Associations of diabesity with all-cause and cardiovascular disease mortality: Findings from the Mexico City Prospective Study

AIM

To investigate the joint associations of diabetes and obesity with all-cause and cardiovascular disease (CVD) mortality in the Mexico City Prospective Study.

MATERIALS AND METHODS

In total, 154 128 participants (67.2% women) were included in this prospective analysis. Diabetes was self-reported, while body mass index was used to calculate obesity. Using diabetes and obesity classifications, six groups were created: (a) normal (no diabetes and normal weight); (b) normal weight and diabetes; (c) overweight but not diabetes (overweight); (d) overweight and diabetes (prediabesity); (e) obesity but not diabetes (obesity); and (f) obesity and diabetes (diabesity). Associations between these categories and outcomes were investigated using Cox proportional hazard models adjusted for confounder factors.

RESULTS

During 18.3 years of follow-up, 27 197 (17.6%) participants died (28.5% because of CV causes). In the maximally adjusted model, participants those with the highest risk {hazard ratio (HR): 2.37 [95% confidence interval (CI): 2.24-2.51]}, followed by those with diabesity [HR: 2.04 (95% CI: 1.94-2.15)]. Similar trends of associations were observed for CVD mortality. The highest CV mortality risk was observed in individuals with diabesity [HR: 1.80 (95% CI: 1.63-1.99)], followed by normal weight and diabetic individuals [HR: 1.78 (95% CI: 1.60-1.98)].

CONCLUSION

This large prospective study identified that diabetes was the main driver of all-cause and CVD mortality in all the categories studied, with diabesity being the riskiest. Given the high prevalence of both conditions in Mexico, our results reinforce the importance of initiating prevention strategies from an early age.

Lifestyle risk factors and all-cause and cause-specific mortality in the Mexico City prospective study: Assessing the influence of reverse causation

BACKGROUND

We examined the association between individual lifestyle risk factors with all-cause and cause-specific mortality.

METHODS

Prospective cohort study including 155,002 participants from the Mexico City Prospective Study. Cox regression models were used to estimate the association between individual lifestyle risk factors and all-cause and cause-specific mortality. Participants with prevalent diseases at baseline and participants who died during the first 2, 5, 10, and 15 years of follow-up were excluded to account for reverse causation.

RESULTS

27,469 people died during 18.3 years of follow-up years. Overweight and moderate alcohol consumption were inversely associated with all-cause mortality, while low physical activity and smoking were positively associated when all participants were included, regardless of prevalent disease or duration of follow-up. The direction of the association of overweight with all-cause mortality changed from inverse to positive after excluding the first 10 years of follow-up. Compared with normal weight, the hazard ratio (95 % confidence interval) was 1.17 (1.13,1.22) for obesity after excluding those who died in the first 5 years of follow-up and 1.71 (1.59,1.84) after excluding the first 15 years of follow-up. The magnitude of the association of alcohol intake, low physical activity, and smoking with mortality attenuated, whereas for fruits and vegetables increased, after excluding longer periods of follow-up.

LIMITATIONS

The data were collected exclusively in Mexico City; lifestyle risk factors were self-reported and thus prone to misclassification bias.

CONCLUSIONS

Reverse causation may influence both the magnitude and the direction of the associations between lifestyle risk factors and mortality.

Associations of the 'weekend warrior' physical activity pattern with all-cause, cardiovascular disease and cancer mortality: the Mexico City Prospective Study

OBJECTIVES

The objective was to investigate the benefits of the 'weekend warrior' physical activity pattern in Latin America, where many people take part in high levels of non-exercise physical activity.

METHODS

Participants in the Mexico City Prospective Study were surveyed from 1998 to 2004 and resurveyed from 2015 to 2019. Those who exercised up to once or twice per week were termed weekend warriors. Those who exercised more often were termed regularly active. Analyses were adjusted for potential confounders.

RESULTS

The main analysis included 26 006 deaths in 154 882 adults (67% female) aged 52±13 years followed for 18±4 years (mean±SD). Compared with those who reported no exercise, the HR (95% CI) was 0.88 (0.83 to 0.93) in the weekend warriors and 0.88 (0.84 to 0.91) in the regularly active. Similar results were observed for cardiovascular disease and cancer mortality, but associations were weaker. Stratified analyses showed that substantial reductions in all-cause mortality risk only occurred when the duration of exercise sessions was at least 30-60 min. The repeated-measures analysis included 843 deaths in 10 023 adults followed for 20±2 years. Compared with being inactive or becoming inactive, the HR was 0.86 (95% CI 0.65 to 1.12) when being a weekend warrior or becoming a weekend warrior and 0.85 (95% CI 0.70 to 1.03) when being regularly active or becoming regularly active.

CONCLUSIONS

This is the first prospective study to investigate the benefits of the weekend warrior physical activity pattern in Latin America. The results suggest that even busy adults could benefit from taking part in one or two sessions of exercise per week.

Physical Activity and Obesity Risk in Adults in Colombia: The Prospective Urban Rural Epidemiology (PURE) Study

PURPOSE

To investigate longitudinal associations between physical activity levels and obesity in adults in Colombia, where participation in large amounts of light-intensity physical activity is a necessity for many people.

METHODS

Participation in moderate- and vigorous-intensity physical activity was assessed from 2005 to 2009 and obesity was assessed from 2011 to 2019 in men and women from the Prospective Urban Rural Epidemiology (PURE) study. Total physical activity level was categorized as low (<600 MET-min/week), medium (600-3,000 MET-min/week), or high (>3,000 MET-min/week) (600 MET-min/week is equivalent to 150 minutes of moderate activity or 75 minutes of vigorous activity per week). Obesity was defined as body mass index ≥30 kg/m2. Analyses were adjusted for age, sex, smoking, socioeconomic status, diet, alcohol, sedentary time, and sleep.

RESULTS

The main analysis included 3,086 men and women aged 51 ± 9 years at baseline (mean ± SD). Compared to the low physical activity group, the odds ratio (95% confidence interval) for obesity was 0.67 (0.53, 0.85) in the medium physical activity group, and 0.78 (0.62, 0.98) in the high physical activity group after adjustment for potential confounders. Smoking is probably a major confounder and it is noteworthy that similar associations were observed in participants who reported never smoking.

CONCLUSIONS

The PURE study is the only prospective cohort study in Colombia. The present analysis is important because it suggests that even the busy people of Colombia could substantially reduce their risk of obesity by participating in moderate- and vigorous-intensity physical activity.

The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations

Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.

Effects of an urban cable car intervention on physical activity: the TrUST natural experiment in Bogotá, Colombia

BACKGROUND

Cable cars are part of the transport system in several cities in Latin America, but no evaluations of their effects on physical activity are available. TransMiCable is the first cable car in Bogotá, Colombia, and the wider intervention includes renovated parks and playgrounds. We assessed the effects of TransMiCable and the wider intervention on physical activity.

METHODS

The Urban Transformations and Health natural experiment was a prospective quasi-experimental study conducted from Feb 1, 2018, to Dec 18, 2018 (baseline, pre-intervention) and from July 2, 2019, to March 15, 2020 (post-intervention follow-up) in the TransMiCable intervention area (Ciudad Bolívar settlement) and a control area without TransMiCable (San Cristóbal settlement). A multistage strategy was used to sample households in each area, with one adult (aged ≥18 years) per household invited to participate. Eligible participants had lived in the intervention or control areas for at least 2 years and were not planning to move within the next 2 years. Physical activity was assessed among participants in the intervention and control areas before and after the inauguration of TransMiCable in Ciudad Bolívar with the International Physical Activity Questionnaire (long form) and with wearable accelerometers. Complete cases (those with baseline and follow-up data) were included in analyses. Respondents were classed as being physically active if they met 2020 WHO guidelines (≥150 min per week of moderate activity, ≥75 min per week of vigorous activity, or equivalent combinations); and accelerometery data were classified with the Freedson cut-points for adults. Data were also gathered in zonal parks (area ≥10 000 m2) and neighbourhood parks (area <10 000 m2) in the intervention and control areas by direct observation with the System for Observing Play and Recreation in Communities, to assess levels of physical activity before and after the TransMiCable intervention. Multilevel regression models were used to assess changes in physical activity associated with the TransMiCable intervention.

FINDINGS

Physical activity questionnaires were completed by 2052 adult participants (1289 [62·8%] women and 763 [37·2%] men; mean age 43·5 years [SD 17·7]) before the inauguration of TransMiCable. After the inauguration, the follow-up (final) questionnaire sample comprised 825 adults in the intervention group and 854 in the control group, including 357 adults in the intervention group and 334 in the control group with valid accelerometery data. 334 (40·5%) of 825 participants in the intervention group reported levels of physical activity that met the 2020 WHO guidelines during walking for transport before the intervention, and 426 (51·6%) afterwards (change 11·1 percentage points [95% CI 6·4 to 15·9]). A similar change was observed in the control group (change 8·0 percentage points [3·4 to 12·5]; adjusted odds ratio [OR] for the time-by-group interaction, intervention vs control group: 1·1 [95% CI 0·8 to 1·5], p=0·38). Time spent doing moderate-to-vigorous physical activity, measured with accelerometers, did not change in the intervention group after the inauguration of TransMiCable (change -0·8 min per day [-4·6 to 3·0]) and did not change compared with the control group (adjusted β for the time-by-group interaction: 1·4 min per day [95% CI -2·0 to 4·9], p=0·41). Moderate-to-vigorous physical activity was 52·1 min per day (SD 24·7) before and 59·4 min per day (35·2) after the inauguration of TransMiCable in new regular users who reported using TransMiCable during mandatory trips for work or education (n=32; change 7·3 min per day [-22·5 to 7·9]). After the intervention, an increase in the proportion of male individuals engaging in moderate or vigorous physical activity was observed in a renovated zonal park (adjusted OR for the time-by-group interaction, intervention vs control park: 2·7 [1·1 to 6·8], p=0·033). Female users of a renovated neighbourhood park were less likely to become engaged in moderate or vigorous physical activity than female users of the control area neighbourhood park (adjusted OR for the time-by-group interaction: 0·4 [0·1 to 0·6], p=0·019).

INTERPRETATION

It is encouraging that walking for transport remained high in the TransMiCable intervention area when the use of private motorised transport had increased elsewhere in Bogotá. In low-income urban areas, where transport-related walking is a necessity, transport interventions should be focused on efforts to maintain participation in active travel while improving conditions under which it occurs.

FUNDING

Wellcome Trust (as part of the Urban Health in Latin America project); Bogotá Urban Planning Department; Ministry of Science, Technology, and Innovation of Colombia; Universidad de Los Andes; Fundación Santa Fe de Bogotá; and Universidad del Norte.

TRANSLATION

For the Spanish translation of the abstract see Supplementary Materials section.

Prenatal and postnatal correlates of moderate-to-vigorous physical activity in midlife: evidence from the 1970 British Cohort Study

Background

It is hypothesised that lifelong physical activity behaviours are established in early life, however there is minimal, and contradictory, evidence examining prenatal and postnatal factors in relation to adulthood physical activity. We investigated associations between prospectively ascertained prenatal/postnatal factors and device-measured moderate-to-vigorous physical activity (MVPA) in midlife.

Methods

Analyses included 5011 participants from the 1970 British Cohort Study, a birth cohort study of individuals born within the same week. At birth, the following factors were ascertained: socioeconomic position (SEP), maternal age, number of previous pregnancies, maternal smoking, maternal diabetes, gestational age, birth weight, breastfeeding status and infant health concerns. MVPA was captured at age 46 with a thigh-worn accelerometer device following a 24-hour protocol over 7 days.

Results

In sex-adjusted models, lower SEP (−6.7 min/day (95% CI: −9.0 to –4.4) in those with a partly or unskilled paternal occupation), younger maternal age (0.4 min/day (0.2 to 0.5) per additional year of maternal age), maternal smoking during pregnancy (−2.5 min/day (−4.0 to –1.0)) and post-term gestational age (−7.4 min/day (−11.5 to –3.4); boys only) were associated with lower MVPA at age 46. In the mutually adjusted model, associations did not change but there was some evidence that birth weight may also be associated with MVPA levels.

Conclusions

SEP, maternal age, maternal smoking, post-term birth in boys and birth weight were associated with MVPA in midlife, indicating that midlife physical activity behaviours may be partially established at birth. Early interventions in disadvantaged environments may have a positive impact on physical activity throughout the life course.

Alcohol drinking in one's thirties and forties is associated with body mass index in men, but not in women: A longitudinal analysis of the 1970 British Cohort Study

Our objective was to investigate longitudinal associations between alcohol drinking and body mass index (BMI). Alcohol drinking (exposure), BMI (outcome), smoking habit, occupation, longstanding illness, and leisure time physical activity (potential confounders) were assessed at ages 30, 34, 42, and 46 in the 1970 British Birth Cohort Study. Multilevel models were used to cope with the problem of correlated observations. There were 15,708 observations in 5931 men and 14,077 observations in 5656 women. Drinking was associated with BMI in men. According to the regression coefficients, BMI was expected to increase by 0.36 (95% confidence interval: 0.11, 0.60) kg/m² per year in men who drank once a week and by 0.40 (0.14, 0.15) kg/m² per year in men who drank most days. In ten years, BMI was expected to increase by 5.4 kg/m² in men who drank and by 2.9 kg/m² in men who drank and were physically active. Drinking was not associated with BMI in women. Rather, BMI was expected to increase by 0.25 (0.07, 0.43) kg/m² per year in women who were former smokers. In ten years, BMI was expected to increase by 4.3 kg/m² in women who were former smokers and by 0.8 kg/m² in women who were former smokers and who were physically active. Associations between drinking and BMI were similar after further adjustment for problematic drinking and diet. These longitudinal data suggest that drinking is associated with BMI in men and that drinking is not associated with BMI in women independent of other lifestyle risk factors.

Estimated cardiorespiratory fitness in childhood and cardiometabolic health in adulthood: 1970 British Cohort Study

Background

Associations of cardiorespiratory fitness in childhood and adulthood with adult cardiometabolic risk factors are poorly understood, not least because of the paucity of studies.

Objectives

We investigated associations between nonexercise testing cardiorespiratory fitness (NETCRF) in childhood/adulthood and cardiometabolic risk factors in adulthood.

Methods

Based on an established algorithm comprising gender, age, body mass index, resting heart rate, and self‐reported physical activity at age 10, we computed NETCRF. Risk factors were assessed at age 46 in 5009 participants when NETCRF was again calculated. Linear regression was used to summarize associations between NETCRF in childhood and risk factors in adulthood and, additionally, the relationship between NETCRF in adulthood and risk factors in adulthood after adjusting for childhood NETCRF.

Results

Inconsistent associations were observed between childhood NETCRF and adult risk factors. NETCRF in adulthood was associated with blood pressure [−5.8 (−6.7, −4.9)], glycated hemoglobin [−3.41 (−4.06, −2.76)], total cholesterol [−0.16 (−0.24, −0.08)], HDL cholesterol [0.19 (0.16, 0.22)], triglycerides [−0.68 (−0.85, −0.50)], and C‐reactive protein [−0.29 (−0.35, −0.22)] in adult males. Similar associations were observed in adult females. Compared to those with low estimated fitness in both childhood and adulthood, participants with low fitness in childhood and high fitness in adulthood had a lower risk of two or more cardiometabolic risk factors (odds ratio: 0.25; 95% confidence interval: 0.19, 0.31).

Conclusion

Associations between estimated fitness and risk factors are stronger in adulthood than from childhood to adulthood. Adults with previously sedentary childhoods may still gain benefits from improving their fitness.

Lifestyle risk factors, obesity and infectious disease mortality in the general population: Linkage study of 97,844 adults from England and Scotland

We examined associations between lifestyle variables and infectious disease mortality in a large general population cohort. A sample of 97,844 men and women (aged 47.1 ± 17.7 yrs.; 46.6% male) recruited from general population, household-based surveys were followed up over mean [SD] 9.4 ± 4.5 years. Exposure measurements included self-reported physical activity, cigarette smoking, alcohol intake, and objective body mass index and waist to hip ratio. There were 9027 deaths, of which 14.1% were attributed to infectious diseases. Compared to physically inactive participants both insufficiently active (Hazard ratio = 0.61; 95% CI, 0.50, 0.75) and sufficiently active (at least 150 min/wk. moderate - vigorous activity) (0.60; 0.45, 0.78) was associated with reduced risk of infectious disease mortality in models mutually adjusted for other lifestyle factors. Ex-smokers and current smokers were at increased risk of infectious disease mortality compared with never smoker, with the strongest associations being observed for heavy smoking (>20 cigarettes/day) and pneumonia (3.30; 2.35, 4.63). Underweight was associated with increased risk of infectious disease mortality (3.65; 2.64, 5.06) compared with normal weight; the risk of viral infection was lower in overweight (0.56; 0.44, 0.72) and obesity (0.39; 0.26, 0.58). Central obesity was, however, related to higher risk of bacterial infections, but only in normal weight centrally obese participants (1.71; 1.10, 2.64). A physically active lifestyle and lifelong absence from cigarette smoking had protective associations against infectious disease mortality. Obesity has divergent associations dependent on peripheral and visceral fat depots, and the specific outcome.

Association between physical activity and sub-types of cardiovascular disease death causes in a general population cohort

Physical activity is thought to be cardioprotective, but associations with different subtypes of cardiovascular disease (CVD) are poorly understood. We examined associations between physical activity and seven major CVD death causes. The sample comprised 65,093 adults (aged 58 ± 12 years, 45.4% men) followed up over mean [SD] 9.4 ± 4.5 years, recruited from The Health Survey for England and the Scottish Health Surveys. A CVD diagnosis was reported in 9.2% of the sample at baseline. Physical activity was self-reported. Outcomes were subtypes of CVD death; acute myocardial infarction; chronic ischaemic heart disease; pulmonary heart disease; a composite of cardiac arrest, arrhythmias, and sudden cardiac death; heart failure; cerebrovascular; composite of aortic aneurysm and other peripheral vascular diseases. There were 3050 CVD deaths (30.8% of all deaths). In Cox proportional hazards models adjusted for confounders, physical activity was associated with reduced relative risk of all CVD outcomes; compared with the lowest, the highest physical activity quintile was associated with reduced risk of acute myocardial infarction (Hazard ratio 0.66: 95% CI 0.50, 0.89), chronic ischaemic heart disease (0.49: 0.38, 0.64), pulmonary heart disease (0.48: 0.22, 1.07), arrhythmias (0.18: 0.04, 0.76); heart failure (0.35: 0.20, 0.63), cerebrovascular events (0.53: 0.38, 0.75); aneurysm and peripheral vascular diseases (0.54: 0.34, 0.93). Results were largely consistent across participants with and without existing CVD at baseline. Physical activity was associated with reduced risk of seven major CVD death causes. Protective benefits were apparent even at levels of activity below the current recommendations.

The Importance of Vigorous-Intensity Leisure-Time Physical Activity in Reducing Cardiovascular Disease Mortality Risk in the Obese

OBJECTIVE

To investigate the role of vigorous-intensity leisure-time physical activity in reducing cardiovascular disease (CVD) mortality risk in the obese.

PARTICIPANTS AND METHODS

Trained interviewers assessed physical activity and body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) in 59,005 adult participants (mean ± SD age, 57±12 years; 46.5% male) in 2 household-based surveillance studies: Health Survey for England and Scottish Health Survey. Mortality was ascertained from death certificates. Data were collected from January 1, 1994, through March 31, 2011. Cox proportional hazards models were adjusted for age, sex, smoking habit, total physical activity, long-standing illness, prevalent CVD, and occupation.

RESULTS

There were 2302 CVD deaths during 532,251 person-years of follow-up (mean ± SD, 9±4 years). A total of 15,002 (25%) participants were categorized as obese (BMI ≥30). Leisure-time physical activity was inversely associated and BMI was positively associated with CVD mortality. Compared with those who reported meeting physical activity guidelines including some vigorous-intensity physical activity and who had a normal BMI (18.5-24.9) (reference group), the CVD mortality hazard ratio was not significantly different in the obese who also reported meeting physical activity guidelines including some vigorous-intensity physical activities (1.25; 95% CI, 0.50-3.12). Compared with the reference group, the CVD mortality hazard ratio was more than 2-fold in the obese who reported meeting physical activity guidelines, including only moderate-intensity physical activities (2.52; 95% CI, 1.15-2.53).

CONCLUSION

This large, statistically powerful study suggests that vigorous-intensity leisure-time physical activity is important in reducing CVD mortality risk in the obese.

The association between leisure-time physical activity and lung function in older adults: The English longitudinal study of ageing

The longitudinal association between physical activity and lung function is unclear. Therefore, we examined said association over eight years. This study included data from 2966 participants in English Longitudinal Study of Ageing (63±7years [mean±SD]), a prospective study of initially healthy, community dwelling adults. Physical activity was assessed using an interview and lung function using a spirometer at baseline (2004-5) and follow-up (2012-13). General linear regression was used to assess associations between activity and lung function. Logistic regression was used to assess the odds of new cases of abnormal lung function. Some 14% of participants were defined as physically inactive at baseline, 50% were classified into the moderate group, and 36% into the vigorous group. In comparison with remaining inactive at follow-up, remaining active was positively associated with forced vital capacity (FVC) (β=0.09, 95% confidence interval [CI]: 0.01, 0.17; p=0.02) and forced expiratory volume in one second (FEV-1) (β=0.09, 95% CI: 0.02, 0.15; p=0.01) after adjustment for baseline lung function score and other covariates. Using the fifth centile to define the lower limit of normal (that is, -1.64 z scores), there were lower odds of incident abnormal lung function in participants who remained physically active compared to those who remained inactive (FVC odds ratio=0.31, 95% CI: 0.17, 0.55. FEV-1 odds ratio=0.43, 95% CI: 0.26, 0.72). Similar associations were observed in those who became active. This study suggests that remaining physically active or becoming active in older age is positively associated with lung function and reduced odds of abnormal lung function.

Association Between Lifestyle Factors and the Incidence of Multimorbidity in an Older English Population

Background

Evidence on the role of lifestyle factors in relation to multimorbidity, especially in elderly populations, is scarce. We assessed the association between five lifestyle factors and incident multimorbidity (presence of ≥2 chronic conditions) in an English cohort aged ≥50 years.

Methods

We used data from waves 4, 5, and 6 of the English Longitudinal Study of Ageing. Data on smoking, alcohol consumption, physical activity, fruit and vegetable consumption, and body mass index were extracted and combined to generate a sum of unhealthy lifestyle factors for each individual. We examined whether these lifestyle factors individually or in combination predicted multimorbidity during the subsequent wave. We used marginal structural Cox proportional hazard models, adjusted for both time-constant and time-varying factors.

Results

A total of 5,476 participants contributed 232,749 person-months of follow-up during which 1,156 cases of incident multimorbidity were recorded. Physical inactivity increased the risk of multimorbidity by 33% (adjusted hazard ratio [aHR]: 1.33, 95% confidence interval [CI]: 1.03-1.73). The risk was about two to three times higher when inactivity was combined with obesity (aHR: 2.87, 95% CI: 1.55-5.31) or smoking (aHR: 2.35, 95% CI: 1.36-4.08) and about four times when combined with both (aHR: 3.98, 95% CI: 1.02-17.00). Any combination of 2, 3, and 4 or more unhealthy lifestyle factors significantly increased the multimorbidity hazard, compared with none, from 42% to 116%.

Conclusion

This study provides evidence of a temporal association between combinations of different unhealthy lifestyle factors with multimorbidity. Population level interventions should include reinforcing positive lifestyle changes in the population to reduce the risk of developing multimorbidity.

Sarcopenic obesity, weight loss, and mortality: the English Longitudinal Study of Ageing

Background: Age-related sarcopenia describes the loss of muscle strength and often accompanies an increase in adiposity in the elderly.Objective: We examined the association of sarcopenic obesity and changes in muscle strength and weight with the risk of mortality.Design: Participants (n = 6864) were community-dwelling men and women (45.6% men; 54.4% women; mean ± SD age: 66.2 ± 9.5 y) from the English Longitudinal Study of Ageing. Handgrip strength and body mass index (BMI; in kg/m²) were measured at baseline and at a 4-y follow-up. Individual participant data were linked with death records from National Health Service registries. Sarcopenic obesity was defined as obese individuals (BMI ≥30) in the lowest tertile of sex-specific grip strength (<35.3 kg for men and <19.6 kg for women).Results: There were 906 deaths over a mean follow-up of 8 y. Compared with the reference group (normal BMI and highest handgrip tertile), the risk of all-cause mortality increased as grip strength reduced within each BMI category. For participants in the lowest handgrip tertile, there was little difference in the risk between normal BMI (HR: 3.25; 95% CI: 1.86, 5.65), overweight (HR: 2.50; 95% CI: 1.44, 4.35), and obesity (HR: 2.66; 95% CI: 1.86, 3.80) after adjusting for covariates. The risk of all-cause mortality was significantly greater in participants who experienced weight loss over 4 y (HR: 2.21; 95% CI: 1.32, 3.71) and/or reduced hand grip strength (HR: 1.53; 95% CI: 10.07, 2.17) than in those with stable weight and grip strength, with the highest risk in those with both weight loss and reduced strength (HR: 3.77; 95% CI: 2.54, 5.60).Conclusions: Sarcopenic obesity did not confer any greater risk than sarcopenia alone. Weight loss combined with sarcopenia presented the greatest risk of mortality.

The association between air pollution and type 2 diabetes in a large cross-sectional study in Leicester: The CHAMPIONS Study

BACKGROUND

Observational evidence suggests there is an association between air pollution and type 2 diabetes; however, there is high risk of bias.

OBJECTIVE

To investigate the association between air pollution and type 2 diabetes, while reducing bias due to exposure assessment, outcome assessment, and confounder assessment.

METHODS

Data were collected from 10,443 participants in three diabetes screening studies in Leicestershire, UK. Exposure assessment included standard, prevailing estimates of outdoor nitrogen dioxide and particulate matter concentrations in a 1×1km area at the participant's home postcode. Three-year exposure was investigated in the primary analysis and one-year exposure in a sensitivity analysis. Outcome assessment included the oral glucose tolerance test for type 2 diabetes. Confounder assessment included demographic factors (age, sex, ethnicity, smoking, area social deprivation, urban or rural location), lifestyle factors (body mass index and physical activity), and neighbourhood green space.

RESULTS

Nitrogen dioxide and particulate matter concentrations were associated with type 2 diabetes in unadjusted models. There was no statistically significant association between nitrogen dioxide concentration and type 2 diabetes after adjustment for demographic factors (odds: 1.08; 95% CI: 0.91, 1.29). The odds of type 2 diabetes was 1.10 (95% CI: 0.92, 1.32) after further adjustment for lifestyle factors and 0.91 (95% CI: 0.72, 1.16) after yet further adjustment for neighbourhood green space. The associations between particulate matter concentrations and type 2 diabetes were also explained away by demographic factors. There was no evidence of exposure definition bias.

CONCLUSIONS

Demographic factors seemed to explain the association between air pollution and type 2 diabetes in this cross-sectional study. High-quality longitudinal studies are needed to improve our understanding of the association.

The association between leisure-time physical activity, low HDL-cholesterol and mortality in a pooled analysis of nine population-based cohorts

The objective of this study was to investigate associations between leisure-time physical activity, low high-density lipoprotein cholesterol (HDL-C) and mortality. Self-reported leisure-time physical activity, HDL-C concentration, and mortality were assessed in 37,059 adults in Health Survey for England and Scottish Health Survey. Meeting physical activity guidelines was defined as ≥150 min wk⁻¹ of moderate-intensity activity, ≥75 min wk⁻¹ of vigorous-intensity activity, or equivalent combinations. Low HDL-C was defined as <1.03 mmol L⁻¹. Cox proportional hazard models were adjusted for age, sex, smoking, total cholesterol, systolic blood pressure, body mass index, longstanding illness, and socioeconomic status. There were 2250 deaths during 326,016 person-years of follow-up. Compared with those who met physical activity guidelines and whose HDL-C was normal (reference group), all-cause mortality risk was not elevated in those who met physical activity guidelines and whose HDL-C concentration was low (hazard ratio: 1.07; 95% confidence interval: 0.75, 1.53). Compared with the reference group, all-cause mortality risk was elevated in those who did not meet physical activity guidelines and whose HDL-C was normal (1.37; 1.16, 1.61), and in those who did not meet physical activity guidelines and whose HDL-C was low (1.65; 1.37, 1.98). Cardiovascular disease mortality hazard ratios were similar, although confidence intervals were wider. There was no statistically significant evidence of biological interaction between physical inactivity and low HDL-C. This novel study supports the notion that leisure-time physical activity be recommended in those with low HDL-C concentration who may be resistant to the HDL-raising effect of exercise training.

Association of "Weekend Warrior" and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality

IMPORTANCE

More research is required to clarify the association between physical activity and health in "weekend warriors" who perform all their exercise in 1 or 2 sessions per week.

OBJECTIVE

To investigate associations between the weekend warrior and other physical activity patterns and the risks for all-cause, cardiovascular disease (CVD), and cancer mortality.

DESIGN, SETTING, AND PARTICIPANTS

This pooled analysis of household-based surveillance studies included 11 cohorts of respondents to the Health Survey for England and Scottish Health Survey with prospective linkage to mortality records. Respondents 40 years or older were included in the analysis. Data were collected from 1994 to 2012 and analyzed in 2016.

EXPOSURES

Self-reported leisure time physical activity, with activity patterns defined as inactive (reporting no moderate- or vigorous-intensity activities), insufficiently active (reporting <150 min/wk in moderate-intensity and <75 min/wk in vigorous-intensity activities), weekend warrior (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from 1 or 2 sessions), and regularly active (reporting ≥150 min/wk in moderate-intensity or ≥75 min/wk in vigorous-intensity activities from ≥3 sessions). The insufficiently active participants were also characterized by physical activity frequency.

MAIN OUTCOMES AND MEASURES

All-cause, CVD, and cancer mortality ascertained from death certificates.

RESULTS

Among the 63 591 adult respondents (45.9% male; 44.1% female; mean [SD] age, 58.6 [11.9] years), 8802 deaths from all causes, 2780 deaths from CVD, and 2526 from cancer occurred during 561 159 person-years of follow-up. Compared with the inactive participants, the hazard ratio (HR) for all-cause mortality was 0.66 (95% CI, 0.62-0.72) in insufficiently active participants who reported 1 to 2 sessions per week, 0.70 (95% CI, 0.60-0.82) in weekend warrior participants, and 0.65 (95% CI, 0.58-0.73) in regularly active participants. Compared with the inactive participants, the HR for CVD mortality was 0.60 (95% CI, 0.52-0.69) in insufficiently active participants who reported 1 or 2 sessions per week, 0.60 (95% CI, 0.45-0.82) in weekend warrior participants, and 0.59 (95% CI, 0.48-0.73) in regularly active participants. Compared with the inactive participants, the HR for cancer mortality was 0.83 (95% CI, 0.73-0.94) in insufficiently active participants who reported 1 or 2 sessions per week, 0.82 (95% CI, 0.63-1.06) in weekend warrior participants, and 0.79 (95% CI, 0.66-0.94) in regularly active participants.

CONCLUSIONS AND RELEVANCE

Weekend warrior and other leisure time physical activity patterns characterized by 1 or 2 sessions per week may be sufficient to reduce all-cause, CVD, and cancer mortality risks regardless of adherence to prevailing physical activity guidelines.

Nonexercise Equations to Estimate Fitness in White European and South Asian Men

PURPOSE

Cardiorespiratory fitness is a strong, independent predictor of health, whether it is measured in an exercise test or estimated in an equation. The purpose of this study was to develop and validate equations to estimate fitness in middle-age white European and South Asian men.

METHODS

Multiple linear regression models (n = 168, including 83 white European and 85 South Asian men) were created using variables that are thought to be important in predicting fitness (V˙O2max, mL·kg⁻¹·min⁻¹): age (yr), body mass index (kg·m⁻²), resting HR (bpm); smoking status (0, never smoked; 1, ex or current smoker), physical activity expressed as quintiles (0, quintile 1; 1, quintile 2; 2, quintile 3; 3, quintile 4; 4, quintile 5), categories of moderate- to-vigorous intensity physical activity (MVPA) (0, <75 min·wk⁻¹; 1, 75-150 min·wk⁻¹; 2, >150-225 min·wk⁻¹; 3, >225-300 min·wk⁻¹; 4, >300 min·wk⁻¹), or minutes of MVPA (min·wk⁻¹); and, ethnicity (0, South Asian; 1, white). The leave-one-out cross-validation procedure was used to assess the generalizability, and the bootstrap and jackknife resampling techniques were used to estimate the variance and bias of the models.

RESULTS

Around 70% of the variance in fitness was explained in models with an ethnicity variable, such as: V˙O2max = 77.409 - (age × 0.374) - (body mass index × 0.906) - (ex or current smoker × 1.976) + (physical activity quintile coefficient) - (resting HR × 0.066) + (white ethnicity × 8.032), where physical activity quintile 1 is 0, 2 is 1.127, 3 is 1.869, 4 is 3.793, and 5 is 3.029. Only around 50% of the variance was explained in models without an ethnicity variable. All models with an ethnicity variable were generalizable and had low variance and bias.

CONCLUSION

These data demonstrate the importance of incorporating ethnicity in nonexercise equations to estimate cardiorespiratory fitness in multiethnic populations.

Long terms trends of multimorbidity and association with physical activity in older English population

Background

Multimorbidity has become one of the main challenges in the recent years for patients, health care providers and the health care systems globally. However, literature describing the burden of multimorbidity in the elderly population, especially longitudinal trends is very limited. Physical activity is recommended as one of the main lifestyle changes in the prevention and management of multiple chronic diseases worldwide; however, the evidence on its association with multimorbidity remains inconclusive. Therefore, we aimed to assess the longitudinal trends of multimorbidity and the association between multimorbidity and physical activity in a nationally representative cohort of the English population aged ≥50 years between 2002 and 2013.

Methods

We used data on 15,688 core participants from six waves of the English Longitudinal Study of Ageing, with complete information on physical activity. Self-reported physical activity was categorised as inactive, mild, moderate and vigorous levels of physical activity. We calculated the number of morbidities and the prevalence of multimorbidity (more than 2 chronic conditions) between 2002 and 2013 overall and by levels of self-reported physical activity. We estimated the odds ratio (OR) and 95 % confidence intervals (CI) for multimorbidity by each category of physical activity, adjusting for potential confounders.

Results

There was a progressive decrease over time in the proportion of participants without any chronic conditions (33.9 % in 2002/2003 vs. 26.8 % in 2012/2013). In contrast, the prevalence of multimorbidity steadily increased over time (31.7 % in 2002/2003 vs. 43.1 % in 2012/2013). Compared to the physically inactive group, the OR for multimorbidity was 0.84 (95 % CI 0.78 to 0.91) in mild, 0.61 (95 % CI 0.56 to 0.66) in moderate and 0.45 (95 % CI 0.41 to 0.49) in the vigorous physical activity group.

Conclusion

This study demonstrated an inverse dose-response association between levels of physical activity and multimorbidity, however, given the increasing prevalence of multimorbidity over time, there is a need to explore causal associations between physical activity and multimorbidity and its impact as a primary prevention strategy to prevent the occurrence of chronic conditions later in life and reduce the burden of multimorbidity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0330-9) contains supplementary material, which is available to authorized users.

The effects of high-intensity interval training on glucose regulation and insulin resistance: a meta-analysis

The aim of this meta-analysis was to quantify the effects of high-intensity interval training (HIIT) on markers of glucose regulation and insulin resistance compared with control conditions (CON) or continuous training (CT). Databases were searched for HIIT interventions based upon the inclusion criteria: training ≥2 weeks, adult participants and outcome measurements that included insulin resistance, fasting glucose, HbA1c or fasting insulin. Dual interventions and participants with type 1 diabetes were excluded. Fifty studies were included. There was a reduction in insulin resistance following HIIT compared with both CON and CT (HIIT vs. CON: standardized mean difference [SMD] = -0.49, confidence intervals [CIs] -0.87 to -0.12, P = 0.009; CT: SMD = -0.35, -0.68 to -0.02, P = 0.036). Compared with CON, HbA1c decreased by 0.19% (-0.36 to -0.03, P = 0.021) and body weight decreased by 1.3 kg (-1.9 to -0.7, P < 0.001). There were no statistically significant differences between groups in other outcomes overall. However, participants at risk of or with type 2 diabetes experienced reductions in fasting glucose (-0.92 mmol L(-1), -1.22 to -0.62, P < 0.001) compared with CON. HIIT appears effective at improving metabolic health, particularly in those at risk of or with type 2 diabetes. Larger randomized controlled trials of longer duration than those included in this meta-analysis are required to confirm these results.

The accountants’ perspective on sustainable business practices in SMEs

Purpose

– This paper aims to explore the accountants’ perspective towards their role and function as business advisors in assisting with the adoption of sustainable business practices (SBPs) in small and medium enterprises (SMEs).

Design/methodology/approach

– A questionnaire-based study was conducted on members from one of Australia’s leading professional accounting organizations.

Findings

– Key findings from this research highlighted deficiencies in the effectiveness of the accounting profession in assisting SMEs in implementing SBPs despite a desire from clients for accountants to provide this advice and a belief that accountants are best placed to do so. Further, an expectations gap is evident between the level of involvement accountants believe they should be having in assisting SMEs and the level of involvement that is currently occurring.

Research limitations/implications

– This finding has implications for the accounting profession, with accountants needing to examine their current business approaches in an effort to close this gap. If this does not occur, SMEs will most likely seek this much-needed advice and support from outside the profession.

Originality/value

– Little attention has been given to the accountant’s role in respect of sustainability from an accountant’s perspective. The findings contribute to understanding the accountant’s importance in advancing their involvement in assisting SMEs in the uptake of SBPs.

The association between neighbourhood greenspace and type 2 diabetes in a large cross-sectional study

OBJECTIVE

To investigate the relationship between neighbourhood greenspace and type 2 diabetes.

DESIGN

Cross-sectional.

SETTING

3 diabetes screening studies conducted in Leicestershire, UK in 2004-2011. The percentage of greenspace in the participant's home neighbourhood (3 km radius around home postcode) was obtained from a Land Cover Map. Demographic and biomedical variables were measured at screening.

PARTICIPANTS

10,476 individuals (6200 from general population; 4276 from high-risk population) aged 20-75 years (mean 59 years); 47% female; 21% non-white ethnicity.

MAIN OUTCOME MEASURE

Screen-detected type 2 diabetes (WHO 2011 criteria).

RESULTS

Increased neighbourhood greenspace was associated with significantly lower levels of screen-detected type 2 diabetes. The ORs (95% CI) for screen-detected type 2 diabetes were 0.97 (0.80 to 1.17), 0.78 (0.62 to 0.98) and 0.67 (0.49 to 0.93) for increasing quartiles of neighbourhood greenspace compared with the lowest quartile after adjusting for ethnicity, age, sex, area social deprivation score and urban/rural status (Ptrend=0.01). This association remained on further adjustment for body mass index, physical activity, fasting glucose, 2 h glucose and cholesterol (OR (95% CI) for highest vs lowest quartile: 0.53 (0.35 to 0.82); Ptrend=0.01).

CONCLUSIONS

Neighbourhood greenspace was inversely associated with screen-detected type 2 diabetes, highlighting a potential area for targeted screening as well as a possible public health area for diabetes prevention. However, none of the risk factors that we considered appeared to explain this association, and thus further research is required to elicit underlying mechanisms.

TRIAL REGISTRATION NUMBER

This study uses data from three studies (NCT00318032, NCT00677937, NCT00941954).

Objectively measured physical activity, cardiorespiratory fitness and cardiometabolic risk factors in the Health Survey for England

OBJECTIVES

The study aims to test the hypothesis that physical activity (PA) and cardiorespiratory fitness (CRF) are associated with cardiometabolic risk factors; and to test the hypothesis that CRF modifies (changes the direction and/or strength of) the associations between PA and cardiometabolic risk factors.

METHODS

PA and CRF were objectively measured in the 2008 Health Survey for England and the present study included 536 adults who completed at least 4 min of the eight-minute sub-maximal step test and wore an accelerometer for at least 10 h on at least four days. Linear regression models were fitted to examine the relationship between PA and cardiometabolic risk factors and between CRF and cardiometabolic risk factors. A test of interaction was performed to examine whether CRF modifies the associations between PA and cardiometabolic risk factors.

RESULTS

PA and CRF were associated with HDL cholesterol, the ratio of total to HDL cholesterol, glycated haemoglobin and BMI after adjustment for potential confounders. There was little evidence that CRF changed the direction or strength of associations between PA and cardiometabolic risk factors.

CONCLUSIONS

PA and CRF are associated with cardiometabolic risk factors. A larger sample is required to determine if CRF modifies associations between PA and cardiometabolic risk factors.

Species compositions and ecology of the riverine ichthyofaunas in two Sulawesian islands in the biodiversity hotspot of Wallacea

This account of the riverine ichthyofaunas from the islands of Buton and Kabaena, off south-eastern mainland Sulawesi, represents the first detailed quantitative checklist and ecological study of the riverine fish faunas in the biological hotspot of Wallacea. The results are based on analysis of samples collected by electrofishing at a wide range of sites from July to September in both 2001 and 2002. While the fauna was diverse, with the 2179 fishes caught comprising 64 species representing 43 genera and 22 families, the catches were dominated by the Gobiidae (26 species and 25% by numbers), Eleotridae (seven species and 27% by numbers), Zenarchopteridae (three species and 22% by numbers) and Anguillidae (two species and 12% by numbers). The most abundant species were the eleotrids Eleotris aff. fusca-melanosoma and Ophieleotris aff. aporos, the anguillid Anguilla celebesensis, the zenarchopterids Nomorhamphus sp. and Nomorhamphus ebrardtii and the gobiids Sicyopterus sp. and Glossogobius aff. celebius-kokius. The introduced catfish Clarias batrachus was moderately abundant at a few sites. Cluster analysis, allied with the similarity profiles routine SIMPROF, identified seven discrete groups, which represented samples from sites entirely or predominantly in either Buton (five clusters) or Kabaena (two clusters). Species composition was related to geographical location, distance from river mouth, per cent contribution of sand and silt, altitude and water temperature. The samples from the two islands contained only one species definitively endemic to Sulawesi, i.e. N. ebrardtii and another presumably so, i.e. Nomorhamphus sp., contrasting starkly with the 57 species that are endemic to Sulawesi and, most notably, its large central and deep lake systems on the mainland. This accounts for the ichthyofaunas of these two islands, as well as those of rivers in northern mainland Sulawesi and Flores, being more similar to each other than to those of the central mainland lake systems. This implies that the major adaptive radiation of freshwater fishes in Sulawesi occurred in those lacustrine environments rather than in rivers.

A non-exercise testing method for estimating cardiorespiratory fitness: associations with all-cause and cardiovascular mortality in a pooled analysis of eight population-based cohorts

AIMS

Cardiorespiratory fitness (CRF) is a key predictor of chronic disease, particularly cardiovascular disease (CVD), but its assessment usually requires exercise testing which is impractical and costly in most health-care settings. Non-exercise testing cardiorespiratory fitness (NET-F)-estimating methods are a less resource-demanding alternative, but their predictive capacity for CVD and total mortality has yet to be tested. The objective of this study is to examine the association of a validated NET-F algorithm with all-cause and CVD mortality.

METHODS AND RESULTS

The participants were 32,319 adults (14,650 men) aged 35-70 years who took part in eight Health Survey for England and Scottish Health Survey studies between 1994 and 2003. Non-exercise testing cardiorespiratory fitness (a metabolic equivalent of VO2max) was calculated using age, sex, body mass index (BMI), resting heart rate, and self-reported physical activity. We followed participants for mortality until 2008. Two thousand one hundred and sixty-five participants died (460 cardiovascular deaths) during a mean 9.0 [standard deviation (SD) = 3.6] year follow-up. After adjusting for potential confounders including diabetes, hypertension, smoking, social class, alcohol, and depression, a higher fitness score according to the NET-F was associated with a lower risk of mortality from all-causes (hazard ratio per SD increase in NET-F 0.85, 95% confidence interval: 0.78-0.93 in men; 0.88, 0.80-0.98 in women) and CVD (men: 0.75, 0.63-0.90; women: 0.73, 0.60-0.92). Non-exercise testing cardiorespiratory fitness had a better discriminative ability than any of its components (CVD mortality c-statistic: NET-F = 0.70-0.74; BMI = 0.45-0.59; physical activity = 0.60-0.64; resting heart rate = 0.57-0.61). The sensitivity of the NET-F algorithm to predict events occurring in the highest risk quintile was better for CVD (0.49 in both sexes) than all-cause mortality (0.44 and 0.40 for men and women, respectively). The specificity for all-cause and CVD mortality ranged between 0.80 and 0.82. The net reclassification improvement of CVD mortality risk (vs. a standardized aggregate score of the modifiable components of NET-F) was 27.2 and 21.0% for men and women, respectively.

CONCLUSION

The CRF-estimating method NET-F that does not involve exercise testing showed consistent associations with all-cause and cardiovascular mortality, and it had good discrimination and excellent risk reclassification improvement. As such, it merits further attention as a practical and potentially and useful risk prediction tool.

Fatness, fitness, and cardiometabolic risk factors in middle-aged white men

The objective was to test the hypothesis that traditional and novel cardiometabolic risk factors would be significantly different in groups of men of different fatness and fitness. Total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, high-sensitivity C-reactive protein, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, leptin, adiponectin, tumor necrosis factor-α, interleukin-6, interleukin-10, fibrinogen, and insulin resistance were assessed in 183 nonsmoking white men aged 35 to 53 years, including 62 who were slim and fit (waist girth ≤90 cm and maximal oxygen consumption [VO(2)max] above average), 24 who were slim and unfit (waist girth ≤90 cm and VO(2)max average or below), 39 who were fat and fit (waist girth ≥100 cm and VO(2)max above average), and 19 who were fat and unfit (waist girth ≥100 cm and VO(2)max average or below). Seventy-six percent gave blood on 2 occasions, and the average of 1 or 2 blood tests was used in statistical tests. Waist girth (centimeters) and fitness (milliliters of oxygen per kilogram of fat-free mass) were associated with high-density lipoprotein cholesterol, leptin, and insulin resistance after adjustment for age, saturated fat intake, and total energy intake. High-density lipoprotein cholesterol, triglycerides, alanine aminotransferase, and insulin resistance were significantly different in men who were fat and fit and those who were fat and unfit. These data suggest that differences in lipid and lipoprotein concentrations, liver function, and insulin resistance may explain why the risks of chronic disease are lower in men who are fat and fit than those who are fat and unfit.

The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences

Our understanding of the relationship between physical activity and health is constantly evolving. Therefore, the British Association of Sport and Exercise Sciences convened a panel of experts to review the literature and produce guidelines that health professionals might use. In the ABC of Physical Activity for Health, A is for All healthy adults, B is for Beginners, and C is for Conditioned individuals. All healthy adults aged 18-65 years should aim to take part in at least 150 min of moderate-intensity aerobic activity each week, or at least 75 min of vigorous-intensity aerobic activity per week, or equivalent combinations of moderate- and vigorous-intensity activities. Moderate-intensity activities are those in which heart rate and breathing are raised, but it is possible to speak comfortably. Vigorous-intensity activities are those in which heart rate is higher, breathing is heavier, and conversation is harder. Aerobic activities should be undertaken in bouts of at least 10 min and, ideally, should be performed on five or more days a week. All healthy adults should also perform muscle-strengthening activities on two or more days a week. Weight training, circuit classes, yoga, and other muscle-strengthening activities offer additional health benefits and may help older adults to maintain physical independence. Beginners should work steadily towards meeting the physical activity levels recommended for all healthy adults. Even small increases in activity will bring some health benefits in the early stages and it is important to set achievable goals that provide success, build confidence, and increase motivation. For example, a beginner might be asked to walk an extra 10 min every other day for several weeks to slowly reach the recommended levels of activity for all healthy adults. It is also critical that beginners find activities they enjoy and gain support in becoming more active from family and friends. Conditioned individuals who have met the physical activity levels recommended for all healthy adults for at least 6 months may obtain additional health benefits by engaging in 300 min or more of moderate-intensity aerobic activity per week, or 150 min or more of vigorous-intensity aerobic activity each week, or equivalent combinations of moderate- and vigorous-intensity aerobic activities. Adults who find it difficult to maintain a normal weight and adults with increased risk of cardiovascular disease or type 2 diabetes may in particular benefit from going beyond the levels of activity recommended for all healthy adults and gradually progressing towards meeting the recommendations for conditioned individuals. Physical activity is beneficial to health with or without weight loss, but adults who find it difficult to maintain a normal weight should probably be encouraged to reduce energy intake and minimize time spent in sedentary behaviours to prevent further weight gain. Children and young people aged 5-16 years should accumulate at least 60 min of moderate-to-vigorous-intensity aerobic activity per day, including vigorous-intensity aerobic activities that improve bone density and muscle strength.

Cardiorespiratory fitness and metabolic risk factors in obesity

PURPOSE OF REVIEW

An increase in cardiorespiratory fitness (CRF) through exercise training appears to partly ameliorate the health hazards of obesity and a number of mechanisms might explain the potential benefits. We review recent evidence about the relationships between CRF, exercise training and metabolic risk factors in obesity.

RECENT FINDINGS

Epidemiological data have shown that the anti-inflammatory effects of exercise could be an important mechanism in explaining cardio-protective effects of physical activity. Emerging evidence suggests that exercise training reduces markers of inflammation and improves glucose control in obesity, independent of weight loss. Novel mechanisms appear to involve exercise-induced changes in CD14+CD16+ cell populations, expression of toll-like receptors, and key changes in the metabolic regulation of visceral white adipose tissue. Other promising recent research has focused on exercise-induced signalling pathways governing glucose metabolism, such as insulin receptor substrate and Akt substrate. Using novel imaging techniques, studies have demonstrated exercise-induced improvements in lipoprotein subfraction particle size, and reduction in visceral adipose tissue and liver fat, independent of weight loss. These effects appear to be mostly restricted to interventions consisting of relatively high doses of exercise or exercise combined with calorie restriction, although further work is required to elucidate the dose-response relationships.

SUMMARY

Physical activity and the pursuit of physical fitness are important in the treatment of obesity because exercise training can improve a number of metabolic risk factors independent of weight loss. Thus exercise can provide important health benefits irrespective of weight loss in obese and overweight individuals.

Antiparasitic activities of novel, orally available fumagillin analogs

Fumagillin, an irreversible inhibitor of MetAP2, has been shown to potently inhibit growth of malaria parasites in vitro. Here, we demonstrate activity of fumagillin analogs with an improved pharmacokinetic profile against malaria parasites, trypanosomes, and amoebas. A subset of the compounds showed efficacy in a murine malaria model. The observed SAR forms a basis for further optimization of fumagillin based inhibitors against parasitic targets by inhibition of MetAP2.

Sedentary, active and athletic lifestyles: Right and left ventricular long axis diastolic function

The early relaxation velocity of the atrioventricular plane (long axis function) of the left ventricle is reported for sedentary, active and athletic men aged 30-45 years. At the left ventricular free wall this velocity is significantly greater for active men than it is for both sedentary and athletic men.

British adults' views on the health benefits of moderate and vigorous activity

OBJECTIVE

It has been suggested that the promotion of moderate-intensity physical activity has created a widespread belief that moderate activity offers greater health benefits than vigorous activity. The present study was designed to test this hypothesis in Britain, where moderate activity has solely been recommended since 1995.

METHODS

Nationally representative survey of 1191 Britons aged 16-65 surveyed from March 3rd to May 12th 2006.

RESULTS

In support of the hypothesis, 56% of men and 71% of women aged 25-65 indicated that moderate activity offered greater health benefits than vigorous activity and indicated that moderate activity was recommended.

CONCLUSIONS

Policymakers have an obligation to equip the public to make fully informed decisions about physical activity and health. British physical activity guidelines should be amended because most men and women erroneously believe that moderate activity offers greater health benefits than vigorous activity.

Cardiovascular disease risk factors in habitual exercisers, lean sedentary men and abdominally obese sedentary men

OBJECTIVE

To investigate whether the favourable cardiovascular disease (CVD) risk factor profile of habitual exercisers is attributable to exercise or leanness.

DESIGN

Cross-sectional study of 113 nonsmoking men aged 30-45 y. CVD risk factors were compared in exercisers (n=39) and sedentary men (n=74), and in subgroups of lean exercisers (n=37), lean sedentary men (n=46) and obese sedentary men (n=28). Waist girth was used to identify lean (<100 cm) and abdominally obese (> or =100 cm) subgroups.

MEASUREMENTS

Blood pressure, physical activity (7-day recall), physical fitness (maximum oxygen consumption) and fasted lipoproteins, apolipoprotein (apo) B, triglycerides, glucose and fibrinogen.

RESULTS

Exercisers were fitter and leaner than sedentary men and had a better CVD risk factor profile. Total cholesterol, LDL-cholesterol and apo B concentrations were lower in lean exercisers than in lean sedentary men, suggesting that exercise influences these risk factors. Indeed, time spent in vigorous activity was the only significant predictor of total cholesterol and LDL-cholesterol in multiple linear regression models. Exercise status had little influence on triglycerides and HDL-cholesterol (HDL-C), and unfavourable levels were only evident among obese sedentary men. Waist girth was the sole predictor of triglycerides and HDL-C, explaining 44 and 31% of the variance, respectively.

CONCLUSIONS

These findings suggest that the CVD risk factor profile of habitual exercisers is attributable to leanness and exercise. Leanness is associated with favourable levels of HDL-C and triglycerides, while exercise is associated with lower levels of total cholesterol, LDL-cholesterol and apo B.

Phosphorus retention and sorption by constructed wetland soils in Southeast Ireland

It may be necessary to use constructed wetlands as a land use practice to mitigate phosphorus (P) loss from agriculture in Ireland. The objectives of this study were to determine the ability of two constructed wetland site soils to retain and sorb P. Intact soil/water column studies were used to determine P release/retention rates during a 30-day incubation period. Soil columns flooded with distilled water released P during the first 2 days; however, soluble reactive P (SRP) concentrations in overlying floodwaters decreased thereafter. Soils with overlying floodwaters spiked at 5 and 15 mg SRP L(-1) retained highest amounts of P (p < 0.05) with retention at these concentrations controlled by SRP in overlying waters. Retention rates by soils ranged between 0.3 and 60.9 mg Pm(-2) d(-1). Maximum P sorption capacity (Smax) was higher for wetland soils at Dunhill, Waterford (1464 mg P kg(-1)) in comparison to soils at Johnstown Castle, Wexford (618 mg P kg(-1)). Equilibrium P concentrations (EPC0) were low (in the microg SRP L(-1) range), indicating a high capacity of these soils to sorb P. Phosphorus sorption parameters were significantly related to ammonium oxalate extractable aluminium (Al) and iron (Fe) content of soils.

The effects of 24 weeks of moderate- or high-intensity exercise on insulin resistance

This study was designed to investigate the effect of exercise intensity on insulin resistance by comparing moderate- and high-intensity interventions of equal energy cost. Maximum oxygen consumption (VO(2max)), insulin, glucose and triglycerides were measured in 64 sedentary men before random allocation to a non-exercise control group, a moderate-intensity exercise group (three 400-kcal sessions per week at 60% of VO(2max)) or a high-intensity exercise group (three 400-kcal sessions per week at 80% of VO(2max)). An insulin sensitivity score was derived from fasting concentrations of insulin and triglycerides, and insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Data were available for 36 men who finished the study. After 24 weeks, insulin concentration decreased by 2.54+/-4.09 and 2.37+/-3.35 mU l(-1), insulin sensitivity score increased by 0.91+/-1.52 and 0.79+/-1.37, and HOMA-IR decreased by -0.6+/-0.8 and -0.5+/-0.8 in the moderate- and high-intensity exercise groups, respectively. When data from the exercise groups were combined, one-way analysis of variance with one-tailed post hoc comparisons indicated that these changes were significantly greater than those observed in the control group (all P<0.05). Twenty-four week changes in insulin concentration, insulin sensitivity score and HOMA-IR were not significantly different between the exercise groups. These data suggest that exercise training is accompanied by a significant reduction in insulin resistance, as indicated by well-validated surrogate measures. These data also suggest that moderate-intensity exercise is as effective as high-intensity exercise when 400 kcal are expended per session.