Movement and circulation : population studies on physical activity and cardiovascular disease risk

The relationship of leisure-time physical activity with cardiovascular risk factors and mortality was determined using data from the German Cardiovascular Prevention Study, conducted from 1984-1991. Three nationally representative crosssectional samples, with a total of 7 689 men and 7 747 women, ages 25-69, were part of this study, originally designed to estimate the impact of community intervention on cardiovascular health. Additionally we analyzed regional cross-sectional and follow-up samples.Physically active individuals were more often urbanized, more likely to have high socioeconomic status, less often smokers and had healthier eating patterns and lower body mass index. Compared with sedentary individuals, the most active quartile of men (>18 kcal/kg/week spent on conditioning activities) had significantly favorable levels of serum total cholesterol (-2.5%), HDL/total cholesterol ratio (+4.2%) and resting heart rate (-4.3%). The most active women (>12 kcal/kg/week) had significantly better HDL cholesterol (+3.7%), HDL/total cholesterol ratio (+3.9%), triglycerides (-5.1%), diastolic (-1.3%) and systolic (-1.6%) blood pressure, body mass index (-2.8%) and resting heart rate (-2.5%). With duration and intensity constant, significantly better risk factor levels were observed with increased frequency of physical activity. For active men, we observed a relative risk of 0.33 (95% CI 0.11-0.94) for cardiovascular disease mortality and of 0.67 (95% CI 0.36-1.25) for all-cause mortality (5-8 year follow-up) compared with the least actives, independent of baseline risk factor levels. The elderly (ages 50-69) showed substantial benefits from participation in light to moderate activities, such as walking and cycling, most apparent when conducted frequently (≥5 times/week). Using data from the Spandau Health Test (1827 men and 2 929 women, ages 40-80, followed from 1982-1994) we estimated an all-cause mortality relative risk of 1.7 (95% CI 1.4-2.2) for men and 1.4 (95% CI 1.1-1.8) for women for each 20 beats/min higher resting heart rate.More than 40% of German adults are sedentary. We recommend them regularly, preferably daily, to conduct moderately intense activities, such as brisk walking, running, swimming or cycling, for at least 30 minutes. Elderly may prefer light activities, such as walking or gardening. An active lifestyle may substantially improve the cardiovascular risk profile of the German population. For example, if only 50% of sedentary German men, ages 40-69, would become modestly active more than 6 500 cardiovascular deaths could be prevented each year

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990�2015: a systematic analysis for the Global Burden of Disease Study 2015

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors�the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25 over the same period. All risks jointly evaluated in 2015 accounted for 57·8 (95 CI 56·6�58·8) of global deaths and 41·2 (39·8�42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million 192·7 million to 231·1 million global DALYs), smoking (148·6 million 134·2 million to 163·1 million), high fasting plasma glucose (143·1 million 125·1 million to 163·5 million), high BMI (120·1 million 83·8 million to 158·4 million), childhood undernutrition (113·3 million 103·9 million to 123·4 million), ambient particulate matter (103·1 million 90·8 million to 115·1 million), high total cholesterol (88·7 million 74·6 million to 105·7 million), household air pollution (85·6 million 66·7 million to 106·1 million), alcohol use (85·0 million 77·2 million to 93·0 million), and diets high in sodium (83·0 million 49·3 million to 127·5 million). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

Vitamins - dietary intake and intake from dietary supplements in Germany.

Objective: To analyse the current vitamin intake and the contribution of dietary supplements to this intake of 4030 participants of the German Nutrition Survey (GeNuS) 1998, which was part of the representative German National Health Interview and Examination Survey (GNHIES), conducted from October 1997 until March 1999. Design: In the GeNuS participants were interviewed comprehensively about their usual diet and supplementation patterns using a modified dietary history. Setting: Population-based nutritional survey. Subjects: A subsample of 4030 persons, aged 18-79 y, randomly selected from the GNHIES 1998. Results: The contribution of dietary supplements to the vitamin intake reached 5% for vitamin E among men and 6% for vitamin C among women. Among the group of regular users, the contribution to the vitamin E intake is 36% among men and 43% among women. A substantial part of the population does not reach the current recommendations for some vitamins, especially for folate and vitamin E through their diet alone. Among regular supplement users, about one-third for folate and about half for the other vitamins reach the recommended intake only when supplemental intake is considered. Among the regular users of folate supplements, this proportion is about half. Conclusion: If reference values are used as preference intake, a substantial population part improves their vitamin intake by taking supplements regularly. Nevertheless, there are persons who stay below the reference values including supplemental intake or already consume more than 100% of recommendation excluding supplemental intake

Do users of dietary supplements differ from nonusers in their food consumption?

The objective of the study was to analyse macronutrient and food intakes of regular users (310 men, 495 women) and nonusers (1136 men, 1269 women) of vitamin and mineral supplements, aged 18–79 years. These were participants of the German Nutrition Survey, which was part of the German National Health Interview and Examination Survey 1998. Information on dietary behaviour including supplementation habits was assessed using a validated computerised dietary history method (DISHES 98). There were no major differences in macronutrient intakes between regular users and nonusers. After adjustment for age, energy intake, smoking, sport activity, socio-economic status and East/West German residence, regular supplement use was associated with a higher consumption of drinking water. Among men, a higher consumption of vegetable fat, poultry and fruit/vegetable juice, and among women, a higher consumption of fish, milk products, fruits and tea was also associated with regular supplement use. An inverse association was observed between regular supplement use and the consumption of coffee among women. Significant differences in food consumption between regular users and nonusers were observed, indicating a tendency for a healthier food choice among regular users