Milk and dairy consumption is positively associated with height in adolescents: results from the Israeli National Youth Health and Nutrition Survey.

PURPOSE: Milk consumption is associated with increased height primarily in early childhood. However, in adolescents, data are scarce with inconsistent results. Since height is a proxy for overall health and well-being, this study evaluated the association of dairy intake with height in adolescents. METHODS: Students in 7th-12th grades, participating in the 2015-2016 Israeli Health and Nutrition Youth Survey, a school-based cross-sectional study, completed self-administered questionnaires, including a semi-quantitative food frequency questionnaire (n = 3529, 48% males, 15.2 ± 1.6 years). Anthropometric measurements were also performed. Dairy servings were calculated as the calcium equivalent of 1 cup of milk, and consumption was divided into four categories from very low (< 1 serving/day) to high (3 + servings/day). BMI- and Height-for-age z scores (HAZs) were calculated according to WHO growth standard; relatively short stature (RSS) was defined as HAZ < - 0.7 SD (< 25th percentile). Multivariable linear and logistic regression analyses were performed to evaluate the association of dairy intake with HAZ and prevalence of RSS, respectively. RESULTS: Median consumption of dairy products was 2 servings/day, 1.4 from unsweetened products (milk, cheese and yogurt). Controlling for age, sex, BMI-z-score and socioeconomic status, each increment of unsweetened dairy intake was associated with on average 0.04 higher HAZ (equivalent to 0.3-0.4 cm, p < 0.05), and with reduced risk for RSS: OR 0.90, 95%CI: 0.84, 0.97, p < 0.01. No such associations were found with sweetened dairy products. CONCLUSION: Consumption of unsweetened dairy products (3-4 servings/day) appears to contribute to achieving growth potential in adolescents. Intervention studies are necessary to determine the causal relationship between dairy intake and linear growth.

Physical Activity and Long-Term Mortality Risk in Older Adults with and without Cardiovascular Disease: A Nationwide Cohort Study.

AIMS: To evaluate the association between physical activity (PA) levels and mortality among older adults, to determine whether it differs according to cardiovascular disease (CVD) status, and to assess the optimal weekly duration of PA associated with subsequent survival. METHODS: Participants (n = 1,799) were drawn from a national survey conducted from 2005 to 2006, constituting Israeli adults aged ≥65 years. Sociodemographic, clinical, behavioral, and psychosocial data were collected via interview at study entry. Based on a detailed PA questionnaire and according to published guidelines, participants were classified as sufficiently active, insufficiently active, and inactive. CVD status was self-reported. Mortality data (last follow-up, December 2016) were obtained from the Israeli Ministry of Health. Using Cox models, inverse probability weighted hazard ratios (HRs) for mortality, based on propensity score, were estimated for PA categories. RESULTS: Among the participants at baseline (mean age, 74.6 years), 559 (31.1%) were sufficiently active, 506 (28.1%) were insufficiently active, and 734 (40.8%) were inactive. During follow-up (mean, 9.0 years), 684 participants (38.0%) died. PA was inversely associated with mortality, with propensity score-adjusted HRs (95% confidence intervals) of 0.84 (0.71-1.01) in insufficiently and 0.73 (0.61-0.88) in sufficiently active participants (ptrend < 0.001). No PA-by-CVD interaction was detected on multiplicative scale (p = 0.36) or additive scale (p = 0.58). A monotonic survival benefit was observed until ∼150 min of PA per week, beyond which no further gain was apparent. CONCLUSIONS: In a nationwide cohort of older adults, nearly 70% did not meet the guideline for PA. PA engagement was inversely associated with long-term mortality risk, similarly in individuals with and without CVD. A maximum survival advantage was achieved at around 150 min of exercise per week.

Comparisons in polypharmacy over a decade in community-dwelling older adults-findings from Israel national health and nutrition surveys.

BACKGROUND: Polypharmacy increases with age and is associated with serious health and economic costs. This study reports changes over a decade in medication-use patterns and polypharmacy, in Israeli community-dwelling older adults aged ≥ 65 years. METHODS: Demographic and health data from two representative national health cross-sectional surveys - MABAT ZAHAV 1 (MZ1) in 2005-2006, and MZ2 in 2014-2015 were analyzed. Polypharmacy was defined as use of ≥ 5 medications. Risk factors for polypharmacy were estimated by multivariable logistic regression with adjusted odds ratios (aOR) and their 95% confidence intervals (CI). RESULTS: Self-reported data on medications taken were available for 1647 participants (91.5%) in MZ1, and for 833 participants (80.2%) in MZ2, 55% women, and about 20% aged ≥ 80, in both surveys. The prevalence of polypharmacy was significantly lower in MZ2 than in MZ1: 64.2% versus 56.3%, p = .0001; with an aOR (95%CI) of 0.64 (0.52, 0.80). The most commonly taken drugs were for hypertension (27.0%, 25.3%), dyslipidemia (9.7%, 12.4%) and anticoagulation (9.2%, 9.8%). For approximately 10% of drugs, indications were either unknown or incorrect. Polypharmacy was significantly associated with poor self-health assessment 2.47 (1.99, 3.06), ≥ 4 versus 1-3 chronic illnesses 6.36 (3.85, 10.50), and age ≥ 80 versus younger 1.72 (1.32, 2.24). Similar associations were observed with major polypharmacy of ≥ 8 medications. CONCLUSION: Polypharmacy, although reduced in the last decade, requires constant attention, especially concerning lack of knowledge of indications which leads to poor adherence and adverse side effects. Health-care teams should carry out regular medicine reconciliation in at-risk elderly patients.

Energy Intake Is Highly Associated with Handgrip Strength in Community-Dwelling Elderly Adults.

BACKGROUND: Handgrip strength (HGS) is used to assess muscle strength, which is an important indicator of health status in older adults. OBJECTIVE: We evaluated associations of demographic, anthropometric, clinical, and nutritional factors with muscle strength in community-dwelling elderly adults. METHODS: This population-based cross-sectional study employed the 2014-2015 Israeli Health and Nutrition Survey in the Elderly (n = 1039, age ≥65 y, 46.7% males, 9.9% Arabs). Trained personnel performed face-to-face interviews that focused on health and nutrition status, as well as anthropometric measurements and examinations. HGS was measured in the dominant hand 3 times using a digital grip strength dynamometer; the highest result was reported. Dietary intake data were collected using single-day 24-h recall. Multivariable logistic regressions were used to explore factors associated with low HGS (<27 kg for men and <16 kg for women). RESULTS: HGS measurements were completed by 704 participants. Following adjustment for several factors, higher prevalence of low HGS was significantly associated with age (OR: 1.14; 95% CI: 1.11, 1.18), whereas decreased prevalence was associated with higher levels of education (OR: 0.55; 95% CI: 0.32, 0.94) and meeting physical activity recommendations (OR: 0.53; 95% CI: 0.31, 0.88); P < 0.05 for all. Incremental increases of 100 kcal/d in energy intake and of 1 cm in midarm circumference were associated with decreased prevalence of low HGS (OR: 0.95; 95% CI: 0.91, 0.99 and OR: 0.91; 95% CI: 0.85, 0.97, respectively; P < 0.01 for both). Associations were not found of low HGS with ethnicity, comorbidity, BMI, smoking, or alcohol consumption or with protein, carbohydrate, or fat intakes. CONCLUSION: Energy intake, physical activity, midarm circumference, and education are associated with HGS in elderly Israeli adults. Further cohort studies are necessary to assess possible causal relations between these factors and HGS. Modifiable factors should be targeted in planning public health strategies for promoting a healthy aging population.

Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016.

PURPOSE: To compare the adherence to the Mediterranean diet (MD) in Israeli adolescents in 2003-4 and in 2015-6, and associated factors. METHODS: Adolescents (aged 11-19 years) from two cross-sectional, school-based, nationally representative surveys, Mabat Youth I (2003-4, n 5005) and II (2015-6, n 3906), completed self-administered questionnaires on food frequency, eating behaviors and lifestyle. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED index), derived from these questionnaires, was used; higher scores indicate better diet quality. The samples comprised eight subgroups, according to population group (Jews/Arabs), school level (middle/high) and sex. RESULTS: The percentages with poor, average and good KIDMED scores were 11.6, 45.3 and 43.1% in 2015-6, compared to 25.5, 55.2 and 19.3%, respectively, in 2003-4. Significant improvement was seen in all subgroups (all p < 0.001), and was attributed to increased consumption of fruits, vegetables, cereals, dairy products, and decreased negative eating behaviors. In Mabat Youth II, physical activity at least 1 h/day was positively associated with good KIDMED scores among Jewish adolescents; dieting and sleeping at least 7 h/day were associated with good MD adherence in Jewish boys; always/often reading food labels predicted good MD adherence among Jewish boys and Arab girls. Overweight and obesity were negatively associated with better KIDMED scores in Jewish boys. CONCLUSION: MD adherence in Israeli adolescents has improved overall. The changes in MD components and the associated behavioral factors indicate the initiatives, relevant to the different subgroups, that are necessary to promote healthier nutrition and lifestyles.

Organophosphate pesticide exposure in children in Israel: Dietary associations and implications for risk assessment.

BACKGROUND: Human biomonitoring (HBM) data is increasingly being compared to risk-based screening values to assess human health risk. However, as screening values have not been established for assessing biomarker concentrations of organophosphate (OP) pesticide metabolites, there are few studies using HBM data on urinary OP concentrations to assess human health risk. The purpose of the current study was to measure OP exposure in a sample of children in Israel; to explore associations between dietary patterns and OP exposure; and to assess risk of OP pesticides using urinary metabolite concentrations. METHODS: We recruited 103 children in Israel and collected demographic and dietary data and urinary samples, and measured creatinine and dialkyl phosphate (DAP) concentrations. We compared urinary DAP concentrations to international populations and analysed associations between fruit and vegetable consumption and urinary DAP concentrations. Using urinary DAP concentrations, we calculated estimated daily intakes (EDI) of OP pesticides in each child and compared those to the acceptable daily intake (ADI). RESULTS: Concentrations of several dialkyl phosphate metabolites (dimethylphosphate (DMP) and dimethylthiophosphate (DMTP)) were higher in our study population of Israeli children (geometric mean concentrations of DMP and DMTP were 6.6 µg/L and 7.6 µg/L, respectively) compared to children in the US, Canada, Spain, and Denmark. We found positive correlations between total fruit consumption and creatinine adjusted log transformed urinary DMP, DMTP, diethylthiophopshate (DETP), total dimethyl (DM) and total DAP concentrations (p < 0.05), positive correlations between cucumber consumption and diethylphosphate (DEP), DETP and diethyl (DE) concentrations (p < 0.05), and positive correlations between apple consumption and DETP concentrations (p = 0.02). Based on urinary DAP concentrations, we found that a portion of the children in our study had EDIs above the ADI, ranging from 2.9% to 79.4% of the children, depending on the active OP ingredient. CONCLUSIONS: We found that Israeli children in our study are widely exposed to OP pesticides; that levels of dimethyl metabolites were high compared to other international populations; and that fruit consumption was associated with higher urinary DAP levels. Using urinary DAP concentration data, we found that a portion of the children in our study may be exposed to OP pesticides at levels above those considered safe.

Loneliness is associated with an increased risk of sedentary life in older Israelis.

OBJECTIVES: Both loneliness and insufficient physical activity are common in old age. This study investigated the association between loneliness and adherence to recommended guidelines of physical activity in a national sample of Israelis, and examined whether loneliness was a risk factor for insufficient physical activity independent of other variables. METHODS: A random sample of 1663 (799 men) older adults aged 65+ reported their physical activity routine, and based on official guidelines were categorized as sufficiently active, insufficiently active, and inactive. In addition, they were divided into lonely or not lonely based on a single question from the Center for Epidemiologic Studies Depression Scale. RESULTS: Chi-square analyses indicated that loneliness, but not living alone, were inversely related to level of physical activity in both genders. Based on multinomial stepwise logistic regressions body mass index, being religious versus secular, self-rated health, and education were associated with engaging in physical activity in men (Cox & Snell R(2) = 0.202). Loneliness contributed significantly to explaining the level of participation in physical activity beyond these variables in women, but not in men (Cox & Snell R(2) = 0.197). CONCLUSIONS: Loneliness is associated with an increasing risk of inactivity in advanced age in women. Further research inquiring into whether loneliness is the cause of reduced physical activity or whether physical activity acts as a protective factor against loneliness is needed. Developing and implementing tailored intervention programs that encourage social interaction in combination with a physical activity program are recommended.

Food Insecurity in Israeli Elderly is Associated with Sociodemographic Characteristics, Disability, and Depression: Policy Implications.

Background: Food insecurity (FI) and poor health can turn into a vicious cycle with detrimental effects, especially in the elderly, however, few studies have examined the relationship between FI and health in this age group. Objectives: We investigated associations of FI with physical and mental health and health behaviors among community-dwelling elderly. Methods: We used nationally representative, cross-sectional data from the 2014-2015 Israel National Health and Nutrition Survey of the Elderly (Rav Mabat Zahav) on FI, sociodemographic characteristics, noncommunicable diseases (NCDs), disability, self-assessed physical, oral, and mental health for 1006 individuals aged ≥65 y. Results: FI affected 12.3% of all households with elderly and was significantly higher among late immigrants and Arabs. Bivariate associations of FI with the number of NCDs, depression, disability in all 6 domains (vision, hearing, mobility, self-care, remembering, communication), poor self-assessed physical and oral health, chewing and swallowing problems, feelings of loneliness, insufficient physical activity, and smoking were significant (P < 0.05). In a multivariable logistic regression controlling for population group, household size, age and sex, FI was significantly associated (P < 0.05) with lack of formal education (OR: 6.26; 95% CI: 1.66, 23.65), being in the lowest (OR: 23.56; 95% CI: 3.71, 149.76) or second-lowest (OR: 16.75; 95% CI: 2.68, 104.52) per capita household income quartile, having one (OR: 2.11; 95% CI: 1.05, 4.23) or several disabilities (OR: 4.04; 95% CI: 1.72, 9.45), and having ever been diagnosed with depression (OR: 3.34; 95% CI: 1.35, 8.28). Conclusions: FI is associated with physical and mental health problems, multiple disabilities, and loneliness among Israeli elderly. Providing income support could reduce FI, and subsidized congregate and home-delivered meal services could be expanded to meet the needs of elderly with disabilities and counter social isolation. Because low education, disability, and depression are particularly prevalent among the food insecure and vulnerable groups face language barriers, assistance with applications for these services should be increased.

Diet Quality and Incident Frailty in Adults 65 Years or Older: The Israeli Longitudinal Study on Aging.

OBJECTIVE: To prospectively examine the association between diet quality and frailty incidence in the oldest-old age group. METHODS: We studied an older adult (65+ years) cohort participating in the Israeli National Health and Nutrition Survey of Older Adults in 2005-2006 (T1 [N=1799]). Survivors of T1 were contacted, and between 2017 and 2019, an extensive interview and a functional assessment were conducted (T2) of 604 past participants. A 24-hour dietary recall, assessed at T1, was used to calculate the Healthy Eating Index (HEI-2015) score. A frailty index based on an accumulation of deficits, including clinical, functional, and cognitive measures, was computed. Frail participants at T1 were excluded from the analysis. Logistic regression models were constructed to assess the association of HEI-2015 score with frailty incidence. Inverse probability weighting was used to minimize selection bias due to attrition. RESULTS: Of the 479 T2 participants analyzed (mean [SD] age, 84 [5] years; 50% women), 225 (46%) were classified as frail. Frail participants were older, were less educated, and had a lower household income and a higher comorbidity burden at baseline than non-frail participants. After adjustment for sociodemographic and lifestyle factors, a higher HEI-2015 score was associated with decreased odds of incident frailty (odds ratio, 0.57 [95% CI, 0.35 to 0.91] for the upper tertile and 0.66 [95% CI, 0.42 to 1.06] for the middle tertile compared with the lower tertile; Ptrend=.02). CONCLUSION: In this cohort study of oldest-old participants, improved diet quality was inversely associated with frailty incidence in a dose-dependent manner.

Association between parental smoking and child exposure to environmental tobacco smoke in Israel.

BACKGROUND: Environmental tobacco smoke (ETS) exposure in children can cause delayed lung development and lifelong cardiovascular damage. The aim of this study was to measure ETS exposure in children in Israel in 2020-2021 using urinary cotinine (UC) measurements and to assess correlates of ETS exposure, including parental smoking. METHODS: In the framework of the National Human Biomonitoring Program, spot urine samples and questionnaire data were collected from 166 children aged 4-12 years, during the years 2020-2021. We collected urine samples in 233 adults, 69 of whom were parents of children included in the study. Parents of participating children were asked about parental smoking, child's exposure to ETS and smoking policy at home. Cotinine and creatinine were measured in urine. Creatinine-adjusted and unadjusted urine cotinine (UC) geometric means were calculated. Associations between potential correlates and UC concentrations were analyzed in univariate and multivariate analyses. For 69 child-parent pairs, correlation between child and parental UC was analyzed. RESULTS: Based on urinary cotinine measurement, 65.2% of children of smokers are exposed to ETS, compared to 20.7% of children in non-smoking families. Greater numbers of smokers living in the home (beta = 1.27, p < 0.01), and low maternal education (beta = - 2.32, p < 0.01) were associated with higher levels of UC in a multivariate analysis. Spearman correlations showed a positive moderate correlation between UC in 69 child-parent pairs (r = 0.52, p < 0.01). CONCLUSIONS: In order to reduce child exposure to ETS, smoking parents should be urgently targeted for smoking cessation and smoke-free home interventions. Further interventions are needed to protect all children from ETS.

Ethnic differences in patterns of secondhand smoke exposure among adolescents in Israel.

INTRODUCTION: Adolescent secondhand smoke exposure (SHSe) is associated with smoking initiation and independently damages health. METHODS: We used data from the school-based 2003-2004 Israel National Health and Nutrition Youth survey (MABAT) to examine patterns and determinants of SHSe in a multiethnic sample of Israeli adolescents. School and child response rates were high (school: 91.8%, child: 87.9%), with 6,274 participants. We used generalized estimating equations to examine SHSe determinants. RESULTS: Most Israeli adolescents were exposed to SHS (total: 85.6%; home: 40%; school: 31.4%; entertainment: 73.3%; other: 16.3%). Exposure patterns differed between the Jewish and non-Jewish sectors. Jews were more frequently exposed at school and entertainment venues than were non-Jews but were less frequently exposed at home. Druze were the least exposed and non-Arab Christians the most exposed. Secular Jews were more exposed than were religious Jews; the opposite was true among Arabs. Children of less-educated fathers were exposed more than children of more-educated fathers. Adolescents who smoked were more exposed than were nonsmokers. CONCLUSIONS: The high levels of SHSe among Israeli adolescents were characterized by different patterns of exposure among different population groups. Interventions to reduce adolescent SHSe, with appropriate tailoring, are urgently needed. These findings provide support for sustainable implementation of the recent governmentally approved tobacco control plan, which includes extended legislation for, and increased enforcement of, laws about smoking bans in schools and entertainment venues. Researchers elsewhere should be aware that levels and patterns of SHSe may vary greatly by subpopulation.

Psychological functioning and adherence to the recommended dose of physical activity in later life: results from a national health survey.

BACKGROUND: Official health organizations have established the dose of physical activity needed for preserving both physical and psychological health in old age. The objective of this study was to explore whether adherence to the recommended criterion of physical activity accounted for better psychological functioning in older adults in Israel. METHODS: A random sample of 1,663 (799 men) Israelis reported their physical activity routine, and based on official guidelines were divided into sufficiently active, insufficiently active, and inactive groups. The General Health Questionnaire (GHQ) was used for assessing mental health and the Mini-Mental State Examination (MMSE) for assessing cognitive functioning. RESULTS: Factor analysis performed on the GHQ yielded two factors - positive and negative. Logistic regressions for the GHQ factors and for the MMSE were conducted for explaining their variance, with demographic variables entered first, followed by health and then physical activity. The explained variance in the three steps was Cox and Snell R2 = 0.022, 0.023, 0.039 for the positive factor, 0.066, 0.093, 0.101 for the negative factor, and 0.204, 0.206, 0.209 for the MMSE. CONCLUSIONS: Adherence to the recommended dose of physical activity accounted for better psychological functioning beyond demographic and health variables; however, the additional explained variance was small. More specific guidelines of physical activity may elucidate a stronger relationship, but only randomized controlled trials can reveal cause-effect relationship between physical activity and psychological functioning. More studies are needed focusing on the positive factor of psychological functioning.

Prediction of standing height among Israeli older adults: results from a national survey.

BACKGROUND: An accurate measurement of full height while standing is sometimes not possible among older adults, in particular among the frail elderly. For such cases, the use of knee height (KH) and ulna bone length (UL) has been suggested for standing height estimation. Studies have shown that predictive equations of height were ethnic-specific. AIM: This study attempted to develop representative equations to predict standing height based on KH, UL and waist circumference (WC) for older adult Israeli women and men. SUBJECTS AND METHODS: A random sample of 1500 older adults (aged 74.48 ± 6.09 years old). Participants were interviewed in their homes and measurements of Standing height, KH, UL and WC were taken. A quadratic regression analysis, for each sex separately, was performed to predict standing height based on age, KH, UL and WC. RESULTS: The adjusted r (2) standing height prediction equations were 0.51 and 0.67 for women and men, respectively. CONCLUSIONS: The prediction of the standing height of frail elderly Israelis, by KH, UL, WC and age, may be an alternative method when actual standing height is difficult or not possible to measure.

Association of Diet Quality With Longevity and Successful Aging in Israeli Adults 65 Years or Older.

Importance: To our knowledge, the role of overall diet quality in successful aging has not been conclusively demonstrated. Objective: To prospectively examine the association between diet quality and longevity and successful aging in a population-based cohort of older adults. Design, Setting, and Participants: Participants in "Mabat Zahav" (the Israeli National Health and Nutrition Survey of Older Adults), an older adult cohort (aged ≥65 years) consisting of a random sample of 1770 individuals, were recruited from July 2005 to December 2006 (time 1 [T1]). Survivors of T1 were again contacted and asked to participate in a second interview. From May 2017 to June 2019 (time 2 [T2]), an extensive face-to-face interview and a functional assessment were conducted in each participant's home in a subsample of 604 participants from T1, representing 72.7% of 820 surviving individuals who were able to complete interviews and assessments. Exposures: A 24-hour dietary recall, assessed at T1, was used to calculate scores from the 2015 version of the Healthy Eating Index (HEI-2015) (scores range from 0 [worst diet] to 100 [best diet]). Main Outcomes and Measures: Time to death, with follow-up lasting through June 2019, and successful aging. The latter, based on T2 assessment, was defined as (objectively measured) preserved physical and cognitive function and (subjective) mental well-being and favorable self-rated health. Inverse probability weighting was used in the analysis to minimize attrition bias. Results: At T1, the study included 1770 participants (mean [SD] age, 74.6 [6.2] years; 943 women [53%]). On average, participants with higher HEI-2015 scores had healthier lifestyles and higher socioeconomic status at T1. During a median follow-up duration of 12.6 years (IQR, 7.6-13.2 years), 893 deaths occurred. Among the 596 T2 participants analyzed (mean [SD] age, 84.1 [4.4] years; 334 [56%] women), 242 (40%) met successful aging criteria. After adjustment for sociodemographic and lifestyle risk factors, a higher HEI-2015 score was inversely associated with mortality (hazard ratios, 0.85; 95% CI, 0.72-0.99 in the upper tertile and 0.83; 95% CI, 0.71-0.98 in the middle tertile vs the lower tertile; P = .04 for trend) and was positively associated with successful aging (odds ratios, 1.73; 95% CI, 1.10-2.72 in the upper tertile and 1.30; 95% CI, 0.83-2.03 in the middle tertile vs the lower tertile; P = .03 for trend). Conclusions and Relevance: In this cohort study of older adults in Israel, improved diet quality was associated with increased longevity and successful aging in a dose-dependent manner. These data contribute to the body of literature that suggests diet quality is associated with aging in the older age group.

An Exercise-Induced Metabolic Shield in Distant Organs Blocks Cancer Progression and Metastatic Dissemination.

Exercise prevents cancer incidence and recurrence, yet the underlying mechanism behind this relationship remains mostly unknown. Here we report that exercise induces the metabolic reprogramming of internal organs that increases nutrient demand and protects against metastatic colonization by limiting nutrient availability to the tumor, generating an exercise-induced metabolic shield. Proteomic and ex vivo metabolic capacity analyses of murine internal organs revealed that exercise induces catabolic processes, glucose uptake, mitochondrial activity, and GLUT expression. Proteomic analysis of routinely active human subject plasma demonstrated increased carbohydrate utilization following exercise. Epidemiologic data from a 20-year prospective study of a large human cohort of initially cancer-free participants revealed that exercise prior to cancer initiation had a modest impact on cancer incidence in low metastatic stages but significantly reduced the likelihood of highly metastatic cancer. In three models of melanoma in mice, exercise prior to cancer injection significantly protected against metastases in distant organs. The protective effects of exercise were dependent on mTOR activity, and inhibition of the mTOR pathway with rapamycin treatment ex vivo reversed the exercise-induced metabolic shield. Under limited glucose conditions, active stroma consumed significantly more glucose at the expense of the tumor. Collectively, these data suggest a clash between the metabolic plasticity of cancer and exercise-induced metabolic reprogramming of the stroma, raising an opportunity to block metastasis by challenging the metabolic needs of the tumor. SIGNIFICANCE: Exercise protects against cancer progression and metastasis by inducing a high nutrient demand in internal organs, indicating that reducing nutrient availability to tumor cells represents a potential strategy to prevent metastasis. See related commentary by Zerhouni and Piskounova, p. 4124.

Dietary Patterns among Adolescents Are Associated with Growth, Socioeconomic Features, and Health-Related Behaviors.

Dietary patterns (DPs), usually established in adolescents, are important modifiable risk factors in the etiology of malnutrition and chronic diseases. This study aimed to identify DPs of adolescents and examine their associations with growth, sociodemographic, and lifestyle characteristics. A nationally representative, school-based, cross-sectional study was conducted in Israeli adolescents aged 11-18 years during 2015-2016. A self-administered survey queried sociodemographics, health behaviors, and diet. Weight and height were measured, and WHO height z-scores and BMI cutoffs were calculated. Food frequency questionnaire data were analyzed using principal components analysis (PCA) to identify DPs. Associations between growth, lifestyle, and sociodemographic characteristics and DPs were modeled using multivariable logistic regressions. A total of 3902 adolescents (46% males, mean age 15.2 ± 1.6 years) completed the survey. PCA identified five DPs, accounting for 38.3% of the total variance. The first two prominent DPs were the 'plant-based food' DP, which was associated with the female sex, higher socioeconomic status, overweight/obesity, and healthy lifestyle and the 'junk food' DP, which was associated with lower SES, unhealthy lifestyle, and lower height z-scores. Our results elucidate major DPs that strongly correlate with lifestyle risk behaviors and suboptimal growth among adolescents. Implementing screening for DPs should be further examined to identify higher risk health factors among youth.

Menarche at an Earlier Age: Results from Two National Surveys of Israeli Youth, 2003 and 2016.

STUDY OBJECTIVE: To assess emergent changes in the age at menarche and investigate associated factors in Israeli adolescents in 2003 and 2016. DESIGN: Cross-sectional study. SETTING: Two national representative school-based surveys (first and second "Mabat Youth"). PARTICIPANTS: Both surveys included female students in 7th-12th grades (ages 11-19 years). The first (N = 3328) was conducted between the years 2003 and 2004, and the second (N = 2535) from 2015 to 2016. INTERVENTIONS: The survey questionnaire was self-administered and anthropometric measurements were performed by trained personnel. MAIN OUTCOME MEASURES: The current age at menarche in Israeli girls was determined and independent factors (demographic, clinical, and lifestyle) examined. Changes that occurred since the past national survey more than a decade ago were documented. RESULTS: The estimated median age at menarche declined from 13.0 (interquartile range, 12.0-14.0) years in 2003-2004 to 12.5 (interquartile range, 12.0-13.0) years in 2015-2016 (P < .0001). Jewish girls reached menarche earlier than Arab girls, but both populations experienced a similar downward trend in the past approximately 14 years. Greater body mass index, higher socioeconomic status, and immigrant status were associated with younger menarche onset (P < .001). Age at menarche remained lower in 2015-2016 vs 2003-2004, even after adjustment for these potential confounders, with a high hazard ratio (HR), which decreased as a function of survival time (t): HRt = 15.417 × 0.813t. CONCLUSION: This study confirms the decline in age at menarche in Israel. Findings were associated with body mass index and population group but also indicated that other factors are likely involved.

Leisure-Time Physical Activity and Cancer Risk Among Older Adults: A Cohort Study.

OBJECTIVE: To examine the association between leisure-time physical activity (LTPA) and long-term cancer risk in a nationwide cohort of older adults. PARTICIPANTS AND METHODS: The cohort comprised participants of a national survey conducted between July 2005 and December 2006, constituting a random sample of Israeli community-dwelling adults aged 65 years or older. Based on self-reported LTPA habits, participants were classified as sufficiently active, insufficiently active, or inactive according to published guidelines. Cancer diagnosis was assessed via the Israeli National Cancer Registry through September 2015. Inverse probability weighted hazard ratios for incident cancer, based on propensity score, were estimated for LTPA categories. RESULTS: Analysis included 1542 participants with no history of cancer at baseline (median [25th-75th percentile] age, 73 years [69-78 years]; 826 [53.6%] women). Inactive participants (n=641 [41.6%]) were more likely to be female, of lower socioeconomic status, and with higher body mass index and poorer perceived health compared with their insufficiently active (n=443 [28.7%]) and sufficiently active (n=458 [29.7%]) counterparts. In the propensity score-weighted synthetic sample, the distribution of measured baseline covariates was similar across LTPA categories. Over a median follow-up of 9 years, 254 new cancer cases (16.5%) were diagnosed. Leisure-time physical activity was inversely associated with incident cancer, with adjusted hazard ratios (95% CIs) of 0.66 (0.46-0.93) in insufficiently active and 0.59 (0.42-0.82) in sufficiently active participants compared with inactive individuals (P value for trend = .002). CONCLUSION: Among older adults, engaging in LTPA, even at lower levels than officially recommended, may have a beneficial effect on primary prevention of cancer.

Disordered eating among Arab and Jewish youth in Israel: the role of eating dinner with the family.

BACKGROUND: Disordered eating (DE), defined as unhealthy eating attitudes and behaviors, is considered a major public health problem among adolescents. Nevertheless, rates of DE among Arab and Jewish adolescents in Israel are still unknown. Furthermore, while previous studies have highlighted the role of frequent family meals as a protective factor against DE, studies examining home family dinners relative to other common dinner options (e.g., eating at home alone, eating out of the home, not eating dinner at all) are largely unavailable. We sought to use representative data of middle and high-school children in Israel in order to identify rates of DE among Arabs and Jews, while examining the relations of home family dinners (vs. other dinner options) with DE. METHODS: A nationally representative school-based survey of 4926 middle and high-school children (11-19 years old) was conducted during 2015-2016. Participants indicated where and with whom they had eaten dinner the day before. The 5-item SCOFF questionnaire was used (> 2 affirmative items were considered a likely case of DE). Height and weight were measured by personnel. RESULTS: DE was more prevalent among girls (29.7%) relative to boys (12.2%), Arabs (25.1%) relative to Jews (19.5%), and older (25.3%) relative to younger (17.6%) adolescents. Arabs were more likely to eat dinner at home with parents/family (chi2 = 10.75, p = .001), or not to eat dinner at all (chi2 = 63.27, p < .001), while Jews were more likely to eat dinner alone (chi2 = 5.37, p = .021) or to eat dinner out of the home (chi2 = 67.65, p < .001). Logistic regressions (stratified by ethnicity and adjusted for gender, age, weight) revealed that family dinners acted as a protective factor against DE, relative to eating out of the home or relative to not eating dinner at all among both ethnic groups, and relative to eating dinner alone among Arabs. CONCLUSION: There are differences between Arab and Jewish adolescents in terms of rates of yesterday's family dinners and DE. Given that eating dinner with the family was linked with lower rates of DE, possible interventions to reduce DE may include educating parents of both Arab and Jewish adolescents regarding the importance of family meals.

Preexisting coronary heart disease and susceptibility to long-term effects of traffic-related air pollution: A matched cohort analysis.

BACKGROUND: Individuals with coronary heart disease are considered susceptible to traffic-related air pollution exposure. Yet, cohort-based evidence on whether preexisting coronary heart disease modifies the association of traffic-related air pollution with health outcomes is lacking. AIM: Using data of four Israeli cohorts, we compared associations of traffic-related air pollution with mortality and cancer between coronary heart disease patients and matched controls from the general population. METHODS: Subjects hospitalized with acute coronary syndrome from two patient cohorts (inception years: 1992-1993 and 2006-2014) were age- and sex-matched to coronary heart disease-free participants of two cycles of the Israeli National Health and Nutrition Surveys (inception years: 1999-2001 and 2005-2006). Ambient concentrations of nitrogen oxides at the residential place served as a proxy for traffic-related air pollution exposure across all cohorts, based on a high-resolution national land use regression model (50 m). Data on all-cause mortality (last update: 2018) and cancer incidence (last update: 2016) were retrieved from national registries. Cox-derived stratum-specific hazard ratios with 95% confidence intervals were calculated, adjusted for harmonized covariates across cohorts, including age, sex, ethnicity, neighborhood socioeconomic status, smoking, diabetes, hypertension, prior stroke and prior malignancy (the latter only in the mortality analysis). Effect-modification was examined by testing nitrogen oxides-by-coronary heart disease interaction term in the entire matched cohort. RESULTS: The cohort (mean (standard deviation) age 61.5 (14) years; 44% women) included 2393 matched pairs, among them 2040 were cancer-free at baseline. During a median (25th-75th percentiles) follow-up of 13 (10-19) and 11 (7-17) years, 1458 deaths and 536 new cancer cases were identified, respectively. In multivariable-adjusted models, a 10-parts per billion nitrogen oxides increment was positively associated with all-cause mortality among coronary heart disease patients (hazard ratio = 1.13, 95% confidence interval 1.05-1.22), but not among controls (hazard ratio = 1.00, 0.93-1.08) (pinteraction = 0.003). A similar pattern was seen for all-cancer incidence (hazard ratioCHD = 1.19 (1.03-1.37), hazard ratioCHD-Free = 0.93 (0.84-1.04) (pinteraction = 0.01)). Associations were robust to multiple sensitivity analyses. CONCLUSIONS: Coronary heart disease patients might be at increased risk for traffic-related air pollution-associated mortality and cancer, irrespective of their age and sex. Patients and clinicians should be more aware of the adverse health effects on coronary heart disease patients of chronic exposure to vehicle emissions.