Does weight loss reduce the incidence of total knee and hip replacement for osteoarthritis?-A prospective cohort study among middle-aged and older adults with overweight or obesity.

OBJECTIVE: This study aims to investigate the association between weight change and total knee or hip replacement (TKR or THR) for OA among middle-aged and older adults with overweight or obesity. METHOD: Weight data were collected in 2006-2009 and in 2010 from the 45 and Up Study-a population-based cohort aged ≥45 years in New South Wales, Australia. Participants were included if they had a baseline body mass index (BMI) ≥ 25 kg/m2 and no history of TKR or THR. Weight change was categorised into four groups: >7.5% loss; >5-7.5% loss; stable (≤5% change) and >5% gain. Hospital admission data were linked to identify TKR and THR for OA, and multivariable Cox regression was used to assess risk of TKR and THR. RESULTS: Of 23,916 participants, 2139 lost >7.5% weight, 1655 lost 5-7.5% weight, and 4430 gained >5% weight. Over 5.2 years, 1009 (4.2%) underwent TKR and 483 (2.0%) THR. Compared to weight-stable, weight loss of >7.5% was associated with reduced risk of TKR after adjusting for age, sex, BMI, socioeconomic and lifestyle factors (hazard ratio 0.69, 95%CI 0.54-0.87), but had no association with THR. Weight loss of 5-7.5% was not associated with altered risk of either TKR or THR. Weight gain was associated with increased risk of THR after adjusting for confounders, but not TKR. CONCLUSION: This study suggests that a weight loss target >7.5% is required to reduce the risk of TKR in adults with overweight or obesity. Weight gain should be avoided as it increases the risk of THR.

Sustained low consumption of fruit and vegetables in Australian children: Findings from the Australian National Health Surveys.

ISSUE ADDRESSED: Intakes of fruit and vegetables in children are inadequate. Our purpose was to examine national data on the proportion of Australian children meeting the fruit and vegetable recommendations in 2011-2012 and 2014-2015, assessing changes over time and differences by age, sex and socio-economic status (SES). METHODS: Secondary analysis of 2011-2012 and 2014-2015 Australian National Health Surveys of Australian children aged 2-18 years. Percentages of children meeting fruit and vegetable recommendations by survey year, age group, sex and SES tertile were calculated using population weights supplied by the Australian Bureau of Statistics (ABS). Chi-squared tests and logistic regression were used to test for the relative influence of each factor. RESULTS: In 2011-2012, 64.6%, 5.1% and 4.6% of children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. In 2014-2015, 68.2%, 5.3% and 5.1% of all children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. There was a large reduction in proportions of children meeting both the fruit and vegetable recommendations between 3 and 4 years of age, which coincides with when most Australian children start pre-school. There were consistent differences by sex for both fruit and vegetables, but we found little evidence that SES is a significant factor predicting the difference in meeting the vegetable recommendations. CONCLUSION: The proportion of Australian children meeting fruit and vegetable recommendations are sub-optimal across all SES groups which suggests that a national approach across demographic strata is warranted. SO WHAT?: Future health promotion interventions should have a refocus on vegetables instead of "fruit and vegetables," particularly in the key transition period when children start pre-school.

Vegetarian diet and all-cause mortality: Evidence from a large population-based Australian cohort - the 45 and Up Study.

The vegetarian diet is thought to have health benefits including reductions in type 2 diabetes, hypertension, and obesity. Evidence to date suggests that vegetarians tend to have lower mortality rates when compared with non-vegetarians, but most studies are not population-based and other healthy lifestyle factors may have confounded apparent protective effects. The aim of this study was to evaluate the association between categories of vegetarian diet (including complete, semi and pesco-vegetarian) and all-cause mortality in a large population-based Australian cohort. The 45 and Up Study is a cohort study of 267,180 men and women aged ≥45years in New South Wales (NSW), Australia. Vegetarian diet status was assessed by baseline questionnaire and participants were categorized into complete vegetarians, semi-vegetarians (eat meat≤once/week), pesco-vegetarians and regular meat eaters. All-cause mortality was determined by linked registry data to mid-2014. Cox proportional hazards models quantified the association between vegetarian diet and all-cause mortality adjusting for a range of potential confounding factors. Among 243,096 participants (mean age: 62.3years, 46.7% men) there were 16,836 deaths over a mean 6.1years of follow-up. Following extensive adjustment for potential confounding factors there was no significant difference in all-cause mortality for vegetarians versus non-vegetarians [HR=1.16 (95% CI 0.93-1.45)]. There was also no significant difference in mortality risk between pesco-vegetarians [HR=0.79 (95% CI 0.59-1.06)] or semi-vegetarians [HR=1.12 (95% CI 0.96-1.31)] versus regular meat eaters. We found no evidence that following a vegetarian diet, semi-vegetarian diet or a pesco-vegetarian diet has an independent protective effect on all-cause mortality.

Associations between multiple indicators of socio-economic status and muscle-strengthening activity participation in a nationally representative population sample of Australian adults.

BACKGROUND: Muscle-strengthening activity (MSA) (e.g. weight training), confers unique health benefits. While socioeconomic status (SES) correlates with leisure time physical activity, little is known about its relation with MSA. METHODS: Cross-sectional study of a representative sample of 8993 Australian adults (>18years) who participated in the National Nutrition and Physical Activity Survey 2011-12. Information was collected on SES (income, education, socio-economic disadvantage and remoteness) and MSA participation. RESULTS: 17.9% (CI: 16.8-19.0) met the national guidelines for MSA (≥2 sessions/week). Men and younger adults (<35years) met MSA guidelines more than females (19.7%; CI: 18.3-21.1% vs 16.1%; CI: 14.6-17.6%; p<0.001) and older adults respectively (25.0%; CI: 22.4-27.7% vs 10.4%; CI: 8.9-11.8%; p<0.001). All SES indicators were associated with meeting the guidelines in unadjusted analyses. When adjusting for total physical activity and mutually adjusting for each socioeconomic indicator only remoteness (OR for city vs rural=1.65; CI: 1.17-2.32; p<0.001) was associated with MSA participation (education OR=1.09 for high vs low; CI: 0.80-1.47, p=0.748; income OR=1.31 for Q5 vs Q1, CI: 0.93-1.85, p=0.328; social disadvantage OR=1.04 for v.high vs v.low, CI: 0.76-1.43, p=0.855). These associations were further attenuated when adjusting for BMI, smoking status and self-rated health. CONCLUSION: Remoteness, and to a lesser degree, education, income and social disadvantage, were independently associated with MSA participation. Public health interventions should improve access to strength training facilities, and/or increase home-based muscle-strengthening activity in remote areas.

Prevalence of elevated alanine transaminase in Australia and its relationship to metabolic risk factors: A cross-sectional study of 9,447 people.

BACKGROUND AND AIM: Elevated alanine transaminase (ALT) is a strong predictor of metabolic syndrome, but there are few data from the Australian population. We aimed to determine the prevalence of elevated ALT and association with metabolic risk factors. METHODS: In this cross-sectional study including adult participants (N = 9,447) from a nationwide, population-based survey, we assessed the prevalence of elevated ALT [defined as ≥ 40 IU/L (men) and ≥ 30 IU/L (women) as baseline, and ALT as ≥ 30 IU/L (men) and ≥ 19 IU/L (women) as lower threshold], distribution of metabolic risk factors, and independent predictors of elevated ALT in logistic regression models. Analyses were weighted to the population with population weights. RESULTS: Elevated ALT levels were found in 11.2% of the Australian population. People with elevated ALT were younger (43 vs 46 yrs) with more truncal adiposity (100 vs 91 cm), higher pro-atherogenic lipids and glucose and exercised less (120 vs 160 min per week, P < 0.05 for all analyses). Regression analyses indicated that younger age, male sex, diabetes, triglycerides, apolipoprotein B, and waist circumference were independent predictors of elevated ALT. The population attributable fraction of elevated ALT due to truncal obesity was estimated at 47%. CONCLUSION: These data demonstrate a high prevalence of elevated ALT in the general population that is closely associated with metabolic risk factors. Individuals with elevated ALT should be evaluated for co-existent metabolic disorders.

Are motivational signs to increase stair use a thing of the past? A multi-building study.

Issue addressed Only half of Australia's adult population is sufficiently physical active. One method thought to increase incidental physical activity at work is the use of stair-promoting interventions. Stairs are readily available and stair climbing is considered vigorous physical activity. Motivational signs have been extensively and effectively trialled to increase stair use, but are they suitable for contemporary populations? Methods Participants were occupants of three selected University of Sydney buildings using the elevators or stairs. Infrared people counters were installed to monitor stair and elevator use for 24 h/day during two baseline weeks, followed by two intervention weeks, where motivational and directional signs were placed at points of choice. Results At baseline there was a large between-building variation in the change in stair to elevator proportion, where we observed a small increase in two buildings (81-84%, odds ratio (OR): 1.16 (1.09, 1.23), and 26-27%, OR: 1.09 (1.03, 1.15)), and a decrease (30-25%, OR: 0.75 (0.72, 0.77) in the third building. Conclusions Differences in stair use among buildings could be due to building design and function. Motivational and directional signs to promote stair use showed small or nil effects. The future of interventions promoting stair use in occupational settings may need more interactive or personalised intervention methods. So what? The implications of this study are that posters to promote stair use might be a thing of the past and this should be considered in future workplace health promotion efforts to increase physical activity. More novel and interactive methods using new media are recommended.

Achieving equity in Crunch&Sip®: a pilot intervention of supplementary free fruit and vegetables in NSW classrooms.

Issue addressed Anecdotal evidence from teachers in Western Sydney Local Health District (WSLHD) indicated that many primary school children are regularly unable to participate in the Crunch&Sip® (C&S) program (breaks during class time to eat fruit and/or vegetables and drink water) as they do not bring produce from home. Actual reach of the program may therefore be currently overestimated, and inequitable. This study examined the feasibility, acceptability and efficacy of providing school children supplementary, fresh free produce in supporting equitable participation in C&S. Methods Free fruit and vegetables were provided for 10 weeks to four schools in a socioeconomically-disadvantaged area in Western Sydney. WSLHD sourced the produce at a discounted rate and storage and distribution was arranged in partnership with industry. Schools determined methods of allocation to children who did not have fruit or vegetables for the C&S break. Pre- and late-intervention (Week 9) classroom surveys provided quantitative data of intervention efficacy. Qualitative methods were used with key school persons to explore barriers and enablers to implementation. Results Participation of children in C&S increased significantly from 46.7% pre-intervention to 92.0% in Week 9. The proportion of children bringing fruit or vegetables from home also increased significantly, from 46.7% to 54.0%. Schools perceived the supplementary strategy to be highly feasible and acceptable. Conclusion Expansion of this equity strategy warrants consideration, although issues of sustainability would need to be addressed. The criteria for 'full implementation' should include high proportional participation by students in participating classes. So what? Establishing a system by which schools in disadvantaged areas can supplement their C&S program would effectively increase access to fruit and vegetables among those children most at need.

Fruit and vegetable consumption and all-cause mortality: evidence from a large Australian cohort study.

BACKGROUND: There is growing evidence for a relationship between fruit and vegetable consumption and all-cause mortality. Few studies, however, specifically explored consuming raw versus cooked vegetables in relation to health and mortality outcomes. The purpose of this study was to examine the relation of all-cause mortality with: a) fruit and vegetable consumption, either combined or separately; b) the consumption of raw versus cooked vegetables in a large cohort of Australian middle-aged and older adults. METHODS: The sample included 150,969 adults aged 45 years and over from the 45 and Up Study, a prospective cohort study conducted in New South Wales, Australia. Self-reported baseline questionnaire data (2006-09) were linked to mortality data up to June 2014. Fruit and vegetable consumption was assessed by validated short questions. Crude and adjusted hazard ratios were calculated using Cox proportional hazard models. Covariates included socio-demographic characteristics, health-related and dietary variables. RESULTS: During a mean follow-up of 6.2 years, 6038 (4 %) participants died from all causes. In the fully adjusted models, increasing consumption of fruit and vegetables combined was associated with reductions in all-cause mortality, with the highest risk reduction seen up to 7 serves/day or more of fruit and vegetables (P for trend = 0.002, hazard ratio for highest versus lowest consumption quartile: 0.90; 95 % confidence interval: 0.84, 0.97). Separate consumption of fruit and vegetables, as well as consumption of raw or cooked vegetables, were associated with a reduced risk of all-cause mortality in the crude and minimally adjusted models (all P for trend <0.05). With the exception of raw vegetables, these associations remained significant in the fully adjusted models (all P for trend <0.05). Age and sex were significant effect modifiers of the association between fruit and vegetable consumption and all-cause mortality. CONCLUSIONS: Fruit and vegetable consumption were inversely related to all-cause mortality in this large Australian cohort. Further studies examining the effects of raw versus cooked vegetables are needed.

The descriptive epidemiology of total physical activity, muscle-strengthening exercises and sedentary behaviour among Australian adults--results from the National Nutrition and Physical Activity Survey.

BACKGROUND: The current Australia's Physical Activity and Sedentary Behaviour Guidelines recommend that adults engage in regular moderate-to-vigorous-intensity physical activity (MVPA) and strength training (ST), and minimise time spent in sedentary behaviours (SB). However, evidence about the specific individual and concurrent distribution of these behaviours in Australia is scarce. Therefore, the aim of this study was to determine the prevalence and sociodemographic correlates of MVPA, ST and SB in a national-representative sample of Australian adults. METHODS: Data were collected using face-to-face interviews, as part of the National Nutrition and Physical Activity Survey 2011-12. The population-weighted proportions meeting the MVPA (≥ 150 min/week), ST (≥ 2 sessions/week) and combined MVPA-ST guidelines, and proportions classified as having 'low levels of SB' (< 480 min/day) were calculated, and their associations with selected sociodemographic and health-related variables were assessed using multiple logistic regression analyses. This was also done for those at potentially 'high-risk', defined as insufficient MVPA-ST and 'high-sedentary' behaviour. RESULTS: Out of 9345 participants (response rate = 77.0 %), aged 18-85 years, 52.6 % (95 % CI: 51.2 %-54.0 %), 18.6 % (95 % CI: 17.5 %-19.7 %) and 15.0 % (95 % CI: 13.9 %-16.1 %) met the MVPA, ST and combined MVPA-ST guidelines, respectively. Female gender, older age, low/medium education, poorer self-rated health, being classified as underweight or obese, and being a current smoker were independently associated with lower odds of meeting the MVPA, ST and combined MVPA-ST guidelines. A total of 78.9 % (95 % CI: 77.9 %-80.0 %) were classified as having low levels of SB. Females, older adults and those with lower education were more likely to report lower levels of SB, whilst those with poor self-rated health and obese individuals were less likely to report lower levels of SB (i.e. SB = ≥ 480 min/day). A total of 8.9 % (95 % CI: 8.1 %-9.6 %) were categorised as individuals at potentially 'high-risk'. Those with poorer self-rated health, obese individuals, those aged 25-44, and current smokers were more likely to be in the 'high risk' group. CONCLUSIONS: The large majority of Australian adults do not meet the full physical activity guidelines and/or report excessive SB. Our results call for public health interventions to reduce physical inactivity and SB in Australia, particularly among the subgroups at the highest risk of these unhealthy behaviours.

Trends in prolonged sitting time among European adults: 27 country analysis.

OBJECTIVE: To examine trends in adult sitting time across 27 European countries. METHOD: Data were from the Eurobarometer surveys collected in 2002, 2005, and 2013. Sitting time data were used to categorise respondents into 'low' (0 to 4h30min), 'middle' (4h31min to 7h30min), and 'high' levels of sitting (>7h30min). We modelled the likelihood of being in the high sitting group within a given country and overall across the three time points, controlling for age, gender, education, employment status, and physical activity. RESULTS: In total 17 countries had sitting data at all three time points; among these countries the prevalence of 'high sitting' decreased steadily from 23.1% (95% CI=22.2-24.1) in 2002 to 21.8% (95% CI=20.8-22.8) in 2005, and 17.8% (95% CI=16.9-18.7) in 2013. A further 10 countries had data only over the latter two time points; among these countries the prevalence of high sitting decreased from 27.7% (95% CI=26.0-29.4) in 2005 to 19.0% (95% CI=17.6-20.5) in 2013. CONCLUSION: Time spent in sedentary behaviour may not be increasing in the European region, and prolonged sitting may, in fact, be decreasing. This finding has important implications for the sedentary behaviour debate and the policy response.