Changes in health behaviors, mental and physical health among older adults under severe lockdown restrictions during the covid-19 pandemic in spain

We used data from 3041 participants in four cohorts of community-dwelling individuals aged =65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If an-other lockdown were imposed during this or future pandemics, public health programs should spe-cially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Diet, Lifestyle and Chronic disease burden

Background Diet, Body Mass Index (BMI), physical activity and smoking are among the most important lifestyle factors that influence global disease burden. In this thesis we investigate the relations of these factors with total disease burden in a large Dutch population, the EPIC-NL cohort. In this cohort lifestyle data were collected between 1993-7 and participants were followed for diseases until December 31, 2007. We defined five different dietary patterns and we expressed disease burden in Disability-Adjusted Life Years (DALYs). DALYs are the sum of Years Lost due to Disability and the Years of Life Lost due to premature mortality. The advantage of this summary health measure is that in the outcome morbidity as well as mortality of several diseases are combined. Lifestyle factors that have small effects on several diseases will be more easily identified as important for public health. Furthermore, DALYs help estimating the overall effect habits that have opposing effects on different diseases. MethodsThe DALYs are estimated for 33,066 healthy men and women aged 20-70 years at recruitment into the EPIC-NL study. BMI, physical activity, diet and smoking are investigated separately and combined into a health behaviour score. We selected 5 dietary patterns that are relevant for the Dutch EPIC-NL population: 1. the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)), 2. the dietary guidelines proposed by the WHO (Healthy Diet Indicator (HDI)), 3. a Mediterranean Style Diet (modified Mediterranean Diet Score (mMDS)), and the a posteriori defined 4. prudent and 5. Western-type dietary pattern. ResultsOur study shows that never smoking, a BMI lower than 25, being physically active and consuming a healthy diet all result in a longer healthy life. Persons who adhere to all four healthy lifestyle factors live approximately two years longer in good health. Higher adherence to any of the studied dietary patterns with the exception for the Western dietary pattern is related to lower disease burden. Persons who reported at baseline stronger adherence to the mMDS or prudent dietary pattern lived on average 2 months longer in good health (per standard deviation increase in score). We find a more modest association between the HDI and the DHD-index and overall disease burden: per standard deviation higher adherence was associated with approximately 1 month longer in good health. ConclusionOur results show a beneficial impact on total disease burden when adhering to a healthy diet, specifically when adhering to a Mediterranean type of diet, including limited meat and meat products, plenty of fruit, nuts, fish and unsaturated fat and a limited amount of alcohol. Next to a healthy diet a combination of healthy lifestyle behaviours is important for a longer life in good health. Due to the underestimation of DALYs the estimates we reported should be considered the minimum estimate. Longer follow-up, a more complete assessment of disabilities and more insight in the impact of comorbidity of disability weights will give a more complete picture and a better insight into the association between lifestyle factors and disease burden

Dairy product intake in relation to glucose regulation indices and risk of type 2 diabetes

Background and aim A high intake of dairy has been linked to lower risk of type 2 diabetes (T2D). The relationship between dairy intake and glucose metabolism is still not well understood. The aim of this study was to investigate the relation between the intake of total dairy and dairy subgroups and T2D and measures of glucose metabolism. Methods and results A total of 5953 Danish men and women aged 30–60 years without baseline diabetes or cardiovascular diseases were included in this prospective analysis. The dairy intake at baseline was categorised into low-fat dairy, full-fat dairy, milk and milk products, cheese and fermented dairy. Fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), HbA1c, insulin resistance (HOMA2-IR) and beta-cell function (HOMA2-B) were considered at 5-year follow-up. In the maximally-adjusted model (demographics, lifestyle factors, dietary factors and waist), cheese intake was inversely associated with 2hPG (ß = -0.048, 95% CI -0.095; -0.001). Fermented dairy intake was inversely associated with FPG (ß = -0.028, 95% CI -0.048; -0.008) and HbA1c (ß = -0.016, 95% CI -0.030; -0.001). Total dairy intake and the dairy subgroups were not related to HOMA-IR and HOMA-B in the maximally-adjusted model. Furthermore, there was no significant association between intake of total dairy or any of the dairy subgroups and incidence of T2D. Conclusion Our data suggest a modest beneficial effect of cheese and fermented dairy on glucose regulation measures; however, this did not translate into a significant association with incident T2D

Dairy Intake and Coronary Heart Disease or Stroke – a population-based cohort study in the Netherlands

AIM: This study aimed to investigate the relationship between total dairy intake and dairy subtypes (high-fat dairy, low-fat dairy, milk and milk products, cheese and fermented dairy) with incident coronary heart disease (CHD) and stroke. METHODS: EPIC-NL is a prospective cohort study among 33,625 Dutch men and women. At baseline (1993-1997), dairy intake was measured with a validated food frequency questionnaire (FFQ). The incidence of both fatal and non-fatal CHD and stroke was obtained by linkage to the national registers. RESULTS: During 13years follow-up, 1648 cases of CHD and 531 cases of stroke were documented. Total dairy intake was not significantly associated with risk of CHD (hazard ratio per standard deviation (SD) increase=0.99; 95%-CI: 0.94-1.05) or stroke (0.95; 0.85-1.05) adjusted for lifestyle and dietary factors. None of the dairy subtypes was to CHD, while only fermented dairy tended to be associated (p=0.07) with a lower risk of stroke (0.92; 0.83-1.01). Hypertension appeared to modify the association of total and low-fat dairy with CHD (p interactio

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort

Background Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke. Methods A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20–70 years recruited into the EPIC-NL study during 1993–1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk. Results After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk. Conclusion The HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke

Supplementary Material for: Multimorbidity patterns in older adults: the role of social variables and lifestyle behaviors

Introduction: While some conditions clusters represent the chance co-occurrence of common individual conditions, others may represent shared causal factors. The aims of this study were to identify multimorbidity patterns in older adults, and to explore the relationship between social variables, lifestyle behaviors, and the multimorbitidity patterns identified. Methods: This was a cross-sectional design. Data came from 3273 individuals aged ≥65 from the Seniors-ENRICA-2 cohort; information on 60 chronic diseases categories, categorized according to the 2nd edition of the International Classification of Primary Care and the 10th edition of the International Classification of Diseases, was obtained from clinical records linkage. To identify multimorbidity patterns, an exploratory factor analysis was conducted over chronic disease categories with prevalence >5%, using Oblimin rotation and Kaiser’s eigenvalues-greater-than-one rule. The association between multimorbidity patterns and their potential determinants was assessed with multivariable linear regression. Results: The three-factor solution (Musculoskeletal diseases and mental disorders, Cardiometabolic diseases, and Cardiopulmonary diseases) explained 64.5% of the total variance. Being older, lower occupational category, higher levels of loneliness, lower levels of physical activity, and higher body mass index were associated with higher scores in the multimorbidity patterns identified. Female sex was linked to the Musculoskeletal diseases and mental disorders pattern, while being male was revealed to the two remaining multimorbidity patterns. A high diet quality was inversely related to Cardiometabolic diseases, while optimal sleep duration was inversely related to Cardiopulmonary diseases. Discussion/Conclusion: Three multimorbidity patterns were identified in older adults. Multimorbidity patterns were differently associated with social variables and lifestyles behavioral factors

WHO guidelines for a healthy diet and mortality from cardiovascular disease in European and American elderly

__Background:__ Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly. __Objective:__ The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y. __Design:__ We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model. __Results:__ During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points was, on average, not associated with CVD mortality, CAD mortality, or stroke mortality. However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts and in the US cohort. __Conclusion:__ Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States