Association of combined healthy lifestyle factors with incident osteoporosis in patients with and without type 2 diabetes

PURPOSE

The association between type 2 diabetes mellitus (T2DM), lifestyle factors, and the risk of osteoporosis (OP) is well-established. However, the impact of a healthy lifestyle on diabetes-related osteoporosis needs further investigation. Our objective was to explore if a combination of healthy lifestyle factors could mitigate the risk of OP in individuals with type 2 diabetes.

METHODS

This longitudinal analysis included 237,725 middle-aged and older participants. An overall lifestyle score, ranging from 0 to 7, was calculated by assigning a point for each of the seven healthy lifestyle factors, including no current smoking, non-excessive alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and adequate sunshine exposure.

RESULTS

During a median follow-up 12.21 years, 5760 OP cases were documented. Participants with T2DM showed a higher risk of OP than those without diabetes. Compared with participants without diabetes who had a lifestyle score of 6-7, the hazard ratios (HRs) for OP were 1.58 (95% CI 1.23-2.03), 1.62 (95% CI 1.16-2.25), and 2.58 (95% CI 1.64-4.05) for participants with T2DM who had a lifestyle score of 4, 3, and 0-2, respectively. There was a graded association between higher lifestyle scores and lower risks of incident OP among participants without diabetes as well as among those with T2DM. We estimated that the population attributable fraction for not adhering to 6-7 lifestyle behaviors was 15.7%.

CONCLUSIONS

Participants with T2DM who adhered to a variety of healthy lifestyle factors demonstrated a substantially reduced risk of developing OP.

Association of social health with all-cause mortality and cause-specific mortality: A population-based cohort study

BACKGROUND

Previous studies only focused on the individual social factors, without considering the overall social health patterns. The present study aimed to develop an integrated social health score (SHS) and investigate its associations with all-cause, cardiovascular disease (CVD), cancer mortality.

METHODS

A total of 330,716 participants (mean age 56.3 years; 52.4 % female) from UK Biobank was included between 2006 and 2010, and thereafter followed up to 2021. SHS was calculated by using information on social connections, social engagement and social support. Cox proportional hazards models was used to estimate the hazard ratios and 95 % confidence intervals (CIs) of the association between SHS and all-cause and cause-specific mortality and the 4-way decomposition was used to quantify the mediating effect of lifestyle factors.

RESULTS

During a median follow-up period of 12.4 years, 37,897 death cases were recorded, including 4347 CVD and 10,380 cancer cases. The SHS was inversely associated with the risks of all-cause, CVD and cancer mortality in a dose-dependent manner (P for trend <0.001). The association between SHS with all-cause mortality was mediated by lifestyle factors including diet score, smoking status and alcohol consumption.

CONCLUSION

Integrated SHS was inversely associated with risks of all-cause, CVD and cancer mortality, and the associations were partially mediated by lifestyle factors. Our study highlights the importance of maintaining high levels of social health by jointly enhancing social involvement, expanding social networks, and cultivating enduring intimate relationships across the life course.

Poor healthy lifestyle and life's essential 8 are associated with higher risk of new-onset migraine: a prospective cohort study

BACKGROUND

Lifestyle are closely related to migraine. However, there is a lack of studies investigating the association between Healthy lifestyle or Life's Essential 8 (LE8) and the risk of migraine. The objective of this research was to investigate the relationship between Healthy lifestyle scores and Life's essential 8 scores, and migraine.

METHODS

332,895 UK Biobank participants without migraine were included. Healthy lifestyle were assessed using seven lifestyle factors, and categorized as poor, intermediate, or ideal. LE8, based on the American Heart Association (AHA) Guidelines for Cardiovascular Health (CVH), consist of eight indicators classified as low, moderate, or high CVH. The Cox proportional hazard model was employed to examine the association between Healthy lifestyle scores, LE8 scores, and migraine, with calculations for population-attributable fraction (PAF) and cumulative incidence.

RESULTS

During a median follow-up of 13.58 years, participants in intermediate (HR: 0.91; 95% CI: 0.85, 0.99) or ideal category of Healthy lifestyle (HR: 0.81; 95% CI: 0.73, 0.91) significantly reduced migraine risk compared to the poor category. Similarly, high CVH (HR: 0.73; 95% CI: 0.58, 0.92) also lowered migraine risk, while moderate CVH (HR: 0.93; 95% CI: 0.85, 1.02) did not show a difference compared to low CVH. If all individuals adhered to higher categories of Healthy lifestyle and LE8, approximately 11.38% and 22.05% of migraine cases could be prevented. Among individual lifestyle factors, maintaining an ideal body mass index (BMI), physical activity, sleep duration, sleep pattern, and sedentary time were associated with substantial reductions in migraine risk, by 5.65%, 0.81%, 10.16%, 16.39%, and 6.57%, respectively.

CONCLUSION

Our study provides evidence that poor Healthy lifestyle and Life's Essential 8 are associated with higher risk of new-onset migraine.

Parental perspectives on Children's lifestyles: A Path for school health promotion

The National School Health Program in Portugal advocates for healthy lifestyles. However, school health teams mostly focus their activities on educating children, whereas it is the families who are primarily responsible for managing children's lifestyles. Although the programme proposes interactive health education activities, such as meetings with the children's families, few parents participate in these activities. The project Gostar de Mim was created to bridge this gap by promoting healthy family lifestyles in school settings. The project used an evaluating instrument called the 'Parents' Booklet' packed with information. This study assessed the usefulness of the booklet in providing health information and planning family engagement. Based on the PRECEDE-PROCEED framework (PRECEDE: Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation; PROCEED: Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development), this article focuses on the social and epidemiological assessment phases. We examined the health surveillance status of children aged 6-10 years (epidemiological phase) and description of health behaviours in different lifestyle dimensions (behavioural and environmental phase). The Parents' Booklet was used to identify parents' perspectives on their children's lifestyles. Data analysis of 568 Parents' Booklet (23 schools) use cases showed that the lifestyle priorities, in order, were 'sleep and rest' (95.6 %), 'energy balance' (100 %), 'oral/body healthcare' (95.6 %), 'alcohol, tobacco/other drugs' (73.9 %), 'consumerism' (91.3 %), 'leisure-time occupation' (91.3 %), and 'literacy and satisfaction at school' (86.9 %). Clearly, the Parents' Booklet was useful, as it made it possible to obtain information that allowed for participatory school health diagnosis and can guide community nursing actions that need to be developed in schools. Crucially, this tool can be useful for parents, enabling them to be more aware of their children's lifestyle via self-monitoring as well as increasing their participation in health education.

Combined healthy lifestyle behaviours and incident dementia: A systematic review and dose-response meta-analysis of cohort studies

BACKGROUND

The associations of combined healthy lifestyle behaviours and incident dementia have not been systematically reviewed and the dose-response relationship was uncertain.

OBJECTIVES

To evaluate the associations of combined healthy lifestyle behaviours with incident dementia and other cognitive outcomes, assess the dose-response relationship between the number of lifestyle behaviours and incident dementia, and summarise the adherence to healthy lifestyle behaviours.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, EMBASE, Web of Science and PsycINFO were searched from inception to 20 Jan 2024. Cohort studies reporting associations of combined healthy lifestyle behaviours with incident dementia or other cognitive outcomes were included. We used the random-effects meta-analysis to pool the risk estimates and the robust error meta-regression method to examine the dose-response relationship. The methodological quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 22 articles including 25 cohort studies mostly from high-income economics were included, with all assessed as high methodological quality. Adherence to a healthy lifestyle was associated with a decreased risk of incident dementia, either per healthy lifestyle behaviour increase (pooled hazard ratio 0.89, 95 % confidence interval 0.85-0.94) or the highest level versus the lowest level (pooled hazard ratio 0.61, 95 % confidence interval 0.49-0.76). An inverse, linear dose-response relationship (Pnon-linear = 0.845) between the number of healthy lifestyle behaviours and incident dementia was observed, with an 11 % risk reduction for each healthy behaviour increase. A relatively limited number of included studies indicated that adherence to a healthy lifestyle combination could yield benefits for cognitive decline, global cognition, memory and executive function. In addition, the adherence rates typically decreased as the number of healthy lifestyle behaviours increased.

CONCLUSIONS

Adherence to a healthy lifestyle was associated with a lower risk of incident dementia and other cognitive outcomes. It is important to find a subtle balance between the benefits and adherence. Further large cohort studies for combined lifestyle behaviours with specific cognitive outcomes and dose-response relationships are required, especially based on middle- and low-income populations.

REGISTRATION

The study was registered in PROSPERO (CRD42023418509).

TWEETABLE ABSTRACT

Engaging in a greater number of healthy lifestyle behaviours yields increased benefits in preventing dementia, albeit with lower adherence rates as a trade-off. Finding a delicate balance between the benefits and adherence is crucial.

Efficacy of lifestyle interventions in the management of systemic lupus erythematosus: a systematic review of the literature

We performed a systematic review to explore existing evidence regarding the efficacy of lifestyle interventions for the management of systemic lupus erythematosus (SLE). The search was conducted on the 22nd of June 2021 for publications between 1st of January 2000 and the date of search. Additional articles within the aforementioned timeframe and until December 2023 were added by hand searching. Databases utilized were Medline, Embase, Web of Science, and Cinahl. Lifestyle interventions were defined as any intervention encompassing one or more of the following: physical exercise, diet and nutrition, mental health, harmful exposures, sleep, and social relations. The Joanna Briggs Institute critical appraisal tools were used for risk of bias assessment. The search yielded 11,274 unique records, we assessed the full text of 199 records, and finally included 102 studies. Overall, the quality of the evidence is limited, and there were multiple sources of heterogeneity. The two domains most extensively researched were mental health (40 records) and physical exercise (39 records). Psychological interventions had a positive effect on depressive symptoms, anxiety, and health-related quality of life (HRQoL), whereas physical exercise improved fatigue, depressive symptoms, aerobic capacity, and physical functioning. Studies on diet and nutrition (15 records) support that low fat intake and Mediterranean diet may be beneficial for reducing cardiovascular risk, but large interventional studies are lacking. Studies on harmful exposures (7 records) support photoprotection and use of sunscreen. While studies imply benefits regarding disease burden and drug efficacy in non-smokers and regarding HRQoL in normal-weight patients, more survey is needed on tobacco smoking and alcohol consumption, as well as weight control strategies. Studies on social relations (1 record) and sleep (no records) were sparse or non-existent. In conclusion, psychosocial interventions are viable for managing depressive symptoms, and exercise appears essential for reducing fatigue and improving aerobic capacity and physical function. Photoprotection should be recommended to all patients. Lifestyle interventions should be considered a complement, not a substitute, to pharmacotherapy.

A cross-sectional study of the relationship between physical activity, diet quality, and high-sensitivity C-reactive protein in US adults

BACKGROUND AND AIMS

High-sensitivity C-reactive protein (hs-CRP) is associated with many diseases, especially cardiovascular disease (CVD). Research into the independent and integrated relationships of physical activity and diet quality with hs-CRP across sex-specific cohorts is lacking.

METHODS AND RESULTS

National Health and Nutrition Examination Survey data (2015-2018) was used to examine the relationship between physical activity and diet quality with hs-CRP and hs-CRP classified CVD risk using multiple multinormal logistic regression adjusted for covariates including demographics. Physical activity was measured using a self-reported survey and further categorized to those who met (MPAR) or did not meet (NPAR) national recommendations. Diet quality was measured using the Healthy Eating Index-2015, and further categorized to higher (HDQ) and lower (LDQ) diet quality. hs-CRP was also categorized as low, average, and high CVD risk using established cut-points. Physical activity was inversely related to hs-CRP in males (p < 0.001) whereas diet quality was inversely related to hs-CRP in females (p = 0.031). Compared to those with NPAR and LDQ, the hs-CRP for males with NPAR and HDQ and females with MPAR and HDQ was 1.18 mg/L and 0.75 mg/L lower respectively. Although, diet quality was inversely associated with high CVD risk in both sexes (p < 0.05), the lowest proportion of high and average CVD risk was observed in males and females with MPAR and HDQ.

CONCLUSION

Physical activity and diet-quality lowered CVD risk regardless of sex. However, the independent effects of physical activity and diet quality on hs-CPR differs between sexes.

Multicomponent Intervention on Improving the Cognitive Ability of Older Adults with Mild Cognitive Impairment: A Pilot Randomized Controlled Trial

This pilot randomized controlled trial aimed to evaluate the feasibility and potential outcomes of an innovative 16-session multicomponent intervention model to improve cognitive abilities in older adults with mild cognitive impairment (MCI) by promoting healthy lifestyle, cognitive skills, tai chi and mindfulness practices. This study was a multicentre, randomized controlled, two-arm, parallel-group, unblinded trial in Hong Kong. 57 Chinese older adults with MCI recruited from three local elderly centers were randomly assigned to either the control or intervention group. The study results support the feasibility and efficacy of the multicomponent intervention, and recommend future larger-scale randomized control trials.

Implementation of recommended treatment for children in weight management programs: Lessons from the stay in treatment study sites

OBJECTIVES

Pediatric obesity remains a public health crisis in the United States, exacerbated by the COVID-19 pandemic. There are recommended guidelines for multidisciplinary care, but they remain challenging to implement, even in tertiary care weight management programs. The aim of this analysis is to describe the implementation of these recommendations among four pediatric weight management programs in the United States.

METHODS

This report capitalizes on a convenience sample of programs participating in the Stay In Treatment (SIT) Study, a multicenter study to address attrition among pediatric weight management programs in tertiary care, academic institutions in diverse geographic locations. The programs were compared regarding structure, program offerings, and funding support.

RESULTS

The four programs were interdisciplinary, offered individual and group treatment options, and were family-based. A range of clinicians provided interventions with nutrition, physical activity, behavioral and psychosocial components. Anti-obesity pharmacotherapy and bariatric surgery were offered, when appropriate. None of the programs were self-sustaining; they required institutional and philanthropic support to provide recommended, comprehensive treatment.

CONCLUSIONS

Ongoing state and national advocacy are needed in the US to create consistent coverage for private and public insurance plans, so that high-risk children can have access to recommended treatment.

Genetic risk, adherence to healthy lifestyle behaviors, and risk of cholelithiasis: A population-based cohort study

OBJECTIVE

Genetic and lifestyles contribute to cholelithiasis, but the impact of adhering to healthy lifestyle on cholelithiasis risk remains uncertain. We aimed to assess combined lifestyle factors and a polygenic risk score on incident cholelithiasis.

METHODS

We utilized cholelithiasis genome-wide association study (GWAS) data from FinnGen study, constructing varied polygenic risk score (PRS), and applied them to 317,640 UK Biobank participants. The relative and absolute risk of incident cholelithiasis associated with six well-established lifestyle risk factors, was evaluated and stratified by PRS (low risk [quintile 1], intermediate risk [quintiles 2-4] and high risk [quintile 5]). Lifestyle score was also categorized into favorable, intermediate, and unfavorable groups.

RESULTS

The PRS derived from 13 single nucleotide polymorphisms (p ≤ 5 × 10-6, r2 < 0.001) showed the best performance. A significant gradient of increase in risk of cholelithiasis was observed across the quintiles of the polygenic risk score (p < 0.001). Compared to participants with low genetic risk, those with intermediate or high genetic risk had a 10% (95% confidence interval [CI] = 1.05-1.17) and 24% (95% CI = 1.16-1.32) higher risk of cholelithiasis. An unfavorable lifestyle was associated with an approximately 50% higher risk of cholelithiasis than a favorable lifestyle. Participants with high genetic risk and an unfavorable lifestyle had 98% (Hazard ratio [HR]: 1.98; 95% CI: 1.67-2.35) higher risk of cholelithiasis than those with low genetic risk and a favorable lifestyle.

CONCLUSIONS

Our study highlights the importance of lifestyle behaviors intervention on cholelithiasis risk regardless of the genetic risk in White European population.

The impact of social media addiction on healthy lifestyle beliefs in adolescents

OBJECTIVE

This study was designed to examine the impact of social media addiction on healthy lifestyle beliefs in adolescents.

METHOD

The study is a descriptive correlational study. The study was conducted with 722 students at middle and high school levels in a city in the eastern part of Turkey. Data were collected using the Socio-Demographic Information Form, Short Form of Social Media Addiction Scale for Adolescents, Adolescent Healthy Lifestyle Belief Scale. The data were reported using numbers, percentages, means, standard values, linear and hierarchical regression.

RESULTS

The mean age of adolescents was 14.44 ± 2.62 and their body mass index was 20.16 ± 3.72. Adolescents scored 14.43 ± 2.63 on the social media addiction scale and 55.23 ± 16.80 on the healthy lifestyle belief scale. Social media addiction explains 8.9% of the total variance in healthy lifestyle beliefs. An increase in social media addiction was found to have a statistically significant effect on healthy lifestyle beliefs. The model established for the impact of age, weight, height, and BMI added to social media addiction on healthy lifestyle beliefs was significant, and the explanatory power of the model was 11.6%.

CONCLUSION

It was concluded that social media addiction has an impact on healthy lifestyle beliefs in adolescents and that creating awareness, maintaining balance, promoting alternative activities, and fostering family-school cooperation are important in this regard.

PRACTICE IMPLICATIONS

In order to increase healthy lifestyle beliefs in adolescents, it is necessary to reduce social media addiction levels. Nursing interventions to be implemented for this purpose are important in improving and protecting adolescent health.

Cardiovascular health in Spain based on the Life's Essential 8 and its association with all-cause and cardiovascular mortality: the ENRICA cohort

INTRODUCTION AND OBJECTIVES

The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death.

METHODS

We used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression.

RESULTS

In total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8 ≤ 49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89).

CONCLUSIONS

A substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality.

Association of Healthy Lifestyle and Incident Polypharmacy

BACKGROUND

Polypharmacy, commonly defined as taking ≥5 medications, is an undesirable state associated with lower quality of life. Strategies to prevent polypharmacy may be an important priority for patients. We sought to examine the association of healthy lifestyle, a modifiable risk factor, with incident polypharmacy.

METHODS

We performed a secondary analysis of the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, including 15,478 adults aged ≥45 years without polypharmacy at baseline. The primary exposure was healthy lifestyle at baseline as measured by the Healthy Behavior Score (HBS), a cumulative assessment of diet, exercise frequency, tobacco smoking, and sedentary time. HBS ranges from 0-8, whereby 0-2 indicates low HBS, 3-5 indicates moderate HBS, and 6-8 indicates high HBS. We used multinomial logistic regression to examine the association between HBS and incident polypharmacy, survival without polypharmacy, and death.

RESULTS

Higher HBS (i.e., healthier lifestyle) was inversely associated with incident polypharmacy after adjusting for sociodemographic and baseline health variables. Compared with participants with low HBS, those with moderate HBS had lower odds of incident polypharmacy (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.73-0.98) and lower odds of dying (OR 0.74; 95% CI, 0.65-0.83). Participants with high HBS had even lower odds of both incident polypharmacy (OR 0.75; 95% CI, 0.64-0.88) and death (OR 0.62; 95% CI, 0.54-0.70). There was an interaction for age, where the association between HBS and incident polypharmacy was most pronounced for participants aged ≤65 years.

CONCLUSIONS

Healthier lifestyle was associated with lower risk for incident polypharmacy.

Impact of a mobile application-based home care nursing program on patients' quality of life and family burden

OBJECTIVE

This study aims to identify the effectiveness of a mobile application-based home care nursing service in improving patient quality of life and healthy lifestyle and reducing the family burden.

METHODS

This study was a clinical trial with a pre- and post-test control group design. The accessible population in this study was post-discharge patients from general hospitals in West Kalimantan and East Kalimantan, Indonesia, who required home care nursing. We allocated a selected sample of 40 people to the intervention group and 40 people to the control group using a randomized block design. We gave mobile application-based home care nursing to the intervention group and community health nursing care to the control group. This study was conducted in 10 months (January-October 2022). We measure the patient quality of life, healthy lifestyle, and family burden before and 3 months after the intervention.

RESULTS

There was no significant difference in the post-test quality of life between the two groups (p =  0.187), but there was a significant difference in the psychological (p =  0.014) and environmental health (p =  0.021) domain of quality of life. There was no significant difference in the post-test of a healthy lifestyle between the two groups (p =  0.083). There was a significant difference in the post-test family burden between the two groups (p =  0.015).

CONCLUSION

Mobile Application-Based Home Care Nursing is effective in improving patient quality of life in the psychological and environmental health domains and reducing the family burden for post-discharge patients.

Socioeconomic status, lifestyle and risk of incident dementia: a prospective cohort study of 276730 participants

Healthy lifestyle might alleviate the socioeconomic inequities in health, but the extent of the joint and interactive effects of these two factors on dementia are unclear. This study aimed to detect the joint and interactive associations of socioeconomic status (SES) and lifestyle factors with incident dementia risk, and the underlying brain imaging alterations. Cox proportional hazards analysis was performed to test the joint and interactive associations. Partial correlation analysis was performed to reflect the brain imaging alterations. A total of 276,730 participants with a mean age of 55.9 (±8.0) years old from UK biobank were included. Over 8.5 (±2.6) years of follow-up, 3013 participants were diagnosed with dementia. Participants with high SES and most healthy lifestyle had a significantly lower risk of incident dementia (HR=0.19, 95% CI=0.14 to 0.26, P<2×10-16), Alzheimer's disease (AD, HR=0.19, 95% CI=0.13 to 0.29, P=8.94×10-15), and vascular dementia (HR=0.24, 95% CI=0.12 to 0.48, P=7.57×10-05) compared with participants with low SES and an unhealthy lifestyle. Significant interactions were found between SES and lifestyle on dementia (P=0.002) and AD (P=0.001) risks; the association between lifestyle and dementia was stronger among those of high SES. The combination of high SES and healthy lifestyle was positively associated with higher volumes in brain regions vulnerable to dementia-related atrophy. These findings suggest that SES and lifestyle significantly interact and influence dementia with its related brain structure phenotypes.

Healthy Lifestyle and the Risk of Metabolic Dysfunction-Associated Fatty Liver Disease: A Large Prospective Cohort Study

Background

The incidence density of metabolic dysfunction-associated fatty liver disease (MAFLD) and the effect of a healthy lifestyle on the risk of MAFLD remain unknown. We evaluated the prevalence and incidence density of MAFLD and investigated the association between healthy lifestyle and the risk of MAFLD.

Methods

A cross-sectional analysis was conducted on 37,422 participants to explore the prevalence of MAFLD. A cohort analysis of 18,964 individuals was conducted to identify the incidence of MAFLD, as well as the association between healthy lifestyle and MAFLD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) with adjustments for confounding factors.

Results

The prevalence of MAFLD, non-alcoholic fatty liver disease, and their comorbidities were 30.38%, 28.09%, and 26.13%, respectively. After approximately 70 thousand person-years of follow-up, the incidence densities of the three conditions were 61.03, 55.49, and 51.64 per 1,000 person-years, respectively. Adherence to an overall healthy lifestyle was associated with a 19% decreased risk of MAFLD (HR, 0.81; 95% CI, 0.72 to 0.92), and the effects were modified by baseline age, sex, and body mass index (BMI). Subgroup analyses revealed that younger participants, men, and those with a lower BMI experienced more significant beneficial effects from healthy lifestyle.

Conclusion

Our results highlight the beneficial effect of adherence to a healthy lifestyle on the prevention of MAFLD. Health management for improving dietary intake, physical activity, and smoking and drinking habits are critical to improving MAFLD.

The role of lifestyle in the association between long-term ambient air pollution exposure and cardiovascular disease: a national cohort study in China

BACKGROUND

Cardiovascular disease (CVD) caused by air pollution poses a considerable burden on public health. We aim to examine whether lifestyle factors mediate the associations of air pollutant exposure with the risk of CVD and the extent of the interaction between lifestyles and air pollutant exposure regarding CVD outcomes.

METHODS

We included 7000 participants in 2011-2012 and followed up until 2018. The lifestyle evaluation consists of six factors as proxies, including blood pressure, blood glucose, blood lipids, body mass index, tobacco exposure, and physical activity, and the participants were categorized into three lifestyle groups according to the number of ideal factors (unfavorable, 0-1; intermediate, 2-4; and favorable, 5-6). Satellite-based spatiotemporal models were used to estimate exposure to ambient air pollutants (including particles with diameters ≤ 1.0 μm [PM1], ≤ 2.5 μm [PM2.5], ≤ 10 μm [PM10], nitrogen dioxide [NO2], and ozone [O3]). Cox regression models were used to examine the associations between air pollutant exposure, lifestyles and the risk of CVD. The mediation and modification effects of lifestyle categories on the association between air pollutant exposure and CVD were analyzed.

RESULTS

After adjusting for covariates, per 10 μg/m3 increase in exposure to PM1 (HR: 1.09, 95% CI: 1.05-1.14), PM2.5 (HR: 1.04, 95% CI: 1.00-1.08), PM10 (HR: 1.05, 95% CI: 1.03-1.08), and NO2 (HR: 1.11, 95% CI: 1.05-1.18) was associated with an increased risk of CVD. Adherence to a healthy lifestyle was associated with a reduced risk of CVD compared to an unfavorable lifestyle (HR: 0.65, 95% CI: 0.56-0.76 for intermediate lifestyle and HR: 0.41, 95% CI: 0.32-0.53 for favorable lifestyle). Lifestyle played a significant partial mediating role in the contribution of air pollutant exposure to CVD, with the mediation proportion ranging from 7.4% for PM10 to 14.3% for PM2.5. Compared to an unfavorable lifestyle, the relative excess risk due to interaction for a healthier lifestyle to reduce the effect on CVD risk was - 0.98 (- 1.52 to - 0.44) for PM1, - 0.60 (- 1.05 to - 0.14) for PM2.5, - 1.84 (- 2.59 to - 1.09) for PM10, - 1.44 (- 2.10 to - 0.79) for NO2, and - 0.60 (- 1.08, - 0.12) for O3.

CONCLUSIONS

Lifestyle partially mediated the association of air pollution with CVD, and adherence to a healthy lifestyle could protect middle-aged and elderly people from the adverse effects of air pollution regarding CVD.

Determinants and outcomes of health-promoting lifestyle among people with schizophrenia

BACKGROUND

Healthy lifestyle is an important protective factor of developing cardiovascular disease in people with schizophrenia. However, little is known about the determinants of lifestyle and its contribution to metabolic syndrome. This study aimed to explore the influencing factors of health-promoting lifestyle (HPL) and its association with metabolic syndrome among people with schizophrenia.

METHODS

A cross-sectional study was conducted in twenty-two primary health centers of Guangzhou, China between December 2022 and April 2023. A total of 538 patients with schizophrenia were recruited through convenience sampling. Self-administered scales, questionnaires, and clinical data were collected. Scales and questionnaires included social-demographic information, Health-Promoting Lifestyles Profile (HPLP-C), UCLA Loneliness Scale (ULS), and International Physical Activity Questionnaire-Short Form (IPAQ-SF). Cluster analyses were used to divide participants into two groups based on the distribution characteristics of HPLP-C scores. Logistic regression models were used to identify factors associated with HPL and the association between HPL and metabolic syndrome.

RESULTS

There were 271 participants in the high HPL group and 267 participants in the low HPL group. Logistic regression analysis revealed that loneliness posed a risk factor for high HPL, while high education and moderate-vigorous physical activity served as protective factors for high HPL. Low HPL was a risk factor for the prevalence of metabolic syndrome.

CONCLUSIONS

Promotion of high education literacy and a physically active lifestyle should be priority targets in the health management of schizophrenia. Primary healthcare providers can play a pivotal role in assisting patients to mitigate metabolic syndrome by reinforcing healthy lifestyle strategies.

The effect of education based on a health belief model and motivational interviews on cardiovascular disease risk factors and healthy lifestyle behaviour changes in patients with essential hypertension: A randomized controlled trial

OBJECTIVE

To determine the effects of "Health Belief Model (HBM)-based education" and "education and motivational interviews (MIs)" by comparing the two methods on cardiovascular disease (CVD) risk factors and healthy lifestyle behaviour changes of patients diagnosed with essential hypertension.

METHODS

The study was a single-centre, single-blind, parallel-group, 6-month follow-up, randomized controlled trial. It was conducted on 80 individuals (40 in the study group, 40 in the control group). Both groups received HBM-based education and an educational booklet on healthy lifestyle behaviour changes at the beginning of the study. Additionally, the study group underwent a total of 6 MIs.

RESULTS

The decrease in the study group's 10-year Framingham CVD risk scores (mean difference 5,33) compared to the baseline values was higher than that observed in the control group (mean difference 3,95). Over the six-month follow-up period, the study group's knowledge of CVD risk factors increased, and healthy lifestyle behaviour improved.

CONCLUSION

HBM-based education and an educational booklet, either alone or in combination with MI, supported patients with essential hypertension in lowering their CVD risk through lifestyle modifications.

PRACTICE IMPLICATIONS

Healthcare professionals within primary healthcare settings can use HBM-based health education and short-term MIs to reduce CVD risk and improve health outcomes.

Healthy lifestyle and essential metals attenuated association of polycyclic aromatic hydrocarbons with heart rate variability in coke oven workers

Whether adopting healthy lifestyles and maintaining moderate levels of essential metals could attenuate the reduction of heart rate variability (HRV) related to polycyclic aromatic hydrocarbons (PAHs) exposure are largely unknown. In this study, we measured urinary metals and PAHs as well as HRV, and constructed a healthy lifestyle score in 1267 coke oven workers. Linear regression models were used to explore the association of healthy lifestyle score and essential metals with HRV, and interaction analysis was performed to investigate the potential interaction between healthy lifestyle score, essential metals, and PAHs on HRV. Mean age of the participants was 41.9 years (84.5% male). Per one point higher healthy lifestyle score was associated with a 2.5% (95% CI, 1.0%-3.9%) higher standard deviation of all normal to normal intervals (SDNN), 2.1% (95% CI, 0.5%-3.6%) higher root mean square of successive differences in adjacent NN intervals (r-MSSD), 4.3% (95% CI, 0.4%-8.2%) higher low frequency, 4.4% (95% CI, 0.2%-8.5%) higher high frequency, and 4.4% (95% CI, 1.2%-7.6%) higher total power, respectively. Urinary level of chromium was positively associated with HRV indices, with the corresponding β (95% CI) (%) was 5.17 (2.84, 7.50) for SDNN, 4.29 (1.74, 6.84) for r-MSSD, 12.26 (6.08, 18.45) for low frequency, 12.61 (5.87, 19.36) for high frequency, and 11.31 (6.19, 16.43) for total power. Additionally, a significant interaction was found between healthy lifestyle score and urinary total hydroxynaphthalene on SDNN (Pinteraction = 0.04), and higher level of urinary chromium could attenuate the adverse effect of total hydroxynaphthalene level on HRV (all Pinteraction <0.05). Findings of our study suggest adopting healthy lifestyle and maintaining a relatively high level of chromium might attenuate the reduction of HRV related to total hydroxynaphthalene exposure.

Novel Approaches to Addressing the US Physical Inactivity and Obesity Pandemics: An Opportunity for Religious Organizations

BACKGROUND

Physical inactivity and obesity crises persist in the United States despite substantial mitigation efforts. The primary goal of this analysis is to determine whether the geographic concentration of religious institutions overlaps with geographic patterns for physical inactivity and obesity prevalence.

METHODS

We obtained 2021 county-level, age-adjusted physical inactivity ("no leisure time physical activity") and obesity prevalence from the 2023 Centers for Disease Control and Prevention PLACES database. Data on number of congregations per 100,000 individuals and adherents as a percentage of the population were obtained from the 2020 US Religion Census. The American Nations regional cultures model was obtained from the Nationhood Lab.

RESULTS

On a national level, all correlations were statistically significant between health factors and religious infrastructure-higher physical inactivity and obesity were related to more congregations per 100,000 population on a county level. The strength of correlations between congregations per 100,000 county population and both physical inactivity and obesity prevalence was greatest in the American Nations model's Deep South and Tidewater regions.

CONCLUSIONS

Approaches to addressing the pandemics of unhealthy lifestyle-related health factors of physical inactivity and obesity in the United States have, in large part, been unsuccessful. Church-based healthy lifestyle programs, particularly in areas where a high concentration of congregations align with high physical inactivity and obesity, may offer a novel and effective approach to addressing this issue.

Healthy lifestyle decreases the risk of the first incidence of non-communicable chronic disease and its progression to multimorbidity and its mediating roles of metabolic components: a prospective cohort study in China

OBJECTIVES

To identify the influence of healthy lifestyles on the incidence of the first NCD (FNCD), multiple chronic conditions (MCCs), and the progression from FNCD to MCCs.

DESIGN

cohort study.

SETTING

Zhejiang, China PARTICIPANTS: 10566 subjects (55.5 ± 13.5 years, 43.1% male) free of NCDs at baseline from the Zhejiang Metabolic Syndrome prospective cohort.

MEASUREMENTS

Healthy lifestyle score (HLS) was developed by 6 common healthy lifestyle factors as smoking, alcohol drinking, physical activity, body mass index (BMI) and waist-to-hip ratio (WHR). Healthy lifestyle data and metabolic biomarkers collected via a face-to-face questionnaire-based interview, clinical health examination and routine biochemical determination. Biochemical variables were determined using biochemical auto-analyzer. Participants were stratified into four group based on the levels of HLS as ≤2, 3, 4 and ≥5. Multiple Cox proportional hazards model was applied to examine the relationship between HLS and the risk of FNCD, MCCs and the progression from FNCD to MCCs. The population-attributable fractions (PAF) were used to assess the attributable role of HLS. Mediating effect was examined by mediation package in R.

RESULTS

After a median of 9.92 years of follow-up, 1572 participants (14.9%) developed FNCD, and 149 (1.4%) developed MCCs. In the fully adjusted model, the higher HLS group (≥5) was associated with lower risk of FNCD (HR = 0.68 and 95% CI: 0.56-0.82), MCCs (HR = 0.31 and 95%CI: 0.14-0.69); and the progression from FNCD to MCCs (HR = 0.39 and 95%CI: 0.18-0.85). Metabolic components (TC, TG, HDL-C, LDC-C, FPG, and UA) played the mediating roles with the proportion ranging from 5.02% to 22.2% for FNCD and 5.94% to 20.1% for MCCs. PAFs (95%CI) for poor adherence to the overall healthy lifestyle (HLS ≤ 3) were 17.5% (11.2%, 23.7%) for FNCD, 42.9% (23.4%, 61.0%) for MCCs, and 37.0% (15.5%, 56.3%) for the progression from FNCD to MCCs.

CONCLUSIONS

High HLS decreases the risk of FNCD, MCCs, and the progression from FNCD to MCCs. These effects are partially mediated by metabolic components. Maintaining healthy lifestyles might reduce the disease burden of common chronic diseases.

Examining a Healthy Lifestyle as a Moderator of the Relationship between Psychological Distress and Cognitive Decline among Older Adults in the NuAge Study

INTRODUCTION

The objective of this study was to examine whether a healthy lifestyle composite score of social engagement, physical activity, and Mediterranean diet adherence moderates the association between psychological distress and global cognitive decline among cognitively healthy older adults (67+ years of age at baseline).

METHODS

A total of 1,272 cognitively intact older adults (Mage = 74.1 ± 4.1 years, 51.9% female) in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) completed a series of self-reported questionnaires to measure psychological distress and lifestyle behaviors, and the Modified Mini-Mental Examination (3MS) to assess cognitive performance at baseline and annually over 3 years.

RESULTS

Controlling for sociodemographic and health-related characteristics, greater psychological distress was associated with steeper cognitive decline over time among males (B = -0.07, 95% CI: [-0.12, -0.02]), but not females (B = 0.008, 95% CI: [0.03, 0.04]). Although a healthy lifestyle composite score did not statistically significantly moderate the distress-cognition relationship (B = -0.005, 95% CI: [-0.02, 0.01]), there was an association between higher psychological distress and greater cognitive decline at low levels of social engagement (B = -0.05, 95% CI: [-0.09, -0.006]), but not at high levels of social engagement (B = 0.02, 95% CI: [-0.03, 0.07]).

CONCLUSION

This study suggests that the potentially harmful impact of stress on cognitive function may be malleable through specific healthy lifestyle behaviors and emphasizes the importance of taking a sex-based approach to cognitive aging research.

Association between healthy lifestyle combinations and periodontitis in NHANES

BACKGROUND

Periodontitis is closely associated with chronic systemic diseases. Healthy lifestyle interventions have health-enhancing effects on chronic systemic disorders and periodontitis, but the extent to which healthy lifestyle combinations are associated with periodontitis is unclear. Therefore, this study aimed to investigate the association between periodontitis and different healthy lifestyle combinations.

METHODS

5611 participants were included from the National Health and Nutrition Examination Survey (NHANES, 2009-2014). Six healthy lifestyles factors were defined as fulfilling either: non-smoking, moderate drinking, moderate body mass index (BMI), physical activity, healthy sleep and appropriate total energy intake. Then, the adjusted logistic regression models were performed to identify the association between the periodontitis and the scoring system composed of six lifestyles (0-6 scale). Finally, different scenarios were dynamically and randomly combined to identify the optimal and personalized combination mode.

RESULTS

Higher healthy lifestyle scores were significantly associated with lower periodontitis prevalence (p < 0.05). Four lifestyle factors (smoking, drinking, BMI, and sleep) significantly varied between the periodontitis and healthy groups (p < 0.05). Smoking was considered as a strong independent risk factor for periodontitis in both former and current smokers. Results further indicated that the combination of these four lifestyles played the most essential role in determining the magnitude of periodontitis occurrence (odds ratio [OR]: 0.33; 95% confidence interval [CI]: 0.21 to 0.50). In the total population, the majority of three lifestyle combinations outperformed the two combination models, whereas the two-combination of nonsmoking-drinking (OR: 0.39; 95% CI: 0.27 to 0.58) had relatively lower periodontitis prevalence than the three-combination of healthy drinking-BMI-sleep (OR: 0.42; 95% CI: 0.26 to 0.66).

CONCLUSION

This cross-sectional study suggests that smoking, drinking, BMI, and sleep are significantly related with periodontitis and smoking is the principal risk factor related among them. This study provides various customized lifestyle combinations for periodontitis prevention.

Impact of an educational intervention about healthy lifestyles in teenagers

BACKGROUND

During the last years, lifestyle has worsened along the entire European population, causing an alarming boom-up regarding overweight and obese people. Pediatric population is also influenced in this sense, which may predispose to suffer from several diseases in adulthood. Educational interventions at early ages could be an effective strategy to face this situation.

AIM

To describe the impact of an educational intervention about healthy lifestyle in adolescents.

METHODS

A quasi-experimental study analyzing the knowledge of high school students, before and after a brief educational intervention based on a self-elaborated questionnaire including questions from the validated questionnaire CAPA (from Spanish, Conocimientos en Alimentación de Personas Adolescentes).

RESULTS

The results of this study show a significant increase in knowledge about healthy lifestyles in the study population after the educational intervention (14.3±3.8 vs. 16.5±4.5; p<0.001). In addition, this improvement presents an asymmetric distribution according to gender (13.2±3.6 vs. 14.9±4.6; p=0.002 in men; 15.6±3 vs. 18.1±3.6; p<0.001 in women) and the type of educational center (14.17±3.6 vs. 16.48±4.17; p<0.001 in public schools and 14.86±4.15 vs. 16.54±5.32; p=0.047 in private schools). Parents' educational level was associated with improvement in knowledge about healthy lifestyles (13.44±2.9 vs. 15.67±5.37; p=0.132 at low level, 14.22±3.42 vs. 16.9±4.68; p<0.001 at medium level and 15.75±3.3 vs. 17.39±4.5; p=0.022 at high level).

CONCLUSION

Educational intervention taught by primary health care professionals is a useful and efficient tool for the acquisition of nutritional and healthy lifestyle knowledge in adolescents.

A retrospective comparative study of antenatal healthy lifestyle service interventions for women with a raised body mass index

BACKGROUND

Women with obesity are more likely to gain excessive gestational weight; with both obesity and excessive weight gain linked to adverse outcomes for mothers and their infant. Provision of antenatal healthy lifestyle services is currently variable, with uncertainty over the most effective gestational healthy lifestyle interventions.

AIM

To compare pregnancy and birth outcomes among women who experienced an antenatal health lifestyle service with a cohort who did not receive this service.

METHODS

A retrospective comparative cohort study was undertaken in women with a BMI ≥ 40 kg/m² attending maternity care in two NHS Trusts. One Trust provided an antenatal healthy lifestyle service, while the comparison Trust provided routine maternity care. Data was collected from medical records.

FINDINGS

No differences were observed between the antenatal healthy lifestyle service and comparison cohorts for average gestational weight gain [adjusted mean difference (aMD) - 0.70 kg (95%CI -2.33, 0.93)], rate of weight gain [aMD - 0.02 kg/week (95%CI -0.08, 0.04)] or weight gain in accordance with recommendations. The proportion of women breastfeeding at discharge was higher for the antenatal healthy lifestyle service than the comparison cohort (42.4% vs 29.8%). No other clinical outcomes were enhanced with the antenatal healthy lifestyle service.

CONCLUSION

Internal audit had suggested the antenatal healthy lifestyle service was successful at managing gestational weight gain in women with a BMI ≥ 40 kg/m². However, no benefit on gestational weight gain was evident once the service was evaluated against a comparison cohort with adequate adjustment for confounders. It is essential that future services are evaluated against a relevant comparison group.

The effect of web-based education delivered as part of cardiac rehabilitation on healthy lifestyle behaviors, and quality of life in patients with coronary artery disease in Turkey: A randomised controlled trial

OBJECTIVE

This study was conducted to evaluate the effect of web-based education delivered as part of cardiac rehabilitation (CR) on healthy lifestyle behaviors, and quality of life in patients with coronary artery disease (CAD) in Turkey.

METHOD

This study is a randomized controlled trial. The experimental group (n = 35) received web-based education and telephone counseling for 12 weeks after discharge, while the control group (n = 35) received standard care.

RESULTS

Post-test healthy lifestyle behaviors scale total score and total scores of all sub-dimensions except nutrition were higher in the experimental group (p < 0.05). The post-test international physical activity total score, and VAS scale scores of the experimental group and were significantly higher (p < 0.05). The number of non-smoking patients in the post-test was statistically significantly higher in the experimental group (p < 0.05).

CONCLUSION

The results showed that web-based education delivered as part of CR in a Turkish hospital improved healthy lifestyle behaviors, physical activity level, and quality of life in CAD.

PRACTICE IMPLICATIONS

Our study proved that web-based education delivered as part of CR, nurse follow-up, and telephone counseling services may be effective tools for CAD patients to adhere to healthy lifestyle behaviors, and to promote quality of life and smoking cessation.

Development and validation of a lifestyle risk index to screen for metabolic syndrome and its components in two multi-ethnic cohorts

BACKGROUND

Metabolic syndrome (MetS) is a precursor to cardiovascular diseases and type 2 diabetes. Existing MetS prediction models relied heavily on biochemical measures and those based on non-invasive predictors such as lifestyle behaviours were limited. We aim to (1) develop a weighted lifestyle risk index for MetS and (2) externally validate this index using two Asian-based cohorts in Singapore.

METHODS

Using data from the Multi-Ethnic Cohort (MEC) 1 (n = 2873, 41% male), multiple logistic regression was used to identify predictors associated with MetS. A weighted lifestyle risk index was generated using coefficients of the selected predictors in the development cohort (MEC1). Subsequently, the performance of the lifestyle risk index in predicting the occurrence of MetS within 10 years was assessed by discrimination and calibration in an external validation cohort (MEC2) (n = 6070, 43% male).

RESULTS

A lifestyle risk index for MetS with nine predictors was developed (age, sex, ethnicity, having a family history of diabetes, BMI, diet, physical activity, smoking status, and screen time). This index demonstrated acceptable discrimination in the development cohort [AUC (95% CI) = 0.74 (0.71, 0.76)] and the validation cohort [AUC (95% CI) = 0.79 (0.77, 0.81)].

CONCLUSION

This lifestyle risk index exhibits potential for risk stratification in population-based screening programmes. Future research could apply a similar methodology to develop disease-specific lifestyle risk indices using nationwide registry-based data.

Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease

AIMS

To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD).

METHODS AND RESULTS

Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92).

CONCLUSION

These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.

Adherence to the American Cancer Society guidelines on nutrition and physical activity for cancer survivors and biomarkers of inflammation among breast cancer survivors

OBJECTIVES

This study investigated whether adherence to the overall lifestyle recommendations in the American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors was associated with inflammation in breast cancer survivors.

METHODS

The study included 409 women who had undergone breast cancer surgery at least 1 year before enrollment. A generalized linear model was used to estimate the least square means and 95% confidence intervals of plasma levels of inflammatory markers according to lifestyle factors defined in terms of adherence to the ACS guidelines.

RESULTS

Higher overall adherence scores were associated with lower levels of high-sensitivity C-reactive protein (hs-CRP) (p for trend=0.015) and higher levels of adiponectin (p for trend=0.009). Similar significant associations of hs-CRP (p for trend= 0.004) and adiponectin (p for trend=0.010) levels were observed with the score for the body mass index (BMI) component of the adherence score. A higher diet component score was associated with a higher adiponectin level (p for trend=0.020), but there was no significant association for the physical activity component score.

CONCLUSIONS

The present study's findings suggest that maintaining a healthy lifestyle according to the ACS guidelines was associated with beneficial effects on inflammatory marker levels, especially hs-CRP and adiponectin, among breast cancer survivors. Among the 3 components of lifestyle guidelines, the BMI component exhibited the most similar tendency to the overall adherence score in relation to inflammatory indicators. Further prospective and intervention studies are needed to investigate longitudinal associations between lifestyle factors and inflammatory markers among breast cancer survivors.

Does digital technology make people healthier: the impact of digital use on the lifestyle of Chinese older adults

BACKGROUND

With the arrival of the era of large-scale production, sharing and application of data, digital use has gradually changed people's daily entertainment, consumption, social interaction, learning and other behaviors in its efficient form. This paper mainly discusses whether this fast and convenient behavior leads Chinese older adults to adopt healthier lifestyles.

METHODS

Using the most recent information from the Chinese Family Panel Studies (CFPS) in 2020, this paper conducted a descriptive statistical analysis on the basic situation of digital use and lifestyles among Chinese older adults and used a structural equation model to analyse the influence of frequency and types of digital use in a variety of different aspects of the real life of Chinese older adults.

RESULTS

Research revealed that the quality of life of Chinese older adults improved significantly as a result of their use of digital technology. The frequency of digital use (FDU) significantly improved Chinese older adults' diet, sleep, exercise, smoking and drinking, and relieved their depression. The types of digital use (TDU) had a significant positive correlation with the lifestyle of Chinese older adults, especially in the influence of digital entertainment (DE), digital consumption (DC) and digital social interaction (DI) on the lifestyle of Chinese older adults.

CONCLUSIONS

Digital use can improve the health of Chinese older adults by promoting a healthy lifestyle through various means. The findings of this study have a substantial positive impact on bridging the digital divide that Chinese older adults face, as well as fostering the integration of digital use into their healthy lifestyles.

Multimorbidity, healthy lifestyle, and the risk of cognitive impairment in Chinese older adults: a longitudinal cohort study

BACKGROUND

Evidence on the association between multimorbidity and cognitive impairment in Chinese older population is limited. In addition, whether a healthy lifestyle can protect cognitive function in multimorbid older population remains unknown.

METHODS

A total of 6116 participants aged ≥ 65 years from the Chinese Longitudinal Healthy Longevity Survey were followed up repeatedly. The number of coexisting chronic diseases was used for assessing multimorbidity and cardiometabolic multimorbidity. Three lifestyle statuses (unhealthy, intermediate, and healthy) were defined based on a lifestyle score covering smoking, alcohol drinking, body mass index, outdoor activities, and dietary pattern. Cognitive impairment was defined as the Mini-Mental State Examination score < 24. A modified Poisson regression model with robust error variance was used to assess the associations between multimorbidity, healthy lifestyle, and cognitive impairment.

RESULTS

During a median follow-up period of 5.8 years, 1621 incident cases of cognitive impairment were identified. The relative risk (RR) of cognitive impairment associated with heavy multimorbidity burden (≥ 3 conditions) was 1.39 (95% confidence interval: 1.22-1.59). This association declined with age, with RRs being 3.08 (1.78-5.31), 1.40 (1.04-1.87), and 1.19 (1.01-1.40) in subjects aged < 70 years, ≥ 70 and < 80 years, and ≥ 80 years, respectively (P for interaction = 0.001). Compared to unhealthy lifestyle, a healthy lifestyle was related to an approximately 40% reduced risk of cognitive impairment regardless of multimorbidity burden. Among the 5 lifestyle factors assessed, daily outdoor activities and a healthy dietary pattern showed convincing protective effects on cognitive function.

CONCLUSIONS

The relationship between multimorbidity and cognitive impairment is age-dependent but remains significant in the population aged 80 years or older. A healthy lifestyle may protect cognitive function regardless of the multimorbidity burden. These findings highlight the importance of targeting individuals with heavy multimorbidity burden and promoting a heathy lifestyle to prevent cognitive impairment in Chinese older population.

Effectiveness of parent-based electronic health (eHealth) intervention on physical activity, dietary behaviors, and sleep in preschoolers: A systematic review

Background

The lifestyles of preschoolers have become physically inactive and sedentary, their eating habits unhealthy, and their sleep routines increasingly disturbed. Parental involvement appears crucial to combat the unhealthy lifestyle of preschoolers. Because of the recognized barriers to traditional face-to-face interventions, easy access and lower costs make electronic health (eHealth) interventions appealing. However, whether parent-based eHealth intervention may be harnessed to improve the aforementioned lifestyle behaviors of preschoolers is currently unclear, a gap that this systematic review intends to address. This study aims to systematically review the current literature concerning the effectiveness of parent-based eHealth intervention on the physical activity, dietary behaviors, and sleep of preschoolers.

Method

This systematic review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Six databases (EMBASE, PubMed, MEDLINE, Web of Science, SPORTDiscus, and PsycINFO) were retrieved for the period from January 2000 to December 2022. Studies were eligible if 1 they were quantitative study design; 2 eHealth interventions in which parents were the change agents targeted children aged 3-6 years; 3 interventions examined the effectiveness of eHealth or incorporated eHealth as one of the intervention modalities; 4 at least one variable included in either primary or secondary outcome had to concentrate on the physical activity, diet, and sleep of preschoolers; 5 publication type was limited to the English language and peer-reviewed journal articles; 6 study settings were confined to family- or parent-based ones. The risk of bias was assessed, based upon Version 2 of the Cochrane risk-of-tool for randomized trials (RoB2).

Results

Twelve studies were screened. No significant group-by-time improvement in physical activity was found in studies related to physical activity outcomes. Two studies reported a significant difference between groups concerning motor ability, with one study indicating improved object control with the other reporting improvement in both object control and locomotor skills. Of the studies related to dietary behavior outcomes, six studies reported a significant difference at the posttest compared to the control group, in terms of vegetable and fruit intake, sugar-sweetened drinks, reduced candy consumption, and improved non-core food. Three studies reported a significant difference between groups in sleep duration at the end of the posttest, with the result of one study limited to preference-only participants. None of the reviewed studies found a significant difference between groups for sleep problems.

Conclusion

Parent-based eHealth interventions were not significantly effective in improving physical activity and reducing sleep problems in preschoolers, but the majority of studies have found that this type of intervention significantly improves the dietary behaviors and sleep duration of preschoolers. High-quality, robustly designed studies to balance the intervention dosage and sequence are needed to investigate the effectiveness of parent-based eHealth intervention on physical activity, dietary behaviors, and sleep in preschoolers, particularly those raised in other cultural background, which may significantly impact their lifestyle.

Trial registration

International Prospective Register of Systematic Review (PROSPERO): CRD42023418861.

A cohort study examining individual factors influencing cycling as a transportation mode in São Paulo, Brazil

The aim of this study is to explore the relationship between individual-level factors and cycling for transportation in a cohort of participants living in São Paulo city, Brazil. The same participants (n = 1,431 adults) were interviewed in 2014/2015 (Wave 1) and 2020/2021 (Wave 2) as part of the 'São Paulo Health Survey-ISA: Physical Activity and Environment'. For the longitudinal transport cycling binary outcome, participants who reported cycling at both time-points and those who were cycling at Wave 2 only were coded as a positive longitudinal pattern for cycling. Those who were not cycling at either Waves, and those who were cycling at Wave 1 only, were grouped into a negative pattern for cycling. The relationship between the longitudinal patterns for transport cycling and sociodemographics, health characteristics, and behaviors at Wave 1 were tested using bivariate analysis, and the significant individual-level factors were then examined in a multivariable binary logistic regression model. The odds of being classified in the positive cycling pattern were lower for women [OR = 0.09; 95 % CI = 0.04---0.19], and higher for persons aged 30 - 39 [OR = 3.25; 95 % CI = 1.38---7.66], those who owned a bicycle [OR = 2.00; 95 % CI = 1.13---3.54], and those who engaged in ≥ 120 min/week of transport walking [OR = 2.07; 95 % CI = 1.24---3.47] or leisure-time physical activity [OR = 1.77; 95 % CI = 1.02---3.06]. Cycling interventions and promotion should target women, the mid-aged and involve facilitating bicycle access. Advocacy for physical activity interventions is needed to influence transport cycling.

Association of depression with incident sarcopenia and modified effect from healthy lifestyle: The first longitudinal evidence from the CHARLS

BACKGROUND

The prospective association of depression with incident sarcopenia remains unknown, as does whether such an association is modified by a healthy lifestyle. Thus, the goal of this study was to determine whether depression is independently related to the risk of developing sarcopenia and to detect the effect of a healthy lifestyle on its modification.

METHODS

The prospective study included 9486 participants from the China Health and Retirement Longitudinal Study who were followed from 2011 to 2015. We calculated a lifestyle score based on body mass index, drinking, smoking, social activities, and sleeping time. Cox proportional hazards regression models with hazard ratios (HRs) and 95 % confidence intervals were used to estimate the effect of depression on the risk of sarcopenia and the modification effect of lifestyle (CIs).

RESULTS

During a mean of 3.53 years of follow-up, 1373 individuals developed sarcopenia. After adjusting for confounding factors, depression was significantly associated with a higher risk of incident sarcopenia (HR = 1.34; 95 % CI: 1.19, 1.50). In addition, we observed that individuals adhering to a healthy lifestyle had an 18 % lower risk of sarcopenia onset, compared with individuals with an unhealthy lifestyle.

LIMITATIONS

We couldn't completely rule out potential residual bias due to its observational design. Second, ascertainment of the history of diseases in CHARLS was based on self-reported information, which may introduce recall bias or misclassification.

CONCLUSIONS

Depression was associated with a higher risk of sarcopenia in Chinese adults, and such a risk may be alleviated by adhering to a healthy lifestyle.

Healthy lifestyle practices: Evidence from clinic attending mothers in the northern province, Sri Lanka

Healthy lifestyles are known to reduce noncommunicable disease-related mortalities and morbidities. Public health initiatives should encourage healthier lifestyles to prevent the risk of noncommunicable diseases. This study aimed to determine healthy lifestyle practices and their associated factors among clinic-attending mothers (mothers attending antenatal clinics, postnatal clinics, well-baby clinics, family planning clinics, well-women clinics, and polyclinics) in the Chavakachcheri Medical Officer of Health (MOH) area. We conducted a clinic-based cross-sectional study in 19 centers covering 28 Public Health Midwives (PHM) areas. Healthy lifestyle practices, such as regular exercise, consumption of recommended servings of fruits and vegetables, measuring their own BMI, and average salt consumption, were poor. In the multivariate analysis, we found only three factors that had higher odds of affecting healthy lifestyle practices that were statistically significant: attributes of higher level of perceptions about healthy lifestyle practices (AOR = 4.36, 1.32-14.39), participating in Mothers' Support Groups (AOR = 7.97, 2.17-29.27) and BMI value of < 23 kg/m2 (AOR = 4.47, 1.35-14.73). Effective targeted healthy lifestyle-related educational programs instead of regular training during clinic visits and promoting participation in peer groups at the community level may benefit clinic-attending mothers.

Evaluation of an application for the self-assessment of lifestyle behaviour in cardiac patients

BACKGROUND

Currently, no uniform, well-validated and comprehensive lifestyle behaviour self-assessment instrument exists for patients with cardiovascular disease.

PURPOSE

To evaluate the usability of a novel mobile application (LifeStyleScore) based on validated instruments for the assessment of cardiovascular risk behaviours. Secondly, the application's acceptance by healthcare professionals (HCPs) and its association with improved patient activation and lifestyle behaviour was evaluated.

METHODS

In this single-centre, non-randomised observational pilot study, patients with coronary artery disease or atrial fibrillation entering cardiac rehabilitation (CR) completed the LifeStyleScore application, the Patient Activation Measure (PAM-13®), and the System Usability Scale (SUS) during the CR intake and after CR completion. A focus group interview was performed with the HCPs involved.

RESULTS

We analysed 20 participants, 3 of whom were women, with a mean age of 61.9 ± 6.7 years. The LifeStyleScore application was rated with a SUS score above average (> 68) before (69.6 ± 13.4) and after CR (68.6 ± 15.1). All HCPs (n = 8) found the application usable. Patient activation did not increase significantly after CR compared with baseline (62.0 ± 8.6 versus 59.2 ± 9.5, respectively, p = 0.28) and only physical activity levels improved significantly (2.4 ± 0.7 (standardised score) at baseline, 2.8 ± 0.4 after CR, p = 0.04).

CONCLUSION

The LifeStyleScore application was found to be usable for patients receiving CR. Its use did not result in increased patient activation, and of the lifestyle behaviours only physical activity levels improved. Further research is needed to evaluate how such applications can be optimally incorporated in CR programmes.

Associations of polychlorinated biphenyls and organochlorine pesticides with metabolic dysfunction-associated fatty liver disease among Chinese adults: Effect modification by lifestyle

Exposure to environmental pollutants and unhealthy lifestyles are key risk factors for metabolic dysfunction-associated fatty liver disease (MAFLD). While previous studies have suggested links between exposure to organochlorine pesticides (PCBs) and organochlorine pesticides (OCPs) and MAFLD, the results have been inconsistent. Furthermore, the combined effects of PCBs and OCPs on MAFLD and whether lifestyle factors can modify the associations remain unknown. Therefore, this study aimed to investigate the individual and joint effects of PCBs and OCPs on MAFLD and explore the potential modifying role of lifestyle. The study included 1923 participants from Wuhan, China. MAFLD was diagnosed based on ultrasonically diagnosed hepatic steatosis and the presence of overweight/obese, diabetes mellitus, or metabolic dysregulation. Healthy lifestyle score was determined by smoking, alcohol consumption, physical activity, and diet. Logistic regression and weighted quantile sum (WQS) were used to assess associations of individual and mixture of PCBs/OCPs with MAFLD. To explore the potential lifestyle modification, joint associations of PCBs/OCPs and lifestyle on MAFLD were conducted. Single-pollutant analysis showed positive associations of p,p'-DDE, β-HCH, PCB-153, and PCB-180 with MAFLD, with ORs (95% CIs) of 1.18 (1.05, 1.33), 1.57 (1.20, 2.05), 1.45 (1.14, 1.83), and 1.42 (1.12, 1.80), respectively. WQS regression demonstrated a harmful effect of PCBs/OCPs mixture on MAFLD (OR = 1.73, 95% CI = 1.24, 2.43), with β-HCH, p,p'-DDE, and PCB-180 being the major contributors. In the joint association analysis, participants with both high PCBs/OCPs exposure and unhealthy lifestyle have the highest odds of MAFLD. In conclusion, exposure to the mixture of PCBs and OCPs was positively correlated with MAFLD, and adopting a healthy lifestyle can mitigate the adverse impact.

Does lifestyle modification (physical exercise and listening to music) improve symptoms in patients with a temporomandibular disorder? A randomized clinical trial

Introduction

The aim of the study was to compare pain relief in temporomandibular disorder (TMD) patients with or without lifestyle modification.

Materials and Methods

This randomized clinical trial was performed on patients with TMD, who did not regularly exercise or listen to music. The participants were allocated into two groups. In the treatment group, the participants were instructed to exercise five times or more per week (30 minutes per session) and listen to the music of their choice five times or more per week (15 minutes per session) for 12 weeks. In the control group, the participants had their usual lifestyle without any modifications. The participants were examined for clicking and crepitus in the joint and maximum mouth opening before and after the intervention. The pain severity was also documented based on a visual analog scale.

Results

Thirty five patients were studied in each group. Twelve weeks after the intervention, the mean pain severity was 2.70 ± 0.73 in the treatment group and 4.63 ± 0.77 in the control group. The results of data analysis demonstrated a significant difference between the two groups regarding the mean pain severity at 12 weeks after the intervention (P <.001).

Conclusions

Lifestyle modification through physical exercise and listening to music may reduce pain in TMD patients.

Habitual fish consumption and healthy lifestyle behaviours may be associated with higher total serum bilirubin level and anti-inflammatory activity: a cross-sectional study

Habitual fish consumption and a healthy lifestyle are associated with lower atherosclerotic CVD (ASCVD) risk. Mildly elevated bilirubin, an end product of Hb metabolism, may be associated with anti-inflammatory effects, suppressing ASCVD risk. No data exist on the relationship between fish consumption, total serum bilirubin (TSB) and inflammation in clinical settings. We conducted a cross-sectional study between April 2019 and March 2020 in a cohort of 8292 participants (average age, 46·7 (sd 12·9) years and 58·9 % men) with no history of ASCVD and TSB concentrations < 2·0 mg/dl. Multiple stepwise regression analysis showed Hb concentrations were a solid positive determinant of TSB concentrations (β = 0·302, P< 0·0001). Fish consumption (β = 0·025, P= 0·019) and aerobic exercise (β = 0·021, P= 0·043) were statistically weak but significantly positive determinants of TSB concentrations. Cigarette smoking negatively affected TSB concentrations (β = −0·104, P< 0·0001). Moreover, with increasing fish consumption, the proportion of participants with a habit of cigarette smoking decreased, and that of participants who engaged in aerobic exercises increased (P< 0·0001 for both). Furthermore, as TSB concentrations increased, the leukocyte counts and C-reactive protein concentrations decreased (P< 0·0001 for both). In conclusion, despite the lesser relevance given to TSB concentrations than Hb concentrations, higher fish consumption and healthier lifestyle behaviours related to fish consumption habits may be additively or synergistically associated with higher TSB concentrations and anti-inflammatory activity, leading to attenuated ASCVD risk. Further investigations are needed to clarify the causal relationships between these factors.

Association of genetic risk and lifestyle with pancreatic cancer and their age dependency: a large prospective cohort study in the UK Biobank

BACKGROUND

Pancreatic cancer (PC) is influenced by both genetic and lifestyle factors. However, further research is still needed to comprehensively clarify the relationships among lifestyle, genetic factors, their combined effect on PC, and how these associations might be age-dependent.

METHODS

We included 340,631 participants from the UK Biobank. Three polygenic risk score (PRS) models for PC were applied, which were derived from the previous study and were categorized as low, intermediate, and high. Two healthy lifestyle scores (HLSs) were constructed using 9 lifestyle factors based on the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) lifestyle score and the American Cancer Society (ACS) guidelines and were categorized as unfavorable, intermediate, and favorable. Data were analyzed using Cox proportional hazards models.

RESULTS

There were 1,129 cases of incident PC during a median follow-up of 13.05 years. Higher PRS was significantly associated with an increased risk of PC (hazard ratio [HR], 1.58; 95% confidence intervals [CI], 1.47-1.71). Adhering to a favorable lifestyle was associated with a lower risk (HR, 0.48; 95% CI, 0.41-0.56). Participants with an unfavorable lifestyle and a high PRS had the highest risk of PC (HR, 2.84; 95% CI, 2.22-3.62). Additionally, when stratified by age, a favorable lifestyle was most pronounced associated with a lower risk of PC among participants aged ≤ 60 years (HR, 0.35; 95% CI, 0.23-0.54). However, the absolute risk reduction was more pronounced among those aged > 70 years (ARR, 0.19%, 95% CI, 0.13%-0.26%). A high PRS was more strongly associated with PC among participants aged ≤ 60 years (HR, 1.89; 95% CI, 1.30-2.73). Furthermore, we observed a significant multiplicative interaction and several significant additive interactions.

CONCLUSIONS

A healthy lifestyle was associated with a lower risk of PC, regardless of the participants' age, sex, or genetic risk. Importantly, our findings indicated the age-dependent association of lifestyle and genetic factors with PC, emphasizing the importance of early adoption for effective prevention and potentially providing invaluable guidance for setting the optimal age to start preventive measures.

Should Familial Hypercholesterolaemia Be Included in the UK Newborn Whole Genome Sequencing Programme?

PURPOSE OF REVIEW

The UK National Health Service (NHS) has recently announced a Newborn Genomes Programme (NGP) to identify infants with treatable inherited disorders using whole genome sequencing (WGS). Here, we address, for familial hypercholesterolaemia (FH), the four principles that must be met for the inclusion of a disorder in the NGP.

RECENT FINDINGS

Principle A: There is strong evidence that the genetic variants causing FH can be reliably detected. Principle B: A high proportion of individuals who carry an FH-causing variant are likely to develop early heart disease if left undiagnosed and not offered appropriate treatment. Principle C: Early intervention has been shown to lead to substantially improved outcomes in children with FH. Principle D: The recommended interventions are equitably accessible for all. FH meets all the Wilson and Jungner criteria for inclusion in a screening programme, and it also meets all four principles and therefore should be included in the Newborn Genomes Programme.

Adherence to healthy lifestyle recommendations in Brazilian cancer survivors

PURPOSE

We aimed to describe the adherence to healthy lifestyle recommendations (regular consumption of fruits, vegetables, and salad greens; limit the consumption of red and processed meat, fast food, sugary and alcoholic beverages; keeping a healthy body weight, being physically activity, and not smoking) of 2314 cancer survivors and 86,517 adults without cancer diagnosis (general population) from the Brazilian National Health Survey, 2019.

METHODS

We developed a score including eight healthy lifestyle recommendations proposed by the World Cancer Research Fund (i.e., the score ranged from 0 to 8; being 0 did not follow any recommendation and 8 followed all recommendations).

RESULTS

Cancer survivors had higher healthy lifestyle score than the general population. In contrast, they presented similar adherence to the recommendations of physical activity, healthy body weight, and quitting smoking. Among cancer survivors, women (OR 1.52; 95%CI 1.12 to 2.06) and widows (OR 1.49; 95%CI 1.02 to 2.18) had greater odds of adherence to healthy lifestyle recommendations, adjusted for other sociodemographic characteristics. However, cancer survivors with complete primary education (OR 0.64; 95%CI 0.44 to 0.94) and higher education (OR 0.58; 95%CI 0.40 to 0.83) had lower adherence to the recommendations.

CONCLUSION

Our findings may be useful to support counseling and interventions aimed at promoting healthy lifestyles for Brazilian cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Healthy lifestyle may reduce mortality and cancer recurrence, and improve quality of life in cancer survivors. Identifying factors associated with the adherence to healthy lifestyle in cancer survivors may be useful to support actions and interventions.

Lifestyle Patterns in the Late Postoperative Period of Bariatric Surgery: a Descriptive Analysis of the CINTO Study

BACKGROUND

The behavior of patients undergoing metabolic bariatric surgery (MBS) has been widely investigated to better understand their attitudes and to formulate effective advisory strategies. Although these elements have been studied separately, the magnitude of these behaviors still needs to be determined from a combined factors approach. This study aimed to identify the lifestyle patterns of patients who underwent MBS 5 or more years ago.

METHODS

In this observational study, 123 patients who underwent MBS at least 5 years ago were included. Anthropometric data, sociodemographic profile, dietary intake, physical activity level, sleeping, smoking, and alcohol consumption were collected for all participants. Lifestyle pattern was evaluated using principal component analysis (PCA) and the Kaiser-Meyer-Olkin (KMO) index was applied to evaluate data factorability.

RESULTS

PCA identified two patterns of behavior adopted by the participants in the late postoperative (PO) period (more than 5 years PO) of MBS. In the first pattern, a positive correlation was found between consumption of ultra-processed foods (r = 0.459), risky consumption of alcoholic beverages (r = 0.630), and tobacco use (r = 0.584). In the second, a positive correlation was observed between the consumption of unprocessed or minimally processed foods (r = 0.692) and more sleep time per day (r = 0.654).

CONCLUSION

After 5 years of PO, combined behavior analysis revealed healthy and unhealthy lifestyle patterns, which points to the relevance of permanent clinical follow-up of these patients to ensure the best health status.

Differential patterns of lifestyle behaviors among low- and high-income postmenopausal women in Korea: a latent class analysis

BACKGROUND

Healthy lifestyle behaviors among postmenopausal women are important to prevent chronic diseases and improve health later in life. Heterogeneous lifestyle patterns may exist among postmenopausal women, and socioeconomic status (SES) is a critical determinant of lifestyle behaviors. However, little is known about distinct SES-specific patterns of lifestyle behaviors among postmenopausal women. Thus, this study used latent class analysis to identify subgroups of postmenopausal women with different health behaviors according to income and to examine the predictors of income-specific subgroups.

METHODS

We analyzed nationally representative data from the Eighth Korea National Health and Nutrition Examination Survey, collected in 2019 and 2020. We used nine lifestyles (i.e., current smoking and drinking, high-risk drinking, walking, muscle-strengthening exercise, sleep, vegetable and fruit intakes, and weight control efforts). We conducted a multiple-group latent class analysis using monthly household income as a proxy for SES. The monthly household income variable was calculated by standardizing monthly household income by the number of family members and then divided into quintiles. We classified the participants into low- (i.e., Q1 and Q2) and high-income (i.e., Q3, Q4, and Q5) groups.

RESULTS

Although the three-class models best fit the data of low- and high-income groups, we found differential patterns by income: (a) for low-income group, "relatively healthy (RH)," "lowest physical activity, insufficient fruit intake, and no intention to control weight," and "high-risk drinking and insufficient fruit intake" classes and (b) for high-income group, "RH," "lowest physical activity," "high-risk drinking and insufficient fruit intake and sleep" classes. The proportion of the RH class was largest in both groups. However, lifestyle patterns in low-income group showed multiple and unhealthy characteristics than those in high-income group.

CONCLUSIONS

This study suggests that different underlying lifestyle patterns exist in postmenopausal women with low- and high-income. To promote healthy behaviors among postmenopausal women, health professionals should develop and apply lifestyle interventions tailored to lifestyle pattern characteristics according to income.

Effects of recreational small-sided games from different team sports on the improvement of aerobic fitness in youth sedentary populations: A systematic review

Aerobic fitness is a critical aspect of overall health and well-being, essential for maintaining a high quality of life. Unfortunately, sedentary behavior has been on the rise among young adults, and this has had a negative impact on their aerobic fitness levels. Therefore, it is crucial to identify enjoyable physical exercise training programs that can play a pivotal role in improving aerobic fitness. The objective of this study was to systematically review the experimental studies concerning the impact of small-sided games (SSGs) training programs, implemented across various team sports, on the enhancement of aerobic fitness in a youth sedentary population. A literature search was conducted in PubMed, Scopus, and the Web of Science on August 01, 2023. Our eligibility criteria focused on studies involving sedentary youth populations (aged <18 years) as the target population. These studies needed to incorporate interventions based on SSGs as the intervention of interest, comparing them to passive or control groups as the comparator. The primary outcomes of interest were related to maximal oxygen uptake (VO2max), assessed either directly or indirectly, or the results of field-based cardiorespiratory tests. We specifically considered two- or multi-arm randomized controlled studies as the study design of interest. Out of the initial pool of 1980 studies, we reviewed 38 full-text articles, ultimately selecting and analyzing 13 studies for inclusion in our review. Among the studies included, a total of 1281 participants were enrolled in SSG-based interventions, while 744 participants acted as part of the control groups. Regarding the impact on VO2max, the six studies that investigated this outcome showed varying improvements, ranging from 2.2 % to 31.3 % when participants were exposed to SSGs. In terms of the outcome related to endurance performance in field-based tests, the eight studies that examined this aspect found that participants exposed to SSGs showed improvements ranging from 0.1 % to 79.8 %. In conclusion, this systematic review suggests that SSG-based interventions conducted among sedentary youth populations can play a positive role in improving their aerobic fitness. This improvement in aerobic fitness can have potential positive impacts on their overall health and quality of life.

Association between healthy lifestyle factors and health-related quality of life among Chinese adolescents: the moderating role of gender

BACKGROUND

To examine the associations of the independent and combined healthy lifestyle factors with health-related quality of life (HRQOL) in adolescents, and to test the moderating role of gender.

METHODS

This cross-sectional study included 5125 adolescents aged between 11 and 20 years. They provided self-reported data on six healthy lifestyle factors, including never smoking, never drinking, good sleep quality, sufficient sleep duration, appropriate Internet use, and adequate physical activity. Adolescents' HRQOL was evaluated using the Pediatric Quality of Life Inventory version 4.0. Linear regression models were conducted to explore the association of individual and combined healthy lifestyle factors with adolescents' HRQOL. We further performed stratified analyses and likelihood ratio test to explore the moderating role of gender in these associations.

RESULTS

Of the included adolescents, the proportions with 0-2, 3, 4, and 5-6 healthy lifestyle factors were 13.6%, 26.4%, 44.3%, and 15.7%, respectively. Compared to adolescents with composite healthy lifestyle scores of 0-2, those with scores of 3, 4, or 5-6 had significantly higher HRQOL scores across all dimensions, summary scales, and total scale in both unadjusted and adjusted models. Specifically, adolescents with 5-6 healthy lifestyle factors had a total scale score that was 19.03 (95%CI: 17.76 to 20.30) points higher than their counterparts who only had 0-2 healthy lifestyle factors. Significant dose-response patterns were also observed in aforementioned associations. Gender was a significant moderator in the associations between composite healthy lifestyle groups and HRQOL scores, except for the social functioning dimension.

CONCLUSIONS

Our results confirmed that combined healthy lifestyle factors were associated with improved HRQOL among adolescents, with a stronger association observed in girls. These findings underscore the necessity for education and healthcare authorities to design health-promoting strategies that encourage multiple healthy lifestyle factors in adolescents, with the objective of enhancing their overall health outcomes.

Genetic factors, adherence to healthy lifestyle behaviors, and risk of bladder cancer

BACKGROUND

Genetic and lifestyle factors both contribute to the pathogenesis of bladder cancer, but the extent to which the increased genetic risk can be mitigated by adhering to a healthy lifestyle remains unclear. We aimed to investigate the association of combined lifestyle factors with bladder cancer risk within genetic risk groups.

METHODS

We conducted a prospective study of 375 998 unrelated participants of European ancestry with genotype and lifestyle data and free of cancer from the UK biobank. We generated a polygenic risk score (PRS) using 16 single nucleotide polymorphisms and a healthy lifestyle score based on body weight, smoking status, physical activity, and diet. Cox models were fitted to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of genetic and lifestyle factors on bladder cancer.

RESULTS

During a median follow-up of 11.8 years, 880 participants developed bladder cancer. Compared with those with low PRS, participants with intermediate and high PRS had a higher risk of bladder cancer (HR 1.29, 95% CI 1.07-1.56; HR 1.63, 95% CI 1.32-2.02, respectively). An optimal lifestyle was associated with an approximately 50% lower risk of bladder cancer than a poor lifestyle across all genetic strata. Participants with a high genetic risk and a poor lifestyle had 3.6-fold elevated risk of bladder cancer compared with those with a low genetic risk and an optimal lifestyle (HR 3.63, 95% CI 2.23 -5.91).

CONCLUSIONS

Adhering to a healthy lifestyle could substantially reduce the bladder cancer risk across all genetic strata, even for high-genetic risk individuals. For all populations, adopting an intermediate lifestyle is more beneficial than a poor one, and adhering to an optimal lifestyle is the ideal effective strategy for bladder cancer prevention.

Adherence to healthy lifestyle was associated with an attenuation of the risk of chronic kidney disease from metabolic dysfunction-associated fatty liver disease: Results from two prospective cohorts

AIMS

Non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) are important risk factors of chronic kidney disease (CKD). Whether adherence to a healthy lifestyle can modify these effects remain unknown. This study aimed to evaluate the modification effects of healthy lifestyle on the associations among NAFLD, MAFLD, and the risk of CKD, with taking into the effect of genetic risk.

METHODS

The Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study (TCLSIH), the UK Biobank Study (UKB). The outcome was incident CKD. The exposures including NAFLD, MAFLD, healthy lifestyle, and a genetic risk score (GRS) for CKD.

RESULTS

After 1,135,334 person-year follow-up, we documented 2975 incident CKD cases in the two cohorts. MAFLD and NAFLD were associated with a higher risk of CKD, particularly in patients with MAFLD. In the TCLSIH and UKB, the hazard ratios (95% confidence intervals) of incident CKD for MAFLD were 1.47 (1.30, 1.66) and 1.73 (1.57, 1.91), respectively. Adherence to a healthier lifestyle decreased the risk of CKD from MAFLD with significant interaction effects (TCLSIH: Pinteraction = 0.02; UKB: Pinteraction = 0.04). Participants with a lower CKD-GRS experienced a higher risk of CKD from MAFLD, but achieved two healthy lifestyles can significantly decreased the risk of CKD in patients with MAFLD.

CONCLUSIONS

MAFLD and NAFLD are associated with a higher CKD risk, particularly MAFLD. Adherence to a healthier lifestyle was associated with a lower risk of CKD from MAFLD. These results highlight the important role of following a healthy lifestyle to prevent CKD.

Associations of polychlorinated biphenyl and organochlorine pesticide exposure with hyperuricemia: modification by lifestyle factors

Recent research has reported positive associations of exposure to polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) with hyperuricemia. However, most of these studies have primarily focused on the individual effects of PCB/OCP exposure. We aimed to explore the associations of both individual and combined PCB/OCP exposure with hyperuricemia and examine whether such associations could be modified by lifestyle factors. The cross-sectional study recruited 2032 adults between March and May 2019 in Wuhan, China. Logistic regression and weighted quantile sum (WQS) regression were applied to explore the relationship of individual and combined PCB/OCP exposure with hyperuricemia, while considering the modified effects of lifestyle factors. Of the 2032 participants, 522 (25.7%) had hyperuricemia. Compared with the non-detected group, the detected groups of PCB153 and PCB180 exhibited a positive association with hyperuricemia, with OR (95% CIs) of 1.52 (1.22, 1.91) and 1.51 (1.20, 1.90), respectively. WQS regression showed that PCB/OCP mixture was positively associated with hyperuricemia (OR: 1.31, 95% CI: 1.08, 1.58). PCB153/PCB180 exposure, combined with an unhealthy lifestyle, has a significant additive effect on hyperuricemia. Overall, PCB/OCP mixture and individual PCB153/PCB180 exposure were positively associated with hyperuricemia. Adherence to a healthy lifestyle may modify the potential negative impact of PCBs/OCPs on hyperuricemia.