The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort

Introduction: The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke. Methods: The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40–69 years, recruited between 2006–2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline. Results: The BCS (median: 12; IQR:11–14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged 59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged 59. Discussion: The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide

The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort

IntroductionThe 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke.MethodsThe BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40–69 years, recruited between 2006–2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline.ResultsThe BCS (median: 12; IQR:11–14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50–59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50–59, and 33% (95%CI, 29-37%) among those aged >59.DiscussionThe BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide

Associations of step counts and aerobic stepping cadence with arterial stiffness in older adults

Purpose: It is unclear if higher daily step counts are associated with lower arterial stiffness (AS) in older adults. Less is known about the effects of aerobic stepping cadence (steps/minute) independent of daily step counts on AS in older adults. We examined the independent and combined associations of objectively-measured step counts and aerobic stepping cadence withAS among older adults. Methods: This cross-sectional study included 409 older adults aged ≥65 years (mean age = 72 ± 6, 59% female). AS was derived from carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor device (SphygmoCor system, AtCor Medical, Sydney, Australia). High AS, an established risk factor of cardiovascular diseases, was defined as cfPWV \u3e10 m/s.. Step counts and aerobic stepping cadence averaged over 7 days were measured with accelerometer-based pedometers (Omron Alvita Optimized pedometer HJ-321, Kyoto, Japan). Odds ratios (ORs) and 95% confidence intervals (CIs) for high AS were calculated among quintiles (fifths) of step counts and five groups of aerobic stepping cadence (slow walkers with 0 aerobic steps and quartiles [fourths] of aerobic stepping cadence for fast walkers). Slow walkers included those participants who accumulated no aerobic stepping cadence data (cadence of \u3e60 steps per minute for more than 10 consecutive minutes). The lowest step count quintile and the slow walkers were considered the reference groups in the corresponding analysis. Logistic regression was used to investigate the independent associations between step counts or aerobic stepping cadence with high AS. Participants were dichotomized as fast/slow walkers (obtaining any steps at \u3e60 steps/minute or not) or active/inactive (≥5,000 steps/day or not) for a joint analysis. Covariates were sex, age, body mass index, smoking, heavy drinking, diabetes, hyperlipidemia, hypertension medication, systolic blood pressure, and step counts or aerobic stepping cadence in respective analyses. Results: Eighty-six (21%) older adults were identified as having high AS. Compared to the lowest quintile of step counts, ORs (95% CIs) of having high AS were 0.47 (0.23-0.99), 0.38 (0.18-0.82), 0.42 (0.19-0.93), 0.52 (0.22-1.11) for second, third, fourth and fifth quintile, respectively, after controlling for age and sex. After further adjustment for comorbidities, lifestyle factors, and aerobic stepping cadence, the second and third quintile of step counts still remained significant (OR, 0.38 [95% CI 0.16-0.91] and OR, 0.38 [95% CI 0.15-0.97]). Compared to those with 0 steps/min aerobic stepping cadence (slow walking), ORs (95% CIs) of having high AS were 0.50 (0.21-1.19), 0.47 (0.18-1.20), 0.46 (0.18-1.16), and 0.42 (0.16-1.09) for ascending groups of fast walking aerobic stepping cadence after adjustment for age, sex, comorbidities, lifestyle factors, and step counts. In the joint analysis, compared to Inactive & Slow walkers, ORs (95% CIs) of having high AS were 1.16 (0.31-4.34), 0.43 (0.20-0.95), and 0.48 (0.23-0.95) for Active & Slow walkers, Inactive & Fast walkers, and Active & Fast walkers, respectively. Conclusion: Higher total daily step counts appeared to be associated with a lower prevalence of high AS status among older adults after adjusting for possible confounders including aerobic stepping cadence in logistic regression analyses. Although aerobic stepping cadence was not significant after adjusting for possible confounders including total daily step counts, this study also suggests a possible association between higher aerobic stepping cadence and lower prevalence of high AS with ORs of \u3c1.00 in all fast walkers (≥1 aerobic steps) compared to slower walkers (0 aerobic steps)

Associations of step counts and aerobic stepping cadence with arterial stiffness in older adults

Purpose: It is unclear if higher daily step counts are associated with lower arterial stiffness (AS) in older adults. Less is known about the effects of aerobic stepping cadence (steps/minute) independent of daily step counts on AS in older adults. We examined the independent and combined associations of objectively-measured step counts and aerobic stepping cadence withAS among older adults. Methods: This cross-sectional study included 409 older adults aged ≥65 years (mean age = 72 ± 6, 59% female). AS was derived from carotid-femoral pulse wave velocity (cfPWV) using the SphygmoCor device (SphygmoCor system, AtCor Medical, Sydney, Australia). High AS, an established risk factor of cardiovascular diseases, was defined as cfPWV >10 m/s.. Step counts and aerobic stepping cadence averaged over 7 days were measured with accelerometer-based pedometers (Omron Alvita Optimized pedometer HJ-321, Kyoto, Japan). Odds ratios (ORs) and 95% confidence intervals (CIs) for high AS were calculated among quintiles (fifths) of step counts and five groups of aerobic stepping cadence (slow walkers with 0 aerobic steps and quartiles [fourths] of aerobic stepping cadence for fast walkers). Slow walkers included those participants who accumulated no aerobic stepping cadence data (cadence of >60 steps per minute for more than 10 consecutive minutes). The lowest step count quintile and the slow walkers were considered the reference groups in the corresponding analysis. Logistic regression was used to investigate the independent associations between step counts or aerobic stepping cadence with high AS. Participants were dichotomized as fast/slow walkers (obtaining any steps at >60 steps/minute or not) or active/inactive (≥5,000 steps/day or not) for a joint analysis. Covariates were sex, age, body mass index, smoking, heavy drinking, diabetes, hyperlipidemia, hypertension medication, systolic blood pressure, and step counts or aerobic stepping cadence in respective analyses. Results: Eighty-six (21%) older adults were identified as having high AS. Compared to the lowest quintile of step counts, ORs (95% CIs) of having high AS were 0.47 (0.23-0.99), 0.38 (0.18-0.82), 0.42 (0.19-0.93), 0.52 (0.22-1.11) for second, third, fourth and fifth quintile, respectively, after controlling for age and sex. After further adjustment for comorbidities, lifestyle factors, and aerobic stepping cadence, the second and third quintile of step counts still remained significant (OR, 0.38 [95% CI 0.16-0.91] and OR, 0.38 [95% CI 0.15-0.97]). Compared to those with 0 steps/min aerobic stepping cadence (slow walking), ORs (95% CIs) of having high AS were 0.50 (0.21-1.19), 0.47 (0.18-1.20), 0.46 (0.18-1.16), and 0.42 (0.16-1.09) for ascending groups of fast walking aerobic stepping cadence after adjustment for age, sex, comorbidities, lifestyle factors, and step counts. In the joint analysis, compared to Inactive & Slow walkers, ORs (95% CIs) of having high AS were 1.16 (0.31-4.34), 0.43 (0.20-0.95), and 0.48 (0.23-0.95) for Active & Slow walkers, Inactive & Fast walkers, and Active & Fast walkers, respectively. Conclusion: Higher total daily step counts appeared to be associated with a lower prevalence of high AS status among older adults after adjusting for possible confounders including aerobic stepping cadence in logistic regression analyses. Although aerobic stepping cadence was not significant after adjusting for possible confounders including total daily step counts, this study also suggests a possible association between higher aerobic stepping cadence and lower prevalence of high AS with ORs of <1.00 in all fast walkers (≥1 aerobic steps) compared to slower walkers (0 aerobic steps).</p

Association between breakfast frequency and physical activity and sedentary time : a cross-sectional study in children from 12 countries

BackgroundExisting research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites.MethodsThis multinational, cross-sectional study included 6228 children aged 9-11years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2days/week [rare], 3 to 5days/week [occasional] or 6 to 7days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200h) and afternoon (1200h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time.ResultsParticipants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated witha higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4min/day and 1.3%) than rare breakfast consumption (all p0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found.ConclusionsIn this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.Trial registrationThe International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at(Identifier NCT01722500).Peer reviewe