Explore the vast range of titles available.

Cardiometabolic disorders are frequently observed among those who have obesity as measured by body mass index (BMI). However, there is limited data available on the cardiometabolic profile of those who are non-obese by BMI but with a high body fat percentage (BFP), a phenotype frequently observed in the Indian population. We examined the prevalence of individuals with normal weight obesity (NWO) and the cardiometabolic profile of NWO individuals at high risk for type 2 diabetes(T2D) in a south Asian population. In the Kerala Diabetes Prevention Program, individuals aged between 30 to 60 years were screened using the Indian Diabetes Risk Score(IDRS) in 60 rural communities in the Indian state of Kerala. We used data from the baseline survey of this trial for this analysis which included 1147 eligible high diabetes risk individuals(IDRS >60). NWO was defined as BMI within the normal range and a high BFP (as per Asia-pacific ethnicity based cut-off); Non-obese (NO) as normal BMI and BFP and overtly obese (OB) as BMI [greater than or equal to]25 kg/m.sup.2 irrespective of the BFP. Data on demographic, clinical and biochemical characteristics were collected using standardized questionnaires and protocols. Body fat percentage was assessed using TANITA body composition analyser (model SC330), based on bioelectrical impedance. The mean age of participants was 47.3 ± 7.5 years and 46% were women. The proportion with NWO was 32% (n = 364; 95% CI: 29.1 to 34.5%), NO was 17% (n = 200) and OB was 51% (n = 583). Among those with NWO, 19.7% had T2D, compared to 18.7% of those who were OB (p value = 0.45) and 8% with NO (p value = 0.003). Among those with NWO, mean systolic and diastolic blood pressure were 129 ± 20; 78 ± 12 mmHg, compared to 127 ± 17; 78±11 mmHg among those with OB (p value = 0.12;0.94) and 120 ± 16; 71±10 mmHg among with NO (p value<0.001; 0.001), respectively. A similar pattern of association was observed for LDL cholesterol and triglycerides. After adjusting for other risk factors, the odds of having diabetes (OR:2.72[95% CI:1.46-5.08]) and dyslipidemia (2.37[1.55-3.64]) was significantly more in individuals with NWO as compared to non-obese individuals. Almost one-third of this South Asian population, at high risk for T2D, had normal weight obesity. The significantly higher cardiometabolic risk associated with increased adiposity even in lower BMI individuals has important implications for recognition in clinical practice.

The major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30-60 years) were those with an Indian Diabetes Risk Score (IDRS) ≥60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66-1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: -1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (≥5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US$22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate. A low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale. Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.

To examine the association between potentially modifiable risk factors with cardiovascular disease (CVD) and all-cause mortality and to quantify their population attributable fractions (PAFs) among a sample of Tehran residents. Overall, 8108 participants (3686 men) aged≥30 years, were investigated. To examine the association between risk factors and outcomes, multivariate sex-adjusted Cox proportional hazard regression analysis were conducted, using age as time-scale in two models including general/central adiposity: 1)adjusted for different independent variables including smoking, education, family history of CVD and sex for both outcomes and additionally adjusted for prevalent CVD for all-cause mortality 2)further adjusted for obesity mediators (hypertension, diabetes, lipid profile and chronic kidney disease). Separate models were used including either general or central adiposity. During median follow-up of >10 years, 827 first CVD events and 551 deaths occurred. Both being overweight (hazard ratio (HR), 95%CI: 1.41, 1.18-1.66, PAF 13.66) and obese (1.51, 1.24-1.84, PAF 9.79) played significant roles for incident CVD in the absence of obesity mediators. Predicting CVD, in the presence of general adiposity and its mediators, significant positive associations were found for hypercholesterolemia (1.59, 1.36-1.85, PAF 16.69), low HDL-C (1.21, 1.03-1.41, PAF 12.32), diabetes (1.86, 1.57-2.27, PAF 13.87), hypertension (1.79, 1.46-2.19, PAF 21.62) and current smoking (1.61, 1.34-1.94, PAF 7.57). Central adiposity remained a significant positive predictor, even after controlling for mediators (1.17, 1.01-1.35, PAF 7.55). For all-cause mortality, general/central obesity did not have any risk even in the absence of obesity mediators. Predictors including diabetes (2.56, 2.08-3.16, PAF 24.37), hypertension (1.43, 1.11-1.84, PAF 17.13), current smoking (1.75, 1.38-2.22, PAF 7.71), and low education level (1.59, 1.01-2.51, PAF 27.08) were associated with higher risk, however, hypertriglyceridemia (0.83, 0.68-1.01) and being overweight (0.71, 0.58-0.87) were associated with lower risk. Modifiable risk factors account for more than 70% risk for both CVD and mortality events.

ObjectivesTo examine demographic, behavioural and clinical determinants of self-rated health (SRH) among Iranian adults with hypertension (HTN), with a particular focus on the association between blood pressure (BP) control and perceived health.DesignNational cross-sectional analysis of 15 predictors spanning demographic, lifestyle and clinical domains.Setting2021 Iranian STEPwise Approach to Non-communicable Disease Risk Factor Surveillance, a nationally representative survey.ParticipantsA total of 8812 adults with HTN (mean age 56.97 years; 57% female). Controlled HTN was defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg among individuals on antihypertensive therapy.Primary and secondary outcome measuresThe primary outcome was SRH, measured on a standard EuroQol-Visual Analogue Scale (0–100).ResultsControlled HTN was independently associated with higher SRH scores (β=1.31, 95% CI 0.07 to 2.54). Positive predictors of SRH included male gender (β=4.34, 95% CI 3.38 to 5.31), higher wealth (richest vs poorest: β=5.52, 95% CI 4.06 to 6.97), sufficient physical activity (β=4.38, 95% CI 3.48 to 5.28), healthier diet (β=3.06, 95% CI 1.99 to 4.14) and complementary insurance coverage (β=2.50, 95% CI 0.63 to 4.37). Significant negative predictors included diabetes mellitus (β=–4.23, 95% CI –5.59 to –3.26), dyslipidaemia (β=–3.61, 95% CI –4.62 to –2.59), people who smoke (β=–4.21, 95% CI –5.64 to –2.78) and older age. Notably, antihypertensive medication use showed one of the strongest negative associations with SRH (monotherapy: β=–4.83; combination therapy: β=–5.28), likely reflecting underlying disease severity and treatment burden.ConclusionsBetter SRH among hypertensive adults was associated with controlled BP, healthier lifestyle patterns and higher socioeconomic status. Conversely, comorbidities, smoking, older age and antihypertensive treatment were linked to poorer perceived health. Integrating SRH screening into HTN management may help identify vulnerable individuals and inform targeted interventions addressing behavioural and socioeconomic determinants of health.

BackgroundCurrent cardiovascular disease (CVD) risk prediction models tailored for older adults are inadequate. This study aimed to validate, update and assess the utility of widely used CVD risk prediction models including American College of Cardiology/American Heart Association, 2008 Framingham, GloboRisk, National Vascular Disease Prevention Alliance and Predict1 originally developed for middle-aged population, as well as an age-specific Systematic COronary Risk Evaluation 2-Older Person model, in Australian and the US community-dwelling older adults.MethodsParticipants, without history of CVD events, dementia or physical disability, enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial and ASPREE-eXTention observational post-trial follow-up, were considered for CVD risk prediction. The main outcome was predicted CVD risk from adjudicated CVD events. The performance of the original, recalibrated (adjusting models’ intercept and slope) and updated (adjusting models’ coefficients) models was evaluated by discrimination (C statistic), calibration (calibration plots) and clinical utility (decision curves). Models were extended by incorporating predictors including serum creatinine, depression and socioeconomic status index (Index of Relative Socio-economic Advantage and Disadvantage, IRSAD) into models’ equation, and the changes in discrimination were evaluated.ResultsAmong 15 618 adults (mean age 75 (4.4) years), 520 men and 498 women experienced CVD events over a median follow-up of 6.3 (IQR: 5.2–7.7) years. Following updating, the discrimination power of models increased for both sexes (C statistics ranged 0.62–0.64 for men and 0.68–0.69 for women). Updated models indicated good calibration, with an added net benefit at the risk thresholds ranging from 4%–10% for women to 5%–12% for men. Incorporating IRSAD, depression and serum creatinine did not improve CVD risk discrimination of updated models.ConclusionsUpdating models, by adjusting model coefficients to better reflect the characteristics and risk factors of older adults, improves CVD risk prediction in a large cohort of relatively healthy Caucasian population aged 70+. Further external validation in diverse older populations including those with frailty and multimorbidity is recommended before clinical implementation.

To determine, the predictors of incident metabolic syndrome (MetS) in a community-based cohort of West Asians, during a mean follow-up of 9.3 years, a sample of 2858 non-MetS Iranian adults aged ≥ 20 years were examined at baseline and followed at three year intervals during three consecutive phases. The MetS was defined using the joint interim statement. Cox proportional hazard regression was used to determine the independent variables associated with incident MetS. Overall, 1117 new cases MetS were identified resulting in an incidence rate of 550.9/10000 person years (95% CI: 519.5-584.2). The corresponding incidence rates among women and men were 433.5/10000 person years (95% CI: 398.8-471.2) and 749.2/10000 person years (95% CI: 689.9-813.5), respectively. Baseline-adjusted predictors of developing MetS included all of the MetS components, being overweight or obese in both gender, and family history of diabetes and age only in women. There were significant effect modifications of gender on age (P<0.001), high blood pressure (0.026), high waist circumference (P<0001) and obesity categories (all P ≤ 0.01) in multivariate analysis. After considering HOMA-IR in the model, among women, all of the MetS predictors as well as those with HOMA-IR ≥ 2.23 showed a significant risk for incident MetS [HR: 1.63 (1.16-2.28)]; however, among men all the MetS components (WC was marginally significant) as well as the fourth quartile of HOMA-IR [HR: 1.50 (1.03-2.17)] and being overweight showed a significant risk. Finally, in the pooled analysis, we showed that female gender had lower risk for incident MetS than male [HR: 0.58 (0.47-0.70)]. In the Iranian population, high incidence of MetS, especially among men, was shown. Our findings confirmed that sex- specific risk predictors should be considered in primary prevention for incident MetS.

Background Longitudinal cohort studies across the lifespan suggest an association between ultra-processed food (UPF) and depression. However, the effect of UPF on depression and mental health in older adults has not been determined. Therefore, this study investigated the effect of UPF on depressive symptoms and mental health in community-dwelling older adults. Methods A pragmatic target trial was designed and emulated using the ASPirin in Reducing Events in the Elderly longitudinal data. Participants were community-dwelling older adults (≥ 70 years) in Australia. We specified and emulated the protocol of a two-arm randomised pragmatic clinical trial using the level of UPF consumption as the intervention. Greater than or equal to 4 servings of UPF per day was considered the intervention, with less than 4 servings per day the control. Dietary consumption was assessed using a mail-based diet screening questionnaire, and the level of food processing was classified based on the NOVA classification. The study outcomes were depressive symptoms, defined as a score of ≥ 8 on the Center for Epidemiological Studies Depression 10-item scale, and general mental health, defined by the mental component summary score of the Short Form-12. We applied inverse probability treatment weighting to balance confounders. Marginal structural models were employed to estimate the population-level average effect of intervention using generalised estimated equations. Results A total of 11,192 participants (3415 intervention and 7777 control) were eligible for the emulation. High UPF consumption at time zero was associated with an increased risk of depressive symptoms at follow-ups (RR: 1.10; CI: 1.04–1.18). The finding was consistent with sensitivity analyses; after excluding participants on antidepressants at time zero, the risk of depressive symptoms in the intervention group was increased by 11% compared to the control (RR: 1.11; 95% CI: (1.04–1.20)). Consumption of UPF adversely affected the mental component quality of life ( β : − 0.40; CI: − 0.65 to − 0.15). Conclusions A higher level of UPF consumption was associated with a higher risk of depressive symptoms and adversely affected mental health among older adults.

To determine levels of change in risk factors for cardiovascular disease among people with and without a previous diagnosis of diabetes from 2007 to 2016 in Iran. Data were obtained from five rounds of the World Health Organization STEPwise approach to Surveillance (STEPS) cross-sectional surveys. Participants were 7665 and 93,733 adults with and without known diabetes, respectively, aged 25–65 years. We used logistic and linear regressions to assess the trends of risk factors. Individuals with known diabetes compared to those without the condition, experienced greater reductions in mean levels of systolic blood pressure (3.0 vs. 0.5 mmHg among women and 3.9 vs. 1.6 mmHg among men), diastolic blood pressure (6.4 vs. 5.11 mmHg in women and 3.3 vs. 1.8 mmHg in men), and non-HDL cholesterol (42.4 vs. 27.2 mg/dL among women and 30.3 vs. 21.0 mg/dL among men) throughout these years. Men with diabetes also showed a greater reduction in the prevalence of daily cigarette smoking compared to their non-diabetic counterparts (7.3% vs. 2.3%). Fasting plasma glucose decreased among subjects with diabetes but increased among those without diabetes. Significant increases were observed in proportions who met goals for blood pressure, triglycerides, non-HDL cholesterol and LDL cholesterol in both groups; however, almost half of diabetic subjects did not achieve risk factor goals in 2016. Secondary prevention in diabetic patients was more effective than primary prevention in the general population; however, the rate of diabetic patients who met the designated goals for each risk factor was still suboptimal.

IntroductionHealth literacy is ‘The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare’. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations.Methods and analysisA scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 ‘pilot’ articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts.Ethics and disseminationThis review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation.Article summaryCVD is the leading cause of death around the world. This paper proposes an exploration of health literacy’s relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.

Background To determine the anthropometric indices that would predict type 2 diabetes (T2D) and delineate their optimal cut-points. Methods In a cohort study, 7017 Iranian adults, aged 20–60 years, free of T2D at baseline were investigated. Using Cox proportional hazard models, hazard ratios (HRs) for incident T2D per 1 SD change in body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and hip circumference (HC) were calculated. The area under the receiver operating characteristics (ROC) curves (AUC) was calculated to compare the discriminative power of anthropometric variables for incident T2D. Cut-points of each index were estimated by the maximum value of Youden’s index and fixing the sensitivity at 75%. Using the derived cut-points, joint effects of BMI and other obesity indices on T2D hazard were assessed. Results During a median follow-up of 12 years, 354 men, and 490 women developed T2D. In both sexes, 1 SD increase in anthropometric variables showed significant association with incident T2D, except for HC in multivariate adjusted model in men. In both sexes, WHtR had the highest discriminatory power while HC had the lowest. The derived cut-points for BMI, WC, WHtR, WHR, and HC were 25.56 kg/m 2 , 89 cm, 0.52, 0.91, and 96 cm in men and 27.12 kg/m 2 , 87 cm, 0.56, 0.83, and 103 cm in women, respectively. Assessing joint effects of BMI and each of the obesity measures in the prediction of incident T2D showed that among both sexes, combined high values of obesity indices increase the specificity for the price of reduced sensitivity and positive predictive value. Conclusions Our derived cut-points differ between both sexes and are different from other ethnicities.