Gold standard program for heavy smokers in a real-life setting

Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising

Physical activity, obesity and mortality: does pattern of physical activity have stronger epidemiological associations?

Background Most studies of physical activity (PA) epidemiology use behaviour measured at a single time-point. We examined whether ‘PA patterns’ (consistently low, consistently high or inconsistent PA levels over time) showed different epidemiological relationships for anthropometric and mortality outcomes, compared to single time-point measure of PA. Methods Data were the Danish MONICA (MONItoring Trends and Determinants in CArdiovascular Disease) study over three waves 1982–3 (time 1), 1987–8 (time 2) and 1993–4 (time 3). Associations between leisure time single time-point PA levels at time 1 and time 3, and sport and active travel at times 1 and 2 with BMI, waist, hip circumference and mortality (death from coronary heart disease (CHD) and cardiovascular disease (CVD)) were compared to ‘PA patterns’ spanning multiple time points. PA pattern classified participants’ PA as either 1) inactive or low PA at both time points; 2) moderate level PA at time 1 and high activity at time 3; or 3) a ‘mixed PA pattern’ indicating a varying levels of activity over time. Similarly, sport and active travel were also classified as indicating stable low, stable high and mixed patterns. Results The moderately and highly active groups for PA at times 1 and 3 had up to 1.7 cm lower increase in waist circumference compared with the inactive/low active group. Across ‘PA patterns’, ‘active maintainers’ had a 2.0 cm lower waist circumference than ‘inactive/low maintainers’. Waist circumference was inversely related to sport but not active travel. CHD risk did not vary by activity levels at time 1, but was reduced significantly by 43% for high PA at time 3 (vs ‘inactive’ group) and among ‘active maintainers’ (vs ‘inactive/low maintainers’) by 62%. ‘Sport pattern’ showed stronger reductions in mortality for cardiovascular disease and CHD deaths among sport maintainers, than the single time point measures. Conclusions PA patterns demonstrated a stronger association with a number of anthropometric and mortality outcomes than the single time-point measures. Operationalising PA as a sustained behavioural pattern may address some of the known under-estimation of risk for poor health in PA self-report measurements and better reflect exposure for epidemiological analysis of risk of health outcomes

The Gold Standard Programme: smoking cessation interventions for disadvantaged smokers are effective in a real-life setting

Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates. Design Observational prospective cohort study. Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database. Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits. Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff. Main outcome measures 6months of continuous abstinence, response rate: 80%. Results Continuous abstinence of the 16?377 responders was 34% (of all 20?588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable format' stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63). Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP

Intake of dairy foods and oral health: review of epidemiological data

Introduction: The relationship between diet and oral health is intriguing. Various components of milk have been suggested to be protective against oral health problems, although specific mechanisms linking dairy components to the pathogenesis of certain diseases are still unclear. Purpose: To provide an overview of the associations between intake of milk and dairy products and dental plaque, periodontal disease and tooth loss based on currently available literature. Methods: We performed a review of relevant literature with critical appraisal of those human epidemiological studies evaluating the association between intake of milk or dairy products and periodontal disease, plaque score or tooth loss among adults and elderly. Results: Nine studies were included in the review, eight of which were cross-sectional and only one applied a longitudinal design. None of the studies included institutionalised participants. Overall, reported studies suggested an inverse association between dairy intake and plaque score and periodontal disease. Results related to tooth loss were inclusive. Conclusion: The methodological quality of reviewed studies was moderate to low with only one longitudinal design. Therefore, well-designed, confounding-controlled, longitudinal studies are warranted to be able to conclude on the potential protective effect of dairy intake on periodontal disease, dental plaque and tooth loss

Neonatal Vitamin D Levels in Relation to Risk of Overweight at 7 Years in the Danish D-Tect Case-Cohort Study

Background: Vitamin D level in pregnancy may be associated with risk of overweight in the offspring later in life. Methods: In a case-cohort study based on Danish biobanks and registers we examined the association between 25-hydroxy-vitamin D (25(OH)D) level at birth and overweight at 7 years. Cases of overweight (n = 871) were randomly selected among 7-year-old children from the Copenhagen School Health Records Register (CSHRR) with a BMI above the 90th percentile. The cohort (n = 1,311) was a random sample selected among all Danish children born during the same period. Neonatal 25(OH)D was measured in dried blood spots. Results: 25(OH)D3 exhibited the expected seasonal variation. Median level of 25(OH)D3 was 20.6 (11.9-33.3) nmol/l in the overweight group and 23.4 (13.5-34.3) nmol/l in the cohort. We found no association between neonatal 25(OH)D3 level and risk of overweight at age 7 years, neither in the crude model (OR (CI) 1.00 (0.99; 1.00)) nor in a model adjusted for maternal ethnicity, educational level, civil status, parity, season and year of birth, and offspring ponderal index (OR (CI) 1.00 (0.99; 1.01)). Conclusion: Risk of overweight at 7 years of age was not associated with vitamin D level at birth

Attained body mass index among children attending rural outdoor or urban conventional kindergartens

ObjectiveThis study aimed to examine whether children in rural outdoor kindergartens had attained a lower body mass index z-score (BMIz) and were at lower risk of overweight after school entrance compared to children in urban conventional kindergartens.MethodsThis is a longitudinal observational study of 1,544 children from outdoor kindergartens and 1,640 from conventional kindergartens. The mean age at kindergarten enrolment was 3.5 years (SD: 0.9) in the outdoor kindergartens and 3.6 years (SD: 1.0) in the conventional kindergartens. Anthropometry was measured after school entry by school health nurses when the children were 6 to 8 years old. Attained BMIz was included as the primary outcome. The risk of attaining overweight (including obesity) was included as a secondary outcome. Register-based information was available on potential confounding factors. Linear and logistic regression models were used to assess group differences in outcome measures.ResultsOur basic models, with information on outcome, kindergarten type, and birth weight showed a borderline statistically significantly lower attained BMIz (−0.07 [95% CI: −0.14, 0.00], P = 0.060) and a lower risk of overweight (adjusted risk ratio: 0.83 [95% CI: 0.72, 0.97], P = 0.016) among children attending outdoor kindergartens. However, when adjusting for sociodemographic factors and parental BMI, there was no evidence of differences in attained BMIz (P = 0.153) or overweight (P = 0.967).ConclusionWhen considering confounding factors, our findings indicate no differences in attained BMIz or risk of overweight after school entry among children attending rural outdoor kindergartens compared to those attending urban conventional kindergartens

Oral Lactobacillus Counts Predict Weight Gain Susceptibility:A 6-Year Follow-Up Study

Background: Recent studies have shown an association between weight change and the makeup of the intestinal microbiota in humans. Specifically, Lactobacillus, a part of the entire gastrointestinal tract's microbiota, has been shown to contribute to weight regulation. Aim: We examined the association between the level of oral Lactobacillus and the subsequent 6-year weight change in a healthy population of 322 Danish adults aged 35-65 years at baseline. Design: Prospective observational study. Results: In unadjusted analysis the level of oral Lactobacillus was inversely associated with subsequent 6-year change in BMI. A statistically significant interaction between the baseline level of oral Lactobacillus and the consumption of complex carbohydrates was found, e.g. high oral Lactobacillus count predicted weight loss for those with a low intake of complex carbohydrates, while a medium intake of complex carbohydrates predicted diminished weight gain. A closer examination of these relations showed that BMI change and Lactobacillus level was unrelated for those with high complex carbohydrate consumption. Conclusion: A high level of oral Lactobacillus seems related to weight loss among those with medium and low intakes of complex carbohydrates. Absence, or a low level of oral Lactobacillus, may potentially be a novel marker to identify those at increased risk of weight gain