Adherence to the Mediterranean Diet among Children and Youth in the Mediterranean Region in Croatia: A Comparative Study

The Mediterranean diet (MD) is considered one of the healthiest dietary patterns. The aim of this study was to assess MD adherence in children and youth living in the Mediterranean region in Croatia and evaluate the differences in adherence to the MD among different educational stages. In total, 2722 individuals aged 2 to 24 years were enrolled in this study. Subjects were divided into different groups according to the Croatian educational system. Mediterranean Diet Quality Index (KIDMED) was used to assess adherence to the MD. In the total sample, the adherence to the MD was poor in 19.2%, average in 60.8%, and good in 20.1% of the study participants. The prevalence rate of poor adherence to the MD increased with higher educational stage, i.e., the highest prevalence rate of poor MD adherence was observed for college students (39.3%). Children having a higher number of snacks on days-off, those with lower physical activity, and not having breakfast together with a family are more likely to have poor MD adherence, while children having a higher number of snacks on working days are less likely to have a poor MD. The results of this study showed low adherence to the principles of the MD, confirming the need for improvement of adherence to the MD pattern in the studied population.

Clinical validation of digital biomarkers for pediatric patients with asthma and cystic fibrosis - Potential for clinical trials and clinical care

BackgroundDigital biomarkers are a promising novel method to capture clinical data in a home-setting. However, clinical validation prior to implementation is of vital importance. The aim of this study was to clinically validate physical activity, heart rate, sleep and FEV1 as digital biomarkers measured by a smartwatch and portable spirometer in children with asthma and cystic fibrosis (CF).MethodsThis was a prospective cohort study including 60 children with asthma and 30 children with CF (age 6–16). Participants wore a smartwatch, performed daily spirometry at home and completed a daily symptom questionnaire for 28-days. Physical activity, heart rate, sleep and FEV1 were considered candidate digital endpoints. Data from 128 healthy children was used for comparison. Reported outcomes were compliance, difference between patients and controls, correlation with disease-activity and potential to detect clinical events. Analysis was performed with linear mixed effect models.ResultsMedian compliance was 88%. On average, patients exhibited lower physical activity and FEV1 compared to healthy children, whereas the heart rate of children with asthma was higher compared to healthy children. Days with a higher symptom score were associated with lower physical activity for children with uncontrolled asthma and CF. Furthermore, FEV1 was lower and (nocturnal) heart rate was higher for both patient groups on days with more symptoms. Candidate biomarkers and showed a distinct pattern before- and after a pulmonary exacerbation.ConclusionPortable spirometer- and smartwatch-derived digital biomarkers show promise as candidate endpoints for use in clinical trials or clinical care in pediatric lung disease.

Pathophysiology of Physical Inactivity-Dependent Insulin Resistance: A Theoretical Mechanistic Review Emphasizing Clinical Evidence

The modern lifestyle has a negative impact on health. It is usually accompanied by increased stress levels and lower physical activity, which interferes with body homeostasis. Diabetes mellitus is a relatively common metabolic disorder with increasing prevalence globally, associated with various risk factors, including lower physical activity and a sedentary lifestyle. It has been shown that sedentary behavior increases the risk of insulin resistance, but the intermediate molecular mechanisms are not fully understood. In this mechanistic review, we explore the possible interactions between physical inactivity and insulin resistance to help better understand the pathophysiology of physical inactivity-dependent insulin resistance and finding novel interventions against these deleterious pathways.

Five-year longitudinal study of frailty prevalence and course assessed using the Kihon Checklist among community-dwelling older adults in Japan

The aim of this study was to analyze the 5-year natural course of frailty status assessed with the Kihon Checklist (KCL) and the risk factors of transition towards frailty in community-dwelling older adults. We used the data from the postal KCL survey conducted by the municipal government between 2011 and 2016. The sample of the current study consisted of 551 older adults (265 men and 286 women) aged 65–70 years in 2011. The median KCL score increased from 2 (interquartile range 1–3) in 2011 to 3 (1–5) in 2016 (p < 0.001). Hence, the prevalence of frailty increased from 8.0 to 12.3% (p < 0.001). Regarding the 5-year transitions in frailty status, 68.3% of participants remained unchanged, while 21.4% transitioned towards a worse frailty status, and 10.3% towards an improved status. Of the 507 respondents who were robust or prefrail at the baseline, 44 experienced a transition towards frailty, indicating that the 5-year incidence of frailty was 8.7%. These 44 individuals had higher body mass indexes (BMI) and lower physical activity scores on the KCL than others (p < 0.05), the latter of which was an independent predictor of transition toward frailty in the multivariate analysis. This study was the first to evaluate the 5-year natural course of frailty status assessed using the KCL in community-dwelling elderly adults, in which the prevalence of frailty increased by 4.3%. To prevent transition towards frailty, maintaining optimal physical activity is recommended.

Congestive Heart Failure Exhibited Higher BMI With Lower Energy Intake and Lower Physical Activity Level: Data From the National Health and Examination Nutrition Survey

Background: Despite that nutritional deficiency existed in congestive heart failure (CHF), there is a large amount of CHF patients suffering from obesity. This study aimed to identify the differences for increased BMI or obesity in CHF patients.Methods: This cross-sectional study included adults from the National Health and Nutrition Examination Survey 2007–2016. Differences were compared between CHF participants vs. non-CHF participants, and BMI ≥ 30 kg/m2 vs. BMI &lt; 30 kg/m2 CHF participants.Results: CHF participants were with higher BMI, lower energy and macronutrient intake, lower physical activity level and longer rest time, and lower hematocrit and hemoglobin level (all P &lt; 0.05) than non-CHF participants. The prevalence of BMI ≥ 30 kg/m2 in participants with CHF was 53.48%. There was no significant difference observed in energy and macronutrient intake between CHF participants with BMI ≥ 30 kg/m2 or &lt;30 kg/m2. The water intake (P = 0.032), sedentary time (P = 0.002), and hematocrit (P = 0.028) were significantly different between CHF with BMI ≥ 30 kg/m2 and with &lt;30 kg/m2.Conclusion: Compared with non-CHF participants, CHF participants exhibited higher BMI with lower energy and macronutrient intake, lower physical activity level, longer rest time, and hemodilution with lower hematocrit and hemoglobin level. Among CHF participants with BMI ≥ 30 kg/m2, higher sedentary time and hematocrit were observed.

The sex difference in gait speed among older adults: how do sociodemographic, lifestyle, social and health determinants contribute?

Background This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among older women compared to men. Methods Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55–81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3–4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) socio-demographic, lifestyle, social and health determinants of gait speed. Results Women had a 0.054 m/s (95 % CI: 0.076 − 0.033, adjusted for height and age) lower mean gait speed compared to men. In general, men and women had similar determinants of gait speed. However, higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). More often having a lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In contrast, men more often being a smoker, having a lower physical activity and a smaller personal network size compared to women contributed to a lower gait speed among men (i.e. higher exposure). Conclusions Both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among older women. The identified (modifiable) contributing factors should be taken into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice, which is currently often lacking.

The influence of working-from-home and digital device use on sleep, physical activity, and wellbeing following COVID-19 lockdown and reopening

The COVID-19 pandemic imposed massive changes to daily lives worldwide. While lockdowns arrived abruptly, the continuation of social-distancing measures like working from home could have longer-term influences. We longitudinally tracked lifestyle behaviors (sleep/physical activity/phone use) and mental wellbeing through lockdown and reopening in Singapore. Earlier sleep and increased physical activity benefited from offices reopening for in-person work. However, this was offset by higher stress and poorer mood. Changes were proportional to the degree of hybrid work adoption. Counter to expectation, smartphone usage did not decrease after reopening, and usage around bedtime increased marginally. Cluster analysis showed that while heavier bedtime smartphone use was associated with later sleep initiation and lower physical activity, intermediate bedtime usage was associated with more favorable wellbeing indicators. As hybrid work arrangements and expanded e-device use will likely persist during the pandemic and its aftermath, our findings could inform strategies on adapting to new societal norms.

Physical Activity as a Predictor of Cognitive Decline in an Elderly Essential Tremor Cohort: A Prospective, Longitudinal Study

Background: Essential tremor (ET), one of the most common neurological diseases, is associated with cognitive impairment. Surprisingly, predictors of cognitive decline in ET remain largely unidentified, as longitudinal studies are rare. In the general population, however, lower physical activity has been linked to cognitive decline.Objectives: To determine whether baseline physical activity level is a predictor of cognitive decline in ET.Methods: One hundred and twenty-seven ET cases (78.1 ± 9.5 years, range = 55–95), enrolled in a prospective, longitudinal study of cognition. At baseline, each completed the Physical Activity Scale for the Elderly (PASE), a validated, self-rated assessment of physical activity. Cases underwent an extensive battery of motor-free neuropsychological testing at baseline, 1.5 years, and 3 years, which incorporated assessments of cognitive subdomains. Generalized estimating equations (GEEs) were used to assess the predictive utility of baseline physical activity for cognitive change.Results: Mean follow-up was 2.9 ± 0.4 years (range = 1.3–3.5). In cross-sectional analyses using baseline data, lower physical activity was associated with lower overall cognitive function as well as lower cognitive scores in numerous cognitive domains (memory, language, executive function, visuospatial function and attention, all p &lt; 0.05). In adjusted GEE models, lower baseline physical activity level significantly predicted overall cognitive decline over time (p=0.047), and declines in the subdomains of memory (p = 0.001) and executive function (p = 0.03).Conclusions: We identified reduced physical activity as a predictor of greater cognitive decline in ET. The identification of risk factors often assists clinicians in determining which patients are at higher risk of cognitive decline over time. Interventional studies, to determine whether increasing physical activity could modify the risk of developing cognitive decline in ET, may be warranted.

Association of depression, anxiety and menopausal-related symptoms with demographic, anthropometric and body composition indices in healthy postmenopausal women

Background The termination of the menstrual cycle is correlated with a number of physiological alterations and symptoms that can negatively impact emotion and mood. We aimed to investigate the association of anxiety, depression, and menopausal related symptoms with demographic, anthropometric, and body composition indices in healthy postmenopausal women. Methods A total of 320 menopausal women were selected randomly from referrals of health centers between January and June 2018 in Tabriz/Iran. All participants completed a demographic questionnaire. Bioelectrical impedance analysis was applied to evaluate body fat mass (BFM), soft lean mass (SLM), and lean body mass (LBM) of participants. The modified Kupperman index, Beck's depression inventory-II, and Spielberger’s state-trait anxiety inventory were applied to measure the severity of menopausal-related symptoms, the frequency, and severity of the symptoms of depression and state (SA) and trait anxiety (TA), respectively. Results Finally, 245 postmenopausal women with age of 55.33 ± 4.48 years and body mass index (BMI) of 27.96 ± 3.22 kg/m2 were studied. Women with the age of 55 years and older (OR 3.928, 95% CI 1.504–10.256) and also women with mild physical activity (OR 10.104, 95% CI 3.785–26.976) had a greater possibility of having mild and moderate depression in comparison with women less than 50 years old and women with moderate and severe physical activity. Moderate and severe physical activity was correlated with a lower possibility of having medium upward, relatively severe and severe TA in comparison with participants with mild physical activity in these women (OR 0.372, 95% CI 0.151–0.917). Women with higher BMI and BFM had and more severe menopause-related symptoms (r = 0.143, p = 0.025 and r = 0.139, p = 0.030, respectively) and more severe TA symptoms (r = 0.198, p = 0.018 and r = 0.151, p = 0.021, respectively). Women with lower LBM (r = − 0.139, p = 0.031) and lower SLM (r = − 0.128, p = 0.047) had more severe depressive symptoms. Conclusion Postmenopausal women with higher age and lower physical activity had a greater possibility of having mild and moderate depression. Lower physical activity was also correlated with a greater possibility of having medium upward to severe TA symptoms. Postmenopausal women with higher BMI and BFM had more severe menopause-related and TA symptoms. Women with lower LBM and SLM had more severe depressive symptoms.