Проценка на здравствените и економски придобивки од пешачењето во Република Северна Македонија со употреба на алатката за економска проценка и здравје

Walking as a form of physical activity has immense health benefits, but it also has economic benefits. Walking is a very efficient activity that prevents certain diseases and enables better quality of life of people who already have some disease.A considerable contribution of walking is detected in cardiovascular diseases, type 2 diabetes, obesity and chronic pulmonary diseases.The aim of this study was to make a health and economic assessment of the benefits of walking in the Republic of North Macedonia by using the Health and Economic Assessment Tool (HEAT).Materials and methods:Health Economic Assessment Tool is a relatively new tool, developed by WHO experts whose expertise is in the field of Public health and is able to calculate the health effects of regular walking and/or cycling. This study was based on using this tool for walking mode for the first time in the Republic of North Macedonia in a population group of 191 participants between the age of 20 to 73 years, with the average age of 35 years.Results:Besides the aforementioned health benefits, HEAT calculates the economic benefits of walking. The tool applied to 191 participants resulted in a total economic value of 108 808.8€ for one yearas well as reduction in mortality rate. Conclusion: We found that less than one fifth of our assessed population spends time in walking according to the WHO, CDC and AHA recommendations. The rest of them, more than four fifths are not following these recommendations. Our assessed population was relatively young, the average age being 35 years old, and the population was healthy, but still the results from this survey were not satisfying.Пешачењето како форма на физичка активност има огромни здравствени придобивки, но покрај нив и економски придобивки за човекот. Пешачењето е ефикасна активност која може да превенира одредени болести и да овозможи подобар квалитет на живот кај лица кои веќе имаат некоја болест.Значаен придонес од пешачењето е регистриран кај кардиоваскуларните болести, дијабет тип 2, обезност и хронични белодробни болести.Целта на ова истражување беше да се направи здравствена и економска проценка на пешачењето во Република Северна Македонија користејќи ја Health Economic Assessment Tool (HEAT) алатката.Материјали и методи: Health Economic Assessment Tool е релативно нова алатка, развиена од експерти на СЗО, чие поле на експертиза е јавното здравје и е оспособена да ги пресмета здравствените и економските ефекти од редовното пешачење и/или возење велосипед. Нашата студија беше базирана на употреба на оваа алатка за првпат во Република Северна Македонија за пешачење, на популациона група од 191 учесник, на возраст помеѓу 20 и 73 години, со просечна возраст од 35 години.Резултати: Покрај гореспоменатите здравствени придобивки, HEAT ги пресмета и економските бенефити од пешачењето. Алатката употребена за 191 учесник резултираше со целосна економска вредност од 108808,8 евра за една година и редукција настапката на морталитетот. Заклучок: Со ова истражување заклучивме дека помалку од една петтина од проценетата популација пешачи во склоп на препораките од СЗО, ЦКБ и АСА. Останатите, повеќе од четири петтини, не ги следат препораките за пешачење. Нашата популација беше релативно млада, просечната возраст беше 35 години, а дополнително и здрава, но и покрај тоа, резултатите од ова истражување не се задоволителни

Социоекономските разлики помеѓу семејствата на деца со зголемена телесна тежина и дебелина во Северна Македонија

Globally, the prevalence of overweight and obesity is increasing among children and adolescents. Halting the rise in obesity is a significant challenge because of the complex interplay of factors and influences. We aimed to explore the role of family socioeconomic status (SES) indicators in relation to overweight and obesity prevalence rates among primary school children in North Macedonia. Materials and methods: Data were collected on a nationally representative sample of children and their parent(s)/caregiver(s) participating in the 6th round of World Health Organization (WHO)-European Childhood Obesity Surveillance Initiative (COSI) in North Macedonia. Every child had their height and weight objectively measured and their family sociodemographic and SES data were obtained through a self-reported record form by their parent(s)/caregiver(s). According to COSI reporting, responses on three SES indicators (parental educational attainment, parental employment status and family-perceived wealth) were categorized in levels for data analysis. Overweight and obesity rates were estimated based on 2007 WHO growth references. Pearson’s χ2-tests, corrected with the Rao-Scott method, were used to test differences in overweight and obesity across various subgroups. Results: The sample consisted of primarily native-born children (97.3%) and parents (mothers - 96.2%; fathers - 97.6%), living in urban areas (66.9%), in two-parent families (84.9%) and spoke Macedonian at home (59.8%). The majority of children lived in families with low to medium SES level. Prevalence of overweight was 30.5% [95% CI: 28.5-32.7], whilst of obesity 14.1% [95% CI: 12.3-16.0]. There were no significant differences observed across family SES indicators in overweight or obesity rates.  Conclusion: Our findings contribute towards reporting on family SES among children living with overweight and obesity to better understand and address potential obesity risk factors. Future research should focus on exploring family SES within the long-term context of children’s health-related behaviours.На глобално ниво, стапката на преваленција од зголемена телесна тежина и дебелина кај деца и адолесценти се зголемува. Запирањето на порастот на дебелината е значаен предизвик поради комплексната интеракција на многу фактори и влијанија. Цел на студијата беше да се истражи улогата на социоекономскиот статус (СЕС) на семејството во однос на преваленцијата на зголемена телесна тежина и дебелина кај децата, ученици во основните училишта во Северна Македонија.  Материјали и методи: Податоците беа собрани на национално репрезентативен примерок на деца и нивните родител(и)/старател(и), учесници во 6-от круг на СЗО - Европската иницијатива за следење на дебелината (COSI) во Северна Македонија. Телесната висина и тежина на секое дете беше објективно измерена, а социодемографските и СЕС податоци беа добиени од прашалникот за семејство пополнет од страна на нивните родител(и)/старател(и). Според претходни COSI публикации, одговорите за трите СЕС индикатори (степен на образование, работен статус и перцепции за економската благосостојба) беа категоризирани во нивоа за анализа на податоците. Стапките на зголемена телесна тежина и дебелина беа пресметани врз основа на СЗО референците за раст од 2007 година. Pearson-ов χ2-тест, коригиран со Rao-Scott методот, беа употребени за тестирање на разликите во стапките на зголемена телесна тежина и дебелина помеѓу различните подгрупи. Резултати: Примерокот за анализа се состоеше примарно од деца (97,3%) и родители мајка - 96,2%; татко - 97,6%) кои се родени во Македонија, живеат во урбани средини (66,9%), како двородителски семејства (84,9%), и зборуваат дома на македонски јазик (59,8%). Поголемиот број деца живееја во семејства со низок до среден социоекономски статус. Преваленцијата на зголемена телесна телесна тежина беше 30,5% [95% CI: 28.5-32.7], додека на дебелина 14,1% [95% CI: 12.3-16.0]. Не беа забележани значајни разлики помеѓу индикаторите на семејниот СЕС и превалентноста на зголемена телесна тежина и дебелина.  Заклучок: Нашите резултати придонесуваат кон евидентирање на социоекономскиот статус на семејството кај децата кои живеат со зголемена телесна тежина и дебелина со подобро разбирање и адресирање на потенцијалните ризик-фактори на дебелина. Идните истражувања треба да се фокусираат кон анализирање на семејниот СЕС во долгорочен контекст на поврзаноста со однесувањата поврзани со здравјето кај децата

Energy, macronutrients and dietary fibre intake among adults in North Macedonia

Objective: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. Methods: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. Results: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, beta = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, beta = -2.077) and among highly educated participants (p = 0.018, beta = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, beta = 4.213). Conclusion: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases

Промени во тежината кај 7-годишни деца во Северна Македонија во периодот меѓу 2010 и 2019 година

Childhood obesity is growing as one of the most important public health issues that affects individual and population health but also puts heavy burden on the health systems. It is frequently associated with immediate adverse consequences, such as psychological problems, and a higher risk of many harmful comorbidities later in life, such as type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, hypertension, and coronary heart disease. Comparability of anthropometric data is crucial to track the changes over time. The aim of this paper was to present prevalence of thinness, overweight, and obesity in 7-year-old schoolchildren in North Macedonia in 2010 and 2019, and the changes in their nutritional status during thatperiod. Material and methods: Anthropometric measurements of body height and body weight were performed to the nationally representative sample of 7-year-oldchildren in school years 2010/2011 and 2018/2019. Measurements followed the Childhood Obesity Surveillance Initiative (COSI) protocol and data collecting procedures. In total, 2737 children (1317 girls and 1420 boys) in 2010 and 2059 children (1045 girls and 1014 boys) in 2019 were measured. WHO Growth references were used to determine the growth and nutritional status of children. Results: The average height of children in the observed period has increased by 1.7 cm, weight for 1.2 kg and the BMI for 0.3 kg/m2. As for the weight classification, thinness prevalence is significantly increased for 0.3%. Overweight (including obesity) significantly increased (p=0.0377) from 34.4% (95% CI 32.6%-36.2%) in 2010 to 37.3% (95% CI 35.2%-39.5%) in 2019. Obesity significantly increased (p=0.040) from 16.3% (95% CI 14.9%-17.7%) in 2010 to 18.4% (95% CI 16.7%-20.1%) in 2019. The main driver of that increase was the highly significant (p=0.0004) increase of almost 7% of overweight (including obesity) in girls. Conclusion: There is unfavorable rising trend which indicates deterioration of the situation with childhood obesity in the country. Focused and more comprehensive public health nutrition actions are needed to plateau or reverse the trends. The childhood obesity national monitoring system is well established and should continue to beone of the key public health monitoring systems that provide evidence for actions.  Детската дебелина прераснува во едно од најважните јавноздравствени прашања кои влијаат на индивидуалното и популациското здравје, но и силно ги оптоваруваат здравствените системи.  Често е поврзана со негативни последици како психолошки проблемии со зголемен ризик од многу други коморбидитети подоцна во животот како што се дијабетес мелитус тип 2, дислипидемија, замастување на црниот дроб кое не е предизвикано од алкохол, хипертензија и коронарна болест на срцето. Споредливоста на антропометриските податоци е клучна за да се прикажат промените низ времето. Цел на овој труд беше да ја прикаже преваленцијата на слаби, како и на деца со зголемена телесна тежина и дебелина во Северна Македонија, на возраст од 7 години, во 2010 и 2019 година, како и променитево нивниот нутритивен статус во тој временски период. Материјал и методи: Беа направениантропометрискимерења на телесната висина и тежина кај национално репрезентативен примерок на 7-годишни деца во училишните години 2010/2011  и 2018/2019. Мерењата ги следеа процедурите и пропишаниот протокол на Иницијативата за следење на дебелината кај децата (COSI). Вкупно беа измерени2737 деца (1317 женскии 1420 машки) во 2010 и 2059 деца (1045 женскии 1014 машки) во 2019. Референците за раст на СЗО беа користени за утврдување на растот и нутритивниот статус на децата. Резултати: Висината на децата за време на испитуваниот период се зголемила за 1,7 cm, тежината за 1,2 kg, а ИТМ за 0,3 kg/m2. Во однос на класификацијата на тежината, преваленцијата на слабосткај децата незначајно пораснала за 0,3%. Зголемената телесна тежина (вклучувајќи дебелина) значајно пораснала (p=0,0377) од 34,4% (95% CI 32,6%-36,2%) во 2010 на 37,3% (95% CI 35,2%-39,5%) во 2019. Дебелината значајно пораснала (p=0,040) од 16,3% (95% CI 14,9%-17,7%) во 2010 на 18,4% (95% CI 16,7%-20,1%) во 2019. Главен двигател на тоа зголемување била значајно зголемената телесна тежина (вклучувајќи дебелина) од скоро 7% кај девојчињата. Заклучок: Постои неповолен растечки тренд кој индицира влошување на ситуацијата со детската дебелина во земјата. Потребни се насочени и посеопфатни јавноздравствени акции во исхраната ре или смени насоката на трендот. Системот на следење на детската дебелина во државата е добро воспоставен и треба да продолжи како еден од клучните јавноздравствени системи на следење кој обезбедува докази за идни акции

Functional Foods in Macedonia: Consumers’ Perspective and Public Health Policy

Background: The objective of our study was to explore the knowledge, attitudes and practices of Macedonian consumers towards functional foods, to predict future trends and to assess the national public health policies encompassing the functional foods market.Methods: Total of 518 respondents aged 18+, from all regions in the country participated in the study. They were sampled through three-staged national representative sampling procedures. The questionnaire comprised questions regarding the level of information about functional foods, trust in health claims, frequency of consumption and knowledge and attitudes related to those foods. Statistical significance was determined at p<0.05.Results: Respondents aged 18-34 were more informed compared to the total population (22 and 16 % respectively, p<0.05). Most of the consumers consume these products once a day. Employed consumers were willing to increase daily consumption from 3 to 18 % (p<0.05). On average 65.1% of the statements assessing knowledge were answered correctly. On a scale from -3 to +3 functional foods were considered as very healthy (mean=2.03, SD=1.42).Conclusion: On average, Macedonian consumers have a positive attitude and high expectations of functional foods. Public health policies still lag when compared to comprehensive approach of the food industry in market placement of these products

Association of Methylenetetrahydrofolate Reductase (MTHFR-677 and MTHFR-1298) Genetic Polymorphisms with Occlusive Artery Disease and Deep Venous Thrombosis in Macedonians

Cilj Ispitati moguću povezanost genetičkog polimorfizma metilen-tetrahidrofolatne reduktaze (MTHFR-677, MTHFR-1298) s okluzivnom arterijskom bolešću i dubokom venskom trombozom u Makedonaca. Postupci Radili smo s 83 zdrave osobe, 76 bolesnika s okluzivnom arterijskom bolešću i 67 bolesnika s dubokom venskom trombozom. Od njih su prikupljeni su uzorci krvi i iz leukocita je izolirana DNA. Mutacije gena za MTHFR identificirane su testom CVD StripAssay (ViennaLab, Labordiagnostika GmbH, Beč, Austrija), a za analizu je uporabljen sustav za genetičku analizu PyPop. Potom su izračunani Pearsonove P vrijednosti, grubi omjer izgleda (odds ratio, OR) i Waldovi 95% intervali pouzdanosti (confidence intervals, CI). Rezultati Frekvencija alela C lokusa za MTHFR-677 bila je 0,575 u bolesnika s dubokom venskom trombozom, 0,612 u onih a okluzivnom arterijskom bolešću i 0,645 u zdravih osoba. Frekvencija alela T lokusa za MTHFR-677 bila je niža u zdravih osoba (0,355) nego u bolesnika s okluzivnom arterijskom bolešću (0,388) i dubokom venskom trombozom (0,425). Frekvencija alela A u lokusu MTHFR-1298 bila je 0,729 u zdravih osoba, 0,770 u bolesnika s okluzivnom arterijskom bolešću i 0,746 u bolesnika s dubokom venskom trombozom. Frekvencija alela C lokusa za MTHFR-1298 bila je 0,271 u zdravih osoba, 0,230 u bolesnika s okluzivnom arterijskom bolešću i 0,425 u bolesnika s dubokom venskom trombozom. Nije opažena povezanost polimorfizma MTHFR-677 i MTHFR-1289 s okluzivnom arterijskom bolešću ili dubokom venskom trombozom, nego se samo pokazao protektivni učinak diplotipa MTHFR/CA:CC za okluzivnu arterijsku bolest. Zaključak Osim protektivnoga učinka diplotipa MTHFR/CA:CC za okluzivnu arterijsku bolest, nismo našli značajnu povezanost polimorfizma lokusa MTHFR-677 i MTHFR-1289 s okluzivnom arterijskom bolešću i dubokom venskom trombozom.Aim To analyze the association of methylenetetrahydrofolate reductase polymorphisms (MTHFR-677 and MTHFR-1298) with occlusive artery disease and deep venous thrombosis in Macedonians. Methods We examined 83 healthy respondents, 76 patients with occlusive artery disease, and 67 patients with deep venous thrombosis. Blood samples were collected and DNA was isolated from peripheral blood leukocytes. Identification of MTHFR mutations was done with CVD StripAssay (ViennaLab, Labordiagnostika GmbH, Vienna, Austria) and the population genetics analysis package, PyPop, was used for the analysis. Pearson P values, crude odds ratio, and Wald’s 95% confidence intervals were calculated. Results The frequency of C alleles of MTHFR-677 was 0.575 in patients with deep venous thrombosis, 0.612 in patients with occlusive artery disease, and 0.645 in healthy participants. The frequency of T allele of MTHFR-677 was lower in healthy participants (0.355) than in patients with occlusive artery disease (0.388) and deep venous thrombosis (0.425). The frequency of A allele for MTHFR-1298 was 0.729 in healthy participants, 0.770 in patients with occlusive artery disease, and 0.746 in patients with deep venous thrombosis. The frequency of C allele of MTHFR-1298 was 0.271 in healthy participants, 0.230 in patients with occlusive artery disease, and 0.425 in patients with deep venous thrombosis. No association of MTHFR-677 and MTHFR- 1289 polymorphisms with occlusive artery disease and deep venous thrombosis was found, except for the protective effect of MTHFR/CA: CC diplotype for occlusive artery disease. Conclusion We could not confirm a significant association of MTHFR- 677 and MTHFR-1289 polymorphisms with occlusive artery disease or deep venous thrombosis in Macedonians, except for the protective effect of MTHFR/CA:CC diplotype against occlusive artery disease

New bioelectrical impedance analysis equations for children and adolescents based on the deuterium dilution technique

Background and aims: Body composition in childhood is not only a marker of the prevalence of obesity, but it can also be used to assess associated metabolic complications. Bioelectrical impedance analysis (BIA) shows promise as an easy to use, rapid, and non-invasive tool to evaluate body composition. The objectives of this study were to: (a) develop BIA prediction equations to estimate total body water (TBW) and fat-free mass (FFM) in European children and early adolescents and to validate the analysis with the deuterium dilution as the reference technique and (b) compare our results with previously published paediatric BIA equations. Methods: The cohort included 266 healthy children and adolescents between 7 and 14 years of age, 46% girls, in five European countries: Bosnia and Herzegovina, Latvia, Montenegro, North Macedonia, and Portugal. TBW and FFM were the target variables in the developed regression models. For model development, the dataset was randomly split into training and test sets, in 70:30 ratio, respectively. Model tuning was performed with 10-fold cross-validation that confirmed the unbiased estimate of its performance. The final regression models were retrained on the whole dataset. Results: Cross-validated regression models were developed using resistance index, weight, and sex as the optimal predictors. The new prediction equations explained 87% variability in both TBW and FFM. Limits of agreement between BIA and reference values, were within ±17% of the mean, ( 3.4, 3.7) and ( 4.5, 4.8) kg for TBW and FFM, respectively. BIA FFM and TBW estimates were within one standard deviation for approximately 83% of the children. BIA prediction equations underestimated TBW and FFM by 0.2 kg and 0.1 kg respectively with no proportional bias and comparable accuracy among different BMI-for-age subgroups. Comparison with predictive equations from published studies revealed varying discrepancy rates with the deuterium dilution measurements, with only two being equivalent to the equations developed in this study. Conclusions: The small difference between deuterium dilution and BIA measurements validated by Bland e Altman analysis, supports the application of BIA for epidemiological studies in European children using the developed equations.This research was funded by the International Atomic Energy Agency [grant number RER6034].info:eu-repo/semantics/publishedVersio

WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010.

BACKGROUND: The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. METHODS: Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. RESULTS: At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change in mean BMI (range: from -0.4 to +0.3) and BMI-for-age Z-scores (range: from -0.21 to +0.14) varied statistically significantly across countries. The highest significant decrease in BMI-for-age Z-scores was found in countries with higher absolute BMI values and the highest significant increase in countries with lower BMI values. The highest significant decrease in overweight prevalence was observed in Italy, Portugal and Slovenia and the highest significant increase in Latvia and Norway. CONCLUSIONS: Changes in BMI and prevalence of overweight over a two-year period varied significantly among European countries. It may be that countries with higher prevalence of overweight in COSI Round 1 have implemented interventions to try to remedy this situation

Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress

To meet the need for regular and reliable data on the prevalence of overweight andobesity among children in Europe, the World Health Organization (WHO) EuropeanChildhood Obesity Surveillance Initiative (COSI) was established in 2007. Theresulting robust surveillance system has improved understanding of the public healthchallenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action onnutrition and physical activity in the region. This paper describes illustrative examplesof how COSI data have fed into national and international policy, but the real scopeof COSI's impact is likely to be much broader. In some countries, there are signs thatpolicy responses to COSI data have helped halt the rise in childhood obesity. As thecountries of the WHO European Region commit to pursuing United Action for BetterHealth in Europe in WHO's new European Programme of Work, COSI provides anexcellent example of such united action in practice. Further collaborative action willbe key to tackling this major public health challenge which affects children through-out the regionThe authors gratefully acknowledge support through a grant from the Russian government in the context of the WHO European Office for the Prevention and Control of NCDs. The Ministries of Health of Austria, Croatia, Greece, Italy, Malta, Norway, and the Russian Federation provided financial support for the meetings at which the protocol, data collection procedures, and analyses were discussed. Data collection in the countries featured in this paper was made possible through funding from: Bulgaria: Ministry of Health, National Center of Public Health and Analyses, WHO Regional Office for Europe; Croatia: Ministry of Health, Croatian Institute of Public Health, and WHO Regional Office for Europe; Georgia: WHO; Ireland: Health Service Executive; Italy: Ministry of Health and Italian National Institute of Health; Latvia: Centre for Disease Prevention and Control, Ministry of Health, Latvia; Malta: Ministry of Health; North Macedonia: funded by the Government of North Macedonia through National Annual Program of Public Health and implemented by the Institute of Public Health and Centers of Public Health. WHO country office provides support for training and data management; Portugal: Ministry of Health Institutions, the National Institute of Health, Directorate General of Health, Regional Health Directorates and the kind technical support from the Center for Studies and Research on Social Dynamics and Health (CEIDSS); Turkey: Turkish Ministry of Health and World Bank.info:eu-repo/semantics/publishedVersio