Psychosocial and biological determinants of ill health in relation to deprivation

Background: Despite public health campaigns and improvements in healthcare, socioeconomic gradients in health and life expectancy persist, and in many cases are becoming more marked – the gradient in coronary heart disease being a prime example. Classic cardiovascular risk factors (e.g. smoking, cholesterol and blood pressure) only partially explain the deprivation effect, and attempts to narrow the health gap by focussing on such risk factors do not appear to be succeeding. There also appear to be socioeconomic differences in uptake of healthy lifestyle advice. The work described in this thesis aimed to expand current understanding of the deprivation-based gap in health and life expectancy, focussing particularly on the socioeconomic gradient in cardiovascular risk. Methods: Using a cross-sectional, population-based study design based in the Greater Glasgow area, 666 participants were selected on the basis of area-level social deprivation (Scottish Index for Multiple Deprivation ranking). The study was designed to include approximately equal numbers from most deprived and least deprived areas; equal numbers of male and female participants and equal numbers of participants from each age group studied (35-44; 45-54 and 55-64 years). Participants completed an extensive questionnaire on health, lifestyle and early life experiences. Anthropometric measures (height, leg length, weight, waist, hip and thigh circumferences) were recorded. Blood pressure, heart rate and parameters of lung function (Forced Expiratory Volume in 1 second [FEV1] and Forced Vital Capacity [FVC]) were recorded. Psychological assessments (General Health Questionnaire-28, Generalised Self-Efficacy Scale, Sense of Coherence Scale, Beck Hopelessness Scale, Eysenck Personality Scale and Rosenberg Self-Esteem Scale) and assessments of cognitive function (Auditory Verbal Learning Test, Choice Reaction Time and Stroop Test) were undertaken. Fasting blood samples were obtained for classic and emerging cardiovascular risk factors including lipid profile, glucose, insulin, leptin, adiponectin, C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, von Willebrand Factor, fibrinogen, D-dimer and tissue plasminogen activator antigen. Carotid ultrasound assessment of intima-media thickness (cIMT), plaque score and arterial stiffness was performed. Results: Total and low density lipoprotein cholesterol were significantly higher in the least deprived group (both p56.3 years). Plaque score showed a much more highly significant deprivation difference in the group as a whole (p<0.0001). No differences in parameters of arterial stiffness were found between the most deprived and least deprived groups. Neither adjustment for classic nor emerging cardiovascular risk factors, either alone or in combination, abolished the area-level deprivation-based difference in plaque presence or cIMT. Adjustment for early life markers of socioeconomic status in addition to classic cardiovascular risk factors abolished the deprivation-based difference in plaque presence. Further associations between early life factors and health outcomes were noted: lung function (FEV1) and cognitive performance appeared to be influenced by father’s occupation, whether the parents/guardians were owner-occupiers or tenants, and by degree of overcrowding; cIMT was modestly related to father’s occupation and carotid plaque was related strongly to father’s occupation and parental home status. Socioeconomic differences were noted in the impact of personality in determining mental wellbeing, and also in relation to the health behaviours of fruit and vegetable consumption and smoking cessation. Conclusions: The relationship between social deprivation and health is complex and multifactorial and appears to involve the interplay of early life factors, biological mediators, psychological parameters such as personality and cognitive function, health behaviours and outcomes such as atherosclerosis. Approaches aiming to narrow the deprivation gap in health will need to be designed to take into account this complexity, addressing factors such as early life experiences and personality, as well as the more classically recognised factors such as smoking, cholesterol and blood pressure, if they are to have a chance of succeeding in improving the health of those most in need

Macular Pigment and Diabetes Mellitus

The macula is a specialised part of the retina responsible for detailed central and colour vision. The carotenoids lutein, zeaxanthin and meso-zeaxanthin are uniquely concentrated in the inner and central layers of the primate macula, where they are collectively known as macular pigment (MP). Macular pigment confers potent antioxidant and anti-inflammatory effects in the eye. Many studies have suggested that these carotenoids are lower in age-related macular degeneration (AMD) and that increased levels of MP may confer protection against AMD, especially the late form of the disease. Research is now beginning to focus on MP optical density (MPOD) and carotenoid intake in diabetes mellitus, a condition which similar to AMD, is known to cause oxidative damage and inflammation in the retina. Methods The optical density of MP was measured in a group of participants with diabetes (Type 1 and Type 2) and findings compared with normal healthy controls. A comprehensive review was performed to investigate the putative causal mechanisms and metabolic perturbations associated with lower MP in diabetes. Surrogate biomarkers for the prediction of low MP in participants with Type 2 diabetes and older adults free of ocular pathology, including clinical [blood pressure], plasma [lipoproteins, inflammatory markers] and anthropometric [waist (cm), hip (cm), height (cm), weight (kg)] parameters, were investigated and identified as part of a large randomly selected sample from the Republic of Ireland (as part of The Irish Longitudinal Study on Ageing [TILDA]). 2 Results The optical density of MP was lower among Type 2 diabetes subjects (0.33 ± 0.21) compared with Type 1 subjects (0.49 ± 0.23) and normal controls (0.48 ± 0.35) (p= 0.01). A comprehensive review of MP and diabetes, Type 2 diabetes, in particular, revealed that MP may become depleted through at least four possible causal mechanisms in this condition including overweight/obesity, dyslipidaemia, oxidative stress and inflammation. Research performed on the TILDA cohort confirmed that participants with Type 2 diabetes had significantly lower MPOD compared with non diabetic controls (p=0.047). In-depth analysis on this Type 2 diabetes cohort revealed that MP was significantly lower in diabetes participants who were deficient in plasma vitamin D (/L) (p=0.006); who had a raised triglyceride (TG) over high density lipoprotein (HDL) ratio (TG/HDL) [\u3e1.74 mmol/L; p=0.039]; who had hypertension (p=0.043); who were current smokers (p=0.022); or who had cataracts (p=0.049). Among older adults who were free of ocular pathology (i.e. AMD, glaucoma, diabetes, pre-diabetes), MPOD was significantly lower among participants with an elevated waist circumference (WC) (p=0.034), those who had low plasma HDL (p=0.038), those with a raised plasma TG/HDL ratio (p=0.003) and those with a raised total cholesterol (TC) over HDL ratio (TC/HDL) (p=0.030). Conclusion Overall, our findings suggest that individuals with Type 2 diabetes have lower MP relative to healthy controls. The metabolic correlates associated with Type 2 diabetes, in particular, i.e. oxidative stress, inflammation, overweight/obesity and dyslipidaemia, may have important implications for MPOD in the retina. Surrogate biomarkers associated with lower MP in Type 2 diabetes include low plasma levels of 3 vitamin D (25(OH) D), dyslipidaemia (i.e. raised TG/HDL ratio), hypertension, cataracts and smoking. While an altered lipoprotein profile (i.e. low HDL, raised TG/HDL ratio, raised TC/HDL ratio), may affect the transport, uptake, and stabilisation of carotenoids in the retina of older adults free of ocular pathology, it appears that WC is a more robust predictor of lower MPOD in this patient cohort. However, its effect size appears to be small and therefore its clinical applicability is questionable

Obesity-induced chronic inflammation in C57Bl6J mice, a novel risk factor in the progression of renal AA amyloidosis?

Background: Compelling evidence links obesity induced systemic inflammation to the development of chronic kidney disease (CKD). This systemic inflammation may result from exacerbated adipose inflammation. Besides the known detrimental effects of typical pro-inflammatory factors secreted by the adipose tissue (TNF-α, MCP-1 and IL-6) on the kidney, we hypothesize the enhanced obesity-induced secretion of serum amyloid A (SAA), an acute inflammatory protein, to play a key role in aggravating obesity-induced CKD. Methods: Groups of male C57Bl/6J mice (n = 99 in total) were fed a low (10% lard) or high (45% lard) fat diet for a maximum of 52 weeks. Mice were sacrificed after 24, 40 and 52 weeks. Whole blood samples, kidneys and adipose tissues were collected. The development of adipose and renal tissue inflammation was assessed on gene expression and protein level. Adipocytokine levels were measured in plasma samples. Results: A distinct inflammatory phenotype was observed in the adipose tissue of HFD mice prior to renal inflammation, which was associated with an early systemic elevation of TNF-α, leptin and SAA (1A-C). With aging, sclerotic lesions appeared in the kidney, the extent of which was severely aggravated by HFD feeding. Lesions exhibited typical amyloid characteristics (2A) and pathological severity positively correlated with bodyweight (2B). Interestingly, more SAA protein was detected in lesions of HFD mice. Conclusion: Our data suggest a causal link between obesity induced chronic inflammation and AA amyloidosis in C57Bl/6J mice. Though future studies are necessary to prove this causal link and to determine its relevance for the human situation, obesity may hence be considered a risk factor for the development and progression of renal AA amyloidosis in the course of CKD. (Figure Presented)

Psychosocial and biological determinants of ill health in relation to deprivation

Background: Despite public health campaigns and improvements in healthcare, socioeconomic gradients in health and life expectancy persist, and in many cases are becoming more marked – the gradient in coronary heart disease being a prime example. Classic cardiovascular risk factors (e.g. smoking, cholesterol and blood pressure) only partially explain the deprivation effect, and attempts to narrow the health gap by focussing on such risk factors do not appear to be succeeding. There also appear to be socioeconomic differences in uptake of healthy lifestyle advice. The work described in this thesis aimed to expand current understanding of the deprivation-based gap in health and life expectancy, focussing particularly on the socioeconomic gradient in cardiovascular risk. Methods: Using a cross-sectional, population-based study design based in the Greater Glasgow area, 666 participants were selected on the basis of area-level social deprivation (Scottish Index for Multiple Deprivation ranking). The study was designed to include approximately equal numbers from most deprived and least deprived areas; equal numbers of male and female participants and equal numbers of participants from each age group studied (35-44; 45-54 and 55-64 years). Participants completed an extensive questionnaire on health, lifestyle and early life experiences. Anthropometric measures (height, leg length, weight, waist, hip and thigh circumferences) were recorded. Blood pressure, heart rate and parameters of lung function (Forced Expiratory Volume in 1 second [FEV1] and Forced Vital Capacity [FVC]) were recorded. Psychological assessments (General Health Questionnaire-28, Generalised Self-Efficacy Scale, Sense of Coherence Scale, Beck Hopelessness Scale, Eysenck Personality Scale and Rosenberg Self-Esteem Scale) and assessments of cognitive function (Auditory Verbal Learning Test, Choice Reaction Time and Stroop Test) were undertaken. Fasting blood samples were obtained for classic and emerging cardiovascular risk factors including lipid profile, glucose, insulin, leptin, adiponectin, C-reactive protein, interleukin-6, soluble intercellular adhesion molecule-1, von Willebrand Factor, fibrinogen, D-dimer and tissue plasminogen activator antigen. Carotid ultrasound assessment of intima-media thickness (cIMT), plaque score and arterial stiffness was performed. Results: Total and low density lipoprotein cholesterol were significantly higher in the least deprived group (both p<0.0001). Triglycerides were higher and high density lipoprotein cholesterol lower in the most deprived group (both p<0.0001). Fasting glucose, insulin and leptin were higher in the most deprived group. C-reactive protein, interleukin-6 and soluble intercellular adhesion molecule-1 were higher in the most deprived group (all p<0.0001). Von Willebrand factor, fibrinogen and D-dimer were higher in the most deprived group. Age- and sex-adjusted cIMT was significantly higher in the most deprived group, but on subgroup analysis this difference was only apparent in the highest age tertile in males (>56.3 years). Plaque score showed a much more highly significant deprivation difference in the group as a whole (p<0.0001). No differences in parameters of arterial stiffness were found between the most deprived and least deprived groups. Neither adjustment for classic nor emerging cardiovascular risk factors, either alone or in combination, abolished the area-level deprivation-based difference in plaque presence or cIMT. Adjustment for early life markers of socioeconomic status in addition to classic cardiovascular risk factors abolished the deprivation-based difference in plaque presence. Further associations between early life factors and health outcomes were noted: lung function (FEV1) and cognitive performance appeared to be influenced by father’s occupation, whether the parents/guardians were owner-occupiers or tenants, and by degree of overcrowding; cIMT was modestly related to father’s occupation and carotid plaque was related strongly to father’s occupation and parental home status. Socioeconomic differences were noted in the impact of personality in determining mental wellbeing, and also in relation to the health behaviours of fruit and vegetable consumption and smoking cessation. Conclusions: The relationship between social deprivation and health is complex and multifactorial and appears to involve the interplay of early life factors, biological mediators, psychological parameters such as personality and cognitive function, health behaviours and outcomes such as atherosclerosis. Approaches aiming to narrow the deprivation gap in health will need to be designed to take into account this complexity, addressing factors such as early life experiences and personality, as well as the more classically recognised factors such as smoking, cholesterol and blood pressure, if they are to have a chance of succeeding in improving the health of those most in need.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Effectiveness of diabetic risk reduction package on knowledge lifestyle and biophysiological measures among prediabetic employees in selected Institutions Thiruvallur District

INTRODUCTION: Diabetes has become a universally recognized health care problem. One in every six adult suffers from diabetes and at the same time every six seconds one individual dies because of diabetes. Diabetes is preceded by a condition known as Prediabetes, where the individual has higher levels of blood sugar but not high enough to be diagnosed as diabetes. It is a reversible condition projecting the last window opportunity against impeding diabetes. Diabetes is also known as the “Sweet heart of Diabetes” due to the increased incidence and complications of cardio vascular diseases, occurring as a result of increased blood sugar. The Centre for Disease Control and National Diabetes Statistics reports that 37% of adults >20 years and 51% adults >65 years had prediabetes during 2009-2012. Type 2 Diabetes Mellitus has given rise to enormous personal, social and economic burdens. World Health Organisation(WHO) estimates that diabetes will increase from 171 million in 2000 to 366 million by 2030.India has been declared as the diabetic capital, so far 41 million have diabetes and every 5th diabetic in the world is an Indian. Diabetes is considered as the 7th leading cause of death. The highest crude prevalence rate of diabetes and prediabetes is in Kerala and lowest crude prevalence rate in Kashmir. Diabetes Atlas published by International Diabetes Federation states that the number of diabetic people in India is currently 40.9 million and expected to rise to 69.9 million by 2025.This is mainly due to the so called “Asian Indian Phenotype” referring to the unique biochemical and clinical abnormalities in Indians including increased insulin resistance, greater abdominal adiposity (higher waist Circumference despite lower BMI), lower adinopectin and higher C-reactive protein. This phenotype makes Indians more prone to diabetes. World Heath Day Theme 2016 rallied to “Halt the Rise of Diabetes”. If rising trends are to be halted and reversed, current approaches to addressing prediabetes needs to be implemented. The following are the suggested strategies to control prediabetes and prevent its progression to diabetes, (i) creating awareness among people about prediabetes (ii) early detection of prediabetic status and (iii) following healthy life style practices by being physically active, eating healthy and avoiding excessive weight gain. A study has been conducted on the effectiveness of Diabetic risk reduction package on knowledge, lifestyle and biophysiological measures among the prediabetic employees in selected institutions of Thiruvalur District. The abstract was presented as Introduction, Method, Results, Analysis and Discussion (IMRAD) format of writing. The objectives of the study were 1. To assess and evaluate the effectiveness of diabetic risk reduction package on knowledge, life style and bio physiological measures among prediabetic employees in experimental and control group. 2. To correlate the mean differed score of knowledge, life style and biophysiolgical measures among prediabetic employees in experimental and control group. 3. To associate the mean difference level of knowledge, life style and biophysiological measures with selected demographic variables of experimental and control group The null hypotheses formulated for the study were NH1: There is no significant difference in knowledge, life style and biophysiological measures with diabetic risk reduction package among prediabetic employees at p<0.05 level. NH2: There is no significant relationship of mean differed score of knowledge, life style and bio physiological measures of experimental group and control group at p<0.05 level. NH3: There is no significant association of mean difference level of knowledge, life style and bio physiological measures with selected demographic variables at p<0.05 level. The research process for this study was guided by the conceptual framework based on the Wiedenbach Theory-helping art theory. The theory focused on health promotion strategies to prevent development of diabetes in future. MATERIALS AND METHODS: A quasi experimental research design was adopted for the study. The independent variable for the study was diabetic risk reduction package and the dependent variables for the study were knowledge, life style and biophysiological measures. The study was conducted in 20 schools at Thiruvallur district. The samples of the study were all prediabetic employees between the age group of 20-60 years. Enumerative sampling technique was used in this study. The data collection instrument was the structured questionnaire to assess the knowledge of prediabetes, Food Frequency Questionnaire to assess the lifestyle practices and height, weight, Body Mass Index (BMI), Waist Circumference (WC) and Fasting Blood Sugar (FBS) to assess the biophysiological measures. Data collection was conducted after receiving the ethical committee approval from International Centre for Collaborative Research (ICCR), Omayal Achi College of Nursing. A formal written permission was obtained from the head of the institution and school authorities. The data collection was preceded with the screening for prediabetes (Indian Diabetic Risk Score >30 and FBS 100-125mg/dl) and all the teachers identified as prediabetics were allocated to the experimental and control group. In the first week, pre test assessment of knowledge was done. After the pretest Diabetic Risk Reduction Package (Information Education Communication package along with food and activity tracker) was explained to the prediabetic employees individually in experimental group alone after obtaining written informed consent and ensuring confidentiality. The post test of knowledge was assessed after 1week in the experimental group. In the experimental group the food and activity tracker was verified after two months and the investigator assessed the achievement of the short term goal by checking the bio physiological measures (excluding FBS) again by the end of 4th month, the food and activity tracker was verified and confirmed the achievement of the long term goal by checking the bio physiological measures (excluding FBS). Finally, by the end of the 6th month food activity and biophysiological measures were verified including FBS. Reinforcement of the interventions was given by the investigator throughout the data collection period once in every 15 days. The reinforcement was given by the investigator directly and also by telephonic conversation. The volunteers who were teachers were used for the follow up and reinforcement, they aided in motivating the group to follow the food and activity tracker. The same scheme of data collection was done for the control group, with exception of intervention alone. All ethical principals were followed during the process of data collection. RESULTS: • The analysis revealed that in the experimental group, the overall mean knowledge score in the post test was 20.70 whereas in the control group, it was 12.55. The unpaired ‘t’ test value was t = 24.54 which was greater than the table value at p<0.001 level and revealed that there was a high significant difference between the experimental and control group at p<0.001 level in knowledge score. • The analysis showed that in the experimental group, in the pre test, the mean life style score was 50.86, in post test 1 the mean life style score was 54.18, in post test 2 the mean life style score was 62.47 and it was further increased to 72.65 in the post test 3. In contrast, the mean life style variable score in the control group remained the same at 50.12, 50.25, 51.05 and 51.30 in pre-test, post test 1, post test 2 and post test 3 respectively. The “F” test revealed that there was high statistically significant difference in the pre and post tests of experimental group at p<0.001, proving the effectiveness of DRRP and there was no significant difference to be found in the level of life style variable for the control group. • Regarding the biophysiological measures reduction, the analysis revealed that in the post test of experimental group, the overall mean BMI, and FBS was 27.15 and 101.60 respectively whereas in control group, it remained the same with mild increase and decrease such as 28.40, and 105.89. The unpaired ‘t’ test for BMI and FBS revealed that there was a high significant difference between the experimental and control group at p<0.05 and p<0.00I respectively. • Oneway Annova test revealed that there was statistically significant association between the study variables namely knowledge, life style, biophysiological variables and the selected demographic variables of age, marital status, type of family, educational status, family monthly income and history of DM. • The evidence generated from the study revealed that for the experimental group the Diabetic Risk Reduction Package had significant impact in improving the knowledge, at p<0.001 level. • There was positive moderate correlation among the knowledge and life style variables. There existed negative moderate correlation between lifestyle and biophysiological measures. Hence there was statistically significant difference between the experimental and control group. CONCLUSION: The study concluded that the Diabetes Risk Reduction Programme (DRRP) is an effective intervention strategy in the prevention of diabetes and management of prediabetes. Hence, the study recommended the utilization of DRRP by the Community Health Nurses, Nurse Researchers, Nurse Administrators, Nurse Educators, Primary and Secondary health care professionals to prevent or delay the occurrence of diabetes mellitus and manage prediabetes, to increase awareness towards prediabetes and empower them to make appropriate healthy lifestyle behaviour decisions

30th European Congress on Obesity (ECO 2023)

This is the abstract book of 30th European Congress on Obesity (ECO 2023

Evaluation of acceptance and efficiency of exercise for Indigenous Australians to benefit physiological, anthropometric and metabolic syndrome outcomes

The proposed study will provide an increased understanding in a much-understudied area of how the Australian Indigenous community perceives physical activity and the beneficial effects for improving health outcomes. The PhD will be made up of three studies: 1) To design an exercise prescription that is culturally appropriate and specifically addresses the major Indigenous health issues around metabolic syndrome. The first will be a cross sectional study that surveys the motivators and barriers to physical activity within the Perth Noongar community. The results of this study will be used to enhance the intervention section of the PhD. It will provide a more accurate and the best means of ensuring not only a greater uptake, but also ways of developing positive lifelong physical activity habits. 2) Determining the amount of physical activity taking place within the Noongar community. Utilising the Global Physical Activity Questionnaire to measure the amount of physical activity and sedentary rates within the Indigenous community. 3) Evaluate the compliance and effectiveness of the developed intervention to inform future exercise therapy programmes for this population. The second study will be a randomised control trial looking at the physiological responses to a combination of aerobic and anabolic (resistance) exercise. The significance of this aspect of the PhD will be to capture and record physiological and quality of life measures some not previous recorded in the Indigenous community. This will inform policy relation to the most appropriate targets for eliciting successful behaviour change to improve health in Indigenous and non-Indigenous population