Cardiovascular Risk Factors in Italy

In the 1950s the Italian population was known for its low mean levels of major cardiovascular risk factors and serum cholesterol in particular. A definite increase of those mean levels was associated, in the next 2 decades, with increasing death rates from cardiovascular diseases and coronary heart disease. Between the late 1970s and early 1990s cardiovascular death rates declined by over 40%. Large population surveys showed, between 1978 and 1987, small decreases in the mean levels of blood pressure (in both sexes), of smoking habits (in men), and of body weight (in women), while serum cholesterol remained stable. These changes mathematically explained about two-thirds of the observed decline in cardiovascular mortality among middle-aged people. In the late 1980s and early 1990s scattered population studies suggested a decline in mean population levels of serum cholesterol, at least in some areas of the country. More coordinated or systematic preventive campaigns were organized by the public health authorities. On the other hand activities of many small private organizations dealing with heart health likely explain the spread of knowledge, attitude, and practice in the prevention of cardiovascular diseases. Food industry started to produce low-fat products and to label foods with nutrition facts. Changes in food consumption in the beneficial direction started to be recorded in the late 1980s. The spread of anti-hypertensive treatment was partly favored by the National Health Service offering anti-hypertensive drugs at relatively low cost. Government regulations have more and more restricted the public areas where smoking is allowed. An increasing interest for prevention on the part of physicians is a recent issue, mainly bound to the success of some major controlled trials of hypocholesterolemic drugs.     

Correlation Between Atherosclerotic Cardiovascular Disease Risk Factors and Statin Prescribing Patterns

BackgroundIn 2018, the American College of Cardiology and the American Heart Association published an updated guideline introducing risk-enhancing factors and promoting a highly individualized approach to the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Although the benefit of the primary prevention of ASCVD is well-established within the literature, there are disparities that exist in statin prescribing patterns.ObjectiveTo assess the use of optimal statin therapy for the primary prevention of ASCVD in high-risk populations, including patients with diabetes mellitus or with elevated low-density lipoprotein (LDL), according to the average number of ASCVD risk factors.MethodsThis single-center, retrospective chart review was conducted between January 2015 and November 2018 at a family medicine clinic. This study included 262 patients who were eligible for statin therapy based on the presence of diabetes, which was defined as an A_1c level of ≥6.5% or an LDL level of ≥190 mg/dL. The primary outcome was the mean number of risk factors between these 2 groups of interest. These 2 groups were further classified by their 10-year ASCVD risk into 2 subgroups—patients with an ASCVD risk of ≥7.5% and patients with an ASCVD risk of <7.5%.ResultsThe subgroup with the highest average number of cardiovascular risk factors was patients with diabetes and an ASCVD risk of ≥7.5%. The mean number of risk factors for that group versus the group with an LDL level of ≥190 mg/dL and an ASCVD risk of ≥7.5% was nonsignificant, but the prescribing patterns for the 2 groups were different. Only 53.3% of patients in the diabetes group with an ASCVD risk of ≥7.5% were receiving a high-intensity statin, despite their increased number of risk factors. The difference in statin prescribing patterns between the diabetes group and the elevated LDL group was significant, at 70.6% versus 50%, respectively (P = .002).ConclusionPatients with diabetes were more likely to be prescribed a statin than patients with an LDL level of ≥190 mg/dL. However, no significant difference was seen in optimal statin therapies between the 2 groups. Future research is warranted to identify the barriers to optimal statin therapy and to implement methods to improve statin use for the primary prevention of ASCVD in patients who are at significant risk.     

Childhood Overweight/Obesity and Pediatric Asthma: The Role of Parental Perception of Child Weight Status

Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child’s weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child’s overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.     

Adolescent Obesity and Its Association with Diet Quality and Cardiovascular Risk Factors

Objective: This study aimed to evaluate the adolescent obesity and its association with Mediterranean Diet Quality Index (KIDMED) and cardiovascular risk factors in adolescents.

Method: This cross sectional study included 95 adolescents aged between 10 and 18 who visited a Primary Health Service Center in Turkey. Participants’ biochemical parameters, anthropometric measurements and blood pressures were measured. The level of adherence to Mediterranean Diet was evaluated by a clinical questionnaire, the Mediterranean Diet Quality Index for children and adolescents (KIDMED).

Results: Overweight adolescents had significantly higher systolic blood pressure, diastolic blood pressure, total cholesterol, very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, hemoglobin A1c, C-reactive protein, alanine aminotransferase, than normal-weight adolescents. Overweight/obese subjects also had significantly lower HDL cholesterol than normal-weight subjects. Results indicated that 60.0% of the adolescents had a low quality diet, 34.7% had a mid-quality/needs-improvement diet, and 5.3% had an optimal quality diet. No association was found between diet quality and obesity and cardiovascular risk factors.

Conclusion: Overweight and obese children are strongly associated with multiple cardiovascular risk factors. To avoid health problems arising from obesity, adolescents should refer to global solutions. Mediterranean diet is a good measure against adverse cardiovascular risk factors in adolescence.     

Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood

Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of ‘tracking’ of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.     

Screening School Personnel for Cardiovascular Disease Risk Factors: Short-Term Impact on Behavior and Perceived Role as Promoters of Heart Health

Background.Few controlled studies have evaluated the impact of community-based screening to detect risk factors for cardiovascular disease (CVD) on behavior change. This study examined the short-term impact of school-based screening on smoking, leisure time exercise, and fat consumption of personnel working in schools offered CVD risk factor screening. Also, the impact of screening on the perceptions that teachers have of their role in promoting heart health at school and the frequency of discussing heart health issues with students was investigated.Methods.The impact of screening was investigated in a before–after study design comparing behaviors of staff working in eight inner-city elementary schools offered the screening with those of staff working in eight matched comparison schools. Data were collected in self-administered questionnaires 2 weeks before and 4 months after screening.Results.A total of 209 subjects in the intervention schools completed the baseline questionnaire. Of these, 125 (59.8%) participated in the screening and completed the 4-month follow-up questionnaire. In the comparison schools, 135 of 177 subjects who completed the baseline questionnaire (76.3%) also completed the follow-up questionnaire. Multivariate analysis of covariance detected no changes in cigarette or fat consumption, but subjects exposed to the screening significantly increased their level of physical activity. Also, teachers exposed to screening increasingly supported the notion that teachers have a role in promoting heart-healthy behaviors among their students.Conclusions.Although several methodological limitations might have influenced the results, these data suggest that screening and counseling for CVD risk factors is an effective strategy to positively influence level of physical activity. If screening does increase motivation and interest among teachers to become heart-health role models or educators, the benefits of school-based screening could extend well beyond those who actually participate.     

Clustering of Cardiovascular Disease Risk Factors and Health-Related Quality of Life among US Adults

Objective:  To assess the association of clusters of multiple cardiovascular disease (CVD) risk factors with health-related quality of life (HRQOL) among US adults aged 18 years or older in 2003.
Methods:  Data from the 2003 Behavioral Risk Factor Surveillance System were analyzed. The four HRQOL questions developed by the Centers for Disease Control and Prevention were used. The CVD risk factors included diabetes, hypertension, high cholesterol, obesity, and current smoking.
Results:  The adjusted odds ratios of having four or more CVD risk factors were 14.0 (95% confidence interval [CI] 12.4–16.0) for poor or fair health, 6.4 (95% CI 5.6–7.3) for 14 or more physically unhealthy days, 4.8 (95% CI 4.2–5.6) for 14 or more mentally unhealthy days, and 8.0 (95% CI6.8–9.3) for 14 or more impaired activity days compared to having none of the five risk factors. A greater number of CVD risk factors was significantly associated with an increasing likelihood of having poor or fair health ( P ₁ < 0.0001 for linear trend, P ₂ < 0.0001 for quadratic trend), 14 or more physically unhealthy days ( P ₁ < 0.0001, P ₂ < 0.0001), 14 or more mentally unhealthy days ( P ₁ < 0.0001, P ₂ = 0.02), and 14 or more impaired activity days ( P ₁ < 0.0001, P ₂ < 0.0001).
Conclusions:  A greater number of multiple CVD risk factors may be associated with more detrimental impairment of HRQOL. Preventing or reducing the clustering of multiple CVD risk factors to improve HRQOL is needed among adults.     

儿童恶性肿瘤的环境危险因素研究进展

恶性肿瘤是影响儿童身心健康的重大疾病之一。有关儿童恶性肿瘤的环境危险因素主要包括物理因素、化学因素、生物因素以及因个体对外界刺激的敏感性不同而形成的个体易感性差异。本文从这4个方面综述了目前儿童恶性肿瘤环境病因学方面的研究现状，为开展儿童恶性肿瘤的病因学研究提供更全面认识，从而采取有效的预防措施，减少有害因素的暴露。     

Pro-Inflammatory Profile of Adipokines in Obesity Contributes to Pathogenesis,Nutritional Disorders,and Cardiovascular Risk in Chronic Kidney Disease

Obesity is a disease which leads to the development of many other disorders. Excessive accumulation of lipids in adipose tissue (AT) leads to metabolic changes, including hypertrophy of adipocytes, macrophage migration, changes in the composition of immune cells, and impaired secretion of adipokines. Adipokines are cytokines produced by AT and greatly influence human health. Obesity and the pro-inflammatory profile of adipokines lead to the development of chronic kidney disease (CKD) through different mechanisms. In obesity and adipokine profile, there are gender differences that characterize the male gender as more susceptible to metabolic disorders accompanying obesity, including impaired renal function. The relationship between impaired adipokine secretion and renal disease is two-sided. In the developed CKD, the concentration of adipokines in the serum is additionally disturbed due to their insufficient excretion by the excretory system caused by renal pathology. Increased levels of adipokines affect the nutritional status and cardiovascular risk (CVR) of patients with CKD. This article aims to systematize the current knowledge on the influence of obesity, AT, and adipokine secretion disorders on the pathogenesis of CKD and their influence on nutritional status and CVR in patients with CKD.     

儿童单纯性肥胖症危险因素的研究

「目的」筛选出儿童肥胖发生的危险因素。「方法」采用问卷和信访调查,记录研究对象三天的活动情况。分别对４９名单纯性肥胖症儿童及正常儿童的饮食习惯、生活方式等因素进行分析。「结果」单纯性肥胖症儿童进食量、看电视时间、婴儿期及出生体重、父母体质指数等明显高于对照组（Ｐ〈０．０５）;进食速度、进食量、受吃淀粉类食品、爱吃零食、不爱运动、父母体质指数等因素进入Ｌｏｇｉｓｔｉｃ回归方程;而活动量显著低于正常儿     

Cardiovascular risk factors in overweight and obese Chinese children

BACKGROUND: Childhood obesity is a widespread and growing problem in the world. Body mass index (BMI) and weight-for-height criterion have been used to determine childhood obesity. No data was available to evaluate cardiovascular risk factors in overweight and obese Chinese children screened by weight-for-height index and Chinese newly developed BMI criterion. AIM OF THE STUDY: To evaluate cardiovascular risk factors in overweight and obese Chinese children by using Chinese BMI and weight-for-height index as screening criterion. METHODS: A total of 215 children aged 7.5-13 years were recruited from 3 primary schools in Guangzhou, PR China. Measurements included body weight, height, waist and hip circumference, fasting serum glucose, insulin, total triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A (apo A), apolipoprotein B (apo B). Chinese BMI and weight-for- height criterion were used to classify overweight and obesity. RESULTS: According to Chinese BMI criterion, 65 from 108 obese children originally identified by weight-for-height were reclassified as obese and other 41 children were classified as overweight. Compared with non-obese children, obese children screened by Chinese BMI and weight-for-height index had increased levels of TG, LDL-C, apo B, insulin; decreased levels of HDL-C, apo A; and significantly higher prevalence of hypertriglyceridemia and high LDL-C. Children identified as overweight by Chinese BMI criterion had also shown high TG, LDL-C, apo B, insulin levels, low HDL-C, apo A levels, and significantly higher prevalence of hypertriglyceridemia than the normal weight children. CONCLUSIONS: Our study reveals that overweight and/or obesity screened by both Chinese new BMI and weight-for-height criterion are associated with increased levels of cardiovascular risk factors (e.g., elevated serum TG, LDL, apo B, and reduced HDL-C, apo A levels). Using Chinese BMI criterion may underestimate the prevalence of childhood obesity but it could be adopted as a unique tool for screening children's overweight in population-based screening programs.     

Obesity and Health Risks

Childhood obesity is multi-factorial in etiology. Several factors contribute to the etiology of childhood obesity, and childhood obesity is itself associated with significant morbidity. This article focuses on the health risks of childhood obesity and on the prenatal and childhood influences that contribute to the genesis of childhood obesity.     

儿童肥胖健康素养量表家长版的编制及评价

目的 编制“儿童肥胖健康素养量表(家长版)”,并评价其信度和效度。方法 依据健康素养内涵,基于世界卫生组织(WHO)提出的终止儿童肥胖相关内容,构建儿童肥胖健康素养量表(家长版)条目池,然后在合肥市小学生家长中进行调查,应用探索性因子分析和验证性因子分析对量表的效度进行检验,应用内部一致性对量表信度进行检验。结果 本次研究共有2 170名小学生家长参与调查,通过敏感性分析、代表性分析、独立性分析及Cronbach′s α系数进行条目筛选,再通过探索性因子分析和验证性因子分析,最终形成29个条目的儿童肥胖健康素养量表(家长版),量表构建成为健康意识、健康知识、健康行为、健康认知及操作技能5个维度。验证性因子分析得到近似误差均方根(root mean square error of approximation,RMSEA)为0.047,残差均方根(root of the mean square residual,RMR)为0.026,拟合优度指数(goodness-of-fit index,GFI)、标准拟合指数(normed fit index,NFI)、相对拟合指数(relative fit index,RFI)和比较拟合指数(comparative fit index,CFI)均接近1,显示模型拟合较好。量表的Cronbach′s α系数为0.833,问卷各维度的Cronbach′s α系数在0.618~0.866之间。结论 所编制的儿童肥胖健康素养量表(家长版)具有较好的信度和效度。     

Utilizing a Board Game to Measure Family/Parenting Factors and Childhood Obesity Risk

Objective

To describe a direct observational approach (ie, interactive family board game) to measure familyfunctioning and parenting behaviors of relevance to child weight and weight-related behaviors and to examine family functioning and parenting factors from multiple family dyads (eg, siblings, parent–child) and their associations with child weight and weight-related behaviors.

医院职工心血管疾病危险因素的现状分析

为评价医院职工心血管疾病危险因素的变化趋势,对50岁以上的840人进行了心血管危险因素的调查,着重对血脂及相关的血压、血糖、吸烟、超重与遗传等异常进行分析。结果表明：（1）随着年龄的增长,血脂异常（尤其是高胆固醇）有逐渐增高趋势;（2）医院职工中医生的脂质异常发生率最高,为75．3％,其次护士为58．9％;（3）随着年龄增大,高血压发生率有上升趋势,高血糖上升幅度更大。结论:50-59岁的在职人员有近1／2血脂异常,医生和护士更为明显,LDL－C在此年龄段异常者最多,吸烟者也高于离退休人员,医院职工的预防工作应加以重视。     

Nutritional Approach to Prevention and Treatment of Cardiovascular Disease in Childhood

Coronary Heart Disease (CHD) is a major mortality and morbidity cause in adulthood worldwide. The atherosclerotic process starts even before birth, progresses through childhood and, if not stopped, eventually leads to CHD. Therefore, it is important to start prevention from the earliest stages of life. CHD prevention can be performed at different interventional stages: primordial prevention is aimed at preventing risk factors, primary prevention is aimed at early identification and treatment of risk factors, secondary prevention is aimed at reducing the risk of further events in those patients who have already experienced a CHD event. In this context, CHD risk stratification is of utmost importance, in order to tailor the preventive and therapeutic approach. Nutritional intervention is the milestone treatment in pediatric patients at increased CHD risk. According to the Developmental Origin of Health and Disease theory, the origins of lifestyle-related disease is formed in the so called “first thousand days” from conception, when an insult, either positive or negative, can cause life-lasting consequences. Nutrition is a positive epigenetic factor: an adequate nutritional intervention in a developmental critical period can change the outcome from childhood into adulthood.     

Primordial Prevention of Cardiovascular Disease Risk in The Netherlands

Developments about cardiovascular disease (CVD) risk factors in The Netherlands since the 1970s are described in relation to health policy. The prevalence of hypercholesterolemia, hypertension, and obesity changed little in the 1970s and 1980s. In recent years, however, the prevalence of hypercholesterolemia tended to decrease and that of obesity to increase. The prevalence of hypertension remained stable but the percentage of treated hypertensives declined since 1987. Between 1958 and 1993 the percentage of male smokers decreased from 90% to about 40%. In women the percentage of smokers decreased from about 40% in 1975 to about 30% in 1993. Between 1987 and 1992 the intake of saturated fat decreased from 16.5 to 14.1% of energy. But during that period the intake of vegetables also decreased from 144 to 128 g/day and that of fruits from 125 to 114 g/day. Recent surveys show that up to age 65, approximately 25% of the Dutch population is physically inactive. This percentage increases sharply after age 65. Health policy for primordial prevention of CVD in The Netherlands is aimed at reduction of smoking prevalence, improvement of dietary habits, and promotion of physical activity.     

Trends of Cardiovascular Risk Factors and Diseases in Japan: Implications for Primordial Prevention

We have documented a 70% fall in stroke mortality and a 20% decline in coronary disease (CHD) mortality over the past 30 years in Japan. This parallels a change away from the traditional Japanese eating pattern, with less salt and more meat and dairy products, and decreased rates of smoking. A recent increase in CHD rates among urban Japanese men raises the need for vigorous primordial prevention efforts to avoid elevated blood lipids in modern Japanese populations, while primary prevention efforts must continue for the prevention of hypertension and smoking.     

父母肥胖对儿童期肥胖的影响

目的：探讨父母肥胖对儿童期肥胖的影响。方法：以北京市近万名6－8岁儿童为调查对象，测量其身高、体重，并发放调查问卷以获得父母的身高与体重。以体重超过身高标准值的120％为标准筛选出肥胖儿童，以BMI超过25或28kg/m^2为标准筛选出超重或肥胖家长。结果：当父亲正常、超重及肥胖时儿童肥胖率分别为12．3％，20．0％和25．0％，当母亲正常、超重及肥胖时儿童肥胖率分别为13．8％，26．5％和30．0％，各组的肥胖率之间差别显。父母均正常的儿童肥胖发生率为11．1％，而父母均超重或肥胖的儿童肥胖率则上升至33．6％。儿童BMI与父亲和母亲BMI均明显相关，相关系数分别为0．195和0．214。结论：父母肥胖是儿童肥胖的重要危险因素，父母肥胖的儿童应成为预防肥胖的重点人群。     

The Effect of Ketogenic Diet on Shared Risk Factors of Cardiovascular Disease and Cancer

Cardiovascular disease (CVD) and cancer are the first and second leading causes of death worldwide, respectively. Epidemiological evidence has demonstrated that the incidence of cancer is elevated in patients with CVD and vice versa. However, these conditions are usually regarded as separate events despite the presence of shared risk factors between both conditions, such as metabolic abnormalities and lifestyle. Cohort studies suggested that controlling for CVD risk factors may have an impact on cancer incidence. Therefore, it could be concluded that interventions that improve CVD and cancer shared risk factors may potentially be effective in preventing and treating both diseases. The ketogenic diet (KD), a low-carbohydrate and high-fat diet, has been widely prescribed in weight loss programs for metabolic abnormalities. Furthermore, recent research has investigated the effects of KD on the treatment of numerous diseases, including CVD and cancer, due to its role in promoting ketolysis, ketogenesis, and modifying many other metabolic pathways with potential favorable health effects. However, there is still great debate regarding prescribing KD in patients either with CVD or cancer. Considering the number of studies on this topic, there is a clear need to summarize potential mechanisms through which KD can improve cardiovascular health and control cell proliferation. In this review, we explained the history of KD, its types, and physiological effects and discussed how it could play a role in CVD and cancer treatment and prevention.