This scientific statement is about sedentary behavior and its relationship to obesity and other cardiometabolic outcomes in youth. A deleterious effect of sedentary behavior on cardiometabolic health ...is most notable for screen-based behaviors and adiposity; however, this relation is less apparent for other cardiometabolic outcomes or when sedentary time is measured with objective movement counters or position monitors. Increasing trends of screen time are concerning; the portability of screen-based devices and abundant access to unlimited programming and online content may be leading to new patterns of consumption that are exposing youth to multiple pathways harmful to cardiometabolic health. This American Heart Association scientific statement provides an updated perspective on sedentary behaviors specific to modern youth and their impact on cardiometabolic health and obesity. As we reflect on implications for practice, research, and policy, what emerges is the importance of understanding the context in which sedentary behaviors occur. There is also a need to capture the nature of sedentary behavior more accurately, both quantitatively and qualitatively, especially with respect to recreational screen-based devices. Further evidence is required to better inform public health interventions and to establish detailed quantitative guidelines on specific sedentary behaviors in youth. In the meantime, we suggest that televisions and other recreational screen-based devices be removed from bedrooms and absent during meal times. Daily device-free social interactions and outdoor play should be encouraged. In addition, parents/guardians should be supported to devise and enforce appropriate screen time regulations and to model healthy screen-based behaviors.
Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child’s bodily integrity, family, or social structures, are known to be ...associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life.
Our primary aim was to evaluate the effects of 2 family-based obesity management interventions compared with a control group on BMI in low-income adolescents with overweight or obesity.
In this ...randomized clinical trial, 360 urban-residing youth and a parent were randomly assigned to 1 of 2 behaviorally distinct family interventions or an education-only control group. Eligible children were entering the sixth grade with a BMI ≥85th percentile. Interventions were 3 years in length; data were collected annually for 3 years. Effects of the interventions on BMI slope (primary outcome) over 3 years and a set of secondary outcomes were assessed.
Participants were primarily African American (77%), had a family income of <25 000 per year, and obese at enrollment (68%). BMI increased over time in all study groups, with group increases ranging from 0.95 to 1.08. In an intent-to-treat analysis, no significant differences were found in adjusted BMI slopes between either of the family-based interventions and the control group (
= .35). No differences were found between the experimental and control groups on secondary outcomes of diet, physical activity, sleep, perceived stress, or cardiometabolic factors. No evidence of effect modification of the study arms by sex, race and/or ethnicity, household income, baseline levels of child and parent obesity, or exposure to a school fitness program were found.
In this low-income, adolescent population, neither of the family-based interventions improved BMI or health-related secondary outcomes. Future interventions should more fully address poverty and other social issues contributing to childhood obesity.
Cardiovascular disease (CVD) is the leading cause of death in the U.S. and globally. Research demonstrates that diet is a leading contributor to the development of CVD, its prevention and management, ...and the overall promotion of cardiovascular health. This article describes the current state of the evidence, including research on the DASH and Mediterranean diets to promote cardiovascular health and prevent CVD. The article suggests approaches to implement evidence-based diets and federal dietary guidance to promote the adoption and integration of these interventions in both community and clinical settings. It highlights the current U.S. federal interest in “Food is Medicine” and its importance in addressing diet-related chronic diseases and promoting cardiovascular health.
A deficient interferon (IFN) response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been implicated as a determinant of severe coronavirus disease 2019 (COVID-19). To ...identify the molecular effectors that govern IFN control of SARS-CoV-2 infection, we conducted a large-scale gain-of-function analysis that evaluated the impact of human IFN-stimulated genes (ISGs) on viral replication. A limited subset of ISGs were found to control viral infection, including endosomal factors inhibiting viral entry, RNA binding proteins suppressing viral RNA synthesis, and a highly enriched cluster of endoplasmic reticulum (ER)/Golgi-resident ISGs inhibiting viral assembly/egress. These included broad-acting antiviral ISGs and eight ISGs that specifically inhibited SARS-CoV-2 and SARS-CoV-1 replication. Among the broad-acting ISGs was BST2/tetherin, which impeded viral release and is antagonized by SARS-CoV-2 Orf7a protein. Overall, these data illuminate a set of ISGs that underlie innate immune control of SARS-CoV-2/SARS-CoV-1 infection, which will facilitate the understanding of host determinants that impact disease severity and offer potential therapeutic strategies for COVID-19.
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•IFN-mediated restriction of SARS-CoV-2 relies on a subset of 65 ISGs•ER- and Golgi-resident proteins are enriched among the inhibitory ISGs•BST2 inhibits SARS-CoV-2 release and is antagonized by virally encoded Orf7a•Eight of the ISGs inhibit SARS-CoV-1 and SARS-CoV-2 but no unrelated viruses
Deficient interferon responses to SARS-CoV-2 infection have been associated with severe COVID-19. Martin-Sancho et al. utilized a gain-of-function screen to identify interferon-stimulated effectors that govern innate immune responses to SARS-CoV-2. These factors could underlie genetic predisposition to severe COVID-19 and can serve as candidates for development of antiviral therapies.
Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health ...care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.
Schools can play an important role in supporting a healthy lifestyle by offering nutritious foods and beverages and providing opportunities for physical activity. A healthy diet and regular physical ...activity may reduce the risk of obesity. This manuscript reports on a Community Guide systematic review examining the effectiveness of interventions in schools combining school meal or fruit and vegetable snack programs and physical activity.
Studies meeting the intervention definition were identified from a literature search (search period: January 1990–November 2019). Community Guide systematic review methods were used to assess effectiveness as measured by dietary behavior, physical activity, and weight changes; analyses were conducted in 2020.
Interventions (n=24 studies) were considered effective for increasing physical activity (median increase=21.8 minutes/day; interquartile interval= –0.8 to 27.4 minutes/day), modestly increasing fruit and vegetable intake (median relative increase=12.1%; interquartile interval= –4.6%, 73.4%), and decreasing the prevalence of overweight and obesity (median decrease=2.5 percentage points; interquartile interval= –8.1, –1.6 percentage points) among elementary school students through sixth grade. There were not enough studies to determine the effectiveness of interventions for middle- and high-school students.
School meal or fruit and vegetable snack interventions combined with physical activity were effective in increasing physical activity, with modest effects for improving fruit and vegetable consumption and reducing the prevalence of overweight and obesity among elementary students. These results may inform researchers and school administrators about healthy eating and physical activity interventions.
Influences on diet quality during the transition from adolescence to adulthood are understudied.
This study examined association of 3 diet-quality indicators-Healthy Eating Index-2010 (HEI), Whole ...Plant Foods Density (WPF), and Empty Calories (EC; the percentage of calories from discretionary solid fat, added sugar and alcohol)-with lifestyle behaviors, baseline weight status, and sociodemographic characteristics in US emerging adults.
Data come from the first 4 waves (annual assessments) of the NEXT Plus Study, a population-based cohort of 10th graders enrolled in 2010 (
= 566). At each assessment, participants completed 3 nonconsecutive 24-h diet recalls, wore accelerometers for 7 d, and self-reported meal practices and sedentary behaviors. Self-reported sociodemographic characteristics were ascertained at baseline. Generalized estimating equations examined associations of time-varying diet quality with baseline weight status and sociodemographic characteristics and time-varying lifestyle behaviors.
Diet quality improved modestly from baseline (mean ± SE: HEI, 44.07 ± 0.53; WPF, 1.24 ± 0.04; and EC, 35.66 ± 0.55) to wave 4 for WPF (1.44 ± 0.05,
< 0.001) and EC (33.47 ± 0.52,
< 0.001), but not HEI (45.22 ± 0.60). In longitudinal analyses, higher HEI and lower EC scores were observed in Hispanic compared with white participants. Better diet quality was associated with greater moderate-to-vigorous physical activity, more frequent breakfast and family meals, less frequent fast food and meals during television viewing, and shorter durations of television viewing, gaming, and online social networking. Diet-quality indicators were not consistently associated with time-varying physical inactivity, baseline weight status, or sociodemographic characteristics.
Diet quality of emerging adults in the US remained suboptimal, but some aspects improved marginally over the 4-y study period. Meal contexts and sedentary behaviors may represent important intervention targets. There is substantial room for improvement in diet quality in all sociodemographic subgroups. This trial was registered at clinicaltrials.gov as NCT01031160.
Highlights • Heroin users had a 2.4 times higher risk of mortality, adjusting for demographics. • Cocaine users had a 1.3 times higher risk of mortality, adjusting for demographics. • Adjusted for ...all covariates, heroin and cocaine use were not linked with mortality. • Health risk factors explained most of the mortality risk for drug users. • Main causes of death for drug users were external causes, poisoning, and infections.
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