Prevalence of hypertension and associated factors in Jalalabad City, Nangarhar Province, Afghanistan

Background: Hypertension affects an estimated one billion people, worldwide. It is a public health challenge characterized by increased morbidity, mortality, as well as cost to the community and health systems. The goal of this study is to determine the prevalence of hypertension and characterize associated risk factors in an urban setting in Afghanistan.Methods: A cross-sectional study of adults aged 25-65 years was conducted in Jalalabad city from May to June 2013 using the World Health Organization STEPwise approach to surveillance (WHO STEPS). A multistage technique was used to enroll 1,200 participants in the study. Demographic and socio-economic variables were collected via individual interviews using the WHO STEPS survey, after which blood samples were collected using a locally developed standard operating procedure (SOP). Bivariate and multivariable analyses were performed to explore the association between hypertension and associated factors.Results: A total of 1,180 adults (40% males, 60% females) of 25-65 years of age were surveyed. The response rate was 98.5 % and the prevalence of hypertension was 28.4. Independent risk factors of hypertension were found to be: age ≥ 50 (AOR = 3.42, 95% CI: 2.50 – 4.76); sex (AOR = 0.58, 95% CI: 0.38 – 0.88); obesity (AOR = 2.1, 95% CI 1.49 – 2.94); and diabetes (AOR = 1.75, 95% CI: 1.10 – 2.79). Independent protective factors were physically demanding occupations (AOR = 0.55, 95% CI: 0.36 – 0.85); physical activity itself (AOR = 0.69, 95% CI: 0.47 – 0.99) and consuming more vegetables (AOR = 0.59, 95% CI: 0.38 – 0.93).Conclusion: This urban setting in Afghanistan evidenced a high prevalence of hypertension; age, obesity, and diabetes were identified as risk factors and physical activity and consuming more vegetables were protective. These findings have implications for future public health intervention and clinical efforts.

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Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study

JMIR mhealth and uhealth ◽

10.2196/14841 ◽

2020 ◽

Vol 8 (4) ◽

pp. e14841

Author(s):

Jairo H Migueles ◽

Cristina Cadenas-Sanchez ◽

Elroy J Aguiar ◽

Pablo Molina-Garcia ◽

Patricio Solis-Urra ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Best Practice ◽

Movement Pattern ◽

Cost Effective ◽

Human Movement ◽

Overweight And Obesity ◽

World Health ◽

Cross Sectional ◽

Steps Per Day

Background Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking—as a proportion of total PA level—is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results Steps per day explained 66%, 40%, and 74% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80%, 92%, and 77% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations. Trial Registration ClinicalTrials.gov NCT02295072; https://clinicaltrials.gov/ct2/show/NCT02295072

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Quality of Life, Physical Activity, and Built Environment Characteristics Among Colombian Adults

Journal of Physical Activity and Health ◽

10.1123/jpah.7.s2.s181 ◽

2010 ◽

Vol 7 (s2) ◽

pp. S181-S195 ◽

Cited By ~ 41

Author(s):

Olga L. Sarmiento ◽

Thomas L. Schmid ◽

Diana C. Parra ◽

Adriana Díaz-del-Castillo ◽

Luis Fernando Gómez ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Health Status ◽

Built Environment ◽

Mass Transit ◽

Urban Setting ◽

World Health ◽

Cross Sectional ◽

The Future

Background:Studies assessing the association between health-related quality of life (HR-QOL) with physical activity (PA) and built environment (BE) characteristics are limited.Methods:A cross-sectional study was conducted among 1,334 adults from Bogotá, to assess the associations between HR-QOL with PA and BE characteristics. HR-QOL was measured using the World Health Organization and the Centers for Disease Control and Prevention instruments. PA was measured using the International PA Questionnaire. BE characteristics included the dimensions of density, diversity, design, and access to mass-transit. Analysis included multilevel modeling.Results:Adults who reported meeting PA recommendations and participating in the Ciclovía were more likely to have a high mean score of HR-QOL and were more likely to perceive their health status as good/excellent. Adults who reported biking for transportation were more likely to have a high mean score of HR-QOL. Regarding BE characteristics, land-use heterogeneity was associated with HR-QOL, perceived good health status and being positive about the future. Park density was associated with HR-QOL, perceived health status good/excellent and being positive about the future. Mass-transit stations availability was negatively associated with HR-QOL.Conclusion:This study provides preliminary evidence that HR-QOL is associated with PA and BE characteristics among adults in an urban setting of the developing world.

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Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study (Preprint)

10.2196/preprints.14841 ◽

2019 ◽

Author(s):

Jairo H Migueles ◽

Cristina Cadenas-Sanchez ◽

Elroy J Aguiar ◽

Pablo Molina-Garcia ◽

Patricio Solis-Urra ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Best Practice ◽

Movement Pattern ◽

Cost Effective ◽

Human Movement ◽

Overweight And Obesity ◽

World Health ◽

Cross Sectional ◽

Steps Per Day

BACKGROUND Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking—as a proportion of total PA level—is performed by children who are overweight and obese in order to determine its utility as a public health strategy. OBJECTIVE This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. METHODS A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. RESULTS Steps per day explained 66%, 40%, and 74% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80%, 92%, and 77% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. CONCLUSIONS Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations. CLINICALTRIAL ClinicalTrials.gov NCT02295072; https://clinicaltrials.gov/ct2/show/NCT02295072

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A Cross-Sectional Needs Assessment of Adolescent Physical Activity in the Early Nutrition Transitioning Country of Haiti (P16-006-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz050.p16-006-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Haley Becker ◽

Sherlie Jean-Louis Dulience ◽

Allan Philippe ◽

Rodrigo Siqueira-Reis ◽

Ross Brownson ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Leisure Time ◽

Dietary Diversity ◽

Reference Group ◽

Demographic Data ◽

Nutrition Transition ◽

World Health ◽

Cross Sectional ◽

Research Award

Abstract Objectives An exploratory assessment of physical activity (PA) to identify covariates of PA behaviors in Haitian adolescents. Methods Students from two urban schools participated in two different data collection methodologies: a self-reported survey (n = 100) assessing school, transportation, and leisure-time PA; an objective accelerometry study (n = 55). Self-reported diet behaviors were also collected. Parent and non-parent caregivers reported demographic data. Logistic regression identified potential correlates of PA; PA was operationalized as meeting the World Health Organization's recommendation (WHO REC) of ≥60 minutes of moderate/vigorous PA per day for adolescents. Results Self-reported data. The school PA model showed age (OR = 2.03; 95% CI = 0.66, 6.31), gender (OR = 1.41; 95% CI = 0.40, 4.97), and dietary diversity score ([DDS]; OR = 1.49; 95% CI = 1.17, 1.90) were significantly associated with WHO REC. Age (OR = 1.90; 95% CI = 1.55, 6.53), gender (OR = 1.22; 95% CI = 1.19, 3.03), DDS (OR = 1.25; 95% CI = 0.99, 1.57), and caregiver's occupation in the market (OR = 5.66; 95% CI = 1.27, 25.20) were significant correlates of WHO REC in the transportation PA model. The leisure-time PA model found gender (OR = 3.95; 95% CI = 1.09, 14.33), DDS (OR = 1.37; 95% CI = 1.09, 1.74), and bringing a snack/meal to school (OR = 4.17, 95% CI = 1.18, 14.67) to be significant covariates of WHO REC. Objective data. The model of accelerometry PA identified age (OR = 4.17; 95% CI = 1.31, 55.79), gender (OR = 48.19; 95% CI = 22.16, 77.92; female reference group), DDS (OR = 4.48; 95% CI = 1.12, 16.76), and household access to a flush toilet (OR = 0.03; 95% CI = 0.46, 64.45) as significant correlates of WHO REC. Conclusions As nutrition transition is underway in Haiti, so is the onset of the dual burden of malnutrition; PA can alleviate the negative health consequences of both phenomena, but heretofore such data have been unavailable for Haiti. Results support a) early adoption of policies and programs for PA and nutrition together and b) future investigation into Haitian PA behaviors and their sociocultural determinants. Funding Sources This study was funded by the Public Health Cubed Grant of the Washington University Institute of Public Health and the Brown School of Social Work International Dissertation Research Award.

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An epidemiological study of risk factors of cardiovascular diseases among medical students in a metropolitan city

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20192347 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2700

Author(s):

Sudam R. Suryawanshi ◽

Sharon S. Sonawane

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Medical Students ◽

Cardiovascular Diseases ◽

Role Models ◽

Dietary Habits ◽

Public Health Intervention ◽

Cross Sectional ◽

Metropolitan City ◽

Statistical Measures

Background: Life-style related risk factors are mainly implicated for increased burden of cardiovascular diseases (CVDs) globally. In India, 21.1% total deaths in 2010 were due to CVDs. Compelling evidence shows that India stands to lose $2.17 trillion (of 2010 dollars) between 2012- 2030 due to CVDs. A study related to cardiovascular risk behaviour among medical students is essential, considering their role as future physicians and role models in public health intervention programs. There are very few studies among the budding physicians, especially in India.Methods: This cross sectional study was carried out among 240 undergraduate MBBS medical students in a metropolitan city. Data was collected by using a semi-structured questionnaire consisting of close and open ended questions. Assessment of demographic profile, medical profile, alcohol use, dietary habits, physical activity and stress (PSS-10) was done. The data was entered in Microsoft Excel and analysed using SPSS 20 statistical software. Descriptive statistical measures like percentage, mean and standard deviations were calculated. An inferential statistical measure like Chi square was applied.Results: Out of total 9 risk factors, the prevalence of ≤3 risk factors was 56.7% and ˃3 risk factors were 43.3%. 100% medical students had unhealthy dietary habits, 90.8% had stress, 59.6% had pre-hypertension/hypertension and 43.3% had insufficient physical activity. Gender and Hostel dwellers showed significant association with >3 risk factors.Conclusions: All medical students had one or more risk factors which would lead to early onset of cardiovascular diseases in near future.

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Are risk factors for non-communicable diseases in adolescents a problem in senior high schools in Accra?

Ghana Medical Journal ◽

10.4314/gmj.v54i2s.10 ◽

2020 ◽

Vol 54 (2) ◽

pp. 59-63

Author(s):

Delia Bandoh ◽

Gifty Sunkwa-Mills ◽

Ernest Kenu

Keyword(s):

Physical Activity ◽

Risk Factors ◽

At Risk ◽

Tobacco Use ◽

Cross Sectional Study ◽

Noncommunicable Diseases ◽

Cross Sectional ◽

Physical Measurements ◽

Minimum Age ◽

Who Steps

Background: We assessed risk factors of noncommunicable diseases (NCDs) among adolescents in a senior high schoolDesign: We conducted a cross-sectional study in 2016Setting: Senior High School in AccraParticipants: Adolescents in senior high schoolInterventions: Adolescents were interviewed with a structured questionnaire designed using the WHO STEPS framework. Data on tobacco use, alcohol consumption, physical activity and physical measurements of respondents were taken.Main outcome measures: risk factors of noncommunicable diseases among adolescentsResults: A total of 360 adolescents in the school were assessed. Mean age was (17±1.21) years with minimum age being 13 and maximum 19 years. Females were 51% (184/360). About 75% (271/360) reported low physical activity, 15% (55/360) were overweight or obese (95%CI: 0.0317-0.078), 7.0% (25/360) consumed alcohol (95%CI: 0.054-0.111) and 2.5% (9/360) smoked tobacco (95%CI: 0.013- 0.048). Majority of the respondents (346/360) were exposed or at risk of developing at least one risk factor. However, no one was found to be at risk of all five risk factors assessed. Females were three times more likely to be overweight or obese compared to their male counterparts (OR:3,95%CI:1.581-5.624)Conclusion: We found that majority of the children had low physical activity and more than 90% of the respondents had at least one NCD risk factor.Keywords: noncommunicable diseases, risk factors, physical activity, tobacco use, consumption of alcoholFunding: This work was funded by the authors

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Epidemiology of hypertension in selected towns of Wollega zones, Western Ethiopia, 2019: A community-based cross-sectional study

SAGE Open Medicine ◽

10.1177/20503121211024519 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110245

Author(s):

Getu Mosisa ◽

Bikila Regassa ◽

Bayise Biru

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Alcohol Consumption ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Community Based ◽

Cross Sectional

Introduction: Hypertension remains an emerging public health problem globally, particularly in developing countries. Age, income level, obesity, alcohol consumption, smoking, vegetables and fruit consumption, physical activity and chat chewing were some risk factors of hypertension. However, there are limited data on the epidemiology of hypertension in Ethiopia. This study aimed to assess Epidemiology of Hypertension among the community of selected towns of Wollega zones. Methods: A community-based cross-sectional study was conducted from 1 to 30 June 2019 in selected towns of Wollega zones. A multistage sampling technique was used to select 840 study participants. Data were collected using the WHO STEP wise approach. The data were coded and entered into EpiData 3, and exported to SPSS version 20.0 for analysis. Bivariate and multivariable logistic regression analyses were conducted. Statistical significance was declared at p-value < 0.05. Results: The study included a total of 838 respondents with a response rate of 99.7%. The prevalence of hypertension was found to be 189 (22.6%) (95% confidence interval = 19.9%–25.2%). Of this, 108 (12.9%) and 81 (9.7%) of female and male were hypertensive, respectively. Age groups of 30–44 years (adjusted odds ratio = 2.65 (1.43, 4.89)), 45–59 years (adjusted odds ratio = 3.55 (1.79, 7.04)), above 60 years (adjusted odds ratio = 2.97 (1.43, 6.18)), having history of alcohol consumption (adjusted odds ratio = 4.29 (2.4, 7.66)), involving in vigorous physical activity (adjusted odds ratio = 0.096 (0.028, 0.33)), not walking to and from the work (adjusted odds ratio = 13.12 (8.34, 20.67)), being overweight (adjusted odds ratio = 1.98 (1.21, 3.25)), inadequate fruits serving per day (adjusted odds ratio = 2.93 (1.75, 4.88)) were significantly associated with hypertension. Conclusion: The prevalence of hypertension was found to be high in the study area. Older age, alcohol consumption, not engaging in vigorous activity, physical inactivity, being overweight and inadequate intake of fruits were found to be risk factors for hypertension. Therefore, health care providers should provide extensive health education and promotion on recommended lifestyle modification to tackle the burden of hypertension.

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High-intensity activity is more strongly associated with metabolic health in children compared to sedentary time: a cross-sectional study of the I.Family cohort

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01156-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Jonatan Fridolfsson ◽

Christoph Buck ◽

Monica Hunsberger ◽

Joanna Baran ◽

Fabio Lauria ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Insulin Resistance ◽

Blood Pressure ◽

Body Mass Index ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Density Lipoprotein ◽

Cross Sectional ◽

Intensity Physical Activity

Abstract Background Physical activity (PA) during childhood is important for preventing future metabolic syndrome (MetS). To examine the relationship between PA and MetS in more detail, accurate measures of PA are needed. Previous studies have only utilized a small part of the information available from accelerometer measured PA. This study investigated the association between measured PA and MetS in children with a new method for data processing and analyses that enable more detailed interpretation of PA intensity level. Methods The association between PA pattern and risk factors related to MetS was investigated in a cross- sectional sample of children (n = 2592, mean age 10.9 years, 49.4% male) participating in the European multicenter I. Family study. The risk factors examined include body mass index, blood pressure, high-density lipoprotein cholesterol, insulin resistance and a combined risk factor score (MetS score). PA was measured by triaxial accelerometers and raw data was processed using the 10 Hz frequency extended method (FEM). The PA output was divided into an intensity spectrum and the association with MetS risk factors was analyzed by partial least squares regression. Results PA patterns differed between the European countries investigated, with Swedish children being most active and Italian children least active. Moderate intensity physical activity was associated with lower insulin resistance (R2 = 2.8%), while vigorous intensity physical activity was associated with lower body mass index (R2 = 3.6%), MetS score (R2 = 3.1%) and higher high-density lipoprotein cholesterol (R2 = 2.3%). PA of all intensities was associated with lower systolic- and diastolic blood pressure, although the associations were weaker than for the other risk factors (R2 = 1.5% and R2 = 1.4%). However, the multivariate analysis implies that the entire PA pattern must be considered. The main difference in PA was observed between normal weight and overweight children. Conclusions The present study suggests a greater importance of more PA corresponding to an intensity of at least brisk walking with inclusion of high-intense exercise, rather than a limited time spent sedentary, in the association to metabolic health in children. The methods of data processing and statistical analysis enabled accurate analysis and interpretation of the health benefits of high intensity PA that have not been shown previously.

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AB0499 PHYSICAL ACTIVITY ASSESSMENT IN TUNISIAN PATIENTS WITH SPONDYLOARTHRITIS: THE IPAQ EVALUATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2053 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1277.1-1277

Author(s):

F. Majdoub ◽

M. Sellami ◽

S. Miladi ◽

A. Fazaa ◽

L. Souabni ◽

...

Keyword(s):

Physical Activity ◽

Disease Activity ◽

Axial Spondyloarthritis ◽

Cross Sectional Study ◽

Urban Setting ◽

Tnf Inhibitor ◽

Sectional Study ◽

Cross Sectional ◽

Tunisian Patients ◽

Different Levels

Background:The occurrence of Spondyloarthritis (SpA) often conditions patients’ quality of life and hinders their well-being. Physical activity (PA) is associated with various health-related benefits among adults with chronic inflammatory rheumatism but may be insufficiently performed.Objectives:This study aimed to assess PA in patients with SpA and explore its associated factors.Methods:This is a single-center cross-sectional study, involving patients with SpA, visiting our outpatient hospital over eight weeks. Patients responded to the International Physical Activity Questionnaire-Short form (IPAQ-S).Results:Sixty patients were included (39 M/21 F) with an average age of 45.8 years [25-78]. The mean duration of SpA was 13.2 years [1-25]. About 80% of patients were from an urban setting. Sixty-three percent of patients had a professional activity, while 13.3% were retired. Twenty-nine patients (48.3%) had axial and peripheral form, 18 patients (30%) had SpA with enteropathic arthritis, 8 (13.3%) with psoriatic arthritis, 3 patients (5%) had axial spondyloarthritis, and only 2 patients (3.3%) with SAPHO-Syndrom. About 23% of patients had hip arthritis and only 5% had uveitis. Fifty-eight patients were on TNF-inhibitor (21/58 Adalimumab, 15/58 Infliximab, 14/58 Etanercept, 8/58 Golimumab). The average BASDAI was 2.7/10. The average ASDASCRP was 2.1/10. The average BASFI was 3.3/10. IPAQ results were distributed as follows: 78.3% of patients were in the « low physical activity » category, 21.7% were in the « moderate physical activity » while none of the patients were in the « high physical activity ». Patients without employment had lower levels of physical activity (29.7%) but no association was observed between those two items (p=0.082). Disease activity objectified with BASDAI was related to low physical activity (p=0.045) whereas no association was observed with ASDASCRP (p=0.870) or BASFI (p=0.056). Otherwise, TNF-inhibitor treatment was not related to different levels of PA (p=0.09).Conclusion:Tunisian patients with SpA don’t perform enough physical activity. Except for high disease activity, the different levels of PA did not appear to be explained by other disease-related variables. Thereby, physical activity should be encouraged in SpA.References:[1]Fabre, S., Molto, A., Dadoun, S. et al. Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients. Rheumatol Int 36, 1711–1718 (2016).Disclosure of Interests:None declared.

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Physical Activity and Diet Quality Modify the Association between Comorbidity and Disability among Stroke Patients

Nutrients ◽

10.3390/nu13051641 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1641

Author(s):

Lien T. K. Nguyen ◽

Binh N. Do ◽

Dinh N. Vu ◽

Khue M. Pham ◽

Manh-Tan Vu ◽

...

Keyword(s):

Physical Activity ◽

Diet Quality ◽

Negative Impact ◽

Cross Sectional Study ◽

World Health ◽

Short Version ◽

Linear Regression Models ◽

Stroke Patients ◽

Disability Score ◽

Cross Sectional

Background: Comorbidity is common and causes poor stroke outcomes. We aimed to examine the modifying impacts of physical activity (PA) and diet quality on the association between comorbidity and disability in stroke patients. Methods: A cross-sectional study was conducted on 951 stable stroke patients in Vietnam from December 2019 to December 2020. The survey questionnaires were administered to assess patients’ characteristics, clinical parameters (e.g., Charlson Comorbidity Index items), health-related behaviors (e.g., PA using the International Physical Activity Questionnaire- short version), health literacy, diet quality (using the Dietary Approaches to Stop Hypertension Quality (DASH-Q) questionnaire), and disability (using the World Health Organization Disability Assessment Schedule II (WHODAS II)). Linear regression models were used to analyze the associations and interactions. Results: The proportion of comorbidity was 49.9% (475/951). The scores of DASH-Q and WHODAS II were 29.2 ± 11.8, 32.3 ± 13.5, respectively. Patients with comorbidity had a higher score of disability (regression coefficient, B, 8.24; 95% confidence interval, 95%CI, 6.66, 9.83; p < 0.001) as compared with those without comorbidity. Patients with comorbidity and higher tertiles of PA (B, −4.65 to −5.48; p < 0.05), and a higher DASH-Q score (B, −0.32; p < 0.001) had a lower disability score, as compared with those without comorbidity and the lowest tertile of PA, and the lowest score of DASH-Q, respectively. Conclusions: Physical activity and diet quality significantly modified the negative impact of comorbidity on disability in stroke patients. Strategic approaches are required to promote physical activity and healthy diet which further improve stroke rehabilitation outcomes.

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