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Abstract It is elusive why some heavy drinkers progress to severe alcohol-related liver disease (ALD) while others do not. This study aimed to investigate if the association between alcohol consumption and severe ALD is modified by diet. This prospective study included 303,269 UK Biobank participants. Alcohol consumption and diet were self-reported. The diet score was created from 4 items selected using LASSO. Cox proportional hazard model showed that the diet score was monotonically associated with severe ALD risk, adjusted for sociodemographics, lifestyle factors, and alcohol consumption. Relative excess risk due to interaction analysis indicated that having a higher ALD diet score and a higher alcohol consumption simultaneously confers to 2.44 times (95% CI: 1.06-3.83) higher risk than the sum of excess risk of each factor. In this work, we show that people who have a poor diet might be more susceptible to severe ALD due to alcohol consumption.

Abstract Background Obesity and central obesity are multifactorial conditions with genetic and non-genetic (lifestyle and environmental) contributions. There is incomplete understanding of whether lifestyle modifies the translation from respective genetic risks into phenotypic obesity and central obesity, and to what extent genetic predisposition to obesity and central obesity is mediated via lifestyle factors. Methods This is a cross-sectional study of 201,466 (out of approximately 502,000) European participants from UK Biobank and tested for interactions and mediation role of lifestyle factors (diet quality; physical activity levels; total energy intake; sleep duration, and smoking and alcohol intake) between genetic risk for obesity and central obesity. BMI-PRS and WHR-PRS are exposures and obesity and central obesity are outcomes. Results Overall, 42.8% of the association between genetic predisposition to obesity and phenotypic obesity was explained by lifestyle: 0.9% by mediation and 41.9% by effect modification. A significant difference between men and women was found in central obesity; the figures were 42.1% (association explained by lifestyle), 1.4% (by mediation), and 40.7% (by modification) in women and 69.6% (association explained by lifestyle), 3.0% (by mediation), and 66.6% (by modification) in men. Conclusions A substantial proportion of the association between genetic predisposition to obesity/central obesity and phenotypic obesity/central obesity was explained by lifestyles. Future studies with repeated measures of obesity and lifestyle would be needed to clarify causation.

BackgroundThe incidence of mental health issues in children is increasing worldwide. In Chile, a recent surge in reports of deteriorating mental health among school populations and an increase in complaints related to poor school climate have been observed. Physical activity, specifically active breaks in the classroom, has shown positive effects on children’s health. However, evidence regarding its impact on mental health and school climate in children is limited.ObjectiveThis work outlines the design, measurements, intervention program, and potential efficacy of the “Active Classes + School Climate and Mental Health” project. This project will assess a 12-week program of active breaks through guided videos with curricular content in the school classroom, and its effects on mental health and school climate as its primary indicators. Additionally, it will measure physical activity, physical fitness, motor competence, and academic performance in students aged 6–10 years in the Biobío province, Chile, as secondary indicators. Methodology: A multicenter randomized controlled trial involving 823 students from 1st to 4th grade (6–10 years old), six schools (three intervention and three control) will be conducted in the Biobío region, Chile. Participants belonging to the intervention group will implement video-guided active breaks through the “Active Classes” web platform, featuring curricular content, lasting 5–10 min and of moderate to vigorous intensity physical activity, twice a day, Monday to Friday, over a span of 12 weeks. Expected Results/Discussion: To our knowledge, this will be the first study in Chile to evaluate the effects of incorporating video-guided active breaks with curricular content on mental health variables and school climate in schoolchildren. Thus, this study contributes to the scarce evidence on the effects of video-guided active breaks on mental health variables and school climate in schoolchildren worldwide. Additionally, it will provide crucial information about active teaching methodologies that have the potential to positively contribute to the wellbeing of students, thus addressing the problems of mental health and climate in Chilean schools. ClinicalTrials.gov ID NCT06423404.

Introducción. Dada la complejidad y costos para determinar el porcentaje de grasa corporal en humanos, se busca establecer nuevas fórmulas para determinar esta variable. La ecuación CUN-BAE usa indicadores simples como sexo e índice de masa corporal (IMC) para estimar el porcentaje de grasa corporal. El objetivo fue determinar el grado de correlación entre el porcentaje de grasa corporal, obtenido mediante ecuación CUN-BAE, IMC y circunferencia de cintura (CC) en adultos chilenos pertenecientes a la muestra de los participantes de la Encuesta Nacional de Salud (ENS) 2016-2017. Metodología. Se incluyeron 5.583 participantes de la ENS 2016-2017, en quienes se obtuvieron medidas antropométricas para determinar IMC, estado nutricional y CC. Se determinó el porcentaje de masa grasa según la ecuación CUN-BAE. La correlación entre IMC, CC y CUN-BAE se analizó mediante el coeficiente de correlación de Pearson (r). Resultados. El IMC y el porcentaje de masa grasa según ecuación CUN-BAE presentaron una fuerte correlación tanto en hombres (r=0,924, p

IntroductionUnderstanding how socioeconomic markers interact could inform future policies aimed at increasing adherence to a healthy diet.MethodsThis cross-sectional study included 437,860 participants from the UK Biobank. Dietary intake was self-reported. Were used as measures socioeconomic education level, income and Townsend deprivation index. A healthy diet score was defined using current dietary recommendations for nine food items and one point was assigned for meeting the recommendation for each. Good adherence to a healthy diet was defined as the top 75th percentile, while poor adherence was defined as the lowest 25th percentile. Poisson regression was used to investigate adherence to dietary recommendations.ResultsThere were significant trends whereby diet scores tended to be less healthy as deprivation markers increased. The diet score trends were greater for education compared to area deprivation and income. Compared to participants with the highest level of education, those with the lowest education were found to be 48% less likely to adhere to a healthy diet (95% Confidence Interval [CI]: 0.60–0.64). Additionally, participants with the lowest income level were 33% less likely to maintain a healthy diet (95% CI: 0.73–0.81), and those in the most deprived areas were 13% less likely (95% CI: 0.84–0.91).Discussion/conclussionAmong the three measured proxies of socioeconomic status – education, income, and area deprivation – low education emerged as the strongest factor associated with lower adherence to a healthy diet.

Abstract Background The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations are lifestyle-based recommendations which aim to reduce cancer risk. This study investigated associations between adherence, assessed using a standardised scoring system, and the risk of all cancers combined and of 14 cancers for which there is strong evidence for links with aspects of lifestyle in the UK. Methods We used data from 94,778 participants (53% female, mean age 56 years) from the UK Biobank. Total adherence scores (range 0–7 points) were derived from dietary, physical activity, and anthropometric data. Associations between total score and cancer risk (all cancers combined; and prostate, breast, colorectal, lung, uterine, liver, pancreatic, stomach, oesophageal, head and neck, ovarian, kidney, bladder, and gallbladder cancer) were investigated using Cox proportional hazard models, adjusting for age, sex, deprivation index, ethnicity, and smoking status. Results Mean total score was 3.8 (SD 1.0) points. During a median follow-up of 8 years, 7296 individuals developed cancer. Total score was inversely associated with risk of all cancers combined (HR: 0.93; 95%CI: 0.90–0.95 per 1-point increment), as well as breast (HR: 0.90; 95%CI: 0.86–0.95), colorectal (HR: 0.90; 95%CI: 0.84–0.97), kidney (HR: 0.82; 95%CI: 0.72–0.94), oesophageal (HR: 0.84; 95%CI: 0.71–0.98), ovarian (HR: 0.76; 95%CI: 0.65–0.90), liver (HR: 0.78; 95%CI: 0.63–0.97), and gallbladder (HR: 0.70; 95%CI: 0.53–0.93) cancers. Conclusions Greater adherence to lifestyle-based recommendations was associated with reduced risk of all cancers combined and of breast, colorectal, kidney, oesophageal, ovarian, liver, and gallbladder cancers. Our findings support compliance with the Cancer Prevention Recommendations for cancer prevention in the UK.

Introducción: La alimentación se construye a partir de experiencias y significados adquiridos en el curso de la vida. Las personas mayores tienen un acervo importante que informa de valores y prácticas culturales aplicadas a la alimentación. El objetivo del estudio fue interpretar los significados que entregan personas mayores a la construcción de su alimentación en trayectorias del curso de vida. Material y métodos: La investigación utilizó un enfoque cualitativo de alcance exploratorio, utilizando el método de Teoría Fundamentada de Strauss y Corbin. Para la recolección de datos se aplicó una entrevista semiestructurada entre julio de 2021 y junio de 2022. El tipo de muestreo fue teórico y el análisis de los datos cualitativos respondió al proceso de codificación abierta, axial y selectiva. Resultados: Participaron 54 personas mayores (72% mujeres) con edad promedio de 68,6 años (6,9 años). Las personas mayores construyeron su alimentación con un alto significado a las comidas caseras, con influencia de género femenino durante la niñez y adolescencia. En la adultez, se reconstruye la alimentación al ingresar al mundo laboral. En la actualidad, cimentan la alimentación con un enfoque de cuidados para su salud. Reconocen transiciones y puntos de inflexión en la alimentación provocados por terremotos, pandemia por COVID-19, situación política en el país, embarazos o el diagnóstico de alguna enfermedad crónica. Discusión: Las personas mayores reconocen diversas vivencias en trayectorias vitales que han marcado sus patrones alimentarios. Estas experiencias de vida pueden ser la base de estrategias o acciones en la práctica clínica que aporten a su bienestar. Abstract Introduction: Food is constructed from experiences and meanings acquired in the course of life. The elderly have an important heritage that informs cultural values and practices applied to food. The objective of the study was to interpret the meanings that older people give to the construction of their food in life trajectories. Methods: The research used a qualitative approach of exploratory scope, using the method of Grounded Theory of Strauss and Corbin. To collect data, a semi-structured interview was applied between July 2021 and June 2022. The type of sampling was theoretical and the analysis of qualitative data responded to the open, axial and selective coding process. Results: 54 elderly people (72% women) with average age of 68.6 years (6.9 years). The elderly built their food with a high meaning to homemade meals, with female gender influence during childhood and adolescence. In adulthood, food is rebuilt when entering the world of work. At present, they base food with a care approach for their health. They recognize transitions and turning points in food provoked by earthquakes, pandemic by COVID-19, political situation in the country, pregnancies or the diagnosis of a chronic disease. Discussion: The elderly recognize diverse experiences in life trajectories that have marked their eating patterns. These life experiences can be the basis of strategies or actions in clinical practice that contribute to your well-being.

Background Previous studies suggest an association between schizophrenia and stroke, but no studies have investigated stroke subtypes. We examined potential causal associations between schizophrenia and a range of atherosclerotic, embolic, and hemorrhagic stroke outcomes. Methods and Results Two‐sample Mendelian randomization analyses were conducted. The summary‐level data (restricted to European ancestry) were obtained for schizophrenia and stroke: ischemic stroke, large‐artery stroke, small‐vessel stroke, cardioembolic stroke, and intracerebral hemorrhage. The associations between schizophrenia and each outcome were analyzed by an inverse variance weighting method primarily and Mendelian randomization Egger, weighted median, and weighted mode subsequently. The presence of pleiotropy was also tested by Cochran Q statistic, I2 index, and Mendelian randomization Egger intercept with scatter and funnel plots. We found associations between schizophrenia and cardioembolic stroke (odds ratio [OR], 1.070 [95% CI, 1.023–1.119]) and intracerebral hemorrhage (OR, 1.089 [95% CI, 1.005–1.180]) using inverse variance weighting. Little evidence of associations with the other stroke subtypes was found. Different Mendelian randomization methods corroborated the association with cardioembolic stroke but not intracerebral hemorrhage. Conclusions We have provided evidence of a potentially causal association between schizophrenia and cardioembolic stroke. Our findings suggest that cardiac evaluation should be considered for those with schizophrenia.

Diet is integral to the healthy ageing process and certain diets can mitigate prolonged and deleterious inflammation. This review aims to assess the impact of diets high in sustainably sourced proteins on nutrient intake, gut, and age-related health in older adults. A systematic search of the literature was conducted on 5 September 2023 across multiple databases and sources. Studies assessing sustainably sourced protein consumption in community dwelling older adults (≥65 years) were included. Risk of bias (RoB) was assessed using ‘RoB 2.0′ and ‘ROBINS-E’. Narrative synthesis was performed due to heterogeneity of studies. Twelve studies involving 12,166 older adults were included. Nine studies (n = 10,391) assessed habitual dietary intake and had some RoB concerns, whilst three studies (n = 1812), two with low and one with high RoB, conducted plant-based dietary interventions. Increased adherence to sustainably sourced diets was associated with improved gut microbial factors (n = 4640), healthier food group intake (n = 2142), and increased fibre and vegetable protein intake (n = 1078). Sustainably sourced diets positively impacted on gut microbiota and healthier intake of food groups, although effects on inflammatory outcomes and health status were inconclusive. Future research should focus on dietary interventions combining sustainable proteins and fibre to evaluate gut barrier function and consider inflammatory and body composition outcomes in older adults.

Abstract Background Most studies investigating the association between physical activity (PA) and the risk of type 2 diabetes are derived from self-reported questionnaires, with limited evidence using device-based measurements. Therefore, this study aimed to investigate the dose–response relationship between device-measured PA and incident type 2 diabetes. Methods This prospective cohort study included 40,431 participants of the UK Biobank. Wrist-worn accelerometers were used to estimate total, light, moderate, vigorous and moderate-to-vigorous PA. The associations between PA and incident type 2 diabetes were analysed using Cox-proportional hazard models. The mediating role of body mass index (BMI) was tested under a causal counterfactual framework. Results The median follow-up period was 6.3 years (IQR: 5.7–6.8), with 591 participants developing type 2 diabetes. Compared to those achieving 600 min/week were at 49% (95% CI 62–32%), 62% (95% CI 71–50%) and 71% (95% CI 80–59%) lower risk of type 2 diabetes, respectively. For vigorous PA, compared to those achieving 75 min/week were at 38% (95% CI 48–33%), 48% (95% CI 64–23%) and 64% (95% CI 78–42%) lower type 2 diabetes risk, respectively. Twelve per cent and 20% of the associations between vigorous and moderate PA and type 2 diabetes were mediated by lower BMI, respectively. Conclusions PA has clear dose-response relationship with a lower risk of type 2 diabetes. Our findings support the current aerobic PA recommendations but suggest that additional PA beyond the recommendations is associated with even greater risk reduction. Trial registration The UK Biobank study was approved by the North West Multi-Centre Research Ethics Committee (Ref 11/NW/0382 on June 17, 2011).

Abstract Background Although non-alcoholic fatty liver disease (NAFLD) is linked to inflammation, whether an inflammatory diet increases the risk of NAFLD is unclear. This study aimed to examine the association between the Energy-adjusted Diet Inflammatory Index (E-DII) score and severe NAFLD using UK Biobank. Methods This prospective cohort study included 171,544 UK Biobank participants. The E-DII score was computed using 18 food parameters. Associations between the E-DII and incident severe NAFLD (defined as hospital admission or death) were first investigated by E-DII categories (very/moderately anti-inflammatory [E-DII 1]) using Cox proportional hazard models. Nonlinear associations were investigated using penalised cubic splines fitted into the Cox proportional hazard models. Analyses were adjusted for sociodemographic, lifestyle and health-related factors. Results Over a median follow-up of 10.2 years, 1489 participants developed severe NAFLD. After adjusting for confounders, individuals in the very/moderately pro-inflammatory category had a higher risk (HR: 1.19 [95% CI: 1.03 to 1.38]) of incident severe NAFLD compared with those in the very/moderately anti-inflammatory category. There was some evidence of nonlinearity between the E-DII score and severe NAFLD. Conclusions Pro-inflammatory diets were associated with a higher risk of severe NAFLD independent of confounders such as the components of the metabolic syndrome. Considering there is no recommended treatment for the disease, our findings suggest a potential means to lower the risk of NAFLD.

Background Combinations of lifestyle factors (LFs) and socioeconomic status (SES) are independently associated with cardiovascular disease (CVD), cancer, and mortality. Less advantaged SES groups may be disproportionately vulnerable to unhealthy LFs but interactions between LFs and SES remain poorly understood. This review aimed to synthesise the available evidence for whether and how SES modifies associations between combinations of LFs and adverse health outcomes. Methods Systematic review of studies that examine associations between combinations of >3 LFs (eg.smoking/physical activity/diet) and health outcomes and report data on SES (eg.income/education/poverty-index) influences on associations. Databases (PubMed/EMBASE/CINAHL), references, forward citations, and grey-literature were searched from inception to December 2021. Eligibility criteria were analyses of prospective adult cohorts that examined all-cause mortality or CVD/cancer mortality/incidence. Results Six studies (n=42,467–399,537; 46.5–56.8 years old; 54.6–59.3% women) of five cohorts were included. All examined all-cause mortality; three assessed CVD/cancer outcomes. Four studies observed multiplicative interactions between LFs and SES, but in opposing directions. Two studies tested for additive interactions; interactions were observed in one cohort (UK Biobank) and not in another (National Health and Nutrition Examination Survey (NHANES)). All-cause mortality HRs (95% confidence intervals) for unhealthy LFs (versus healthy LFs) from the most advantaged SES groups ranged from 0.68 (0.32–1.45) to 4.17 (2.27–7.69). Equivalent estimates from the least advantaged ranged from 1.30 (1.13–1.50) to 4.00 (2.22–7.14). In 19 analyses (including sensitivity analyses) of joint associations between LFs, SES, and all-cause mortality, highest all-cause mortality was observed in the unhealthiest LF-least advantaged suggesting an additive effect. Conclusions Limited and heterogenous literature suggests that the influence of SES on associations between combinations of unhealthy LFs and adverse health could be additive but remains unclear. Additional prospective analyses would help clarify whether SES modifies associations between combinations of unhealthy LFs and health outcomes. Registration Protocol is registered with PROSPERO (CRD42020172588;25 June 2020).

Abstract Background Regular participation in resistance exercise is known to have broad-ranging health benefits and for this reason is prominent in the current physical activity guidelines. Recovery after such exercise is important for several populations across the age range and nutritional strategies to enhance recovery and modulate post-exercise physiological processes are widely studied, yet effective strategies remain elusive. Vitamin K2 supplementation has emerged as a potential candidate, and the aim of the current study, therefore, is to test the hypothesis that vitamin K2 supplementation can accelerate recovery, via modulation of the underlying physiological processes, following a bout of resistance exercise in young and older adults. Methods The current study is a two-arm randomised controlled trial which will be conducted in 80 (40 young (≤40 years) and 40 older (≥65 years)) adults to compare post-exercise recovery in those supplemented with vitamin K2 or placebo for a 12-week period. The primary outcome is muscle strength with secondary outcomes including pain-free range of motion, functional abilities, surface electromyography (sEMG) and markers of inflammation and oxidative stress. Discussion Ethical approval has been granted by the College of Medical Veterinary and Life Sciences Ethical Committee at the University of Glasgow (Project No 200190189) and recruitment is ongoing. Study findings will be disseminated through a presentation at scientific conferences and in scientific journals. Trial registration ClinicialTrials.gov NCT04676958. Prospectively registered on 21 December 2020.

Abstract Background Studies on physical activity (PA) and mental health are largely limited to self-reported PA. This study aims to use prospective cohort data to investigate the association between device-measured PA and affective disorders. Methods A total of 37,327 participants from UK Biobank who had not had any prior affective disorder diagnoses were included in this prospective cohort study. Wrist-worn accelerometers were used to measure total, light (LPA), moderate (MPA), and vigorous (VPA) PA. Associations between PA domains and affective disorders were analysed using penalised splines in Cox proportional hazard models. Analyses were adjusted for other intensity-specific PA and sociodemographic and lifestyle factors. Sensitivity analyses were conducted adjusting for body mass index and longstanding illnesses as well as excluding events in the first 2 years of follow-up. Preventable fractions for the population were estimated for MPA and VPA. Results Over a median follow-up of 6.8 years, 1262 (3.4%) individuals were diagnosed with affective disorders. Replacing 30 min of sedentary behaviour in a week with MPA (HR 0.95, 95% CI 0.94–0.97) or VPA (HR 0.91, 95% CI 0.85–0.98) was associated with lower risk of affective behaviours, up to 500 and 120 min of MPA and VPA. Assuming causality, 5.14% and 18.88% of affective disorders could have been prevented if MPA ≥150 min/week and VPA ≥75 min/week were achieved, respectively, across the study population. Conclusions Device-measured MPA and VPA were associated with lower risk of affective disorders. The potential mental health benefits of MPA continue to accrue above the current World Health Organization recommendation.

Abstract Background Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio‐demographic, lifestyle, and health‐related factors. Methods The analytic sample comprised 162 167 participants (55% women), aged 38–70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety. Results Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow‐up period of 10.0 years (inter‐quartile range: 9.3–10.8) for depression and 9.9 (inter‐quartile range: 9.0–10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 [95% CI: 1.05, 1.10]; P

Abstract Background This study aimed to investigate the associations of grip strength with incidence and mortality from dementia and whether these associations differ by sociodemographic and lifestyle factors. Methods A total of 466 788 participants of the UK Biobank (median age 56.5 years, 54.5% women). The outcome was all‐cause dementia incidence and mortality and the exposure was grip strength. Grip strength was assessed using a Jamar J00105 hydraulic hand dynamometer. Results Excluding the first 2 years of follow‐up (landmark analysis), mean follow‐up was 9.1 years (inter‐quartile range: 8.3; 9.7) for incidence and 9.3 (inter‐quartile range: 8.7; 10.0) for mortality. During this time, 4087 participants developed dementia, and 1309 died from it. Lower grip strength was associated with a higher risk of dementia incidence and mortality independent of major confounding factors (P

Abstract Background Ethnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals. Methods This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group. Results When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59–1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03–1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants. Conclusions Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles.

IntroductionIn 2018, The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) published ten evidence-based Cancer Prevention Recommendations designed to reduce the risk of cancer via improved lifestyle behaviours. In 2019, Shams-White and colleagues created the “2018 WCRF/AICR Score” which aimed to standardise how adherence to these recommendations is assessed. The standardised scoring system includes seven of the recommendations concerning weight, physical activity and diet, with an optional eighth recommendation on breastfeeding. To promote transparency and reproducibility, the present paper describes the methodology for operationalisation of the standardised scoring system in the UK Biobank.MethodsUK Biobank recruited >500,000 individuals aged 37–73 years, between 2006 and 2010. In 2021, we held a workshop with experts which aimed to reach consensus on how to operationalise the scoring system using data available within UK Biobank. We used data on anthropometric measurements, physical activity and diet to calculate adherence scores. 24 h dietary assessment data were used to measure adherence to the following recommendations: “Eat a diet rich in wholegrains, vegetables, fruit, and beans”, “Limit consumption of “fast foods” and other processed foods high in fat, starches or sugars” and “Limit consumption of sugar-sweetened drinks”; food frequency questionnaire data were used to assess adherence to “Limit consumption of red and processed meat” and “Limit alcohol consumption”. Participants were allocated points for meeting, partially meeting or not meeting each recommendation, using cut-offs defined in the standardised scoring system.ResultsAt our workshop, discussions included the use of national guidelines to assess adherence to the recommendation on alcohol consumption, as well as challenges faced including defining the adapted ultra-processed food variables. A total score was calculated for 158,415 participants (mean 3.9 points, range 0–7 points). We also describe the methodology to derive a partial 5-point adherence score using data from the food frequency questionnaire in 314,616 participants.ConclusionWe describe the methodology used to estimate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for participants in the UK Biobank, including some of the challenges faced operationalising the standardised scoring system.

Abstract Background Growing evidence suggests that individuals with anxiety disorder have an elevated risk of cardiovascular disease (CVD) but few studies have assessed this association independently of or jointly with depression. Methods We conducted a prospective cohort study using UK Biobank. Diagnoses of anxiety disorder, depression, and CVDs were ascertained through linked hospital admission and mortality data. Individual and joint associations between anxiety disorder and depression and CVD overall, as well as each of myocardial infarction, stroke/transient ischemic attack, and heart failure, were analyzed using Cox proportional hazard models and interaction tests. Results Among the 431,973 participants, the risk of CVD was higher among those who had been diagnosed with anxiety disorder only (hazard ratio [HR] 1.72; 95% confidence interval [CI] 1.32–2.24), depression only (HR 2.07; 95% CI 1.79–2.40), and both conditions (HR 2.89; 95% CI 2.03–4.11) compared to those without these conditions, respectively. There was very little evidence of multiplicative or additive interaction. Results were similar for myocardial infarction, stroke/transient ischemic attack, and heart failure. Conclusions Having anxiety is associated with the same magnitude of increased risk of CVD among people who do not have depression and those who do. Anxiety disorder should be considered for inclusion in CVD risk prediction and stratification, in addition to depression.

Resumen: Objetivo: Identificar la asociación entre salud oral y sospecha de deterioro cognitivo en personas mayores chilenas. Método: Estudio transversal con 1826 participantes ≥60 años de la Encuesta Nacional de Salud de Chile, 2016-2017. La salud oral fue evaluada por el número de dientes, la presencia de caries, el uso de prótesis dental y el autorreporte de salud oral y dolor en la cavidad oral. La sospecha de deterioro cognitivo fue evaluada mediante el Mini-Mental State Examination (MMSE). Se empleó regresión logística y lineal, ajustada por variables sociodemográficas y de estilos de vida. Resultados: En comparación con personas sin sospecha de deterioro cognitivo, aquellas con sospecha de deterioro cognitivo presentaron cinco dientes menos (13,4 vs. 8,5 dientes), diferencia muy superior en mujeres que en hombres, y mayor frecuencia de dolor oral. El edentulismo y el menor número de dientes se asociaron a mayor probabilidad de sospecha de deterioro cognitivo, asociaciones que no se mantuvieron en modelos ajustados. El dolor oral se asoció a mayor probabilidad de sospecha de deterioro cognitivo (odds ratio: 1,99; intervalo de confianza del 95% [IC95%]: 1,09-3,63). Por cada diente adicional se observó un aumento del 2% (IC95%: 0,01-0,05) en la puntuación del MMSE. Conclusiones: La mala salud oral, en particular la pérdida de dientes y la presencia de dolor, se asociaron con deterioro cognitivo en personas mayores chilenas. Abstract: Objective: To identify the association between oral health and suspected cognitive impairment in older adults in Chile. Method: Cross-sectional study including 1826 people ≥60 years who participated in the National Health Survey of Chile, 2016-2017. Oral health was evaluated by the number of teeth, presence of caries, use of dental prostheses, self-reported oral health, and pain and/or discomfort in the oral cavity. Cognitive impairment was assessed using the Mini-Mental State Examination (MMSE). The association was evaluated by logistic and linear regression, adjusted for sociodemographic and lifestyle variables. Results: Compared with people without suspicion of cognitive impairment, people with suspected impairment had five fewer teeth (13.4 vs. 8.5 teeth), a much higher difference in women than in men, and a higher frequency of oral pain. Edentulism and fewer teeth were associated with a higher likelihood of suspected cognitive impairment, associations that were not maintained in adjusted models. Oral pain was associated with a higher likelihood of suspected impairment even in the most adjusted model (odds ratio: 1.99; 95% confidence interval [95%CI]: 1.09-3.63). In linear models, an increase of 2% (95%CI: 0.01-0.05) in the MMSE score was observed for each additional tooth. Conclusions: Poor oral health, particularly tooth loss and the presence of pain, was associated with cognitive impairment in older adults in Chile.

Abstract Background Infection with SARS-CoV-2 virus (COVID-19) impacts disadvantaged groups most. Lifestyle factors are also associated with adverse COVID-19 outcomes. To inform COVID-19 policy and interventions, we explored effect modification of socioeconomic-status (SES) on associations between lifestyle and COVID-19 outcomes. Methods Using data from UK-Biobank, a large prospective cohort of 502,536 participants aged 37–73 years recruited between 2006 and 2010, we assigned participants a lifestyle score comprising nine factors. Poisson regression models with penalised splines were used to analyse associations between lifestyle score, deprivation (Townsend), and COVID-19 mortality and severe COVID-19. Associations between each exposure and outcome were examined independently before participants were dichotomised by deprivation to examine exposures jointly. Models were adjusted for sociodemographic/health factors. Results Of 343,850 participants (mean age > 60 years) with complete data, 707 (0.21%) died from COVID-19 and 2506 (0.76%) had severe COVID-19. There was evidence of a nonlinear association between lifestyle score and COVID-19 mortality but limited evidence for nonlinearity between lifestyle score and severe COVID-19 and between deprivation and COVID-19 outcomes. Compared with low deprivation, participants in the high deprivation group had higher risk of COVID-19 outcomes across the lifestyle score. There was evidence for an additive interaction between lifestyle score and deprivation. Compared with participants with the healthiest lifestyle score in the low deprivation group, COVID-19 mortality risk ratios (95% CIs) for those with less healthy scores in low versus high deprivation groups were 5.09 (1.39–25.20) and 9.60 (4.70–21.44), respectively. Equivalent figures for severe COVID-19 were 5.17 (2.46–12.01) and 6.02 (4.72–7.71). Alternative SES measures produced similar results. Conclusions Unhealthy lifestyles are associated with higher risk of adverse COVID-19, but risks are highest in the most disadvantaged, suggesting an additive influence between SES and lifestyle. COVID-19 policy and interventions should consider both lifestyle and SES. The greatest public health benefit from lifestyle focussed COVID-19 policy and interventions is likely to be seen when greatest support for healthy living is provided to the most disadvantaged groups.

Abstract Background Sarcopenia is defined as the loss of muscle mass and strength. Despite the seriousness of this disease, a single diagnostic criterion has not yet been established. Few studies have reported the prevalence of sarcopenia globally, and there is a high level of heterogeneity between studies, stemmed from the diagnostic criteria of sarcopenia and the target population. The aims of this systematic review and meta‐analysis were (i) to identify and summarize the diagnostic criteria used to define sarcopenia and severe sarcopenia and (ii) to estimate the global and region‐specific prevalence of sarcopenia and severe sarcopenia by sociodemographic factors. Methods Embase, MEDLINE, and Web of Science Core Collections were searched using relevant MeSH terms. The inclusion criteria were cross‐sectional or cohort studies in individuals aged ≥18 years, published in English, and with muscle mass measured using dual‐energy x‐ray absorptiometry, bioelectrical impedance, or computed tomography (CT) scan. For the meta‐analysis, studies were stratified by diagnostic criteria (classifications), cut‐off points, and instruments to assess muscle mass. If at least three studies reported the same classification, cut‐off points, and instrument to measure muscle mass, they were considered suitable for meta‐analysis. Following this approach, 6 classifications and 23 subgroups were created. Overall pooled estimates with inverse‐variance weights obtained from a random‐effects model were estimated using the metaprop command in Stata. Results Out of 19 320 studies, 263 were eligible for the narrative synthesis and 151 for meta‐analysis (total n = 692 056, mean age: 68.5 years). Using different classifications and cut‐off points, the prevalence of sarcopenia varied between 10% and 27% in the studies included for meta‐analysis. The highest and lowest prevalence were observed in Oceania and Europe using the European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2, respectively. The prevalence ranged from 8% to 36% in individuals

Abstract Background Reduced muscular strength, as measured by absolute grip strength, has been associated with increased risk of some site‐specific cancers. The ability of grip strength to predict other diseases may be affected by whether it is expressed in absolute or relative terms, but the evidence for cancer is scarce. This study compared the associations of absolute and relative grip strength with all‐cause and 15 site‐specific cancers. Methods A prospective cohort study was undertaken using data from the UK Biobank. The exposure variable was grip strength, in absolute form (kilogrammes) and relative to weight, body mass index (BMI), height. and body fat mass. The outcome was incident cancer, at 15 sites and overall. Cox proportional hazard models were performed to study the associations. Results This study included 445 552 participants, where 53.8% of the participants were women, with a mean (SD) age of 56.3 (8.11) years. During a median of 8.8 years follow‐up period, 48 886 (11.0%) patients were diagnosed with cancer. After adjusting for sociodemographic and lifestyle factors, as well as multiple testing, absolute grip strength was inversely and linearly associated with endometrial [hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.69; 0.79, P value

Abstract The aims of the current study, therefore, were to compare (1) free-living MPS and (2) muscle and metabolic adaptations to resistance exercise in South Asian and white European adults. Eighteen South Asian and 16 White European men were enrolled in the study. Free-living muscle protein synthesis was measured at baseline. Muscle strength, body composition, resting metabolic rate, VO2max and metabolic responses (insulin sensitivity) to a mixed meal were measured at baseline and following 12 weeks of resistance exercise training. Free-living muscle protein synthesis was not different between South Asians (1.48 ± 0.09%/day) and White Europeans (1.59 ± 0.15%/day) (p = 0.522). In response to resistance exercise training there were no differences, between South Asians and White Europeans, muscle mass, lower body strength or insulin sensitivity. However, there were differences between the ethnicities in response to resistance exercise training in body fat, resting carbohydrate and fat metabolism, blood pressure, VO2max and upper body strength with responses less favourable in South Asians. In this exploratory study there were no differences in muscle protein synthesis or anabolic and metabolic responses to resistance exercise, yet there were less favourable responses in several outcomes. These findings require further investigation.

Abstract Background Previous cohort studies have investigated the relationship between self-reported physical activity (PA) and dementia. Evidence from objective device-measured PA data is lacking. This study aimed to explore the association of device-measured PA with the risk of dementia incidence and common subtypes (Alzheimer’s disease [AD] and vascular dementia) using the UK Biobank study. Methods 84,854 participants (55.8% women), invited to participate in the device-measured PA between 2013 and 2015, were included in this prospective cohort study. Wrist accelerometers were used to measure light, moderate, vigorous, moderate-to-vigorous PA (MVPA) and total PA intensity and duration (MET/min/week). Incident dementia (fatal and non-fatal) was extracted from hospital episodes records for incidence and death register for mortality. Incidence follow-up was carried out until the end of March 2021in England and Scotland and the end of March 2018 in Wales. Mortality data were available until February 2021. Nonlinear associations were first investigated using penalised cubic splines fitted in the Cox proportional hazard models. In addition, using MVPA, five categories were created. Associations of these categories with the outcomes were investigated using Cox proportional hazard models. Analyses were adjusted for sociodemographic, lifestyle and health-related factors. Results After a median follow-up of 6.3 years, 678 individuals were diagnosed with dementia. Evidence of nonlinearity was observed for all PA modes and all-cause dementia. For categories of MVPA, there was a significant trend towards a low risk of overall dementia when higher levels of MVPA were achieved (HRtrend 0.66 [95% CI 0.62 to 0.70]. The lowest risk was identified in individuals who performed more than 1200 MET/min/week, those who had 84% (95% CI 0.12 to 0.21) lower risk of incident dementia compared to those who performed

Abstract Background Sarcopenia often co‐occurs with osteoporosis in cross‐sectional studies. However, this association has rarely been studied in prospective studies. This study aimed to investigate the association between sarcopenia categories—along with its individual components—and incident osteoporosis in both middle‐aged and older men and women from the UK Biobank study. Methods A total of 168,682 participants (48.8% women, aged 37 to 70 years at baseline) were included in this prospective study. Categories of sarcopenia (pre‐sarcopenia and sarcopenia), and its individual components, were defined according to the EWGSOP2 criteria (2019). Associations with incident osteoporosis by sex were investigated using Cox‐proportional hazard models adjusted for socio‐demographic, lifestyle and health‐related factors, and morbidity count. Associations between categories of sarcopenia and incident osteoporosis were also investigated by age‐groups and subtype of osteoporosis (with and without pathological fractures). Results After a median follow‐up of 7.4 years, 6296 participants were diagnosed with osteoporosis. When the analyses were adjusted for a range of relevant confounding factors, pre‐sarcopenia was associated with 1.3‐times higher risk of osteoporosis in men (HR: 1.30 [95% CI: 1.03 to 1.63]) but not in women, and sarcopenia was associated with 1.66‐times increased osteoporosis risk in women (HR: 1.66 [95% CI: 1.33 to 2.08]) but not in men compared with people without sarcopenia or pre‐sarcopenia. A similar magnitude of associations was found in osteoporosis without pathological fractures but weaker for those with pathological fractures. Within the individual components, low muscle mass (HRwomen: 1.36 [95% CI: 1.22 to 1.51] and HRmen: 3.07 [95% CI: 1.68 to 5.59]), followed by slow gait speed (HRwomen: 1.30 [95% CI: 1.17 to 1.45] and HRmen: 1.70 [95% CI: 1.43 to 2.02]), were associated with a higher risk of incident osteoporosis in both sexes. Low grip strength was associated with a higher risk of incident osteoporosis in men (HR: 1.38 [95% CI: 1.15 to 1.65]), but not in women. No significant interaction between the exposures and incident osteoporosis by age groups were identified. Conclusions Our findings demonstrated that pre‐sarcopenic men and sarcopenic women had a higher risk of developing osteoporosis even after adjustment for a large range of potential confounders. Considering that sarcopenia could be prevented, health interventions to improve physical capability may delay or prevent the onset of osteoporosis.

Abstract We estimated the proportion and number of deaths from non-communicable diseases (NCD) attributable to high body mass index (BMI) in Chile in 2018. We used data from 5927 adults from a 2016–2017 Chilean National Health Survey to describe the distribution of BMI. We obtained the number of deaths from NCD from the Ministry of Health. Relative risks (RR) and 95% confidence intervals per 5 units higher BMI for cardiovascular disease, cancer, and respiratory disease were retrieved from the Global BMI Mortality Collaboration meta-analyses. The prevalences of overweight and obesity were 38.9% and 39.1%, respectively. We estimated that reducing population-wide BMI to a theoretical minimum risk exposure level (mean BMI: 22.0 kg/m2; standard deviation: 1) could prevent approximately 21,977 deaths per year (95%CI 13,981–29,928). These deaths represented about 31.6% of major NCD deaths (20.1–43.1) and 20.4% of all deaths (12.9–27.7) that occurred in 2018. Most of these preventable deaths were from cardiovascular diseases (11,474 deaths; 95% CI 7302–15,621), followed by cancer (5597 deaths; 95% CI 3560–7622) and respiratory disease (4906 deaths; 95% CI 3119–6684). A substantial burden of NCD deaths was attributable to high BMI in Chile. Policies and population-wide interventions are needed to reduce the burden of NCD due to high BMI in Chile.

This research aimed (1) to examine the agreement between body mass index (BMI)-based nutritional status and perceived nutritional status overall and by socio-demographic factors and (2) to state the association between the accuracy of weight perception and weight control practices in the Chilean adult population. A population-based cross-sectional study was carried out with 5,192 Chilean adult participants from the Chilean National Health Survey 2016–2017. Agreement between BMI-based weight status and body weight perception for the total sample and across subgroups was determined using the weighted kappa coefficient. The agreement between BMI-based and perceived nutritional status of the total sample was fair (kappa = 0.38). A higher rate of weight perception accuracy was identified in women, younger respondents, and participants with higher education, a higher income, and from urban areas than their counterparts. Respondents with overweight or obesity tended to underestimate their nutritional status. Actions to lose weight were higher in those who had the right perception of their overweight/obesity condition and those who overestimated their body weight, regardless of their nutritional status. In all groups, weight loss behaviors were more related to the perceived than the BMI-based nutritional status. The consequences of accurate perception of the nutritional status are discussed including its effects on body weight and mental health.

Abstract Background The effect of personalised nutrition advice on discretionary foods intake is unknown. To date, two national classifications for discretionary foods have been derived. This study examined changes in intake of discretionary foods and beverages following a personalised nutrition intervention using these two classifications. Methods Participants were recruited into a 6-month RCT across seven European countries (Food4Me) and were randomised to receive generalised dietary advice (control) or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Dietary intake was derived from an FFQ. An analysis of covariance was used to determine intervention effects at month 6 between personalised nutrition (overall and by levels) and control on i) percentage energy from discretionary items and ii) percentage contribution of total fat, SFA, total sugars and salt to discretionary intake, defined by Food Standards Scotland (FSS) and Australian Dietary Guidelines (ADG) classifications. Results Of the 1607 adults at baseline, n = 1270 (57% female) completed the intervention. Percentage sugars from FSS discretionary items was lower in personalised nutrition vs control (19.0 ± 0.37 vs 21.1 ± 0.65; P = 0.005). Percentage energy (31.2 ± 0.59 vs 32.7 ± 0.59; P = 0.031), percentage total fat (31.5 ± 0.37 vs 33.3 ± 0.65; P = 0.021), SFA (36.0 ± 0.43 vs 37.8 ± 0.75; P = 0.034) and sugars (31.7 ± 0.44 vs 34.7 ± 0.78; P

Introduction: Carbohydrate intake and physical activity are related to glucose homeostasis, both being influenced by individual genetic makeup. However, the interactions between these 2 factors, as affected by genetics, on glycaemia have been scarcely reported. Objective: We focused on analysing the interplay between carbohydrate intake and physical activity levels on blood glucose, taking into account a genetic risk score (GRS), based on SNPs related to glucose/energy metabolism. Methods: A total of 1,271 individuals from the Food4Me cohort, who completed the nutritional intervention, were evaluated at baseline. We collected dietary information by using an online-validated food frequency questionnaire, a questionnaire on physical activity, blood biochemistry by analysis of dried blood spots, and by analysis of selected SNPs. Fifteen out of 31 SNPs, with recognized participation in carbohydrate/energy metabolism, were included in the component analyses. The GRS included risk alleles involved in the control of glycaemia or energy-yielding processes. Results: Data concerning anthropometric, clinical, metabolic, dietary intake, physical activity, and genetics related to blood glucose levels showed expected trends in European individuals of comparable sex and age, being categorized by lifestyle, BMI, and energy/carbohydrate intakes, in this Food4Me population. Blood glucose was inversely associated with physical activity level (β = −0.041, p = 0.013) and positively correlated with the GRS values (β = 0.015, p = 0.047). Interestingly, an interaction affecting glycaemia, concerning physical activity level with carbohydrate intake, was found (β = −0.060, p = 0.033), which also significantly depended on the genetic background (GRS). Conclusions: The relationships of carbohydrate intake and physical activity are important in understanding glucose homeostasis, where a role for the genetic background should be ascribed.

ABSTRACT Objective: To study the association of SLC16A11 gene variants with obesity and metabolic markers in nondiabetic Chilean adults. Materials and methods: This cross-sectional study included 263 non-diabetic adults. The genotype of the rs75493593 polymorphism of SLC16A11 gene was performed by real-time PCR. It's association with adiposity markers (body weight, BMI, waist circumference and fat mass percentage), metabolic markers (glucose, insulin, HOMAIR, leptin, total cholesterol, LDLc, HDLc, triglycerides, ALT, GGT and hsCRP) and blood pressure was analyzed by linear regression. Results: The minor allele (T) of the SLC16A11 gene (rs75493593) has a frequency of 29.7% among Chileans. Risk genotypes (GT and TT) were associated with a significant 1.49 mU/l increase in plasmatic insulin for each copy of the minor allele (95% CI: 0.12, 2.87, p < 0.05). This association remained significant after adjusting for socio-demographic variables, physical activity and smoking (1.36 mU/l, 95% CI: 0.16, 2.58 p < 0.05), but was lost when BMI was included as a confounding factor. Higher BMI was also significantly associated with polymorphic genotypes in SLC16A11, independent of socio-demographic variables. Conclusion: The minor allele of the SLC16A11 gene (T) is highly prevalent among Chileans and is associated with increased insulin and BMI in nondiabetic individuals. These findings suggest that the genetic variant in SLC16A11 is not only associated with type 2 diabetes as previously shown in Mexicans, but is also related to early metabolic alterations in healthy subjects that may lead to type 2 diabetes.

Abstract Background For many years smoking has been the major threat to public health in developed countries. However, smoking prevalence has declined over a period when adiposity has increased. The aim of this study was to determine whether adiposity now accounts for more deaths than smoking in the general population as a whole or sub-groups of it. Methods This is a comparative risk assessment study using Health Surveys for England and Scottish Health Surveys from 2003 to 2017. Annual prevalence of overweight, obesity, current and former smoking were obtained and combined using population-based weights. Sex-specific risk ratios for all-cause mortality were obtained from the most recently published meta-analyses. Population attributable fractions across yeas were then estimated. Findings Overall, deaths attributable to current/former smoking declined from 23.1% (95% CI 20.6–25.8%) in 2003 to 19.4% (95% CI 17.3–21.6%) in 2017, whilst those attributable to adiposity (overweight or obesity) increased from 17.9% (95% CI 17.3–18.4%) in 2003 to 23.1% (95% CI 22.3–23.8%) in 2017 with cross-over occurring in 2013. Cross-over occurred earlier in men (2011) than women (2014). It occurred in 2006 for those aged over 65 years of age and in 2012 for those aged 45–64 years. Below 45 years, smoking remained the larger contributor to mortality. Interpretation Adiposity now accounts for more deaths in England and Scotland than smoking among people in middle- and old-age. National strategies to address adiposity should be a public health priority.

RESUMEN Objetivos: Determinar si la velocidad de marcha lenta se asocia a un mayor riesgo de deterioro cognitivo en personas mayores de 60 años, sanas, que viven en la comunidad, e investigar si esta asociación es modificable según niveles de actividad física y tiempo que permanecen sentados. Métodos: Estudio correlacional, transversal y retrospectivo. Se incluyeron 1082 personas mayores de 60 años de la Encuesta Nacional de Salud (ENS) 2009-2010 de Chile. La velocidad de la marcha (normal o lenta) fue autorreportada y el riesgo de deterioro cognitivo se evaluó con el cuestionario Mini-Mental State Examination. Las variables sociodemográficas y de estilos de vida se obtuvieron mediante la aplicación de cuestionarios validados en la ENS 2009-2010. Adicionalmente se evaluó el estado nutricional a través del índice de masa corporal. Resultados: Las personas mayores que presentaban una menor velocidad de marcha evidenciaron un mayor riesgo de presentar deterioro cognitivo en comparación con aquellos que caminan a velocidad de paso normal (OR:1,62 [IC95%:1,06;2,54], p=0,036). Esta asociación fue independiente de factores sociodemográficos, obesidad, tiempo sedente, actividad física y estilos de vida. Conclusión: Las personas mayores que reportaron caminar a un paso más lento que sus pares de la misma edad presentan un mayor riesgo de deterioro en comparación con aquellos que tienen una velocidad de la marcha normal. La probabilidad de deterioro cognitivo en personas mayores con marcha lenta aumenta en aquellas que no cumplen con las recomendaciones de actividad física dadas por la Organización Mundial de Salud o pasan más de 4 horas diarias en actividades sedentarias. Estos resultados refuerzan la idea de que la velocidad de la marcha podría ser usada como una herramienta de detección de riesgo de deterioro cognitivo en personas mayores.

Abstract Background Adiposity is a strong risk factor for cancer incidence and mortality. However, most of the evidence available has focused on body mass index (BMI) as a marker of adiposity. There is limited evidence on relationships of cancer with other adiposity markers, and if these associations are linear or not. The aim of this study was to investigate the associations of six adiposity markers with incidence and mortality from 24 cancers by accounting for potential non-linear associations. Methods A total of 437,393 participants (53.8% women; mean age 56.3 years) from the UK Biobank prospective cohort study were included in this study. The median follow-up was 8.8 years (interquartile range 7.9 to 9.6) for mortality and 9.3 years (IQR 8.6 to 9.9) for cancer incidence. Adiposity-related exposures were BMI, body fat percentage, waist-hip ratio, waist-height ratio, and waist and hip circumference. Incidence and mortality of 24 cancers sites were the outcomes. Cox proportional hazard models were used with each of the exposure variables fitted separately on penalised cubic splines. Results During follow-up, 47,882 individuals developed cancer and 11,265 died due to cancer during the follow-up period. All adiposity markers had similar associations with overall cancer incidence. BMI was associated with a higher incidence of 10 cancers (stomach cardia (hazard ratio per 1 SD increment 1.35, (95% CI 1.23; 1.47)), gallbladder (1.33 (1.12; 1.58)), liver (1.27 (1.19; 1.36)), kidney (1.26 (1.20; 1.33)), pancreas (1.12 (1.06; 1.19)), bladder (1.09 (1.04; 1.14)), colorectal (1.10 (1.06; 1.13)), endometrial (1.73 (1.65; 1.82)), uterine (1.68 (1.60; 1.75)), and breast cancer (1.08 (1.05; 1.11))) and overall cancer (1.03 (1.02; 1.04)). All these associations were linear except for breast cancer in postmenopausal women. Similar results were observed when other markers of central and overall adiposity were used. For mortality, nine cancer sites were linearly associated with BMI and eight with waist circumference and body fat percentage. Conclusion Adiposity, regardless of the marker used, was associated with an increased risk in 10 cancer sites.

This systematic review aimed to assess the available evidence on the effects of neuromuscular training on physical performance in older adults. A literature search was conducted across four databases (Psychology and Behavioral (EBSCO), Scopus, Web of Science and PubMed). The PRISMA guidelines were followed. The PEDro scale and Cochrane risk of bias tool were used to assess the quality of and risk of bias in the studies, respectively. The protocol was registered in PROSPERO (code: CRD42022319239). The outcomes were muscle strength, cardiorespiratory fitness, postural balance and gait speed. From 610 records initially found, 10 were finally included in the systematic review, involving 354 older people with a mean age of 67.3 years. Nine of them reported significant changes in at least one variable related to physical performance in the intervention compared to the control groups. The neuromuscular training caused significant improvements in postural balance, flexibility, cardiorespiratory fitness, strength power of the upper and lower limbs and autonomy. The available evidence indicates that neuromuscular training has a positive effect on some variables of physical performance, especially in postural balance; however, the methodological quality and certainty of the evidence in the available literature are limited. Therefore, a greater number of high-quality studies are required to draw definitive conclusions.

Children carrying the minor allele ‘A’ at the fat mass and obesity-associated protein (FTO) gene have higher obesity prevalence. We examined the link between FTO rs9939609 polymorphism and plasma adiponectin and the mediating role of body adiposity, in a cross-sectional study comprising 323 children aged 6–11 years. Adiponectin and FTO genotypes were assessed using a commercial kit and a real-time polymerase chain reaction with high-resolution melting analysis, respectively. Body adiposity included body mass index z-score, body fat percentage and waist-to-hip ratio. To investigate adiponectin (outcome) associations with FTO and adiposity, linear regressions were implemented in additive models and across genotype categories, adjusting for sex, age and Tanner’s stage. Using mediation analysis, we determined the proportion of the association adiponectin-FTO mediated by body adiposity. Lower adiponectin concentrations were associated with one additional risk allele (βadditive = −0.075 log-μg/mL [−0.124; −0.025]), a homozygous risk genotype (βAA/TT = −0.150 [−0.253; −0.048]) and a higher body mass index z-score (β = −0.130 [−0.176; −0.085]). Similar results were obtained for body fat percentage and waist-to-hip ratio. Body adiposity may mediate up to 29.8% of the FTO-adiponectin association. In conclusion, FTO rs9939609-related differences in body adiposity may partially explain lower adiponectin concentrations. Further studies need to disentangle the biological pathways independent from body adiposity.

Abstract Background Frailty has been associated with worse prognosis following COVID-19 infection. While several studies have reported the association between frailty and COVID-19 mortality or length of hospital stay, there have been no community-based studies on the association between frailty and risk of severe infection. Considering that different definitions have been identified to assess frailty, this study aimed to compare the association between frailty and severe COVID-19 infection in UK Biobank using two frailty classifications: the frailty phenotype and the frailty index. Methods A total of 383,845 UK Biobank participants recruited 2006–2010 in England (211,310 [55.1%] women, baseline age 37–73 years) were included. COVID-19 test data were provided by Public Health England (available up to 28 June 2020). An adapted version of the frailty phenotype derived by Fried et al. was used to define frailty phenotype (robust, pre-frail, or frail). A previously validated frailty index was derived from 49 self-reported questionnaire items related to health, disease and disability, and mental wellbeing (robust, mild frailty, and moderate/severe frailty). Both classifications were derived from baseline data (2006–2010). Poisson regression models with robust standard errors were used to analyse the associations between both frailty classifications and severe COVID-19 infection (resulting in hospital admission or death), adjusted for sociodemographic and lifestyle factors. Results Of UK Biobank participants included, 802 were admitted to hospital with and/or died from COVID19 (323 deaths and 479 hospitalisations). After analyses were adjusted for sociodemographic and lifestyle factors, a higher risk of COVID-19 was observed for pre-frail (risk ratio (RR) 1.47 [95% CI 1.26; 1.71]) and frail (RR 2.66 [95% CI 2.04; 3.47]) individuals compared to those classified as robust using the frailty phenotype. Similar results were observed when the frailty index was used (RR mildly frail 1.46 [95% CI 1.26; 1.71] and RR moderate/severe frailty 2.43 [95% CI 1.91; 3.10]). Conclusions Frailty was associated with a higher risk of severe COVID-19 infection resulting in hospital admission or death, irrespective of how it was measured and independent of sociodemographic and lifestyle factors. Public health strategies need to consider the additional risk that COVID-19 poses in individuals with frailty, including which additional preventive measures might be required.

Abstract Background To identify modifiable risk factors that contribute to cancer holds important public health relevance for setting up prevention strategies. Therefore, the aim of this study was to estimate the proportion of cancer cases and deaths attributable to alcohol consumption, high body mass index (BMI), low fruits and vegetables consumption, lack of physical activity, tobacco smoking, and passive smoking in Chile in 2018. Methods We retrieved data from a national representative survey to describe the distribution of six lifestyle risk factors. Relative risks of each risk factor-cancer pair were obtained from published meta-analysis and pooled cohort studies. Cancer cases and deaths were obtained from the GLOBOCAN 2018. Results Nearly 30% of all cancer cases (15,097 out of 50,320 cases) and 36% of all cancer deaths (10,155 out of 28,010 deaths) in Chile in 2018 were attributable to lifestyle risk factors. Smoking and high BMI accounted for most of the cancer cases (9232 and 4394, respectively) and deaths (6868 and 2572). The cancer burden of other lifestyle risk factors varied by sex. In men, the proportion of all cancer cases attributed to alcohol were 3.7% compare to 2.0% for women. Cancers cases and deaths of the larynx, lung, oral/cavity, esophagus and bladder could be at least halved if lifestyle risk factors were eliminated. Conclusion Smoking and high BMI were the leading causes of preventable cancer cases and deaths within the six lifestyles factors considered. Cancer prevention strategies should consider evidence-based interventions and public policies to encourage the adoption of a healthier lifestyle.

Abstract Background Child maltreatment is associated with cardiovascular disease (CVD), but mediation pathways have not been fully elucidated. The aim of the current study was to determine and quantify the underlying pathways linking child maltreatment and CVD. Methods We conducted a retrospective cohort study using the UK Biobank. The number and types of child maltreatment, including abuse and neglect, were recalled by the participants. Lifestyle, biological, physical, and mental health factors measured at baseline were explored as potential mediators. Incident CVD was ascertained through record linkage after baseline measurement. Age, sex, ethnicity, area-based deprivation, and education level were adjusted for as confounders. Cox proportional hazard models were conducted to test for associations between child maltreatment and incident CVD. Results A total of 152,040 participants who completed the child maltreatment assessment were included in the analyses, and one third reported at least one type of child maltreatment. There was a dose-response relationship between the number of maltreatment types and incident CVD. On average, each additional type of child maltreatment was associated with an 11% (95% CI 8–14%, P

Abstract Background Understanding of the role of ethnicity and socioeconomic position in the risk of developing SARS-CoV-2 infection is limited. We investigated this in the UK Biobank study. Methods The UK Biobank study recruited 40–70-year-olds in 2006–2010 from the general population, collecting information about self-defined ethnicity and socioeconomic variables (including area-level socioeconomic deprivation and educational attainment). SARS-CoV-2 test results from Public Health England were linked to baseline UK Biobank data. Poisson regression with robust standard errors was used to assess risk ratios (RRs) between the exposures and dichotomous variables for being tested, having a positive test and testing positive in hospital. We also investigated whether ethnicity and socioeconomic position were associated with having a positive test amongst those tested. We adjusted for covariates including age, sex, social variables (including healthcare work and household size), behavioural risk factors and baseline health. Results Amongst 392,116 participants in England, 2658 had been tested for SARS-CoV-2 and 948 tested positive (726 in hospital) between 16 March and 3 May 2020. Black and south Asian groups were more likely to test positive (RR 3.35 (95% CI 2.48–4.53) and RR 2.42 (95% CI 1.75–3.36) respectively), with Pakistani ethnicity at highest risk within the south Asian group (RR 3.24 (95% CI 1.73–6.07)). These ethnic groups were more likely to be hospital cases compared to the white British. Adjustment for baseline health and behavioural risk factors led to little change, with only modest attenuation when accounting for socioeconomic variables. Socioeconomic deprivation and having no qualifications were consistently associated with a higher risk of confirmed infection (RR 2.19 for most deprived quartile vs least (95% CI 1.80–2.66) and RR 2.00 for no qualifications vs degree (95% CI 1.66–2.42)). Conclusions Some minority ethnic groups have a higher risk of confirmed SARS-CoV-2 infection in the UK Biobank study, which was not accounted for by differences in socioeconomic conditions, baseline self-reported health or behavioural risk factors. An urgent response to addressing these elevated risks is required.

El envejecimiento es un proceso universal, irreversible e individual que provoca cambios morfofisiológicos en los sistemas músculo-esquelético, sistema nervioso central y los sistemas sensoriales (visual, vestibular y propiocepción), ocasionando mayor riesgo de caídas. Las caídas tienen una alta prevalencia y se han transformado en un importante problema de salud pública debido a los altos costos económicos y funcionales que representan en el adulto mayor. Para evitar estos eventos es importante conocer los cambios morfofisiológicos asociados al envejecimiento y planear estrategias de salud en las que se incorpore estimulación ósea, muscular, somatosensorial (propioceptiva) y cognitiva con el propósito de evitar el deterioro funcional y la discapacidad. En base a lo anterior, el objetivo de esta revisión es exponer el conocimiento actual de los cambios morfofisiológicos involucrados en el riesgo de caídas del adulto mayor.

Background: Understanding the mental health consequences of child maltreatment at different life stages is important in accurately quantifying the burden of maltreatment. This study investigated the association between child maltreatment and incident mental disorders in middle and older age as well as the potential mediators and moderators. Methods: This is a retrospective cohort study of 56,082 participants from UK Biobank. Child maltreatment was recalled using the Childhood Trauma Screener. Incident mental disorders, including depressive, anxiety and affective disorders, behavioural syndromes, post-traumatic stress disorder (PTSD), schizophrenia, substance abuse, and dementia, after baseline assessment were ascertained through linkage to primary care records. Findings: There was a dose-response relationship between child maltreatment and mental disorder. Those who experienced three or more maltreatment types had the highest risk of all mental disorders (HR 1.85, 95% CI: 1.67-2.06) followed by those who experienced two (HR 1.48, 95% CI: 1.35-1.63) and then one (HR 1.26, 95% CI: 1.19-2.35). Child maltreatment was most strongly associated with PTSD (HR 1.59, 95% CI: 1.20-2.10 P=0.001). The excess risk was largely unexplained by the included mediators. The association between child maltreatment and all mental disorders were stronger among participants who binge drank (Pinteraction=0.003) or had few social visits (Pinteraction=0.003). Interpretation: The mental health consequence of child maltreatment could last decades, even among those who had no recorded mental disorders in early adulthood. In the absence of strong mediators, prevention of child maltreatment remains the priority. Funding: Wellcome Trust Institutional Strategic Support Fund

Introduction: La esperanza de vida está aumentando en todo el mundo, así como la diabetes tipo 2 (DM2). Estudios poblacionales han demostrado que la duración de la DM2 se ha asociado con el deterioro cognitivo. Sin embargo, a pesar de la alta prevalencia de DM2 y deterioro cognitivo en Chile, aún no se ha investigado la asociación entre años con DM2 y la sospecha de deterioro cognitivo. El objetivo del estudio fue investigar la asociación entre la duración de la diabetes mellitus 2 (DM2) y la sospecha de deterioro cognitivo en personas mayores chilenas. Métodos: Participaron 1.040 personas ≥60 años de la Encuesta Nacional de Salud de Chile (2009-2010). El deterioro cognitivo se evaluó mediante el Mini Examen del Estado Mental abreviado (MMSE). El número de años con DM2 fue categorizado en cuatro grupos. Para valorar la asociación entre MMSE alterado y el número de años con DM2, se utilizó una regresión de Poisson, ajustados a posibles factores de confusión sociodemograficos, de estilos de vida, adiposidad y salud. Resultados: Cuando se ajustaron los análisis por factores sociodemográficos, las personas con 15 a 24 y ≥25 años con DM2 presentaron 2,2 veces (IC 95%: 1,07; 3,33) y 5,8 veces (IC 95%: 3,81; 11,0) riesgo relativo (RR) de deterioro cognitivo, en comparación con aquellas sin DM2. Luego de ajustar adicionalmente los análisis para las covariables relacionadas con el estilo de vida y la salud, el RR para deterioro cognitivo fue 1,76 veces (IC 95%: 1,02; 2,50) y 4,54 veces (IC 95%: 2,70; 6,38) más alto para aquellas personas con 14-24 y ≥25 años de DM2. Conclusiones: Se asoció el número de años con DM2 con la sospecha de deterioro cognitivo. Una mayor duración de la DM2 se asoció con una mayor probabilidad de deterioro cognitivo en la población mayor chilena.

Introduction Early detection and treatment of diabetes as well as its prevention help lessen longer-term complications. We determined the prevalence of pre-diabetes and undiagnosed diabetes in the UK Biobank and standardized the results to the UK general population.Research design and methods This cross-sectional study analyzed baseline UK Biobank data on plasma glycated hemoglobin (HbA1c) to compare the prevalence of pre-diabetes and undiagnosed diabetes mellitus in white, South Asian, black, and Chinese participants. The overall and ethnic-specific results were standardized to the UK general population aged 40–70 years of age.Results Within the UK Biobank, the overall crude prevalence was 3.6% for pre-diabetes, 0.8% for undiagnosed diabetes, and 4.4% for either. Following standardization to the UK general population, the results were similar at 3.8%, 0.8%, and 4.7%, respectively. Crude prevalence was much higher in South Asian (11.0% pre-diabetes; 3.6% undiagnosed diabetes; 14.6% either) or black (13.8% pre-diabetes; 3.0% undiagnosed diabetes; 16.8% either) participants. Only six middle-aged or old-aged South Asian individuals or seven black would need to be tested to identify an HbA1c result that merits action.Conclusions Single-stage population screening for pre-diabetes or undiagnosed diabetes in middle-old or old-aged South Asian and black individuals using HbA1c could be efficient and should be considered.

Introduction Grip strength has been associated with chronic diseases and mortality. However, current evidence of the association between grip strength and incident type 2 diabetes mellitus (T2DM) is controversial. The aim of this study was to investigate the associations of absolute and relative grip strength with incident T2DM and whether these associations differ by sociodemographic, lifestyle and adiposity-related factors.Research design and methods This was a prospective cohort study of 166 894 participants in the UK Biobank (mean age 56.5 years, 54.4% women). The outcome was T2DM incidence and the exposure was grip strength, expressed in absolute (kg) and relative (kg per kg of body weight) values. The association between grip strength and T2DM incidence was investigated using Cox-proportional regression.Results The median follow-up was 5.3 years (IQR: 4.7–6.1). During this time, 3713 participants developed T2DM. Lower grip strength was associated with a higher risk of T2DM in both sexes. Those in the lowest quintile of absolute grip strength had a 50% higher risk in men (HR: 1.50 (95% CI: 1.30 to 1.73)) and 25% higher risk in women (HR: 1.25 (95% CI: 1.06 to 1.47)) compared with those in the highest quintile. For relative grip strength, risk of diabetes was more than double for men (HR: 2.22 (95% CI: 1.84 to 2.67)) and 96% higher for women (HR: 1.96 (95% CI: 1.52 to 2.53)) in the lowest compared with highest quintiles.Conclusions Grip strength is associated with a higher risk of T2DM incidence in both men and women independent of important confounding factors including age, deprivation, adiposity and lifestyle. However, the associations were stronger when grip strength is expressed relative to body weight, which could reflect the importance of muscle quality.

Background: We examined whether an increased risk of cancer incidence and death is associated with kidney function and albuminuria and whether the risk is more readily identified when kidney function is estimated using cystatin C. Methods: Participants were from UK Biobank (recruitment spanning 2007–2010), excluding those with a prior diagnosis of cancer. Estimated glomerular filtration rate (ml/min/1.73m2) was calculated using creatinine (eGFRcr), cystatin C (eGFRcys) and creatinine-cystatin C (eGFRcr-cys). Cox proportional hazards models tested associations between eGFR, urinary albumin:creatinine ratio (uACR) and cancer incidence and death. Findings: In 431,263 participants over median follow-up of 11.3 (IQR 10.6–12.0) years, there were 41,745 incident cancers and 11,764 cancer deaths. eGFRcys was most strongly associated with cancer incidence and death (HR 1.04 (95% CI 1.03–1.04) and 1.06 (1.05–1.07) per 10 ml/min/1.73m2 decline, respectively). eGFRcr was not associated with either outcome (incidence: HR 1.00 (1.00–1.01); death: HR 0.99 (0.98–1.01) per 10 ml/min/1.73m2 decline). Relative to eGFRcys>90 or uACR

Los suplementos deportivos que se etiquetan como ergogénicos son muchos, pero pocos son los que realmente han demostrado su efectividad como tal. Actualmente, su uso se ha masificado, tanto por falta de regulación en uso y venta, así como por su utilización en la población general, y no sólo en deportistas de alto rendimiento. Frente a estas limitantes ¿cuál es la efectividad de estos productos más allá de la moda? En esta comunicación breve se abordan algunos de los suplementos y plantas más utilizados como ergogénicos; no obstante, es necesario tener precaución al momento de generalizar los resultados obtenidos por algunos ergogénicos, ya que su efecto podría ser secundario y/o estar condicionado por otros factores.

Objetivo. Asociar una nueva e integradora clasificación de actividad física (AF) y sedentarismo con riesgo de síndrome metabólico (SM) en una muestra representativa de adultos chilenos. Material y métodos. Se incluyeron 5 040 parti­cipantes de la Encuesta Nacional de Salud de Chile 2009-2010. Fueron creadas cuatro categorías mediante una combinación entre niveles de AF y sedentarismo (SED) usando el cuestio­nario GPAQ. El SM fue definido según las normas del NCEP ATP-III. Resultados. Se observa una menor probabilidad de presentar SM sólo en las categorías que cumplen con las recomendaciones internacionales de AF (p