Relative vaccine effectiveness against COVID-19 hospitalisation in persons aged ≥ 65 years: results from a VEBIS network, Europe, October 2021 to July 2023.

To monitor relative vaccine effectiveness (rVE) against COVID-19-related hospitalisation of the first, second and third COVID-19 booster (vs complete primary vaccination), we performed monthly Cox regression models using retrospective cohorts constructed from electronic health registries in eight European countries, October 2021-July 2023. Within 12 weeks of administration, each booster showed high rVE (≥ 70% for second and third boosters). However, as of July 2023, most of the relative benefit has waned, particularly in persons ≥ 80-years-old, while some protection remained in 65-79-year-olds.

Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices.

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.

Methodological considerations in injury burden of disease studies across Europe: a systematic literature review.

BACKGROUND: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. METHODS: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. RESULTS: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. CONCLUSIONS: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond.

Conducting national burden of disease studies and knowledge translation in eight small European states: challenges and opportunities.

BACKGROUND: Several countries across Europe are engaging in burden of disease (BoD) studies. This article aims to understand the experiences of eight small European states in relation to their research opportunities and challenges in conducting national BoD studies and in knowledge translation of research outputs to policy-making. METHODS: Countries participating in the study were those outlined by the WHO/Europe Small Countries Initiative and members of the Cooperation in Science and Technology (COST) Action CA18218 European Burden of Disease Network. A set of key questions targeting the research landscape were distributed to these members. WHO's framework approach for research development capacities was applied to gain a comprehensive understanding of shortages in relation to national BoD studies in order to help strengthen health research capacities in the small states of Europe. RESULTS: Most small states lack the resources and expertise to conduct BoD studies, but nationally representative data are relatively accessible. Public health officials and researchers tend to have a close-knit relationship with the governing body and policy-makers. The major challenge faced by small states is in knowledge generation and transfer rather than knowledge translation. Nevertheless, some policy-makers fail to make adequate use of knowledge translation. CONCLUSIONS: Small states, if equipped with adequate resources, may have the capacity to conduct national BoD studies. This work can serve as a model for identifying current gaps and opportunities in each of the eight small European countries, as well as a guide for translating country BoD study results into health policy.

Mapping the burden of diabetes in five small countries in Europe and setting the agenda for health policy and strategic action.

BACKGROUND: Diabetes is a global epidemic affecting every country. Small countries, however, face distinctive challenges related to their health system governance and their ability to implement effective health systems' reforms. The aim of this research was to perform a comparative assessment of existing diabetes management practices at the population level and explore governmental-related policy for Cyprus, Iceland, Luxembourg, Malta and Montenegro. This is the first time that such an evidence-based review study has been performed in the field of diabetes. The overall purpose was to set the agenda for health policy and inform strategic actions for small countries that can benefit from dealing with the diabetes epidemic at a country level. METHODS: We collected data and synthesized the evidence on dealing with diabetes for each of the five small European countries according to the (1) epidemiology of diabetes and other related metabolic abnormalities, (2) burden of diabetes status and (3) diabetes registers and national plans. We collected data by contacting Ministry representatives and other bodies in each state, and by searching through publicly available information from the respective Ministry of Health website on strategies and policies. RESULTS: Diabetes rates were highest in Cyprus and Malta. National diabetes registers are present in Cyprus and Montenegro, while national diabetes plans and diabetes-specific strategies have been established in Cyprus, Malta and Montenegro. These three countries also offer a free holistic healthcare service to their diabetes population. CONCLUSIONS: Multistakeholder, national diabetes plans and public health strategies are important means to provide direction on diabetes management and health service provision at the population level. However, political support is not always present, as seen for Iceland. The absence of evidence-based strategies, lack of funding for conducting regular health examination surveys, omission of monitoring practices and capacity scarcity are among the greatest challenges faced by small countries to effectively measure health outcomes. Nevertheless, we identified means of how these can be overcome. For example, the creation of public interdisciplinary repositories enables easily accessible data that can be used for health policy and strategic planning. Health policy-makers, funders and practitioners can consider the use of regular health examination surveys and other tools to effectively manage diabetes at the population level.

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

BACKGROUND: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.).

Challenges and benefits of integrating diverse sampling strategies in the observation of cardiovascular risk factors (ORISCAV-LUX 2) study.

BACKGROUND: It is challenging to manage data collection as planned and creation of opportunities to adapt during the course of enrolment may be needed. This paper aims to summarize the different sampling strategies adopted in the second wave of Observation of Cardiovascular Risk Factors (ORISCAV-LUX, 2016-17), with a focus on population coverage and sample representativeness. METHODS: Data from the first nationwide cross-sectional, population-based ORISCAV-LUX survey, 2007-08 and from the newly complementary sample recruited via different pathways, nine years later were analysed. First, we compare the socio-demographic characteristics and health profiles between baseline participants and non-participants to the second wave. Then, we describe the distribution of subjects across different strategy-specific samples and performed a comparison of the overall ORISCAV-LUX2 sample to the national population according to stratification criteria. RESULTS: For the baseline sample (1209 subjects), the participants (660) were younger than the non-participants (549), with a significant difference in average ages (44 vs 45.8 years; P = 0.019). There was a significant difference in terms of education level (P < 0.0001), 218 (33%) participants having university qualification vs. 95 (18%) non-participants. The participants seemed having better health perception (p < 0.0001); 455 (70.3%) self-reported good or very good health perception compared to 312 (58.2%) non-participants. The prevalence of obesity (P < 0.0001), hypertension (P < 0.0001), diabetes (P = 0.007), and mean values of related biomarkers were significantly higher among the non-participants. The overall sample (1558 participants) was mainly composed of randomly selected subjects, including 660 from the baseline sample and 455 from other health examination survey sample and 269 from civil registry sample (constituting in total 88.8%), against only 174 volunteers (11.2%), with significantly different characteristics and health status. The ORISCAV-LUX2 sample was representative of national population for geographical district, but not for sex and age; the younger (25-34 years) and older (65-79 years) being underrepresented, whereas middle-aged adults being over-represented, with significant sex-specific difference (p < 0.0001). CONCLUSION: This study represents a careful first-stage analysis of the ORISCAV-LUX2 sample, based on available information on participants and non-participants. The ORISCAV-LUX datasets represents a relevant tool for epidemiological research and a basis for health monitoring and evidence-based prevention of cardiometabolic risk in Luxembourg.

Stability-based validation of dietary patterns obtained by cluster analysis.

BACKGROUND: Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have an influence on the results. Therefore, there is a need of an objective methodology helping researchers in their decisions during cluster analysis. The objective of this study was to use such a methodology based on stability of clustering solutions to select the most appropriate clustering method and number of clusters for describing dietary patterns in the NESCAV study (Nutrition, Environment and Cardiovascular Health), a large population-based cross-sectional study in the Greater Region (N = 2298). METHODS: Clustering solutions were obtained with K-means, K-medians and Ward's method and a number of clusters varying from 2 to 6. Their stability was assessed with three indices: adjusted Rand index, Cramer's V and misclassification rate. RESULTS: The most stable solution was obtained with K-means method and a number of clusters equal to 3. The "Convenient" cluster characterized by the consumption of convenient foods was the most prevalent with 46% of the population having this dietary behaviour. In addition, a "Prudent" and a "Non-Prudent" patterns associated respectively with healthy and non-healthy dietary habits were adopted by 25% and 29% of the population. The "Convenient" and "Non-Prudent" clusters were associated with higher cardiovascular risk whereas the "Prudent" pattern was associated with a decreased cardiovascular risk. Associations with others factors showed that the choice of a specific dietary pattern is part of a wider lifestyle profile. CONCLUSION: This study is of interest for both researchers and public health professionals. From a methodological standpoint, we showed that using stability of clustering solutions could help researchers in their choices. From a public health perspective, this study showed the need of targeted health promotion campaigns describing the benefits of healthy dietary patterns.

Prevalence and related risk factors of chronic kidney disease among adults in Luxembourg: evidence from the observation of cardiovascular risk factors (ORISCAV-LUX) study.

BACKGROUND: Evidence on stages of renal impairment and related risk factors in Luxembourg is lacking. This study aimed to assess the prevalence of chronic kidney disease (CKD) and identify potential correlates among the general population, using the recent definition suggested by the Kidney Disease Improving Global Outcomes guidelines. METHODS: Data analysed from 1361 participants aged 18-69 years, enrolled in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study, 2007-08. Descriptive and multivariable logistic regression analyses were performed to identify demographic, socio-economic, behavioural, and clinical factors associated with CKD, defined as a single estimated glomerular filtration rate (eGFR) measure <60 ml/min/1.73m2 and/or urinary albumin: creatinine ratio (ACR) > 30 mg/g. RESULTS: Overall, 6.3% had CKD, including 4.4% and 0.7% with moderate and severe macroalbuminuria respectively. 0.1% had kidney failure (eGFR < 15 ml/min/1.73 m2). CKD was higher among subjects with primary education and risk increased significantly with age; the odd ratio was more than 2-fold higher among participants aged 50-69 years. Hypertension and diabetes were associated with more than 3-fold and 4-fold higher risks of CKD [adjusted odd ratio (AOR 3.46 (95%CI 1.92, 6.24), P < 0.001] and [AOR 4.45 (2.18, 9.07), P < 0.001] respectively. Increased physical activity measured as total MET-hour/week was independently associated with a lower odds of CKD (P = 0.035). CONCLUSION: The national baseline prevalence estimate of CKD, a neglected public health problem, stresses the benefit of early detection particularly in high-risk subjects with associated cardiovascular pathologies (e.g. hypertension, diabetes), to prevent and defray costs related to eventual complications.

Daily chocolate consumption is inversely associated with insulin resistance and liver enzymes in the Observation of Cardiovascular Risk Factors in Luxembourg study.

This study examined the association of chocolate consumption with insulin resistance and serum liver enzymes in a national sample of adults in Luxembourg. A random sample of 1153 individuals, aged 18-69 years, was recruited to participate in the cross-sectional Observation of Cardiovascular Risk Factors in Luxembourg study. Chocolate consumption (g/d) was obtained from a semi-quantitative FFQ. Blood glucose and insulin levels were used for the homoeostasis model assessment of insulin resistance (HOMA-IR). Hepatic biomarkers such as serum γ-glutamyl-transpeptidase (γ-GT), serum aspartate transaminase and serum alanine transaminase (ALT) (mg/l) were assessed using standard laboratory assays. Chocolate consumers (81·8 %) were more likely to be younger, physically active, affluent people with higher education levels and fewer chronic co-morbidities. After excluding subjects taking antidiabetic medications, higher chocolate consumption was associated with lower HOMA-IR (ß=-0·16, P=0·004), serum insulin levels (ß=-0·16, P=0·003) and γ-GT (ß=-0·12, P=0·009) and ALT (ß=-0·09, P=0·004), after adjustment for age, sex, education, lifestyle and dietary confounding factors, including intakes of fruits and vegetables, alcohol, polyphenol-rich coffee and tea. This study reports an independent inverse relationship between daily chocolate consumption and levels of insulin, HOMA-IR and liver enzymes in adults, suggesting that chocolate consumption may improve liver enzymes and protect against insulin resistance, a well-established risk factor for cardiometabolic disorders. Further observational prospective research and well-designed randomised-controlled studies are needed to confirm this cross-sectional relationship and to comprehend the role and mechanisms that different types of chocolate may play in insulin resistance and cardiometabolic disorders.

Chocolate intake is associated with better cognitive function: The Maine-Syracuse Longitudinal Study.

Chocolate and cocoa flavanols have been associated with improvements in a range of health complaints dating from ancient times, and has established cardiovascular benefits. Less is known about the effects of chocolate on neurocognition and behaviour. The aim of this study was to investigate whether chocolate intake was associated with cognitive function, with adjustment for cardiovascular, lifestyle and dietary factors. Cross-sectional analyses were undertaken on 968 community-dwelling participants, aged 23-98 years, from the Maine-Syracuse Longitudinal Study (MSLS). Habitual chocolate intake was related to cognitive performance, measured with an extensive battery of neuropsychological tests. More frequent chocolate consumption was significantly associated with better performance on the Global Composite score, Visual-Spatial Memory and Organization, Working Memory, Scanning and Tracking, Abstract Reasoning, and the Mini-Mental State Examination. With the exception of Working Memory, these relations were not attenuated with statistical control for cardiovascular, lifestyle and dietary factors. Prospective analyses revealed no association between cognitive function and chocolate intake measured up to 18 years later. Further intervention trials and longitudinal studies are needed to explore relations between chocolate, cocoa flavanols and cognition, and the underlying causal mechanisms.

Consumption of ready-made meals and increased risk of obesity: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study.

The consumption of ready-made meals, such as pre-packaged dishes, available at grocery stores and fast-food restaurants, is a habit related to our modern fast-paced lives. No study has examined the association of daily ready-made meal consumption with diet quality or health-related outcomes. The present study aimed to investigate the association between self-reported ready-made meal consumption and diet quality, as measured by compliance with dietary recommendations and with a set of adiposity measures, in a nationally representative sample of 1352 subjects, aged 18-69 years, participating in the nationwide population-based ORISCAV-LUX (Observation of Cardiovascular Risk Factors in Luxembourg) survey. The daily consumption of ready-made meals was calculated as follows: frequency of consumption × portion size × number of portions consumed. The sum of the daily consumption values of the eleven pre-packaged dishes included in the FFQ represented the total daily consumption of ready-made meals (g/d) for each participant. About 97% of the participants reported daily consumption of ready-made meals. The intake was highly prevalent in men living alone and varied according to education level. Ready-made meal consumption provided >7% of total daily energy. The fractions (%) of macro- and micronutrients derived from daily consumption of ready-made meals varied from 10% for total cholesterol to 0.65% for total fibre. Increased consumption of ready-made meals was found to be independently associated with abdominal obesity. On controlling for age, sex, socio-economic status and lifestyle factors, daily consumption of ready-made meals was found to be associated with higher energy intake and with poor compliance with national nutritional recommendations, and hence it could plausibly increase the risk of central obesity and fat deposition.

Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study.

The scientific community has become increasingly interested in the overall quality of diets rather than in single food-based or single nutrient-based approaches to examine diet-disease relationships. Despite the plethora of indices used to measure diet quality, there still exist questions as to which of these can best predict health outcomes. The present study aimed to compare the ability of five diet quality indices, namely the Recommendation Compliance Index (RCI), Diet Quality Index-International (DQI-I), Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet Score (MDS), and Dietary Inflammatory Index (DII), to detect changes in chronic disease risk biomarkers. Nutritional data from 1352 participants, aged 18-69 years, of the Luxembourg nationwide cross-sectional ORISCAV-LUX (Observation of Cardiovascular Risk Factors in Luxembourg) study, 2007-8, were used to calculate adherence to the diet quality index. General linear modelling was performed to assess trends in biomarkers according to adherence to different dietary patterns, after adjustment for age, sex, education level, smoking status, physical activity and energy intake. Among the five selected diet quality indices, the MDS exhibited the best ability to detect changes in numerous risk markers and was significantly associated with lower levels of LDL-cholesterol, apo B, diastolic blood pressure, renal function indicators (creatinine and uric acid) and liver enzymes (serum γ-glutamyl-transpeptidase and glutamate-pyruvate transaminase). Compared with other dietary patterns, higher adherence to the Mediterranean diet is associated with a favourable cardiometabolic, hepatic and renal risk profile. Diets congruent with current universally accepted guidelines may be insufficient to prevent chronic diseases. Clinicians and public health decision makers should be aware of needs to improve the current dietary guidelines.

The potential impact of animal protein intake on global and abdominal obesity: evidence from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study.

OBJECTIVE: To examine the association of total animal protein intake and protein derived from different dietary sources (meat; fish and shellfish; eggs; milk products) with global and abdominal obesity among adults in Luxembourg. DESIGN: Binary logistic regression analysis was used to assess the relationship between animal protein intake (as a percentage of total energy intake) and global obesity (BMI ≥ 30.0 kg/m(2)) and abdominal obesity (waist circumference ≥ 102 cm for men and ≥ 88 cm for women), after controlling for potential confounders. SETTING: Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study. SUBJECTS: The study population was derived from a national cross-sectional stratified sample of 1152 individuals aged 18-69 years, recruited between November 2007 and January 2009. RESULTS: There was an independent positive association between total animal protein intake and both global (OR = 1.18; 95% CI 1.12, 1.25) and abdominal obesity (OR = 1.14; 95% CI 1.08, 1.20) after adjustment for age, gender, education, smoking, physical activity and intakes of total fat, carbohydrate, fibre, and fruit and vegetables. Protein intakes from meat, fish and shellfish were positively associated with global and abdominal obesity with further adjustment for vegetal protein and other sources of animal-derived protein (all P < 0.01). Protein derived from eggs or milk products was unrelated to global or abdominal obesity. CONCLUSIONS: Our findings suggest that protein derived from animal sources, in particular from meat, fish and shellfish, may be associated with increased risk of both global and abdominal obesity among presumably healthy adults in Luxembourg. These findings suggest that lower animal protein intakes may be important for maintenance of healthy body weight.

Physical activity, sedentary behavior time and lipid levels in the Observation of Cardiovascular Risk Factors in Luxembourg study.

BACKGROUND: Recently attention has been drawn to the health impacts of time spent engaging in sedentary behaviors. While many studies have investigated general physical activity (PA) in relation to blood lipid levels, the current study aimed to examine the intensity of activity, including sedentary behavior time, and time spent engaging in moderate and intense PA, with concentrations of HDL and LDL-cholesterol, total cholesterol, and triglycerides. METHODS: Participants comprised 1331 individuals, aged 18 to 70 years, from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study, who underwent objective cardiovascular health assessments and completed the International Physical Activity Questionnaire (IPAQ). Time spent engaging in sedentary behaviors (screen time on a workday and a day off, and total sitting time on a work day), and moderate and intense PA, were related to levels of HDL and LDL-cholesterol, total cholesterol, and triglycerides. Analyses were conducted in the whole sample, and then with stratification according to BMI (normal weight versus overweight/obese). RESULTS: Both lower screen time during days off and higher intense PA time were significantly associated with higher HDL-cholesterol after full adjustment for socio-demographic factors, dietary factors and smoking (both p < 0.05). In normal weight individuals, consistent positive relations between triglycerides, LDL, and total cholesterol with all sedentary behavior time variables were observed (all p < 0.05; adjusted for age, education, gender). There were no statistically significant associations between any intensity level of PA or sedentary behavior time variable and lipid levels in those overweight or obese. CONCLUSIONS: Spending less time in sedentary behaviors, and engaging in medium levels of intense physical activity may be associated with a more favorable blood lipid profile, particularly with regard to levels of HDL and triglycerides.

Cardiovascular health: a cross-national comparison between the Maine Syracuse Study (Central New York, USA) and ORISCAV-LUX (Luxembourg).

BACKGROUND: Cardiovascular disease is the number one cause of death in the United States and in most European countries. Cardiovascular health, as defined by the American Heart Association, is comprised of seven health metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). No studies have compared US data with data collected elsewhere, using this index of cardiovascular health METHODS: We performed comparative analyses of cardiovascular health status in participants from 2 study sites in 2 different countries: the Maine-Syracuse Study, conducted in Central New York, USA in 2001-2006 (n=673), and the Observation of Cardiovascular Risk Factors in Luxembourg, conducted in 2007-2009 (n=1145). RESULTS: The Cardiovascular Health Score, the sum of the total number of metrics at ideal levels, was higher in the Luxembourg site than in the Central New York site. Ideal cardiovascular health levels for body mass index, smoking, physical activity, and diet were more prevalent in the Luxembourg site than the Central New York site. Ideal levels for blood pressure were more prevalent in Central New York. Differences between the two sites remained with control for age, gender and socioeconomic indicators. CONCLUSIONS: Cardiovascular health, as indexed by seven health metrics, was higher in the European study site than in the US study site. The largest differences were for the four lifestyle/behavior metrics, namely body mass index, smoking, physical activity, and diet. Preventative and intervention strategies will continue to be important for both countries in order to improve cardiovascular health.

Use of food frequency questionnaire to assess relationships between dietary habits and cardiovascular risk factors in NESCAV study: validation with biomarkers.

BACKGROUND: Validation of Food frequency questionnaire (FFQ) is particularly important element, as incorrect information may lead to false associations between dietary factors and diseases. The aim of the study was to evaluate the validity of the FFQ used in NESCAV (Nutrition, Environment and Cardiovascular Health) study, by comparing the estimated intakes of fruits and vegetables and of several micro-nutrients with corresponding nutritional biomarkers. METHODS: Relative validity was assessed in a sample of 922 subjects (452 men and 470 women). Comparisons between FFQ-estimates and their corresponding biomarkers were performed through correlation and cross classification into quintiles by using both crude and energy-adjusted FFQ-estimates. Correlations adjusted for confounders were also computed. All analyses were performed separately for men and women. RESULTS: Concerning micro-nutrients, significant correlations were found for vitamin B9, D, E, B12 ß-carotene and iodine in both men and women. Energy-adjustment led to an increase of all correlations cited previously. However, after excluding supplement users, correlations for vitamin D were not significant anymore. Concerning fruits and vegetables, all correlations were significant. Vegetables alone and fruits and vegetables correlated better in men (r around 0.2) than in women (r around 0.1). In men, correlation was also better for vegetables alone and fruits and vegetables than fruits alone. CONCLUSION: These data demonstrate that this FFQ is a reasonable tool to assess intakes of fruits and vegetables and of several micro-nutrients. We conclude that our FFQ is suitable to be used in NESCAV study, although protein and vitamin D estimates should be interpreted with caution.

Monitoring COVID-19 vaccine effectiveness against COVID-19 hospitalisation and death using electronic health registries in ≥65 years old population in six European countries, October 2021 to November 2022.

BACKGROUND: Within the ECDC-VEBIS project, we prospectively monitored vaccine effectiveness (VE) against COVID-19 hospitalisation and COVID-19-related death using electronic health registries (EHR), between October 2021 and November 2022, in community-dwelling residents aged 65-79 and ≥80 years in six European countries. METHODS: EHR linkage was used to construct population cohorts in Belgium, Denmark, Luxembourg, Navarre (Spain), Norway and Portugal. Using a common protocol, for each outcome, VE was estimated monthly over 8-week follow-up periods, allowing 1 month-lag for data consolidation. Cox proportional-hazards models were used to estimate adjusted hazard ratios (aHR) and VE = (1 - aHR) × 100%. Site-specific estimates were pooled using random-effects meta-analysis. RESULTS: For ≥80 years, considering unvaccinated as the reference, VE against COVID-19 hospitalisation decreased from 66.9% (95% CI: 60.1; 72.6) to 36.1% (95% CI: -27.3; 67.9) for the primary vaccination and from 95.6% (95% CI: 88.0; 98.4) to 67.7% (95% CI: 45.9; 80.8) for the first booster. Similar trends were observed for 65-79 years. The second booster VE against hospitalisation ranged between 82.0% (95% CI: 75.9; 87.0) and 83.9% (95% CI: 77.7; 88.4) for the ≥80 years and between 39.3% (95% CI: -3.9; 64.5) and 80.6% (95% CI: 67.2; 88.5) for 65-79 years. The first booster VE against COVID-19-related death declined over time for both age groups, while the second booster VE against death remained above 80% for the ≥80 years. CONCLUSIONS: Successive vaccine boosters played a relevant role in maintaining protection against COVID-19 hospitalisation and death, in the context of decreasing VE over time. Multicountry data from EHR facilitate robust near-real-time VE monitoring in the EU/EEA and support public health decision-making.

Population compliance with national dietary recommendations and its determinants: findings from the ORISCAV-LUX study.

The objective of the present study was to determine the proportion of adults meeting national recommendations for food and nutrient intake and to identify the demographic, socio-economic and behavioural factors that may contribute to weaken dietary compliance. ORISCAV-LUX is a cross-sectional study that took place in Luxembourg (2007-8). A representative stratified random sample of 1352 adults aged 18-69 years participated in the nationwide cardiovascular health survey. A FFQ was used to estimate food intake. Radar charts were built to compare graphically the compliance of the participants with different key dietary guidelines on the same set of axes. The thirteen food- and nutrient-based recommendations were scored and summed to create a recommendation compliance index (range -0·5 to 14). Ordinal logistic regression analyses were performed to determine the factors contributing to poor dietary compliance. Several food- and nutrient-based guidelines were insufficiently respected compared with others. The greatest gaps occurred in the adherence to grain and dairy product consumption guidelines, as well as to total fat and notably to SFA recommendations. Age, country of birth, economic status, smoking status and subject's awareness of the importance of balanced meals emerged as independently associated with weak dietary compliance. Obese subjects conformed more to dietary recommendations compared with normal-weight subjects. The findings underscore the need for specific nutrition education messages along with targeted interventions. Efforts should be continued to increase population awareness of the importance of a healthy lifestyle and a balanced diet.

Dietary, behavioural and socio-economic determinants of the metabolic syndrome among adults in Luxembourg: findings from the ORISCAV-LUX study.

OBJECTIVE: The purpose of the present research was to investigate the epidemiological profile of the metabolic syndrome (MetS) and to explore its potential dietary, behavioural and socio-economic determinants among European adults residing in Luxembourg. DESIGN: Cross-sectional, population-based ORISCAV-LUX survey. SETTING: European adults aged 18-69 years residing in Luxembourg. SUBJECTS: A total of 1349 Europid adults, who participated in the ORISCAV-LUX survey, were included in the study. The prevalence of MetS was estimated according to the Revised-Adult Treatment Panel (R-ATPIII) criteria. Multivariate logistic regression was used to identify the dietary, behavioural and socio-economic factors independently associated with MetS. RESULTS: The overall prevalence of MetS was 24.7 % with significant gender difference (18.5 % for women v. 30.8 % for men, P < 0.0001). Age, male gender, primary level of education, physical inactivity, family history of diabetes and hypertension and inadequate protein intake were identified as significant determinants of MetS, after adjusting for other socio-economic, family medical history and lifestyle factors. CONCLUSIONS: MetS is a common condition among Europid adults in Luxembourg and increases dramatically with age, in both genders. Several dietary, socio-economic and behavioural factors explain the disparity observed. These findings highlight the importance of a comprehensive approach to MetS encompassing dietary, lifestyle and socio-economic aspects, both in clinical and community settings.