Context:
Previous studies have identified an obese phenotype without the burden of adiposity-associated cardiometabolic risk factors, although the health effects remain unclear.
Objective:
We ...examined the association between metabolically healthy obesity and risk of cardiovascular disease (CVD) and all-cause mortality.
Design and Setting:
This was an observational study with prospective linkage to mortality records in community-dwelling adults from the general population in Scotland and England.
Participants:
A total of 22,203 men and women aged 54.1 (SD 12.7 yr), 45.2% men without known history of CVD at baseline.
Interventions:
Based on blood pressure, high-density lipoprotein-cholesterol, diabetes diagnosis, waist circumference, and low-grade inflammation (C-reactive protein ≥ 3 mg/liter), participants were classified as metabolically healthy (0 or 1 metabolic abnormality) or unhealthy (two or more metabolic abnormalities). Obesity was defined as a body mass index of 30 kg/m2 or greater.
Main Outcome Measure:
Study members were followed up, on average, more than 7.0 ± 3.0 yr for cause-specific mortality. Cox proportional hazards models were used to examine the association of metabolic health/obesity categories with mortality.
Results:
There were 604 CVD and 1868 all-cause deaths, respectively. Compared with the metabolically healthy nonobese participants, their obese counterparts were not at elevated risk of CVD hazard ratio (HR) 1.26, 95% confidence interval (CI) 0.74–2.13, although both nonobese (HR 1.59, 95% CI 1.30–1.94) and obese (HR 1.64, 95% CI 1.17–2.30) participants with two or more metabolic abnormalities were at elevated risk. Metabolically unhealthy obese participants were at elevated risk of all-cause mortality compared with their metabolically healthy obese counterparts (HR 1.72, 95% CI 1.23–2.41).
Conclusion:
Metabolically healthy obese participants were not at increased risk of CVD and all-cause mortality over 7 yr.
The impact of social isolation and loneliness on health risk may be mediated by a combination of direct biological processes and lifestyle factors. This study tested the hypothesis that social ...isolation and loneliness are associated with less objective physical activity and more sedentary behavior in older adults.
Wrist-mounted accelerometers were worn over 7 days by 267 community-based men (n = 136) and women (n = 131) aged 50-81 years (mean 66.01), taking part in the English Longitudinal Study of Ageing (ELSA; wave 6, 2012-13). Associations between social isolation or loneliness and objective activity were analyzed using linear regressions, with total activity counts and time spent in sedentary behavior and light and moderate/vigorous activity as the outcome variables. Social isolation and loneliness were assessed with standard questionnaires, and poor health, mobility limitations and depressive symptoms were included as covariates.
Total 24 h activity counts were lower in isolated compared with non-isolated respondents independently of gender, age, socioeconomic status, marital status, smoking, alcohol consumption, self-rated health, limiting longstanding illness, mobility limitations, depressive symptoms, and loneliness (β = - 0.130, p = 0.028). Time spent in sedentary behavior over the day and evening was greater in isolated participants (β = 0.143, p = 0.013), while light (β = - 0.143, p = 0.015) and moderate/vigorous (β = - 0.112, p = 0.051) physical activity were less frequent. Physical activity was greater on weekdays than weekend days, but associations with social isolation were similar. Loneliness was not associated with physical activity or sedentary behavior in multivariable analysis.
These findings suggest that greater social isolation in older men and women is related to reduced everyday objective physical activity and greater sedentary time. Differences in physical activity may contribute to the increased risk of ill-health and poor wellbeing associated with isolation.
INTRODUCTIONModern-day lifestyles are characterized by large amounts of prolonged sedentary activities, which may pose a risk to health in its own right, although little is known about their effects ...on mental health. We examined the association between several types of common sedentary behaviors (TV viewing, Internet use, reading) and different aspects of mental health.
METHODSWe conducted a 2-yr follow-up of 6359 (age 64.9 ± 9.1 yr) men and women from the English Longitudinal Study of Ageing, a cohort of community-dwelling older adults. Self-reported TV viewing time, reading, and use of the Internet was assessed at baseline. Mental health was assessed using the eight-item Centre of Epidemiological Studies Depression scale to measure depressive symptoms and neuropsychological tests of memory and verbal fluency to assess cognitive function.
RESULTSAt baseline, TV viewing time (≥6 vs. <2 h·d) was associated with higher depressive symptoms (coefficient = 0.49, 95% confidence interval CI = 0.63 to 0.35) and poorer global cognitive function (coefficient = −1.16, 95% CI = −1.00 to −1.31). Conversely, participants using the Internet reported lower depressive symptoms (coefficient = −0.58, 95% CI = −0.50 to −0.66) and higher global cognitive function (coefficient = 1.27, 95% CI = 1.37 to 1.18). There was no association between any sedentary behaviors at baseline and change in mental health measures over follow-up, suggesting that the difference in scores persisted but did not increase over time.
CONCLUSIONSSome, but not all sedentary behaviors, are linked to adverse mental health. It is likely that these associations are being driven by the contrasting environmental and social contexts in which they occur.
This
meta-analysis included 729 studies from 161 articles investigating how acute
stress responsivity (including stress reactivity and recovery of
hypothalamic-pituitary-adrenal HPA axis, autonomic, ...and
cardiovascular systems) changes with various chronic psychosocial exposures (job
stress; general life stress; depression or hopelessness; anxiety, neuroticism,
or negative affect; hostility, aggression, or Type-A behavior; fatigue, burnout,
or exhaustion; positive psychological states or traits) in healthy populations.
In either the overall meta-analysis or the methodologically strong subanalysis,
positive psychological states or traits were associated with reduced HPA
reactivity. Hostility, aggression, or Type-A behavior was associated with
increased cardiovascular (heart rate or blood pressure) reactivity, whereas
anxiety, neuroticism, or negative affect was associated with decreased
cardiovascular reactivity. General life stress and anxiety, neuroticism, or
negative affect were associated with poorer cardiovascular recovery. However,
regarding the sympathetic nervous system and parasympathetic nervous system,
there were no associations between the chronic psychosocial factors and stress
reactivity or recovery. The results largely reflect an integrated stress
response pattern of hypo- or hyperactivity depending on the specific nature of
the psychosocial background.
•The association between lifestyle factors and risk of COVID-19 hospitalisation is unknown.•Poorer lifestyle habit and elevated C-reactive protein was associated with greater risk of COVID-19 ...hospitalisation.•Unhealthy lifestyle behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID-19.•Low grade inflammation may be an important mechanism.•Adopting simple lifestyle changes could lower the risk of severe COVID-19 infection.
We conducted the first large-scale general population study on lifestyle risk factors (smoking, physical inactivity, obesity, and excessive alcohol intake) for COVID-19 using prospective cohort data with national registry linkage to hospitalisation. Participants were 387,109 men and women (56.4 ± 8.8 yr; 55.1% women) residing in England from UK Biobank study. Physical activity, smoking, and alcohol intake, were assessed by questionnaire at baseline (2006–2010). Body mass index, from measured height and weight, was used as an indicator of overall obesity. Outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16-March-2020 to 26-April-2020. There were 760 COVID-19 cases. After adjustment for age, sex and mutually for each lifestyle factor, physical inactivity (Relative risk, 1.32, 95% confidence interval, 1.10, 1.58), smoking (1.42;1.12, 1.79) and obesity (2.05 ;1.68, 2.49) but not heavy alcohol consumption (1.12; 0.93, 1.35) were all related to COVID-19. We also found a dose-dependent increase in risk of COVID-19 with less favourable lifestyle scores, such that participants in the most adverse category had 4-fold higher risk (4.41; 2.52–7.71) compared to people with the most optimal lifestyle. C-reactive protein levels were associated with elevated risk of COVID-19 in a dose-dependent manner, and partly (10–16%) explained associations between adverse lifestyle and COVID-19. Based on UK risk factor prevalence estimates, unhealthy behaviours in combination accounted for up to 51% of the population attributable fraction of severe COVID-19. Our findings suggest that an unhealthy lifestyle synonymous with an elevated risk of non-communicable disease is also a risk factor for COVID-19 hospital admission, which might be partly explained by low grade inflammation. Adopting simple lifestyle changes could lower the risk of severe infection.
It is unclear what level of moderate to vigorous intensity physical activity (MVPA) offsets the health risks of sitting.
The purpose of this study was to examine the joint and stratified associations ...of sitting and MVPA with all-cause and cardiovascular disease (CVD) mortality, and to estimate the theoretical effect of replacing sitting time with physical activity, standing, and sleep.
A longitudinal analysis of the 45 and Up Study calculated the multivariable-adjusted hazard ratios (HRs) of sitting for each sitting-MVPA combination group and within MVPA strata. Isotemporal substitution modeling estimated the per-hour HR effects of replacing sitting.
A total of 8,689 deaths (1,644 due to CVD) occurred among 149,077 participants over an 8.9-year (median) follow-up. There was a statistically significant interaction between sitting and MVPA only for all-cause mortality. Sitting time was associated with both mortality outcomes in a nearly dose-response manner in the least active groups reporting <150 MVPA min/week. For example, among those reporting no MVPA, the all-cause mortality HR comparing the most sedentary (>8 h/day) to the least sedentary (<4 h/day) groups was 1.52 (95% confidence interval: 1.13 to 2.03). There was inconsistent and weak evidence for elevated CVD and all-cause mortality risks with more sitting among those meeting the lower (150 to 299 MVPA min/week) or upper (≥300 MVPA min/week) limits of the MVPA recommendation. Replacing sitting with walking and MVPA showed stronger associations among high sitters (>6 sitting h/day) where, for example, the per-hour CVD mortality HR for sitting replaced with vigorous activity was 0.36 (95% confidence interval: 0.17 to 0.74).
Sitting is associated with all-cause and CVD mortality risk among the least physically active adults; moderate-to-vigorous physical activity doses equivalent to meeting the current recommendations attenuate or effectively eliminate such associations.
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Abstract Objective. Inflammatory processes contribute to disease pathways and may be affected by behavioral lifestyle factors. The relative contributions of fatness and cardiorespiratory fitness to ...inflammatory factors remain unclear. The present review examines the hypothesis that the association between fitness and inflammatory factors is independent of fatness. Methods. Data were examined from 40 observational studies on the association between fitness/physical activity and inflammatory factors after making statistical adjustment for measures of fatness, and from 12 randomized controlled trials that considered the impact of improved fitness and weight loss. Results. Two thirds of the observational studies report an inverse relationship between inflammatory factors and fitness after adjustment for fatness. Evidence from randomized controlled trials does not consistently support the hypothesis. Inconsistencies in the literature may be related to various factors such as age, gender, and disease status. Conclusions. Both fitness and fatness appear to contribute to inflammatory factors, although it is unclear whether fatness is a mediator or if both fitness and fatness share the same causal pathways. Lifestyle interventions for primary prevention in the general public should therefore focus on both increasing physical activity and the prevention of excess adiposity, although the optimal exercise dose and body composition for preventing chronic inflammatory processes is not well established.
Abstract Objective. Leisure time physical activity is inversely associated with cardiovascular risk, although evidence for the protective effects of active commuting is more limited. The present ...review examines evidence from prospective epidemiological studies of commuting activity and cardiovascular risk. Methods. Meta-analytic procedures were performed to examine the association between commuting physical activity and cardiovascular risk. Several cardiovascular endpoints were examined including mortality, incident coronary heart disease, stroke, hypertension and diabetes. Results. We included eight studies in the overall analysis (173,146 participants) that yielded 15 separate risk ratios (RR). The overall meta-analysis demonstrated a robust protective effect of active commuting on cardiovascular outcomes (integrated RR = 0.89, 95% confidence interval 0.81–0.98, p = 0.016). However, the protective effects of active commuting were more robust among women (0.87, 0.77–0.98, p = 0.02) than in men (0.91, 0.80–1.04, p = 0.17). Conclusions. Active commuting that incorporates walking and cycling was associated with an overall 11% reduction in cardiovascular risk, which was more robust among women. Future studies should investigate the reasons for possible gender effects and also examine the importance of commuting activity intensity.
The role of obesity and overweight in occurrence of COVID-19 is unknown. We conducted a large-scale general population study using data from a community-dwelling sample in England (n = 334,329; 56.4 ...±8.1 y; 54.5% women) with prospective linkage to national registry on hospitalization for COVID-19. Body mass index (BMI, from measured height and weight) was used as an indicator of overall obesity, and waist–hip ratio for central obesity. Main outcome was cases of COVID-19 serious enough to warrant a hospital admission from 16 March 2020 to 26 April 2020. Around 0.2% (n = 640) of the sample were hospitalized for COVID-19. There was an upward linear trend in the likelihood of COVID-19 hospitalization with increasing BMI, that was evident in the overweight (odds ratio, 1.39; 95% CI 1.13 to 1.71; crude incidence 19.1 per 10,000) and obese stage I (1.70;1.34 to 2.16; 23.3 per 10,000) and stage II (3.38; 2.60 to 4.40; 42.7 per 10,000) compared to normal weight (12.5 per 10,000). This gradient was little affected after adjustment for a wide range of covariates; however, controlling for biomarkers, particularly high-density lipoprotein cholesterol and glycated hemoglobin, led to a greater degree of attenuation. A similar pattern of association emerged for waist–hip ratio. In summary, overall and central obesity are risk factors for COVID-19 hospital admission. Elevated risk was apparent even at modest weight gain. The mechanisms may involve impaired glucose and lipid metabolism.
Sarcopenia is associated with loss of independence and ill-health in the elderly although the causes remain poorly understood. We examined the association between two screen-based leisure time ...sedentary activities (daily TV viewing time and internet use) and muscle strength.
We studied 6228 men and women (aged 64.9 ± 9.1 yrs) from wave 4 (2008-09) of the English Longitudinal Study of Ageing, a prospective study of community dwelling older adults. Muscle strength was assessed by a hand grip test and the time required to complete five chair rises. TV viewing and internet usage were inversely associated with one another. Participants viewing TV ≥ 6 hrs/d had lower grip strength (Men, B = -1.20 kg, 95% CI, -2.26, -0.14; Women, -0.75 kg, 95% CI, -1.48, -0.03) in comparison to <2 hrs/d TV, after adjustment for age, physical activity, smoking, alcohol, chronic disease, disability, depressive symptoms, social status, and body mass index. In contrast, internet use was associated with higher grip strength (Men, B = 2.43 kg, 95% CI, 1.74, 3.12; Women, 0.76 kg, 95% CI, 0.32, 1.20). These associations persisted after mutual adjustment for both types of sedentary behaviour.
In older adults, the association between sedentary activities and physical function is context specific (TV viewing vs. computer use). Adverse effects of TV viewing might reflect the prolonged sedentary nature of this behavior.
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