Lessons from Studies in Middle-Aged and Older Adults Living in Mediterranean Islands: The Role of Dietary Habits and Nutrition Services

Background. Islands in the Mediterranean basin share particular habits and traditions and greater life expectancy than other European regions. In this paper, particular interest has been given to the effect of the Mediterranean diet, as well as nutritional services on CVD risk, on Mediterranean islands. Methods. Published results from observational studies were retrieved from electronic databases (Pubmed and Scopus) and summarized. Results. Prevalence of CVD risk factors is increased. Adherence to the Mediterranean diet was moderate, even among the elderly participants. Furthermore, the presence of a dietician was associated with higher adherence to the Mediterranean dietary pattern and consequently lowers CVD risk. Conclusion. Adherence to the Mediterranean diet is reduced, while the prevalence of CVD risk factors is increasing at alarming rates. Public health nutrition policy has the opportunity to improve the health and quality of life of people living in isolated insular areas of the Mediterranean basin

Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study

Skeletal muscle mass (SMM) is inversely associated with cardiometabolic health and the ageing process. The aim of the present work was to evaluate the relation between SMM and 10 year cardiovascular disease (CVD) incidence, among CVD-free adults 45+ years old. METHODS: ATTICA is a prospective, population-based study that recruited 3042 adults without pre-existing CVD from the Greek general population (Caucasians; age ≥18 years; 1514 men). The 10 year study follow-up (2011-2012) captured the fatal/non-fatal CVD incidence in 2020 participants (50% men). The working sample consisted of 1019 participants, 45+ years old (men: n=534; women: n=485). A skeletal muscle mass index (SMI) was created to reflect SMM, using appendicular skeletal muscle mass (ASM) standardised by body mass index (BMI). ASM and SMI were calculated with specific indirect population formulas. RESULTS: The 10 year CVD incidence increased significantly across the baseline SMI tertiles (p<0.001). Baseline SMM showed a significant inverse association with the 10 year CVD incidence (HR 0.06, 95% CI 0.005 to 0.78), even after adjusting for various confounders. Additionally, participants in the highest SMM tertile had 81% (95% CI 0.04 to 0.85) lower risk for a CVD event as compared with those in the lowest SMM tertile. CONCLUSIONS: The presented findings support the importance of SMM evaluation in the prediction of long-term CVD risk among adults 45+ years old without pre-existing CVD. Preservation of SMM may contribute to CVD health

Mental Disorders, Musculoskeletal Disorders and Income-Driven Patterns: Evidence from the Global Burden of Disease Study 2017

Background: The aim of the present study was to use the extensive Global Burden ofDiseases, Injuries, and Risk Factors Study (GBD) database from 1990-2017 to evaluate the levels andtemporal correlation trends between disability adjusted life years (DALYs) attributed tomusculoskeletal (MSK) disorders, all mental disorders collectively and by mental disorder subcategory. Methods: We utilized results of the GBD 2017 to describe the correlation patterns betweenDALYs due to MSK disorders, mental disorders and other diseases among 195 countries. Mixedmodel analysis was also applied. Results: A consistent relation was reported between age-adjustedDALYs attributed to MSK and mental disorders (in total) among the 195 countries, in both sexes,for 1990 to 2017 (1990 Rho = 0.487; 2017 Rho =0.439 p < 0.05). Distinct regional and gender correlationpatterns between age-adjusted DALYs due to MSK and mental disorders were reported. Nocorrelation was reported between DALYs due to MSK and all mental disorders collectively, amongLow- or Middle-income countries. However, in High-income countries (HICs), the correlation wasstrong and consistent between 1990 and 2017 (1990 Rho = 0.735; 2017 Rho = 0.727, p < 0.05). Conclusions: The reported correlation patterns call for targeted preventive strategies andintervention policies for mental and MSK disorders internationally. Special attention is neededamong HICs

Population prevalence of edentulism and its association with depression and self-rated health

Edentulism is associated with various adverse health outcomes but treatment options in low- and middle-income countries (LMICs) are limited. Data on its prevalence and its effect on mental health and overall-health is lacking, especially from LMICs. Self-reported data on complete edentulism obtained by standardized questionnaires on 201,953 adults aged ≥18 years from 50 countries which participated in the World Health Survey (WHS) 2002-2004 were analyzed. Age and sex-standarized edentulism prevalence ranged from 0.1% (95% CI = 0.0-0.3) (Myanmar) to 14.5% (95% CI = 13.1-15.9) (Zimbabwe), and 2.1% (95% CI = 1.5-3.0) (Ghana) to 32.3% (95% CI = 29.0-35.8) (Brazil) in the younger and older age groups respectively. Edentulism was significantly associated with depression (OR 1.57, 95% CI = 1.23-2.00) and poor self-rated health (OR 1.38, 95% CI = 1.03-1.83) in the younger group with no significant associations in the older age group. Our findings highlight the edentulism-related health loss in younger persons from LMICs. The relative burden of edentulism is likely to grow as populations age and live longer. Given its life-long nature and common risk factors with other NCDs, edentulism surveillance and prevention should be an integral part of the global agenda of NCD control

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods: Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings: In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation: GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations

Pre-Pregnancy Excess Weight Association with Maternal Sociodemographic, Anthropometric and Lifestyle Factors and Maternal Perinatal Outcomes

BACKGROUND: Pre-pregnancy excess weight is an important factor for adverse maternal perinatal outcomes; however, data for Greek women remain limited. Therefore, the aim of the present work was to evaluate the relation between pre-pregnant weight status and sociodemographic, anthropometric and lifestyle factors and maternal perinatal outcomes. METHODS: In the present cross-sectional study, 5133 healthy women were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Validated questionnaires were used to assess the sociodemographic characteristics and certain lifestyle factors of the study population. Anthropometric and clinical data were retrieved from medical history files of the women, including measured weight in the first weeks of pregnancy and right before delivery, and maternal perinatal outcomes. Women\u27s weights and heights were also measured 2-5 years postpartum by trained nutritionists. Non-adjusted and adjusted statistical analysis was performed to assess whether pre-pregnancy weight status was associated with sociodemographic, anthropometric and lifestyle factors and maternal perinatal outcomes. RESULTS: In pre-pregnancy, 17.5% of the women were overweight, and 4.9% were classified as obese. These rates were increased 2-5 years postpartum, reaching 21.0% for overweight and 9.6% for obese women. Pre-pregnancy overweight/obesity were associated with older maternal age, higher prevalence of overweight/obesity at 2-5 years postpartum and nonexclusive breastfeeding, as well as increased rates for preterm birth and pregnancy-induced hypertension after multiple adjustments. CONCLUSIONS: Overweight and obesity rates were high among women of childbearing age in Greece. These findings highlight the urgent need for healthy lifestyle promotion and targeted obesity prevention and intervention schemes among women of reproductive age

The burden of disease in Spain: results from the global burden of disease study 2010

BackgroundWe herein evaluate the Spanish population¿s trends in health burden by comparing results of two Global Burden of Diseases, Injuries, and Risk Factors Studies (the GBD studies) performed 20 years apart.MethodsData is part of the GBD study for 1990 and 2010. We present results for mortality, years of life lost (YLLs), years lived with disability, and disability-adjusted life years (DALYs) for the Spanish population. Uncertainty intervals for all measures have been estimated.ResultsNon-communicable diseases accounted for 3,703,400 (95% CI 3,648,270¿3,766,720) (91.3%) of 4,057,400 total deaths, in the Spanish population. Cardiovascular and circulatory diseases were the main cause of mortality among non-communicable diseases (34.7% of total deaths), followed by neoplasms (27.1% of total deaths). Neoplasms, cardiovascular and circulatory diseases, and chronic respiratory diseases were the top three leading causes for YLLs. The most important causes of DALYs in 2010 were neoplasms, cardiovascular and circulatory diseases, musculoskeletal disorders, and mental and behavioral disorders.ConclusionsMortality and disability in Spain have become even more linked to non-communicable diseases over the last years, following the worldwide trends. Cardiovascular and circulatory diseases, neoplasms, mental and behavioral disorders, and neurological disorders are the leading causes of mortality and disability. Specific focus is needed from health care providers and policy makers to develop health promotion and health education programs directed towards non-communicable disorders

Differential Impact of Transient and Chronic Loneliness on Health Status. A Longitudinal Study

Loneliness is associated with worse health status out-comes. Yet, the present study is one of the first to identify howpatterns of loneliness (transient and chronic) are associated withhealth over time.Design:A total of 2,390 individuals were inter-viewed in 2011–2012 and 2014–2015 in a follow-up study con-ducted over a nationally representative sample of Spain. Afterconfirming a longitudinal relationship between loneliness andhealth status, a growth curve mixture modeling was used toexamine health trajectories.Main outcome measures:The three-item UCLA Loneliness Scale was used to assess loneliness. Healthstatus was measured with self-reported questions regarding tendomains (vision, mobility, and self-care, among others), and sevenmeasured tests (including grip strength, walking speed and imme-diate and delayed verbal recall).Results:A quarter of participantswere lonely at baseline. Both the group of transient and chronicloneliness showed a negative significant relationship with healthstatus at follow-up, (b¼ 0.063 andb¼ 0.075 respectively,p<0.001). Nevertheless, the health status did not change acrosstime in any group.Conclusion:People experiencing chronic lone-liness had the worst health status. Different patterns of lonelinesscould benefit from the appropriate interventionsThis work was supported by the EU Horizon 2020 Framework Programme for Research andInnovation [635316 (ATHLOS Project)], by the European Community’s Seventh FrameworkProgramme (FP7/2007-2013) under agreement number 223071 (COURAGE in Europe), by theSpanish Ministry of Science and Innovation ACI-Promociona (ACI2009-1010), and by the Institutode Salud Carlos III-FIS research grants [PS09/00295, PS09/01845, PI12/01490, PI13/00059, PI16/00218 and PI16/01073]. Projects PI12/01490, PI13/00059, PI16/00218 and PI16/01073 have beenco-funded by the European Union European Regional Development Fund (ERDF)‘A Way toBuild Europe’. The work was also supported by the Instituto de Salud Carlos III Centro deInvestigaci on Biom edica en Red de Salud Mental (CIBERSAM). ST is supported by theFoundation for Education and European Culture (IPEP), the Sara Borrell postdoctoral programme(reference no. CD15/00019 from the Instituto de Salud Carlos III (ISCIII–Spain) and the Fondo190N. MART IN-MAR IA ET AL.Europeo de Desarrollo Regional (FEDER). NMM is supported by the programme‘Contratos pre-doctorales para Formaci on de Personal Investigador, FPI-UAM’, Universidad Aut onoma deMadrid, Spai