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Precision Medicine in Weight Loss and Healthy Living.
Severin, R, Sabbahi, A, Mahmoud, AM, Arena, R, Phillips, SA
Progress in cardiovascular diseases. 2019;(1):15-20
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Abstract
Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.
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The Importance of School-based Healthy Living Initiatives: Introducing the Health and Wellness Academy Concept.
Strieter, L, Laddu, DR, Sainsbury, J, Arena, R
Progress in cardiovascular diseases. 2019;(1):68-73
Abstract
Over the last 15 years, the number of school and community based health-intervention programs in the United States has grown. Many of these programs aim to prevent non-communicable chronic disease diagnoses (e.g., obesity, cardiovascular disease and type-2 diabetes). The Department of Physical Therapy in the College of Applied Health Sciences (CAHS) at the University of Illinois at Chicago (UIC) created a school-based wellness program (SBWP) that focuses on nutrition and physical activity, providing tailored experiences that motivate adolescents to make healthier lifestyle choices. The SBWP began as a camp for children in the surrounding neighborhoods and implemented healthy living practices utilizing students from Departments in the CAHS. From this camp, the Health and Wellness Academy (HWA) evolved. This paper provides a review of school-based initiatives and introduces the UIC HWA, an innovative and reproducible approach that can bring positive environmental change by improving health outcomes for children and their families.
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Promoting mobility and healthy aging in men: a narrative review.
Ebeling, PR, Cicuttini, F, Scott, D, Jones, G
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2019;(10):1911-1922
Abstract
Maintaining mobility is an important aspect of health and well-being in older men. This literature review describes several modifiable and nonmodifiable risk factors impacting bone, muscle, and joint health. Exercise and nutritional interventions may help to prevent the progressive deterioration in bones, muscles, and joints impacting mobility in later life. Limitations in mobility are increasingly recognized as a major public health problem due to an aging population and growing number of older individuals affected by disabling comorbidities. Despite increasing numbers and debilitating consequences, there are no guidelines providing recommendations on strategies to maintain mobility for healthy aging among older men. This narrative review aims to fill this literature gap. PubMed, Scopus, and Google Scholar databases were searched using predefined search terms. Primary studies, exploratory analyses, cross-sectional surveys, meta-analyses, evidence-based clinical reviews, and guidelines from nationally recognized societies focusing on mobility in older men and key elements including bone, muscle and joint health, and balance were selected. Several modifiable and nonmodifiable risk factors have been reported in the literature that impact bone, muscle, and joint health and predispose older men to falls and fractures. The most common conditions impacting bones, muscles, and joints are osteoporosis, sarcopenia, and osteoarthritis, respectively. In addition to being key contributors to disability in the elderly, these conditions are all associated with a higher mortality risk. Although more studies are required, current evidence supports the use of various nonpharmacological (mainly exercise and nutrition) and/or pharmacological treatment modalities to help prevent and/or reverse these conditions. Incorporating lifestyle interventions involving exercise and nutrition at a younger age can help prevent the age-related, progressive deterioration in bones, muscles, and joints that can reduce mobility in later life. Established barriers to physical activities (e.g., poor health, social isolation) in men are important to consider for optimizing outcomes.
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Targeting the delivery of dietary plant bioactives to those who would benefit most: from science to practical applications.
de Roos, B, Aura, AM, Bronze, M, Cassidy, A, Conesa, MG, Gibney, ER, Greyling, A, Kaput, J, Kerem, Z, Knežević, N, et al
European journal of nutrition. 2019;(Suppl 2):65-73
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Abstract
BACKGROUND A healthy diet and optimal lifestyle choices are amongst the most important actions for the prevention of cardiometabolic diseases. Despite this, it appears difficult to convince consumers to select more nutritious foods. Furthermore, the development and production of healthier foods do not always lead to economic profits for the agro-food sector. Most dietary recommendations for the general population represent a "one-size-fits-all approach" which does not necessarily ensure that everyone has adequate exposure to health-promoting constituents of foods. Indeed, we now know that individuals show a high variability in responses when exposed to specific nutrients, foods, or diets. PURPOSE This review aims to highlight our current understanding of inter-individual variability in response to dietary bioactives, based on the integration of findings of the COST Action POSITIVe. We also evaluate opportunities for translation of scientific knowledge on inter-individual variability in response to dietary bioactives, once it becomes available, into practical applications for stakeholders, such as the agro-food industry. The potential impact from such applications will form an important impetus for the food industry to develop and market new high quality and healthy foods for specific groups of consumers in the future. This may contribute to a decrease in the burden of diet-related chronic diseases.
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The obesity transition: stages of the global epidemic.
Jaacks, LM, Vandevijvere, S, Pan, A, McGowan, CJ, Wallace, C, Imamura, F, Mozaffarian, D, Swinburn, B, Ezzati, M
The lancet. Diabetes & endocrinology. 2019;(3):231-240
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Abstract
The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6-8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to attenuate the transition, taking into consideration local contextual factors.
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Nutrition-related interventions targeting childhood overweight and obesity: A narrative review.
Kerr, JA, Loughman, A, Knox, A, Koplin, JJ, Allen, KJ, Wake, M
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;:45-60
Abstract
Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition-related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition-related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P < 0.05) treatment benefit on body weight and/or composition outcomes at their longest follow-up assessment. Fourteen trials met inclusion criteria (median n = 554; mean intervention duration = 10.8 mo; follow-up = 4.4 mo). "Effective" approaches included environmental changes such as school water fountain installations and cafeteria menu changes and possibly less sustainable strategies such as health education lessons. However, effect sizes even of these selected significant treatment benefits were modest-significant body mass index z-score effects range from -0.1 to -0.2. Each trial was associated with very small improvements in body composition. Because this is a "best-case" scenario (reflecting our design), trialists should rigorously test these strategies alone and possibly together; be open to novel strategies; and ensure that each strategy is culturally relevant and self-sustainable.
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Precision in Promoting Physical Activity and Exercise With the Overarching Goal of Moving More.
Ozemek, C, Arena, R
Progress in cardiovascular diseases. 2019;(1):3-8
Abstract
Physical inactivity is strongly associated with an unfavorable health profile, increasing an individual's risk for developing cardiovascular disease. Initiating a regular exercise routine contributes to improvements in cardiorespiratory fitness, body composition, resting blood pressure, blood glucose, and circulating lipoproteins. However, the extent to which positive changes occur come with significant inter-individual variability within intervention groups; non-responders and responders have been commonly identified across populations, highlighting that not all exercise regimens are universally effective in all individuals and should therefore not be treated as a "one-size fits all" prescription. Recent studies have therefore emphasized reporting the quantity of participants favorably and meaningfully "responding" to varying amounts and intensities of exercise, thereby presenting the opportunity to view exercise prescription in the context of precision medicine. This review will address the impact of varying amounts and intensities of physical activity and exercise, highlighting their impact on key health metrics.
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Screen Time in Under-five Children.
Kaur, N, Gupta, M, Malhi, P, Grover, S
Indian pediatrics. 2019;(9):773-788
Abstract
CONTEXT Screen-viewing in childhood is primarily a mean of entertainment, during the unstructured time. We aimed to review the burden of the problem, delineate the associated factors and correlates, evaluate the impact of screen-time on the overall health of under-five children, and the interventions to reduce screen-time. EVIDENCE ACQUISITION Published articles from January 2009 to June 2018 were searched through PubMed, Clinical Key, Scopus, Embase, and Google Scholar using key Medical Subject Heading words. RESULTS The burden of screen-time varied from 21% to 98% in the middle-income, and 10% to 93.7% in the high-income countries. The social ecological model was used to illustrate associated factors and correlates including child, caregiver, micro and macro digital-media environment related factors. The interventions included increase in the physical activity, reduction in the body mass index, improving sleep and dietary behaviors etc. The effectiveness of these interventions ranged from 0.3 minutes (standard error 13.3) to -47.16 minutes (standard error 2.01). CONCLUSION Clinicians should obtain history of screen-time in children, and advise limiting the screen exposure according to the child's age. There is a need to generate evidence on burden and effectiveness of interventions among children in the Indian settings, owing to the limited data.
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[The Project to Extend Healthy Life Expectancy by Having Fun, in Collaboration with Kobe Women's University (KWU)].
Sanda, K, Itoi, A, Shigefuku, K, Yoshikawa, Y, Tsuchiya, K
Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 2019;(4):533-538
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Abstract
We have conducted health promotion workshops in Kobe City, beginning in June 2016, to promote the view of pharmacies as community health centers that provide not only medicine but also offer support for maintaining and enhancing a person's health. To this end, we collaborated with Kobe Women's University (KWU). Our health promotion workshops included: 1. Activities of daily living (ADL) exercises led by a KWU professional; 2. Lectures on various diseases by dietitians and pharmacists; 3. Nutritional guidance from a dietitian; 4. Health counseling by a pharmacist; and 5. Measurements of bone density, vascular age, and so on. A significant portion of the participants were relatively healthy and had strong legs. In October 2017, we investigated changes in the participants' awareness about health through a questionnaire study. We analyzed the results of 26 individuals who participated in the workshops more than once-18 of them (69%) expressed increased interest in exercise, 15 (58%) had begun walking regularly, and 11 (42%) changed their diet in terms of dietary fiber and salt. This suggests that our health promotion workshops brought about positive changes in people with regard to awareness of health and a healthy lifestyle. To further explore how pharmacies might contribute to healthy life expectancy, we will continue to investigate the relationship between changes in exercise and diet and people's awareness of health. As a group exercise, from now on we have decided to expand the role of pharmacies as community health promotion centers with the slogan "Extend healthy life expectancy by having fun".
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Health Promotion and Obesity in the Arab Gulf States: Challenges and Good Practices.
Samara, A, Andersen, PT, Aro, AR
Journal of obesity. 2019;:4756260
Abstract
This debate paper focuses on available strategies, policies, and challenges of health promotion for combating obesity in the Arab Gulf states (Saudi Arabia, Bahrain, Kuwait, Oman, and Qatar). The paper focuses on the abovementioned countries due to their similarity on many aspects and because of their alarming obesity rates that are on the rise and keep increasing. The paper argues that there are significant efforts to be made in sectors such as policies, intersectoral work, primary healthcare, health promotion strategies development, and qualified personnel for health promotion and health education. Among the six states, Qatar, United Arab Emirates, and to a degree Oman have shown some development with regard to the implementation and evaluation of obesity-related health promotion policies, and thus other Arab Gulf countries could be inspired by existing good practices and move from good intentions to using their available wealth to invest in the implementation and evaluation of published policies and strategies. All Arab Gulf countries are in need of more qualified personnel and the development of infrastructure that can help tackle the growing obesity challenge that such countries are experiencing.