Epilepsy in second-generation immigrants: a cohort study of all children up to 18 years of age in Sweden.

BACKGROUND AND PURPOSE: Our purpose was to study the association between country of birth and incident epilepsy in second-generation immigrants in Sweden. METHODS: The study population included all children (n = 4 023 149) aged up to 18 years in Sweden. Epilepsy was defined as at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy, using individuals with Swedish-born parents as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence interval (95% CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and comorbid conditions, also using data from the Total Population Register. RESULTS: A total of 26 310 individuals had a registered epilepsy event, i.e. 6.5/1000 (6.6/1000 amongst boys and 6.3/1000 amongst girls). After adjustment, the risk of epilepsy was lower than in children of Swedish-born parents. Amongst girls the significant HR was 0.85 (95% CI 0.81-0.88), but in boys only when adjusting also for comorbidity (HR 0.96, 95% CI 0.92-0.99). Amongst specific immigrant groups, a higher incidence of epilepsy was observed amongst boys with parents from Turkey and Africa, but not when adjusting for comorbidity, and a lower risk was observed in many other groups (boys with parents from Latvia, girls with parents from Finland, Iceland, Southern Europe, countries from the former Yugoslavia, and Asia). CONCLUSION: The risk of epilepsy was lower in second-generation immigrant children compared to children with Swedish-born parents, but with substantial differences between different immigrant groups.

The association of fruit and vegetable consumption with changes in weight and body mass index in Chinese adults: a cohort study.

OBJECTIVES: Findings regarding the benefits of fruit and vegetables (FV) on weight control are inconsistent and little is known among Chinese populations. Therefore, we examined the relationship between change in FV consumption, weight, and change in body mass index (BMI) among Chinese adults, participants of the China Health and Nutrition Survey (CHNS). STUDY DESIGN: A prospective cohort study. METHODS: Two waves of CHNS conducted in 2006 and 2011 were used. Continuous FV consumption increase was considered as the exposure and changes in weight and BMI as outcomes. Change in FV consumption was categorized into quintiles. Analysis of covariance and multiple linear regression models, after controlling for potential confounders such as energy intake, physical activity, and smoking, were used to describe the relationship between change in FV consumption and change in weight and BMI. RESULTS: A total of 4357 participants aged 18-65 years were included in this study. The respective weight and BMI gains in male individuals were 1.81 kg and 0.73 kg/m2 in the fifth quintile of FV change relative to individuals in the first quintile (3.67 kg for weight gain and 1.48 kg/m2 for BMI gain). An increase in FV consumption by 100 g was associated with a 211 g weight loss (B = -2.11; 95% confidence interval [CI], -3.34, -0.89, P < 0.001) and a decrease in BMI by 0.94 kg/m2 (B = -0.94; 95% CI, -1.36, -0.46, P < 0.001) in men; and a 140 g weight loss (B = -0.14; 95% CI, -0.97, 0.69, P = 0.74) and a decrease in BMI by 0.29 kg/m2 BMI (B = -0.29; 95% CI, -0.63, 0.06, P = 0.11) in women. CONCLUSIONS: Increase in FV consumption was associated with statistically significant weight loss and decrease in BMI among Chinese men, and, although suggested, weight loss among women was not significant. Considering the protective effect of FV on human health, increasing FV consumption in the Chinese population is recommended.

The association between physical activity and liver fat after five years of follow-up in a primary prevention multi-ethnic cohort.

OBJECTIVE: Excess liver fat (LF) is associated with dyslipidemia, insulin resistance and cardiovascular disease. Evidence suggests that there is an independent relationship between physical activity (PA) and LF although little is known of the role of PA intensity in reducing LF. The purpose was to evaluate whether meeting PA guidelines, the amount of PA and the intensity of PA at baseline were associated with LF after five-years. METHODS: Men and women (n=478) living in Vancouver, Canada of Aboriginal, Chinese, European or South Asian background completed baseline measurements in 2004-2005. Liver fat was assessed using CT scans at 5-year follow-up, and PA using a PA questionnaire at baseline as well as demographics and anthropometry. RESULTS: In separate unadjusted models, meeting moderate-vigorous PA (MVPA) guidelines (p=0.009), vigorous PA (p=0.002) and MVPA (p=0.017) but not moderate PA (p=0.068) was predictive of LF at five years (p=0.009). In multiple linear regression models, when adjusted for covariates, meeting MVPA guidelines and MVPA with LF at five years was no longer significant (p>0.05) while vigorous PA remained significant (p=0.021). CONCLUSION: Meeting PA guidelines through MVPA may not be adequate to prevent the accumulation of LF and PA guidelines may require revision. Vigorous PA should be encouraged to prevent LF accumulation.

Correlates of Meal Skipping in Community Dwelling Older Adults: A Cross-Sectional Study.

In this cross-sectional analysis of 10,071 community dwelling adults aged ≥70 years, we examined factors associated with meal skipping (self-reported) using multivariable logistic regression. Prevalence of meal skipping in this study was 19.5%. The adjusted odds (aOR [95%CI]) of meal skipping were lower in those 85+ years (vs. 70-74.9 years, 0.56 [0.45-0.70]), and in those in regional areas (vs. urban area, 0.81 [0.72-0.92]). Higher odds of meal skipping were observed for those living alone (vs. living with someone, 1.84 [1.64-2.05]), current smokers (vs. non-smokers, 2.07 [1.54-2.80]), consumers of high amounts of alcohol (vs. abstainers 1.93 [1.35-2.75]), those with poor oral health (vs. excellent oral health, 1.71 [1.07 -2.73]) diabetes (vs. not 1.26 [1.06-1.50]), or frailty (vs. not, 1.63 [1.09-2.43]). This study identified socio-demographic, social, behavioural and biomedical correlates of meal skipping in later life, which may assist in targeting interventions to address meal skipping.

Self-Reported Early and Later Life Weight and the Risk of All-Cause Mortality in Older Adults.

OBJECTIVES: The extent to which body weight in early adulthood is associated with late-life mortality risk is unclear. This study aimed to determine the association between body mass index (BMI) in early adulthood (at 18 years of age) and older age (70 years and over), and the risk of mortality in later life. DESIGN: Secondary analysis of the ASPREE Longitudinal Study of Older Persons (ALSOP). SETTING, PARTICIPANTS: Data were from 14,853 relatively healthy community-dwelling Australians aged ≥ 70 years when enrolled in the study. MEASUREMENTS: Self-reported weight at age ≥ 70 years and recalled weight at age 18 years were collected at ALSOP study baseline. Height was measured with a stadiometer and was used for calculation of BMI at both timepoints. BMI at each timepoint was defined as: underweight, normal weight, overweight and obese. Individuals were categorised into one of five 'lifetime' BMI groups: normal weight (BMI between 18.5 and 24.9 at both times), overweight (25.0-29.9 at either or both times), obesity to non-obese (≥30.0 at age 18 and <30.0 ≥ 70 years), non-obese to obesity (<30.0 at age 18 and ≥30.0 at age ≥ 70 years), and early and later life obesity (≥30.0 at both times). RESULTS: During a median 4.7 years follow-up, 715 deaths occurred. Obesity at 18 years, but not in older age (p=0.44), was significantly associated with the risk of mortality in later life, even after accounting for current health status (HR: 2.35, 95% CI: 1.53-3.58, p<0.001). Compared with participants with normal BMI at both time points, being obese at both time points was associated with increased mortality risk (HR=1.99, 95% CI: 1.04-3.81, p=0.03), and the risk was even greater for individuals who were obese at 18 years but were no longer obese in older age (HR=2.92, 95% CI: 1.65-5.16, p<0.001), in fully adjusted models. Participants who were normal weight at 18 years and were obese in later life, did not have an increased mortality risk (p=0.78). CONCLUSIONS: Obesity in early adulthood, and obesity in both early and later life, were associated with increased mortality risk in later life. This highlights the importance of preventing obesity in early adulthood and maintaining a normal weight over an adult lifespan.

Self-reported oral health status, edentulism and all-cause mortality risk in 12 809 Australian older adults: a prospective cohort study.

OBJECTIVE: To investigate the association between oral health status and all-cause mortality in older adults using prospective cohort study design. SETTING AND PARTICIPANTS: In total, 12 809 adults aged ≥70 years (54.3% females) were participants of the ASPREE Longitudinal Study of Older Persons (ALSOP). METHODS: Participants self-reported the presence of natural teeth and oral health status. The association of self-reported oral health, edentulism and the integrative measure of the two with all-cause mortality were explored using the Cox-regression models adjusted for age, gender, socio-economic status, health-related behaviours, weight status, aspirin and polypharmacy. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS: In total, 22.2% of participants reported edentulism and 13.8% had fair/poor oral health. After adjustment for confounders, risk of all-cause mortality was higher among those with edentulism (vs. no edentulism) HR (95% CI) 1.43 (1.18, 1.73); and those with edentulism and reporting poor/fair oral health HR (95% CI) 1.69 (1.02, 2.82), or with no edentulism but reporting poor/fair oral health HR (95% CI) 1.46 (1.19-1.80) vs. no edentulism and reporting good/very good/excellent oral health. No association was observed between self-reported oral health alone and all-cause mortality. CONCLUSIONS: The risk of all-cause mortality was 69% higher among older adults reporting both edentulism and poor/fair oral health compared with those with teeth and more favourable self-reported oral health. © 2023 Australian Dental Association.

The association of smoking status with glycemic control, metabolic profile and diabetic complications- Results of the Australian National Diabetes Audit (ANDA).

BACKGROUND: Tobacco smoking and diabetes mellitus contribute significantly to the overall health burden and mortality of Australians. We aimed to assess the relationship of smoking with glycemic control, metabolic profile and complications in Australian patients living with diabetes. METHODS: We analysed the 2011-2017 biennial Australian National Diabetes Audit cross-sectional data. Patients were classified as current, past or never smokers. Linear (or quantile) and logistic regression models were used to assess for associations. RESULTS: Data from 15,352 patients were analysed, including 72.2% with type 2 diabetes. Current smokers comprised 13.5% of the study population. Current and past smokers had a median HbA1c that was 0.49% and 0.14% higher than never smokers, respectively, as well as higher triglyceride and lower HDL levels (all p values < .0001). Compared to never smokers, current smokers had higher odds of severe hypoglycemia and current and past smokers had higher odds of myocardial infarction, stroke, peripheral vascular disease, lower limb amputation, erectile dysfunction and peripheral neuropathy (all p values ≤.001), with no significant change over time. CONCLUSION: When compared to never smokers, current and past smokers had poorer glycemic and lipid control and higher odds of macrovascular and microvascular complications. Despite this, current smoking remains prevalent among Australians with diabetes.

Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies.

OBJECTIVES: Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control. DESIGN: Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries). PARTICIPANTS: Patients originating from Pakistan, Bangladesh or India with type 2 diabetes. PRIMARY OUTCOME: Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge. RESULTS: 23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and bilingual community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference. CONCLUSIONS: Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The smaller studies in India demonstrated significant improvements in glycaemic and other end points. Novel strategies are needed to improve glycaemic control in South Asians living outside of India.