A Randomised Controlled Trial of YOGa and Strengthening Exercise for Knee OsteoArthritis: Protocol for a Comparative Effectiveness Trial (YOGA Trial).

Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise intervention that can improve flexibility, muscle strength, balance, and fitness and potentially reduce symptoms of OA. However, there is a scarcity of robust, high-quality conclusive evidence on the efficacy of yoga in knee OA. We are currently conducting the first randomised comparative effectiveness and cost-effectiveness trial of a yoga program compared with a strengthening exercise program in patients with symptomatic knee OA. This study protocol describes the design and conduct of this trial. The YOGA study is a phase III, single-centre, parallel, superiority, randomised, active-controlled trial which will be conducted in Hobart, Australia. One hundred and twenty-six participants (63 in each arm) aged over 40 years with symptomatic knee OA will be recruited from the community and randomly allocated to receive either a 24-week yoga program (3×/week) or a strengthening exercise program (3×/week). The primary outcome will be change in knee pain over 12 weeks, assessed using a 100 mm visual analogue scale (VAS). The secondary outcomes include change in knee pain, patient global assessment, physical function, quality of life, gait speed, biomarkers, and others over 12 and 24 weeks. We will also assess whether the presence of neuropathic pain moderates the effects of yoga compared to strengthening exercise. Additional data, such as cost and resource utilization, will be collected for the cost-effectiveness analysis. The primary analysis will be conducted using an intention-to-treat approach. Adverse events will be monitored throughout the study. Once completed, this trial will contribute to the knowledge of whether yoga can be used as a simple, effective, low-cost option for the management of knee OA, thus saving economic costs in the healthcare system.

Association between knee symptoms, change in knee symptoms over 6-9 years, and SF-6D health state utility among middle-aged Australians.

OBJECTIVES: Health state utilities (HSUs) are an input metric for estimating quality-adjusted life-years (QALY) in cost-utility analyses. Currently, there is a paucity of data on association of knee symptoms with HSUs for middle-aged populations. We aimed to describe the association of knee symptoms and change in knee symptoms with SF-6D HSUs and described the distribution of HSUs against knee symptoms' severity. METHODS: Participants (36-49-years) were selected from the third follow-up (completed 2019) of Australian Childhood Determinants of Adult Health study. SF-6D HSUs were generated from the participant-reported SF-12. Association between participant-reported WOMAC knee symptoms' severity, change in knee symptoms over 6-9 years, and HSUs were evaluated using linear regression models. RESULTS: For the cross-sectional analysis, 1,567 participants were included; mean age 43.5 years, female 54%, BMI ± SD 27.18 ± 5.31 kg/m2. Mean ± SD HSUs for normal, moderate, and severe WOMAC scores were 0.820 ± 0.120, 0.800 ± 0.120, and 0.740 ± 0.130, respectively. A significant association was observed between worsening knee symptoms and HSUs in univariable and multivariable analyses after adjustment (age and sex). HSU decrement for normal-to-severe total-WOMAC and WOMAC-pain was - 0.080 (95% CI - 0.100 to - 0.060, p < 0.01) and - 0.067 (- 0.085 to - 0.048, p < 0.01), exceeding the mean minimal clinically important difference (0.04). Increase in knee pain over 6-9 years was associated with a significant reduction in HSU. CONCLUSION: In a middle-aged population-based sample, there was an independent negative association between worse knee symptoms and SF-6D HSUs. Our findings may be used by decision-makers to define more realistic and conservative baseline and ongoing HSU values when assessing QALY changes associated with osteoarthritis interventions.

Impact of overweight and obesity on life expectancy, quality-adjusted life years and lifetime costs in the adult population of Ghana.

INTRODUCTION: Prior studies have revealed the increasing prevalence of obesity and its associated health effects among ageing adults in resource poor countries. However, no study has examined the long-term and economic impact of overweight and obesity in sub-Saharan Africa. Therefore, we quantified the long-term impact of overweight and obesity on life expectancy (LE), quality-adjusted life years (QALYs) and total direct healthcare costs. METHODS: A Markov simulation model projected health and economic outcomes associated with three categories of body mass index (BMI): healthy weight (18.5≤BMI <25.0); overweight (25.0≤BMI < 30.0) and obese (BMI ≥30.0 kg/m2) in simulated adult cohorts over a 50-year time horizon from age fifty. Costs were estimated from government and patient perspectives, discounted 3% annually and reported in 2017 US$. Mortality rates from Ghanaian lifetables were adjusted by BMI-specific all-cause mortality HRs. Published input data were used from the 2014/2015 Ghana WHO Study on global AGEing and adult health data. Internal and external validity were assessed. RESULTS: From age 50 years, average (95% CI) remaining LE for females were 25.6 (95% CI: 25.4 to 25.8), 23.5 (95% CI: 23.3 to 23.7) and 21.3 (95% CI: 19.6 to 21.8) for healthy weight, overweight and obesity, respectively. In males, remaining LE were healthy weight (23.0; 95% CI: 22.8 to 23.2), overweight (20.7; 95% CI: 20.5 to 20.9) and obesity (17.6; 95% CI: 17.5 to 17.8). In females, QALYs for healthy weight were 23.0 (95% CI: 22.8 to 23.2), overweight, 21.0 (95% CI: 20.8 to 21.2) and obesity, 19.0 (95% CI: 18.8 to 19.7). The discounted total costs per female were US$619 (95% CI: 616 to 622), US$1298 (95% CI: 1290 to 1306) and US$2057 (95% CI: 2043 to 2071) for healthy weight, overweight and obesity, respectively. QALYs and costs were lower in males. CONCLUSION: Overweight and obesity have substantial health and economic impacts, hence the urgent need for cost-effective preventive strategies in the Ghanaian population.

Factors Associated with Persistently High Muscular Power from Childhood to Adulthood.

PURPOSE: Child and adult muscular power have been shown to associate with contemporary cardiometabolic health. Muscular power typically persists (tracks) between childhood and adulthood. Few studies span childhood to adulthood, so we aimed to identify modifiable and environmental factors associated with the persistence or change in muscular power across the life course. METHODS: Prospective study examining 1938 participants who had their muscular power (standing long jump distance) measured in 1985 as children 7-15 yr old and again 20 yr later in adulthood (26-36 yr old). A selection of objectively measured anthropometric characteristics (adiposity and fat-free mass), cardiorespiratory fitness (CRF), self-reported physical activity, dietary (quality and fruit, vegetable, and protein intake), and sociodemographic data were available at both time points. Muscular power was separated into thirds, and participants were reported as having persistently low, decreasing, persistently moderate, increasing, or persistently high muscular power. RESULTS: Higher adiposity, lower physical activity, diet quality and socioeconomic status (SES) across the life course, and lower adult CRF were associated with persistently low muscular power. Lower adult protein intake and an increase in adiposity over time were associated with decreasing muscular power. An increase in fat-free mass was associated with a reduced probability of decreasing or persistently high muscular power and an increased probability of increasing muscular power. Higher adult fruit intake was associated with increasing muscular power. Lower adiposity across the life course, higher adult CRF and SES, and higher child protein intake were associated with persistently high muscular power. CONCLUSION: Healthy weight, good CRF, greater protein intake, and high SES are important correlates of high muscular power maintained from childhood to adulthood.

An age- and sex-specific dietary guidelines index is a valid measure of diet quality in an Australian cohort during youth and adulthood.

Measuring diet quality over time is important due to health impacts, but to our knowledge, a Dietary Guidelines Index (DGI) with consistent scoring across childhood/adolescence (youth) and adulthood has not been validated. We hypothesized that a DGI that reflected age- and sex-specific guidelines would be a valid measure of diet quality in youth and adulthood. The DGI is based on the 2013 Australian Dietary Guidelines to reflect current understanding of diet quality and comprises 9 indicators, with a maximum score of 100 points. DGI scores were calculated for participants of the Australian Childhood Determinants of Adult Health study, which included a 24-hour food record during youth (1985, n = 5043, age: 10-15 years) and a 127-item food frequency questionnaire during adulthood (2004-2006, n = 2689, age: 26-36 years). We evaluated construct validity (distribution of scores, principal components analysis, correlation with nutrient density of intakes) and criterion validity (linear regression with population characteristics). DGI scores were multidimensional in underlying structure and normally distributed. Among youth, a lower DGI was significantly associated (P < .05) with smoking and with lower academic achievement and socioeconomic status. DGI scores were negatively correlated with energy, sugar, and fat and positively correlated with fiber, protein, and micronutrients. Among adults, a lower DGI was associated with lower education and self-reported health and higher waist circumference, insulin resistance, and total and low-density lipoprotein serum cholesterol. The DGI is an appropriate measure of diet quality in youth and adulthood because higher scores reflect nutrient-dense, rather than energy-dense, intake and discriminate between population characteristics consistent with the literature.

Socioeconomic position over the life course from childhood and smoking status in mid-adulthood: results from a 25-year follow-up study.

BACKGROUND: It remains unclear how life course socioeconomic position (SEP) variations impact later smoking status. We aimed to investigate the associations using a novel methodology - a structured regression framework and to explore the potential underlying mechanisms. METHODS: Data were from an Australian national cohort (n = 1489). SEP was measured in childhood (aged 7-15 years), young- (aged 26-36 years) and mid-adulthood (aged 31-41 years), including highest parental occupation in childhood and self-occupation in young- and mid-adulthood. Smoking status was self-reported in mid-adulthood. Four smoking-related variables in childhood including exposure to parental smoking, smoking experimentation, self-rated importance to be a non-smoker and intention to smoke were tested as potential mediators. A structured life course modelling approach was used to select the best-fit life course model(s). The log multinomial model was used to estimate the smoking risk in mid-adulthood with never smokers as the excluded category. RESULTS: 63.6% of participants were classified as stable non-manual occupation across the life course from childhood. The sensitive period and the accumulation model described the data equally as well as the saturated model. In the sensitive period model, compared to the non-manual group, those who had highest parental occupation of manual had a 21% lower risk of being former smokers and a 32% greater risk of being current smokers in mid-adulthood, and those who were occupied manually in mid-adulthood reported a 55% greater risk of being current smokers in mid-adulthood. In the accumulation model, compared to those who consistently reported non-manual occupations across the life course, those with manual occupations for longer had higher risk of being current smokers in mid-adulthood, with a 43% risk increase per time point in a manual occupation. Exposure to parental smoking and intention to smoke during childhood explained up to 40.2% of the excess risk of being current smokers in mid-adulthood associated with manual occupations in the sensitive period and the accumulation model. CONCLUSIONS: Childhood, young- and mid-adulthood are all important, but SEP in childhood and mid-adulthood may be of more importance in determining mid-adulthood smoking status. Exposure to parental smoking and intention to smoke in childhood seems to moderately mediate the associations.

Population estimates and characteristics of Australians potentially eligible for bariatric surgery: findings from the 2011-13 Australian Health Survey.

Objective The aim of the present study was to determine the potential demand for publicly and privately funded bariatric surgery in Australia. Methods Nationally representative data from the 2011-13 Australian Health Survey were used to estimate the numbers and characteristics of Australians meeting specific eligibility criteria as recommended in National Health and Medical Research Council guidelines for the management of overweight and obesity. Results Of the 3352037 adult Australians (aged 18-65 years) estimated to be obese in 2011-13, 882441 (26.3%; 95% confidence interval (CI) 23.0-29.6) were potentially eligible for bariatric surgery (accounting for 6.2% (95% CI 5.4-7.1) of the adult population aged 18-65 years (n=14122020)). Of these, 396856 (45.0%; 95% CI 40.4-49.5) had Class 3 obesity (body mass index (BMI) ≥40kgm-2), 470945 (53.4%; 95% CI 49.0-57.7) had Class 2 obesity (BMI 35-39.9kgm-2) with obesity-related comorbidities or risk factors and 14640 (1.7%; 95% CI 0.6-2.7) had Class 1 obesity (BMI 30-34.9kgm-2) with poorly controlled type 2 diabetes and increased cardiovascular risk; 458869 (52.0%; 95% CI 46.4-57.6) were female, 404594 (45.8%; 95% CI 37.3-54.4) had no private health insurance and 309983 (35.1%; 95% CI 28.8-41.4) resided outside a major city. Conclusion Even if only 5% of Australian adults estimated to be eligible for bariatric surgery sought this intervention, the demand, particularly in the public health system and outside major cities, would far outstrip current capacity. Better guidance on patient prioritisation and greater resourcing of public surgery are needed. What is known about this topic? In the period 2011-13, 4million Australian adults were estimated to be obese, with obesity disproportionately more prevalent in areas of socioeconomic disadvantage. Bariatric surgery is considered to be cost-effective and the most effective treatment for adults with obesity, but is mainly privately funded in Australia (>90%), with 16650 primary privately funded procedures performed in 2015. The extent to which the supply of bariatric surgery is falling short of demand in Australia is unknown. What does this paper add? The present study provides important information for health service planners. For the first time, population estimates and characteristics of those potentially eligible for bariatric surgery in Australia have been described based on the best available evidence, using categories that best approximate the national recommended eligibility criteria. What are the implications for practitioners? Even if only 5% of those estimated to be potentially eligible for bariatric surgery in Australia sought a surgical pathway (44122 of 882441), the potential demand, particularly in the public health system and outside major cities, would still far outstrip current capacity, underscoring the immediate need for better guidance on patient prioritisation. The findings of the present study provide a strong signal that more funding of public surgery and other effective interventions to assist this population group are necessary.

Skipping breakfast among Australian children and adolescents; findings from the 2011-12 National Nutrition and Physical Activity Survey.

OBJECTIVE: Skipping breakfast has been linked with poor diet quality, higher BMI and adverse cardiometabolic outcomes. This study aimed to determine the prevalence and correlates of skipping breakfast among Australian children and adolescents. METHODS: A total of 1,592 2-17-year-olds completed two 24-hour recalls, collected via face-to-face and telephone interview, in the 2011-12 National Nutrition and Physical Activity Survey. Breakfast was an eating occasion of ≥210kJ named as 'breakfast' by the participant. Child, household and adult correlates of skipping breakfast were reported. Odds ratios were calculated using ordinal regression. Linear regression was used to examine differences in dietary intake. Survey weights were applied to give nationally representative estimates. RESULTS: Most (86.8% of boys, 81.4% of girls) ate breakfast on both days, 11.8% of boys and 14.8% girls skipped on one day and 1.4% boys and 3.8% girls skipped on both days. Characteristics associated with skipping breakfast were being female, being older, being underweight or overweight/obese, poorer diet, lower physical activity, inadequate sleep, lower household income, greater socioeconomic disadvantage, and being from a single-parent home. CONCLUSION: Skipping breakfast was common among Australian adolescents but few consistently skipped. Implications for public health: Interventions to increase breakfast should target adolescents, particularly girls, and low SEP households.

Barriers and facilitators to participation in workplace health promotion (WHP) activities: results from a cross-sectional survey of public-sector employees in Tasmania, Australia.

Issue addressed Workplaces are promising settings for health promotion, yet employee participation in workplace health promotion (WHP) activities is often low or variable. This study explored facilitating factors and barriers associated with participation in WHP activities that formed part of a comprehensive WHP initiative run within the Tasmanian State Service (TSS) between 2009 and 2013. Methods TSS employee (n=3228) completed surveys in 2013. Data included sociodemographic characteristics, employee-perceived availability of WHP activities, employee-reported participation in WHP activities, and facilitators and barriers to participation. Ordinal log-link regression was used in cross-sectional analyses. Results Significant associations were found for all facilitating factors and participation. Respondents who felt their organisation placed a high priority on WHP, who believed that management supported participation or that the activities could improve their health were more likely to participate. Time- and health-related barriers were associated with participation in fewer activities. All associations were independent of age, sex, work schedule and employee-perceived availability of programs. Part-time and shift-work patterns, and location of activities were additionally identified barriers. Conclusion Facilitating factors relating to implementation, peer and environmental support, were associated with participation in more types of activities, time- and health-related barriers were associated with less participation. So what? Large and diverse organisations should ensure WHP efforts have manager support and adopt flexible approaches to maximise employee engagement.

Workplace Health Promotion and Mental Health: Three-Year Findings from Partnering Healthy@Work.

This study aimed to investigate the association between mental health and comprehensive workplace health promotion (WHP) delivered to an entire state public service workforce (~28,000 employees) over a three-year period. Government departments in a state public service were supported to design and deliver a comprehensive, multi-component health promotion program, Healthy@Work, which targeted modifiable health risks including unhealthy lifestyles and stress. Repeated cross-sectional surveys compared self-reported psychological distress (Kessler-10; K10) at commencement (N = 3406) and after 3 years (N = 3228). WHP availability and participation over time was assessed, and associations between the K10 and exposure to programs estimated. Analyses were repeated for a cohort subgroup (N = 580). Data were weighted for non-response. Participation in any mental health and lifestyle programs approximately doubled after 3 years. Both male and female employees with poorer mental health participated more often over time. Women's psychological distress decreased over time but this change was only partially attributable to participation in WHP, and only to lifestyle interventions. Average psychological distress did not change over time for men. Unexpectedly, program components directly targeting mental health were not associated with distress for either men or women. Cohort results corroborated findings. Healthy@Work was successful in increasing participation across a range of program types, including for men and women with poorer mental health. A small positive association of participation in lifestyle programs with mental health was observed for women but not men. The lack of association of mental health programs may have reflected program quality, its universality of application or other contextual factors.

Investigating Employee-Reported Benefits of Participation in a Comprehensive Australian Workplace Health Promotion Program.

OBJECTIVE: To investigate employee-reported benefits of participation, employee organizational commitment, and health-related behaviors and body mass index (BMI) following implementation of a comprehensive workplace health promotion (WHP) program. METHODS: State government employees from Tasmania, Australia, completed surveys in 2010 (n = 3408) and 2013 (n = 3228). Repeated cross-sectional data were collected on sociodemographic, health, and work characteristics. Participation in WHP activities, employee-reported organizational commitment, and benefits of participation were collected in 2013. RESULTS: Respondents who participated in multiple activities were more likely to agree that participation had motivated them, or helped them to address a range of health and work factors (trends: P < 0.05). There were significant associations between participation and employee organizational commitment. No differences were observed in health-related behaviors and BMI between 2010 and 2013. CONCLUSIONS: Healthy@Work (pH@W) was either ineffective, or insufficient time had elapsed to detect a population-level change in employee lifestyle factors.

Quantitative Assessment of Knee Effusion-Synovitis in Older Adults: Association With Knee Structural Abnormalities.

OBJECTIVE: To describe the natural history of quantitatively measured knee effusion-synovitis and the longitudinal associations between effusion-synovitis and knee structural factors, including cartilage defects, cartilage volume, subchondral bone marrow lesions, and meniscal pathology, in older adults. METHODS: A total of 406 subjects (with a mean age of 63 years, 50% women) were randomly selected at baseline and followed up 2.7 years later. T2- or T1-weighted fat saturation magnetic resonance imaging was used to assess knee effusion-synovitis maximal area, cartilage defects, cartilage volume, bone marrow lesions, and meniscal pathology at baseline and follow-up. Multivariable generalized linear regression was performed to analyze the associations between the maximal area of effusion-synovitis and other joint structural factors after adjustment for age, sex, body mass index, tibial bone area, and/or radiographic osteoarthritis (OA). RESULTS: Over 2.7 years of follow-up, the size of effusion-synovitis increased in 29%, remained stable in 50%, and decreased in 22% of the participants. Baseline effusion-synovitis maximal area was significantly associated with changes in knee cartilage defects (ß = 0.18 [95% confidence interval (95% CI)] 0.07, 0.29), bone marrow lesions (ß = 0.17 [95% CI 0.05, 0.30]), and cartilage volume (ß = -0.40 [95% CI -0.71, -0.09]) but not with change in meniscal pathology. In contrast, baseline structural measures were not associated with change or increase in effusion-synovitis maximal area. CONCLUSION: Our findings indicate that knee effusion-synovitis is not static in older adults. It is predictive of, but not predicted by, other structural abnormalities, suggesting a potential role in early knee OA changes.

Factors Associated With Availability of, and Employee Participation in, Comprehensive Workplace Health Promotion in a Large and Diverse Australian Public Sector Setting: A Cross-Sectional Survey.

PURPOSE: The aim of this study was to explore factors associated with the perceived availability of, and reported participation in workplace health promotion activities implemented in the Tasmanian State Service, Australia. METHODS: Data from 3228 employees were collected in 2013 on sociodemographic and work characteristics, health-related behaviors, and employee-reported availability of and participation in health-related activities. Ratios of prevalence for reported availability and participation by each factor were estimated using negative binomial regression (availability) and Poisson regression (participation). RESULTS: Significant differences in availability of different activity types were found for numerous factors. Compared with the reference categories, only administrative staff or respondents reporting any leisure-time physical activity were more likely to participate, and smokers and respondents with variable work schedules or cardiometabolic conditions were less likely. CONCLUSIONS: Employees with suboptimal health-related factors were less likely to engage with activities offered through this comprehensive workplace health promotion initiative.

Workplace health promotion: what public-sector employees want, need, and are ready to change.

OBJECTIVE: To examine whether employees selected appropriate health change targets (HCTs) compared with self-reported lifestyle factors (smoking, nutrition, alcohol, physical activity [PA], sedentariness, weight status, and psychological distress) and readiness to change their HCT. METHODS: Cross-sectional data of 3367 state-government employees from Tasmania, Australia, were collected in 2010. RESULTS: Overall, respondents chose HCTs relevant to their health behaviors. The most frequently selected HCTs were PA, diet, and weight. The majority was in the "action" stage for their HCT, except for those nominating smoking cessation, changes to work characteristics, and moderating alcohol intake. CONCLUSIONS: Employee perceptions of their own health needs broadly corresponded to their health-related behaviors, weight status, and stress. Workplace health facilitators should be prepared for variable uptake on smoking cessation programs. Physical activity interventions are likely well received, irrespective of risk-related lifestyle factors.

Involvement of young Australian adults in meal preparation: cross-sectional associations with sociodemographic factors and diet quality.

Involvement in meal preparation has the potential to affect diet quality, but has not been thoroughly investigated. The study aims were to describe the involvement of young adult men and women in meal preparation and to investigate whether extent of involvement was associated with diet quality. During 2004 to 2006, a national sample of 2,814 Australian adults aged 26 to 36 years completed a self-administered questionnaire on demographics, diet, and lifestyle factors. Participants were asked to report who was usually responsible for preparing the main meal on working days. Responses were categorized as "myself," "shared," or "someone else." Diet quality was assessed by calculating the mean number of daily servings for each food group. Analysis of variance was used to test for differences in means of dietary intake data. More women (65%) than men (29%) had sole responsibility for meal preparation. Shared meal preparation was reported by 23% of women and 27% of men. Factors associated with greater involvement in meal preparation included marital status, education, occupation, and physical activity. After adjusting for sociodemographic and lifestyle factors, men who prepared the main meal themselves had a higher intake of lean meat and alternatives. Women who shared the meal preparation had higher intakes of vegetables and dairy; however, these differences in diet quality were only small. These results suggest that strategies seeking to motivate greater involvement in meal preparation might not be sufficient to markedly improve diet quality in young Australian adults.

Chronic kidney disease in Tasmania.

AIM: Chronic kidney disease (CKD) is a progressive disease which is becoming a major public health issue due to its high rate of premature death, poor quality of life and expensive end-stage treatment (dialysis or transplantation). The burden of this chronic condition in a community setting was examined. METHODS: Data were obtained from 369,098 Tasmanian adults (aged >or=18 years) and included 1,640,687 measurements of creatinine taken between 1995 and 2007. In 2007 alone, testing comprised 25.5% of the state's adult population. A modelled estimate of CKD prevalence was developed. RESULTS: For those at risk of CKD (aged >50 years), 50.6%, 70.2% and 82% had a measured creatinine (and reported estimated glomerular filtration rate (eGFR)) during the last 1, 2 and 3 years respectively. However, only 9.4% of people with eGFR of less than 60 mL/min per 1.73 m(2) had albuminuria formally measured. Estimated prevalence of stage III or greater CKD (eGFR <60 mL/min per 1.73 m(2)) was at least 11.4% of women and 8.6% of men during 2007. Detection of low eGFR increased significantly over the last 13 years. There was a large geographic variation throughout Tasmania and high relative mortality with lower eGFR. There is a broad gap between the number of people with eGFR of less than 15 mL/min per 1.73 m(2) (stage V CKD) and those receiving dialysis treatment. CONCLUSION: The number of people identified with low eGFR has increased significantly since 1995 with a large geographic variation. Despite this, testing for kidney disease (by measuring serum creatinine and albuminuria) in people at risk is still suboptimal.

Healthy lifestyles and cardiovascular risk profiles in young Australian adults: the Childhood Determinants of Adult Health Study.

INTRODUCTION: We examined whether a healthy lifestyle was associated with cardiovascular risk factors in a cohort of young adults. DESIGN: Cross-sectional. METHOD: Data from the 2004-2006 Childhood Determinants of Adult Health Study (age range 25-36 years) were used. A lifestyle score [0 (unhealthy) to 8 (healthy)] was derived from eight behaviours (normal body mass index, nonsmoking, low alcohol, salt, meat and regular fish consumption, leisure time physical activity and skim milk use). Using linear regression to adjust sociodemographic characteristics, we examined relationships between the lifestyle score and blood pressure (BP), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglycerides, insulin, glucose and an estimate of insulin resistance (IR). RESULTS: In men (n = 863), after adjustment, higher lifestyle scores were linearly associated with lower diastolic BP [regression coefficient (beta): -0.83; 95% confidence interval (CI): -1.23 to -0.43], LDL cholesterol (beta: -0.05; 95% CI: -0.09 to -0.007), HDL cholesterol (beta: 0.01; 95% CI: 0.001-0.003), insulin (beta: -0.50; 95% CI: -0.75 to -0.25) and IR (beta: -0.10; 95% CI: -0.16 to -0.04). In women (n = 941), after adjustment, healthy lifestyles were linearly associated with HDL cholesterol (beta: 0.02; 95% CI: 0.01 to 0.04) and glucose (beta: -0.02; 95% CI: -0.04 to -0.003). There were significant nonlinear associations of the lifestyle score with triglycerides in males and with diastolic BP, LDL cholesterol, triglycerides, insulin and IR in females. CONCLUSION: Even in young adults, a healthy lifestyle is clearly associated with a better cardiovascular risk profile.