Obesity and associated health related factors among university staff in Serdang, Malaysia

Obesity is a well-established risk factor for coronary heart disease, ischemic stroke, type 2 diabetes, cancers of the breast, colon, prostate and other organs. Objectives: To determine the prevalence of obesity and associated factors among university staffs. Methods: A cross sectional study was carried out among university staffs of University Putra Malaysia using a self-administered validated pre-tested questionnaire. Weight was measured using a digital bathroom scale (TANITA Model HD 319) and height was measured using a SECA Body Meter Model 206. Body mass index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m2). A p value of <0.05 was considered to be statistically significant. Overweight was defined as a body mass index (BMI) of 25 to 29.9 kg/m2 and obesity as a BMI of equal or more than 30 kg/m2. Results: The mean age of the 454 university staffs was 42.86 years. The overall mean BMI was 24.52 ± 4.43 kg/m2, ranged 16.12 to 36.57 (25.69 ± 3.69 kg/m2 for males and 23.31 ± 4.81 kg/m2 for females). The prevalence of overweight and obesity was 31.1% (40.3% males and 21.5% females) and 11.8% (12.1% males and 11.7% females) respectively. After adjusting for all the variables in the logistic regression model, gender, age, occupation, smoking, alcohol intake and physical inactivity were the main predictors of obesity. Conclusions: The prevalence of overweight and obesity is very high among the university staffs. There is a need for a comprehensive integrated non-communicable disease prevention program. There is also a need to establish proactive networks for building up capacity in research and training, mobilizing contributions from within the country and overseas

Nutritional supplement use among fitness club participants in Tehran, Iran

The aim of this study was to assess nutritional supplement use among fitness club participants in Tehran, Iran. A cross sectional study was conducted in 24 fitness clubs throughout the city of Tehran, Iran. A total of 1625 fitness club participants were recruited to participate in this study. They were asked to complete a self-administered pre-tested questionnaire. Descriptive statistics and chi-square test were performed to determine the characteristics of participants, reasons for supplement use, sources of information and also the influential advisors regarding nutritional supplement use. A high prevalence rate of nutritional supplement use (66.7%) was reported. Overall, multivitamin–mineral (43.8%) and iron tablets (30.5%) were the common nutritional supplements used and only a small number of participants used illegal substances (0.5%). Younger participants were more likely to use ergogenic aids, whereas, older participants were more likely to use vitamin D. Males were more likely than females to use creatine and amino acids, whereas, iron tablets and mint water were more common among females. Also, males were more likely to use nutritional supplements for increasing energy, whereas, females were more likely to use nutritional supplements for nutritional deficiencies. In conclusion, a high prevalence rate of nutritional supplement use was seen among participants

The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children

National, sub-national, and risk-attributed burden of thyroid cancer in Iran from 1990 to 2019

An updated exploration of the burden of thyroid cancer across a country is always required for making correct decisions. The objective of this study is to present the thyroid cancer burden and attributed burden to the high Body Mass Index (BMI) in Iran at national and sub-national levels from 1990 to 2019. The data was obtained from the GBD 2019 study estimates. To explain the pattern of changes in incidence from 1990 to 2019, decomposition analysis was conducted. Besides, the attribution of high BMI in the thyroid cancer DALYs and deaths were obtained. The age-standardized incidence rate of thyroid cancer was 1.57 (95% UI: 1.33–1.86) in 1990 and increased 131% (53–191) until 2019. The age-standardized prevalence rate of thyroid cancer was 30.19 (18.75–34.55) in 2019 which increased 164% (77–246) from 11.44 (9.38–13.85) in 1990. In 2019, the death rate, and Disability-adjusted life years of thyroid cancer was 0.49 (0.36–0.53), and 13.16 (8.93–14.62), respectively. These numbers also increased since 1990. The DALYs and deaths attributable to high BMI was 1.91 (0.95–3.11) and 0.07 (0.04–0.11), respectively. The thyroid cancer burden and high BMI attributed burden has increased from 1990 to 2019 in Iran. This study and similar studies’ results can be used for accurate resource allocation for efficient management and all potential risks’ modification for thyroid cancer with a cost-conscious view

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

Comparison of Factors Associated with Nutritional Supplement Use and Non-Use Among Members of Fitness Centers in Tehran, Iran

The aim of the first phase of this study was to determine the prevalence of nutritional supplement (NS) use among the members of the fitness center in Tehran, Iran. Twenty four fitness centers participated in this study. A questionnaire asking about socio-demographic characteristics and also supplement use in the previous six months of the study was used. Of 1625 fitness center members, aged 18 years old and above, a majority (66.7%) reported the use of NS in the previous six months of the study. Also, 0.5% of them used illegal substances (IS), and 11.2% reported the use of both NS and IS. The second phase of the study was an unmatched case-control study which aimed to determine the differences in socio-demographic factors, health-related factors, psychological factors and dietary intake between 147 nutritional supplement users and 147 non-users in fitness centers in Tehran, Iran. All data, except for dietary intake were collected using a self-administered questionnaire. The participants comprised 52.0% males and 48.0% females, with a mean age of 32.03 ± 11.40 years and 33.36 ± 11.23 years, respectively. More than half of the NS users (53.7%) were females and 46.3% were males, but among the non-users 42.2% were females and 57.8% were males. More than half of the NS users (55.1%) and 47.6% of non-users had bachelor/post graduate degree. A majority of the male and female NS users (66.2% and 50.6%, respectively) felt that it was “very important” to receive information about NS, whereas male and female non-users reported lower levels of importance. Creatine (63.2%) was a common NS among male users whereas iron tablets (50.6%) were common among female users. Exercise performance (54.4%) was the main reason for using NS among male users while maintaining health/preventing nutritional deficiencies (51.9%) was the main reason for female users. Multivariate logistic regression analysis showed that moderate (OR= 16.00, 95% CI=1.50-170.25) and high (OR= 16.73, 95% CI= 1.35-207.71) physical activity levels were the strongest predictors of NS use. Another strong predictor of NS use was sex,whereby NS users were more likely than non-users to be female (OR= 12.98, 95% CI= 4.59-36.71). Moreover, NS users were six times more likely than non-users to be at risk for eating disorders (OR= 6.60, 95% CI= 3.08-14.14). In addition, NS users were more likely than non-users to be smokers (OR= 3.65, 95% CI= 1.56-8.56).Furthermore, NS users were likely to be younger than non-users (OR= 2.11, 95% CI= 1.05-4.27). NS users were also two times more likely than non-users to perceive their current body weight as overweight/obese (OR= 2.39, 95% CI= 1.05-5.10). However, there was no significant difference in total energy, protein, carbohydrate and fat intakes between NS users and non-users. This study showed a high rate of NS use in this sample. Being female, being younger than 30 years old, having high levels of physical activity, being at risk of eating disorders and being smokers were associated with NS use. These results were consistent with other studies on NS use

Dietary patterns, physical fitness, and markers of cardiovascular health in 9-11 year-old Dunedin children

Chronic diseases such as cancer, diabetes, and cardiovascular diseases (CVD) are the main health concerns of the 21st century, with CVD as the number one cause of mortality in New Zealand and worldwide. Although CVD hard endpoints such as stroke or heart attacks do not usually occur in children, there is evidence that the manifestation of CVD risk factors begins in childhood, preceding clinical complications of CVD in adulthood. Several factors including biological, environmental, and behavioural factors are associated with the development and advancement of CVD complications. Of these, dietary intake is a modifiable risk factor that has been shown to make a substantial contribution to the risk of death from CVD. Health professionals have long recognised the importance of diets high in fruits and vegetables, wholegrain/high fibre bread and cereals, and limited intakes of sugar and sugar-sweetened beverages in reducing the risk of CVD in adults. However, there is a lack of research in the paediatric population. Thus, the aim of this thesis was to determine associations between dietary intake, particularly dietary patterns as a more global approach of assessing dietary intake and markers of cardiovascular health in 9-11 year-old children in Dunedin, New Zealand. The study was conducted in two phases. In the first phase, a short (28-item) non-quantitative food frequency questionnaire (FFQ) was developed and assessed for its reproducibility and relative validity. Fifty children (mean age±SD: 9.40±0.49 years old) from three Dunedin primary schools completed the FFQ twice, as well as a four-day estimated food diary (4DEFD) over a two-week period. Intraclass correlation coefficients (ICC) and Spearman’s correlation coefficients (SCC) were used to determine the reproducibility and relative validity of the FFQ, respectively. More than half of the food items/groups (52.2%) had an ICC ≥0.50. In relative validity analyses, 70% of food items/groups had a SCC ≥0.30. This FFQ has been used to rank children according to the frequency of consumption of specified food items/groups. The low respondent burden and relative simplicity of the FFQ make it suitable for use in large cohort studies in New Zealand children with similar characteristics. The second phase of the thesis used data from the ‘Physical activity, Exercise, Diet, And Lifestyle Study’ (PEDALS), conducted in 17 primary schools in Dunedin. Of the children who took part in PEDALS, the mean age±SD was 9.72±0.68 years old, 76% were of normal weight, 80% met the guidelines of 60 minutes of daily moderate-vigorous physical activity, and 99% were categorised as fit based on the FITNESSGRAM standards. The first objective of phase II was to identify dietary patterns using principal component analysis (PCA), using the FFQ validated in phase I. Two dietary patterns, namely ‘Snacks’ and ‘Fruit & Vegetables’ were identified. The mean ‘Snacks’ and ‘Fruit & Vegetables’ scores were -0.068±1.98 and -0.005±1.83, respectively. The two identified dietary patterns in PEDALS were similar to commonly identified dietary patterns in both international and national studies. The second objective of phase II was to determine associations between the two identified dietary patterns and components of physical fitness (i.e., cardiorespiratory fitness and handgrip strength). Cardiorespiratory fitness was measured as mean relative V ̇O2max obtained from a 20-metre shuttle run test (20msrt). A digital hand dynamometer was used to measure handgrip strength of both the dominant and non-dominant hands. Complete data was available for 398 participants. Mixed effects linear regression models with robust standard errors and school as a random effect were employed to assess relationships between dietary patterns and components of physical fitness. Mean relative V ̇O2max was 48.7±4.75 ml/kg/min. Handgrip strength of the dominant and non-dominant hand was 15.2±3.29 and 14.4±3.17 kg, respectively. There were no significant associations between the dietary pattern scores and cardiorespiratory fitness. However, fat mass index (FMI) was independently associated with cardiorespiratory fitness. Excess body fat is associated with poorer performance and consequently lower estimated V ̇O2max (ml/kg/min). Furthermore, PEDALS did not find clinically meaningful associations between dietary patterns and handgrip strength of the dominant or non-dominant hand, while sex and fat-free mass index were independent determinants of handgrip strength. Considering the important impact of muscular strength on current and future health status, sex-specific exercise training to improve children’s fat-free mass and muscular strength from as young as 9 years old should be promoted. The third objective of phase II was to investigate relationships between dietary patterns and indices of arterial stiffness (i.e., augmentation index (AIx) and pulse wave velocity (PWV)). Indices of arterial stiffness were assessed using the XCEL system. Data for AIx and PWV analyses were available for 337 and 389 participants, respectively. Mixed effects linear regression models were used to assess associations between dietary patterns and indices of arterial stiffness. Mean AIx and PWV were -2.14±14.1% and 5.78±0.79 m/s, respectively. There were no clinically significant relationships between the dietary pattern scores and AIx and PWV. Arterial stiffness is one of the earliest detectable measures of vascular damage and can be seen in the first decade of life. Although evidence has shown that obesity can accelerate the age-associated arterial stiffening process, the majority (76%) of PEDALS children were normal weight, which may explain the lack of an association. Overall, there were no significant associations between dietary patterns and markers of cardiovascular health in children who took part in PEDALS. The majority of the PEDALS population had a healthy weight status, were of New Zealand European ethnicity, and from families of middle/high socio-economic status. Further research is suggested in a cohort of 9-11 year-old children from families of low socio-economic status and minority ethnic groups such as Māori and Pacific children, using the established methodology of PEDALS. Comparison of the results from PEDALS with a similar study on a group of children with different socio-demographic characteristics would be useful to inform policy and provide further insights on the importance of designing appropriate prevention strategies in both the general and high-risk paediatric populations

Reproducibility and Relative Validity of a Short Food Frequency Questionnaire in 9–10 Year-Old Children

The aim of this study was to assess the reproducibility and validity of a non-quantitative 28-item food frequency questionnaire (FFQ). Children aged 9–10 years (n = 50) from three schools in Dunedin, New Zealand, completed the FFQ twice and a four-day estimated food diary (4DEFD) over a two-week period. Intraclass correlation coefficients (ICC) and Spearman’s correlation coefficients (SCC) were used to determine reproducibility and validity of the FFQ, respectively. Weekly intakes were estimated for each food item and aggregated into 23 food items/groups. More than half of the food items/groups (52.2%) had an ICC ≥0.5. The median SCC between FFQ administrations was 0.66 (ranging from 0.40 for processed meat to 0.82 for sweets and non-dairy drinks). Cross-classification analysis between the first FFQ and 4DEFD for ranking participants into thirds showed that breakfast cereals had the highest agreement (54.0%) and pasta the lowest (34.0%). In validity analyses, 70% of food items/groups had a SCC ≥0.3. Results indicate that the FFQ is a useful tool for ranking children according to food items/groups intake. The low respondent burden and relative simplicity of the FFQ makes it suitable for use in large cohort studies of 9–10 year-old children in New Zealand

Dietary patterns, physical fitness, and markers of cardiovascular health in 9-11 year-old Dunedin children

Chronic diseases such as cancer, diabetes, and cardiovascular diseases (CVD) are the main health concerns of the 21st century, with CVD as the number one cause of mortality in New Zealand and worldwide. Although CVD hard endpoints such as stroke or heart attacks do not usually occur in children, there is evidence that the manifestation of CVD risk factors begins in childhood, preceding clinical complications of CVD in adulthood. Several factors including biological, environmental, and behavioural factors are associated with the development and advancement of CVD complications. Of these, dietary intake is a modifiable risk factor that has been shown to make a substantial contribution to the risk of death from CVD. Health professionals have long recognised the importance of diets high in fruits and vegetables, wholegrain/high fibre bread and cereals, and limited intakes of sugar and sugar-sweetened beverages in reducing the risk of CVD in adults. However, there is a lack of research in the paediatric population. Thus, the aim of this thesis was to determine associations between dietary intake, particularly dietary patterns as a more global approach of assessing dietary intake and markers of cardiovascular health in 9-11 year-old children in Dunedin, New Zealand. The study was conducted in two phases. In the first phase, a short (28-item) non-quantitative food frequency questionnaire (FFQ) was developed and assessed for its reproducibility and relative validity. Fifty children (mean age±SD: 9.40±0.49 years old) from three Dunedin primary schools completed the FFQ twice, as well as a four-day estimated food diary (4DEFD) over a two-week period. Intraclass correlation coefficients (ICC) and Spearman’s correlation coefficients (SCC) were used to determine the reproducibility and relative validity of the FFQ, respectively. More than half of the food items/groups (52.2%) had an ICC ≥0.50. In relative validity analyses, 70% of food items/groups had a SCC ≥0.30. This FFQ has been used to rank children according to the frequency of consumption of specified food items/groups. The low respondent burden and relative simplicity of the FFQ make it suitable for use in large cohort studies in New Zealand children with similar characteristics. The second phase of the thesis used data from the ‘Physical activity, Exercise, Diet, And Lifestyle Study’ (PEDALS), conducted in 17 primary schools in Dunedin. Of the children who took part in PEDALS, the mean age±SD was 9.72±0.68 years old, 76% were of normal weight, 80% met the guidelines of 60 minutes of daily moderate-vigorous physical activity, and 99% were categorised as fit based on the FITNESSGRAM standards. The first objective of phase II was to identify dietary patterns using principal component analysis (PCA), using the FFQ validated in phase I. Two dietary patterns, namely ‘Snacks’ and ‘Fruit & Vegetables’ were identified. The mean ‘Snacks’ and ‘Fruit & Vegetables’ scores were -0.068±1.98 and -0.005±1.83, respectively. The two identified dietary patterns in PEDALS were similar to commonly identified dietary patterns in both international and national studies. The second objective of phase II was to determine associations between the two identified dietary patterns and components of physical fitness (i.e., cardiorespiratory fitness and handgrip strength). Cardiorespiratory fitness was measured as mean relative V ̇O2max obtained from a 20-metre shuttle run test (20msrt). A digital hand dynamometer was used to measure handgrip strength of both the dominant and non-dominant hands. Complete data was available for 398 participants. Mixed effects linear regression models with robust standard errors and school as a random effect were employed to assess relationships between dietary patterns and components of physical fitness. Mean relative V ̇O2max was 48.7±4.75 ml/kg/min. Handgrip strength of the dominant and non-dominant hand was 15.2±3.29 and 14.4±3.17 kg, respectively. There were no significant associations between the dietary pattern scores and cardiorespiratory fitness. However, fat mass index (FMI) was independently associated with cardiorespiratory fitness. Excess body fat is associated with poorer performance and consequently lower estimated V ̇O2max (ml/kg/min). Furthermore, PEDALS did not find clinically meaningful associations between dietary patterns and handgrip strength of the dominant or non-dominant hand, while sex and fat-free mass index were independent determinants of handgrip strength. Considering the important impact of muscular strength on current and future health status, sex-specific exercise training to improve children’s fat-free mass and muscular strength from as young as 9 years old should be promoted. The third objective of phase II was to investigate relationships between dietary patterns and indices of arterial stiffness (i.e., augmentation index (AIx) and pulse wave velocity (PWV)). Indices of arterial stiffness were assessed using the XCEL system. Data for AIx and PWV analyses were available for 337 and 389 participants, respectively. Mixed effects linear regression models were used to assess associations between dietary patterns and indices of arterial stiffness. Mean AIx and PWV were -2.14±14.1% and 5.78±0.79 m/s, respectively. There were no clinically significant relationships between the dietary pattern scores and AIx and PWV. Arterial stiffness is one of the earliest detectable measures of vascular damage and can be seen in the first decade of life. Although evidence has shown that obesity can accelerate the age-associated arterial stiffening process, the majority (76%) of PEDALS children were normal weight, which may explain the lack of an association. Overall, there were no significant associations between dietary patterns and markers of cardiovascular health in children who took part in PEDALS. The majority of the PEDALS population had a healthy weight status, were of New Zealand European ethnicity, and from families of middle/high socio-economic status. Further research is suggested in a cohort of 9-11 year-old children from families of low socio-economic status and minority ethnic groups such as Māori and Pacific children, using the established methodology of PEDALS. Comparison of the results from PEDALS with a similar study on a group of children with different socio-demographic characteristics would be useful to inform policy and provide further insights on the importance of designing appropriate prevention strategies in both the general and high-risk paediatric populations