The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show ...potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention.
This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual’s risk, readiness, barriers, and digital competency.
While empirical evidence continues to show that low socio-economic position is associated with less likely chances of being in good health, our understanding of why this is so remains less than ...clear. In this paper we examine the theoretical foundations for a structure–agency approach to the reduction of social inequalities in health. We use Max Weber’s work on lifestyles to provide the explanation for the dualism between life chances (structure) and choice-based life conduct (agency). For explaining how the unequal distribution of material and non-material resources leads to the reproduction of unequal life chances and limitations of choice in contemporary societies, we apply Pierre Bourdieu’s theory on capital interaction and habitus. We find, however, that Bourdieu’s habitus concept is insufficient with regard to the role of agency for structural change and therefore does not readily provide for a theoretically supported move from sociological explanation to public health action. We therefore suggest Amartya Sen’s capability approach as a useful link between capital interaction theory and action to reduce social inequalities in health. This link allows for the consideration of structural conditions as well as an active role for individuals as agents in reducing these inequalities. We suggest that people’s capabilities to be active for their health be considered as a key concept in public health practice to reduce health inequalities. Examples provided from an ongoing health promotion project in Germany link our theoretical perspective to a practical experience.
► Draws attention to capital interaction as key in providing options for health-relevant agency. ► Provides theoretical guidance to consider structurally transformative agency and its potential for reducing social inequalities in health. ► Proposes the capability approach as a theoretically meaningful concept for public health action.
A history of gestational diabetes mellitus (GDM) has been related to an elevated risk of type 2 diabetes. The melanocortin-4 receptor (MC4R) genotype has been related to glycemic changes in women ...with prior GDM.
The objective of this study was to analyze whether lifestyle intervention modified the association between the MC4R genotype and changes in insulin sensitivity among women with prior GDM.
We genotyped MC4R rs6567160 and measured glucose and insulin in fasting plasma samples at baseline and during the first 2 follow-up visits in 1128 women with prior GDM. They were randomly assigned to either a 4-y lifestyle intervention involving both diet and physical activity or a control group from a randomized clinical trial, the Tianjin Gestational Diabetes Mellitus Prevention Program. We analyzed the interaction between the MC4R genotype and lifestyle intervention on changes in insulin resistance.
From baseline to 1.28 y, the MC4R genotype was related to changes in fasting insulin, HOMA-IR, and homeostasis model assessment of β cell function (HOMA-B) in the intervention group. Each risk allele (C) of rs6567160 was associated with a 0.08-unit greater decrease in log(insulin), log(HOMA-IR), and log(HOMA-B) (P = 0.02, 0.04, and 0.04, respectively), whereas in the control group, each C allele tended to be associated with a greater increase in HOMA-IR (P = 0.09). We found significant interactions between the MC4R genotype and lifestyle intervention on 1.28-y changes in fasting insulin and HOMA-IR (P = 0.006 and 0.008, respectively), and such interaction remained significant when we analyzed the trajectory of changes in insulin and HOMA-IR from baseline to 2.55 y (both P = 0.03).
The exploratory results from the first 2 follow-up visits indicate that women with prior GDM carrying a diabetes-increasing MC4R genotype (CC or TC) may obtain better improvement than the TT genotype in insulin resistance through lifestyle intervention. This trial was registered at clinicaltrials.gov as NCT01554358.
Many lifestyle behaviors such as diet, exercise, social interaction, and substance use are related to physical and mental health. Less understood are the day-to-day associations of these behaviors ...with both psychological distress, well-being, and with each other.
This study investigated how a number of common lifestyle behaviors were associated with psychological distress and well-being using a daily diary study with multilevel modeling. Associations among behaviors were analyzed with multilevel mediation and network models.
An online participant pool consisting of seventy-six adults (age range: 19–64; mean age: 40.29; 58% female) completed daily diary surveys over 14 days and reported their engagement in lifestyle behaviors, psychological distress, hedonic well-being, and eudaimonic well-being.
Time spent in social interaction was the most consistent within-person correlate of psychological distress and well-being. The association between daily time in nature and well-being was mediated by social interaction and exercise. Network models found within-person associations among the lifestyle behaviors.
The results indicate that social interaction may be an especially important lifestyle behavior to consider when promoting well-being. Future research should recognize that daily fluctuations in many lifestyle behaviors cluster together.
•Meaningful social interaction is the strongest predictor of same day well-being and psychological distress.•Daily fluctuations in fruit and vegetable intake predicts well-being and psychological distress.•The relationship between time in nature and well-being is mediated by social interaction and exercise.•Daily fluctuations in lifestyle behaviors demonstrate clustering.
Healthy lifestyle behaviours are effective means to reduce the burden of diseases. This study was aimed to fill the knowledge gaps on the distribution, associated factors, and potential health ...benefits on mortality of four healthy lifestyle behaviours in China.
During 2015-2019, participants aged 35-75 years from 31 provinces were recruited by the China PEACE Million Persons Project. Four healthy lifestyle behaviours were investigated in our study, including non-smoking, none or moderate alcohol use, sufficient leisure time physical activity (LTPA), and healthy diet.
Among 903,499 participants, 74.1% were non-smokers, 96.0% had none or moderate alcohol use, 23.6% had sufficient LTPA, 11.1% had healthy diet, and only 2.8% had all the four healthy lifestyle behaviours. The adherence varied across seven regions; the highest median of county-level adherence to all the four healthy lifestyle behaviours was in North China (3.3%) while the lowest in the Southwest (0.8%) (p < 0.05). Participants who were female, elder, non-farmers, urban residents, with higher income or education, hypertensive or diabetic, or with a cardiovascular disease (CVD) history were more likely to adhere to all the four healthy lifestyle behaviours (p < 0.001). County-level per capital Gross Domestic Product (GDP) was positively associated with sufficient LTPA (p < 0.05 for both rural and urban areas) and healthy diet (p < 0.01 for urban areas), while negatively associated with none or moderate alcohol use (p < 0.01 for rural areas). Average annual temperature was negatively associated with none or moderate alcohol use (p < 0.05 for rural areas) and healthy diet (p < 0.001 for rural areas). Those adhering to all the four healthy lifestyle behaviours had lower risks of all-cause mortality (HR 0.64 95% CI: 0.52, 0.79) and cardiovascular mortality (HR 0.53 0.37, 0.76) after a median follow-up of 2.4 years.
Adherence to healthy lifestyle behaviours in China was far from ideal. Targeted health promotion strategies were urgently needed.
The UK Biobank cohort is a population-based cohort of 500,000 participants recruited in the United Kingdom (UK) between 2006 and 2010. Approximately 9.2 million individuals aged 40-69 years who lived ...within 25 miles (40 km) of one of 22 assessment centers in England, Wales, and Scotland were invited to enter the cohort, and 5.5% participated in the baseline assessment. The representativeness of the UK Biobank cohort was investigated by comparing demographic characteristics between nonresponders and responders. Sociodemographic, physical, lifestyle, and health-related characteristics of the cohort were compared with nationally representative data sources. UK Biobank participants were more likely to be older, to be female, and to live in less socioeconomically deprived areas than nonparticipants. Compared with the general population, participants were less likely to be obese, to smoke, and to drink alcohol on a daily basis and had fewer self-reported health conditions. At age 70-74 years, rates of all-cause mortality and total cancer incidence were 46.2% and 11.8% lower, respectively, in men and 55.5% and 18.1% lower, respectively, in women than in the general population of the same age. UK Biobank is not representative of the sampling population; there is evidence of a "healthy volunteer" selection bias. Nonetheless, valid assessment of exposure-disease relationships may be widely generalizable and does not require participants to be representative of the population at large.
A health lifestyles approach holds promise for understanding change in women's and men's health behaviors and reducing gendered health disparities. The emerging theoretical and empirical literature ...on health lifestyles (individuals' bundled health behaviors that are shaped by group-based identities and norms) helps elucidate complex disparities in health behaviors, but research is needed on how gender shapes the development of health lifestyles. This study proposed and assessed a dynamic multilevel framework for understanding health lifestyles that draws on insights from contemporary gender and life course scholarship.
Using the transition from adolescence into adulthood as an empirical case, we analyzed US data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 6605), which followed adolescents through young adulthood, collecting information on their health behaviors and social contexts.
Latent class analyses showed that health lifestyles differed significantly by gender. Results supported the dynamic multilevel framework, finding more variation in health lifestyle behaviors within genders than between, high levels of change across ages, intersections of gender with age, and socioeconomic status as a structural pathway for gender's influence.
Taken together, these findings suggest that conceptualizing gender as a dynamic multilevel system intersecting with other social statuses is fruitful for understanding how health lifestyles form and change. These findings can inform more effective policies to change health behaviors.
•Gender and life course theories help predict health lifestyle formation and change.•Health lifestyle behaviors vary more within than between genders.•Health lifestyles change in gendered ways with age.•Socioeconomic status is a structural pathway for gender's influence.•Health lifestyle is shaped by a dynamic, multilevel, intersectional gender system.
The aim of this study was to evaluate the association between lifestyle profile and disease incidence/mortality in patients with non-alcoholic fatty liver disease (NAFLD). Lifestyle profiles ...ascertainment was based on the latent profile analysis. The associations of lifestyle profile and outcomes were analyzed by multivariate logistic or Cox regressions. Four lifestyle profiles (profile 1 and 2 for male, profile 3 and 4 for female) were established for all participants. Compared to profile 1, profile 2 (P = 0.042) and profile 3 (P = 0.013) had lower incidence for NAFLD. In contrast, profile 4 showed similar NAFLD prevalence compared to profile 1 (P = 0.756). Individuals with NAFLD within profile 3 had the best long-term survival, and the HR was 0.55 (95% CI 0.40-0.76) for all-cause mortality (compared to profile 1). Profile 4 (P = 0.098) and profile 2 (P = 0.546) had similar all-cause survival compared to profile 1. We explored the associations of healthy lifestyle score with mortality and incidence of NAFLD stratified by lifestyle profiles. We observed that with the increase of healthy lifestyle score, participants within profile 2 did not display lower NAFLD incidence and better long-term survival in NAFLD cases. In this study, lifestyle profiles were constructed in NHANES participants. The distinct lifestyle profiles may help optimize decision-making regarding lifestyle management in preventing NAFLD development, as well as selection of a more personalized approach for improving NAFLD survival.
Why should Salman Rushdie describe his truth telling as an act of swallowing impure "haram" flesh from which the blood has not been drained? Why should Rudyard Kipling cast Kim, the imperial ...child-agent, as a body/text written upon and damaged by empire? Why should E. M. Forster evoke through the Indian landscape the otherwise unspeakable racial or homosexual body in his writing? InMaking Words Matter: The Agency of Colonial and Postcolonial Literature,Ambreen Haiargues that these writers focus self-reflectively on the unstable capacity of words to have material effects and to be censored, and that this central concern with literary agency is embedded in, indeed definitive of, colonial and postcolonial literature.Making Words Mattercontends that the figure of the human body is central to the self-imagining of the text in the world because the body uniquely concretizes three dimensions of agency: it is at once the site of autonomy, instrumentality, and subjection. Hai's work exemplifies a new trend in postcolonial studies: to combine aesthetics and politics and to offer a historically and theoretically informed mode of interpretation that is sophisticated, lucid, and accessible.This is the first study to identify and examine the rich convergence of issues and to chart their dynamic. Hai opens up the field of postcolonial literary studies to fresh questions, engaging knowledgeably with earlier scholarship and drawing on interdisciplinary theory to read both well known and lesser-known texts in a new light. It should be of interest internationally to students and scholars in a variety of fields including British, Victorian, modernist, colonial, or postcolonial literary studies, queer or cultural studies, South Asian studies, history, and anthropology.
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