-aged and older adults from three waves of a longitudinal study conducted in China in 2011-2015, generalized estimating equation (GEE) models were used for the overall sample and subsample to examine the association between life-course SES and AL.

RESULTS

On the whole, those who were literate had lower AL (β = -0.034, 95% CI = -0.065, -0.004), while those with a non-agricultural occupation (β = 0.093, 95% CI = 0.065, 0.120) and better financial status in childhood (β = 0.037, 95% CI = 0.012, 0.063) or adulthood (β = 0.033, 95% CI = 0.009, 0.058) had higher AL. In terms of SES mobility, a stable high education was associated with lower AL (β = -0.041, 95% CI = -0.078, -0.004). Upward (β = 0.090, 95% CI = 0.061, 0.120) or stable high (β = 0.075, 95% CI = 0.025, 0.125) occupation was related to higher AL. Downward (β = 0.034, 95% CI = 0.003, 0.064) or stable high (β = 0.072, 95% CI = 0.037, 0.107) financial status was associated with higher AL. Education manifested no associations with AL for the rural and men samples. Financial status showed no relationship with AL for the urban sample.

CONCLUSIONS

Our findings demonstrate the importance of applying life-course models for gaining an understanding of SES and AL. Efforts to lower AL among Chinese middle-aged and older adults should consider childhood and current SES status, as well as different subgroups. Geriatr Gerontol Int 2022; 22: 425-432.

County-Level Social Vulnerability Is Positively Associated with Cardiometabolic Disease in Colorado

Cardiometabolic diseases are a group of interrelated diseases that pose greater burden among socially vulnerable communities. The social vulnerability index (SVI) identifies communities vulnerable to emergencies and may also help determine communities at risk of adverse chronic health outcomes. However, no studies have examined the relationship between the SVI and cardiometabolic health outcomes in Colorado or focused on rural settings. The aim of this ecological study was to determine whether the county-level SVI is associated with county-level cardiometabolic health indicators with a particular focus on rurality and racial/ethnic diversity. We obtained 2014 SVI scores from the Centers for Disease Control and Prevention (scored 0-1; higher = more vulnerable) and 2013-2015 cardiometabolic health estimates from the Colorado Department of Public Health and Environment. The distribution of social determinants of health was spatially evaluated. Bivariate relationships between the SVI and cardiometabolic indicators were estimated using simple linear regression models. The highest SVI scores were observed in rural areas, including the San Luis Valley (mean: 0.78, median: 0.91), Southeast (mean: 0.72, median: 0.73), and Northeast (mean: 0.66, median: 0.76) regions. Across Colorado, the SVI accounted for 41% of the variability in overweight and obesity prevalence (p < 0.001), 17% of the variability in diabetes prevalence (p = 0.001), and 58% of the age-adjusted myocardial infarction hospitalization rate (p < 0.001). SVI values may be useful in determining a community's burden of cardiometabolic diseases.

Prevalence of multimorbidity of cardiometabolic conditions and associated risk factors in a population-based sample of South Africans: A cross-sectional study

Objectives

Ageing populations have led to a growing prevalence of multimorbidity. Cardiometabolic multimorbidity (CM), the co-existence of two or more cardiometabolic disorders in the same person, is rapidly increasing. We examined the prevalence and risk factors associated with CM in a population-based sample of South African adults.

Study design

Data were analysed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES), a cross sectional population-based survey conducted in 2011-2012.

Methods

CM was defined as having ≥2 of hypertension, diabetes, stroke and angina. Hypertension was defined as blood pressure ≥140/90 mmHg or self-reported antihypertensive medication use. Diabetes was defined by HbA1c ≥ 6.5% or self-reported medication use. Stroke and angina were assessed by self-report. Multivariable logistic regression was used to investigate the sociodemographic and modifiable risk factors associated with CM. The association of CM with the functional status of individuals was examined using logistic regression, where functional status was measured by the WHO DAS 2.0 12-item instrument.

Results

Of the 3832 individuals analysed, the mean age was 40.8 years (S.D. 18.3), 64.5% were female and 18% were ≥60 years. The prevalence of CM was 10.5%. The most prevalent CM cluster was hypertension and diabetes (7.3%), followed by hypertension and angina (2.6%) and hypertension and stroke (1.9%). Of the individuals with diabetes, nearly three quarters had multimorbidity from co-occurring hypertension, angina and/or stroke and of those with hypertension, 30% had co-occurring diabetes, angina and/or stroke. Age (30-44 years Adjusted Odds Ratio (AOR) = 2.68, 95% CI: 1.15-6.26), 45-59 years AOR = 16.32 (7.38-36.06), 60-74 years AOR = 40.14 (17.86-90.19), and ≥75 years AOR = 49.54 (19.25-127.50) compared with 15-29 years); Indian ethnicity (AOR = 2.58 (1.1-6.04) compared with black African ethnicity), overweight (AOR = 2.73 (1.84-4.07)) and obesity (AOR = 4.20 (2.75-6.40)) compared with normal or underweight) were associated with increased odds of CM. When controlling for age, sex and ethnicity, having ≥2 conditions was associated with significantly higher WHO DAS percentage scores (β = 5.4, S.E. = 1.1, p < 0.001).

Conclusions

A tenth of South Africans have two or more cardiometabolic conditions. The findings call for immediate prioritisation of prevention, screening and management of cardiometabolic conditions and their risk factors to avert large scale health care costs and adverse health outcomes associated with multimorbidity.

Childhood Socioeconomic Position and Risk of Cardiovascular Disease in Adulthood: Systematic Review of Evidence From Low- and Middle-Income Countries

INTRODUCTION

Socioeconomic disadvantage in childhood is strongly associated with a higher risk of cardiovascular disease in high-income countries. However, the association in low- and middle-income countries, where childhood poverty remains prevalent, has not been reviewed.

METHODS

The authors systematically searched Embase, MEDLINE, and Global Health databases for articles on the association between childhood socioeconomic position and risk of cardiovascular disease in adulthood in low- and middle-income countries until September 2020. Outcomes included measures of cardiovascular disease, its subclinical markers (e.g., carotid intima-media thickness), and its major risk factors (e.g., hypertension, dyslipidemia, diabetes). Where available, associations were extracted before and after adjustment for socioeconomic position in adulthood. Results were synthesized qualitatively by outcome. The study protocol is registered on PROSPERO (CRD42018086984).

RESULTS

The search returned 3,568 unique abstracts, from which 29 eligible articles from 14 middle-income countries were identified, representing >150,000 participants. The most commonly reported outcomes were cardiovascular risk factors; very few studies reported prevalent measures of cardiovascular disease, and no studies reported cardiovascular disease incidence or mortality. Of the 46 reported associations between childhood socioeconomic position and risk of cardiovascular disease, 8 were inverse, 0 were positive, and 38 showed no clear evidence of association. All articles had high (16/29) or medium (13/29) risk of bias.

CONCLUSIONS

Current evidence from middle-income countries provides little support for an association between childhood socioeconomic position and risk of cardiovascular disease, and evidence from low-income countries is lacking. It would be premature to consider childhood poverty as a target for cardiovascular disease prevention in these settings.

Coexistence of risk factors for cardiovascular diseases among Brazilian adolescents: Individual characteristics and school environment

Cardiovascular diseases (CVD) share common and modifiable risk factors; among them, unhealthy eating, physical inactivity, alcohol intake and smoking habit. However, these factors are not observed in separate and, most often, they influence each other. Risk factors established during adolescence are highly likely to remain in adult life. The aims of the current study were to evaluate the prevalence and coexistence of risk factors for CVD, as well as to investigate individual characteristic of the adolescent and environmental factors associated with risk factors' coexistence profiles. This was a cross-sectional, national, school-based epidemiological study that estimated the prevalence of cardiovascular risk factors and metabolic syndrome in adolescents aged 12 to 17 years who attended public and private schools located in Brazilian counties with a population of more than 100 thousand. For this study, thematic blocks referring to alcohol consumption, eating habits, smoking, and physical activity were used. The grade of membership method was used to identify the coexistence of risk and protective factors for CVD among adolescents. The study analytical sample comprised 71,552 adolescents. Multilevel logistic regression was used to assess the association between factors influencing the coexistence profile of risk factors for CVD. Based on adolescent-level variables, has shown that meeting positive criterion for Common Mental Disorders and not consuming the meals provided by the school have significantly increased the likelihood of belonging to the CVD-risk profile. On the other hand, school-level variables, show that studying in private schools and living in economically favored Brazilian regions have increased adolescents' likelihood of belonging to the CVD-risk profile. These results can be used to substantiate the inclusion of food environment variables in public policies focused on preventing CVD development among Brazilian adolescents.

Estimated visceral adiposity is associated with risk of cardiometabolic conditions in a population based study

Visceral adiposity is a major risk factor of cardiometabolic diseases. Visceral adipose tissue (VAT) is usually measured with expensive imaging techniques which present financial and practical challenges to population-based studies. We assessed whether cardiometabolic conditions were associated with VAT by using a new and easily measurable anthropometric index previously published and validated. Data (1529 participants) came from the European Health Examination Survey in Luxembourg (2013–2015). Logistic regressions were used to study associations between VAT and cardiometabolic conditions. We observed an increased risk of all conditions associated with VAT. The total adjusted odds ratio (AOR, [95% CI]) for hypertension, prediabetes/diabetes, hypercholesterolemia, and hypertriglyceridemia for the fourth quartile of VAT compared to the lowest were 10.22 [6.75, 15.47]), (5.90 [4.02, 8.67]), (3.60 [2.47, 5.25]) and (7.67 [5.04, 11.67]. We observed higher odds in women than in men for all outcomes with the exception of hypertension. Future studies should investigate the impact of VAT changes on cardiometabolic health and the use of anthropometrically predicted VAT as an accurate outcome when no biomedical imaging is available.

Competing Risks of Cancer and Non-Cancer Mortality When Accompanied by Lifestyle-Related Factors-A Prospective Cohort Study in Middle-Aged and Older Adults

Background

The study aimed to identify the association between the lifestyle-related factors and the cancer-specific, or non-cancer-specific mortality, when accompanied by a competing risk. Two statistical methods were applied, i.e., cause-specific hazard (CSH), and sub-distribution hazard ratio (SHR). Their respective key advantages, relative to the actual study design, were addressed, as was overall application potential.

Methods

Source data from 4,584 residents (34.2% men), aged 45–64 years, were processed using two different families of regression models, i.e., CSH and SHR; principal focus upon the impact of lifestyle-related factors on the competing risk of cancer and non-cancer mortality. The results were presented as hazard ratios (HR) with 95% confidence intervals (95% CI).

Results

Age, smoking status, and family history of cancer were found the leading risk factors for cancer death; the risk of non-cancer death higher in the elderly, and smoking individuals. Non-cancer mortality was strongly associated with obesity and hypertension. Moderate to vigorous physical activity decreased the risk of death caused by cancer and non-cancer causes.

Conclusions

Specific, lifestyle-related factors, instrumental in increasing overall, and cancer-specific mortality, are modifiable through health-promoting, individually pursued physical activities. Regular monitoring of such health-awareness boosting pursuits seems viable in terms of public health policy making.

Energy imbalance: obesity, associated comorbidities, prevention, management and public health implications

The prevalence of obesity has been continually increasing, as have its associated comorbidities and health care costs. Effective management of obesity and early intervention measures are necessary to overcome this global issue. The responsibility for preventing and managing this global epidemic does not lie solely on an individual, but also on the entire health care system. Policy makers-nationally and globally-must play their roles to solve the issue. In this review article, we examine methods of controlling and managing obesity through interventions, such as a low caloric diet, physical exercise, pharmacological guidance, and bariatric surgical procedures. While health care professionals should educate patients about all available treatment options for severe obesity, bariatric surgical procedures have increased in popularity and are considered very beneficial with outcomes fruitful in managing severe obesity.

Childhood Maternal School Leaving Age (Level of Education) and Risk Markers of Metabolic Syndrome in Mid-Adulthood: Results from the 1958 British Birth Cohort

PURPOSE

The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study.

DESIGN

Cohort study.

PARTICIPANTS

A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis.

MAIN OUTCOME MEASURES

Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c).

METHODS

The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE.

RESULTS

The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065-1.30, p<0.001) and SBP 1.48 (95% CI 0.48-2.47 p<0.001).

CONCLUSION

There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.

Systolic Blood Pressure and Socioeconomic Status in a large multi-study population

The present study used harmonized data from eight studies (N = 28,891) to examine the association between socioeconomic status (SES) and resting systolic blood pressure (SBP). The study replicates and extends our prior work on this topic by examining potential moderation of this association by race and gender. We also examined the extent to which body mass index (BMI), waist circumference (WC), and smoking might explain the association between SES and SBP. Data were available from six race/gender groups: 9200 Black women; 2337 Black men; 7248 White women; 6519 White men; 2950 Hispanic women; and 637 Hispanic men. Multivariable regression models showed that greater annual household income was associated with lower SBP in all groups except Hispanic men. The magnitude and form of this negative association differed across groups, with White women showing the strongest linear negative association. Among Black men and Hispanic women, the association was curvilinear: relatively flat among lower income levels, but then negative among higher income ranges. Education also was independently, negatively related to SBP, though evidence was weaker for race and gender differences in the strength of the association. Higher BMI and WC were associated with higher SBP, and current smoking with lower SBP. Inclusion of these risk factors resulted in only a modest change in the magnitude of the SBP and SES relation, accounting on average about 0.4 mmHg of the effect of income and 0.2 mmHg of the effect of education—effects unlikely to be clinically significant. Further understanding of mechanisms underlying the association between SBP and SES may improve risk stratification in clinical settings and potentially inform interventions aimed at reductions in social disparities in health.

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Harmonized data (n = 28,291) examined association between blood pressure and socioeconomic status.

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Replication and extension of prior work by examining potential moderation of this association by race and gender.

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Further understanding of this association inform interventions aimed at reductions in social disparities in health.

Association between the time spent watching television and the sociodemographic characteristics with the presence of overweight and obesity in Colombian adolescents (secondary analysis of the ENSIN 2010)

OBJECTIVE

To determine the association between the time spent watching television and the sociodemographic characteristics with the presence of overweight and obesity in Colombian adolescents.

MATERIALS AND METHODS

Secondary analysis of the information obtained in the National Survey of the Nutritional Situation 2010 of Colombia, in a probabilistic sample of 18177 adolescents with an age range between 13 and 17 years. The time spent watching television and / or videogames and sociodemographic factors was determined. Anthropometric markers and body composition were recorded. Associations were established through logistic regression models.

RESULTS

The prevalence of overweight was 13.0% (95% CI 12.4-13.8) and obesity was 3.0% (95% CI 2.8-3.3). The prevalences of overweight and obesity were higher in adolescent women [16.6% (95% CI 15.8-17.5) and 3.4% (95% CI 3.1-3.7), respectively]. Overweight and obesity were associated with being female [OR 1.94 (95%CI 1.77-2.12) and OR 1.29 (95%CI 1.09-1.53), respectively], high socioeconomic level [OR 1.22 (95%CI 1.10-1.36) and OR 1.47 (95%CI 1.19-1.81), respectively], reside in urban area [OR 1.13 (95%CI 1.03-1.24) and OR 1.47 (95%CI 1.21-1.79), respectively]. Being indigenous was associated with being overweight [OR 1.25 (95%CI 1.10-1.42)], while being Afro-Colombian was associated with obesity [OR 1.33 (95%CI 1.05-1.69)]. Watching television and / or video games for two or more hours a day [OR1.17 (95%CI 1.06-1.30)] was associated with being overweight; whereas watching television every day of the week was associated with obesity [OR 1.66 (95%CI 1.13-2.43)].

CONCLUSIONS

The population studied has a significant prevalence of overweight and obesity, being overweight is associated with being a woman, a high socioeconomic status, residing in an urban area, having an indigenous ethnicity, watching television for three days during the week and looking at more than two hours of television in a day; Obesity is associated with being a woman, a medium-high and high socioeconomic status, residing in an urban area, Afro-Colombian ethnicity, watching television at least once in the last week and watching television every day during the last week.