Time trends in liver cancer mortality rates in Montenegro from 1990 to 2018.

OBJECTIVE: Liver cancer is the third most common cause of cancer-related deaths worldwide. Hepatitis B and C infections are the main factors affecting mortality. During recent years, Montenegro conducted activities on eradication of viral hepatitis according to the global strategy for the primary prevention of liver cancer mortality. The objective of this study was to assess the liver cancer mortality trend in Montenegro for the period of 1990-2018 using regression techniques. METHODS: liver cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age standardized to the World Standard Population. The joinpoint, linear and Poisson regressions were used to assess liver cancer mortality trends both overall and gender specific. RESULTS: The mortality trend was constant, with no significant increase or decrease in mortality rates both at the overall level and by gender. The number of cases, however, increases significantly at the overall level by an average of 1.4% per year [average annual percentage change (AAPC) (95% confidence interval, CI): 1.4 (0.5-2.3); P  = 0.004] and in women by 1.9% per year [AAPC (95% CI): 1.9 (0.8-3.1); P  = 0.002]. In men, there was no change in the number of cases. The three age groups most burdened by mortality from liver cancer were 65-74 (34.9%), 75-84 (26.6%) and 55-64 (25.8%). CONCLUSION: The consistent implementation of prevention measures and hepatitis virus infection treatment has played a role in partially favorable liver cancer mortality trends in Montenegro. It is crucial to closely monitor guidelines for this cancer and give particular attention to the elderly population as the most affected.

Trends in gastric cancer mortality in Montenegro, 1990 - 2018: joinpoint regression.

Background Gastric cancer (GC) remains a significant global public health problem, despite the decreasing trends in GC mortality rates in the last five decades. Our study aimed to examine the pattern of GC mortality in Montenegro between 1990 and 2018 and to contribute to the future designing a national long-term strategy for the control and prevention of GC. Methods Gastric cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age-standardized to the World Standard Population for estimating both the overall and gender-specific trends. The joinpoint regression model was used to assess GC mortality and identified significant changes in the linear time trend. Linear and Poisson regressions were also applied for additional trend analyses. Results Joinpoint regression reveals a statistically significant decrease in the age-standardized rate for the overall level, on average by 1.4% per year (AAPC (95% IP)= -1.4 (-2.4)-(-0.4); P= 0.007), which was due to a decrease in the age-standardized rate in men with an average annual change of -1.8% (AAPC (95% IP)= -1.8 (-2.9)-(-0.6); P=0.003), while in women the rates were stable (p=0.565). The results for age groups indicate that a decline was registered at the overall level, and among men, as a consequence of the trend of decreasing age-specific rates for the age group 55-64 on average annually by 2% among men (AAPC (95% IP)= -2 ((-3.8)-(-0.1)); P=0.035), and for the overall level (AAPC (95% IP)= -2 ((-3.7)-(-0.3)); P=0.026). Conclusions Our findings indicate a noteworthy decline in age-standardized overall GC mortality rates among men in Montenegro, while rates for women have remained constant. National strategies to further reduce mortality rates for GC are necessary.

CARDIOMETABOLIC RISK AMONG MONTENEGRIN URBAN CHILDREN IN RELATION TO OBESITY AND GENDER.

Considering previously reported discrepant results in the literature, we aimed to investigate the impact of gender and overweight/obesity on cardiometabolic risk (CMR) among Montenegrin urban children. The cross-sectional study included random sample of 201 schoolchildren aged 7-12 years (64% of boys) from Podgorica. Children's nutritional status was determined according to the International Obesity Task Force criteria. CMR was assessed using a sum of z values of the following five indicators: glucose, total cholesterol, inverted value of high-density lipoprotein cholesterol, triglycerides, and hypertension. Higher CMR was found among both overweight and obese boys compared to normal weight boys (p<0.001). The effect size of the difference in CMR between overweight and obese girls and normal weight counterparts was less prominent (p<0.05). Logistic regression analysis revealed that body mass index was independent predictor of high CMR [odds ratio (OR)=1.06; 95% confidence interval (CI)=1.02-1.10); p=0.002]. On the contrary, we found no impact of socioeconomic status, physical activity or sedentary time on CMR in the examined cohort of schoolchildren. In conclusion, both overweight and obesity even among young population are related to higher CMR and this effect is more prominent among boys as compared to girls.

Relationship between insulin-like growth factor-1, insulin resistance and metabolic profile with pre-obesity and obesity in children.

OBJECTIVES: Childhood obesity is a serious medical condition with alarmingly high rates worldwide. There is controversy regarding the relationship between insulin-like growth factor-1 (IGF-1) and pediatric obesity. We investigated the relationship between IGF-1, insulin resistance and metabolic profile with childhood pre-obesity/obesity. METHODS: The study involved 201 children aged 7-15 years, divided in three groups according to their nutritional status (International Obesity Task Force criteria): normal-weight (n=84), pre-obese (n=82), obese (n=35). Laboratory IGF-1, insulin, fasting blood glucose (FBG), lipid profile, alanine-aminotransferase (ALT), uric acid (UA), anthropometric and body composition parameters were analyzed. Body mass index and IGF-1 standard deviation score (SDS), waist-to-height ratio (WtHR) and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score were calculated. RESULTS: Pre-obese/obese children had significantly higher IGF-1 SDS, FBG, insulin, HOMA-IR, UA, ALT, triglycerides, and lower high-density lipoprotein cholesterol (HDL-c); obese group had higher WtHR and low-density lipoprotein cholesterol (LDL-c) compared to controls (p<0.05). In obese group, IGF-1 SDS was positively correlated with fat free/muscle mass, total body water (p<0.05) and negatively correlated with LDL-c (p<0.05). In pre-obese/obese HOMA-IR and insulin were positively correlated with age, total body fat (TBF) (p<0.05) and negatively correlated with HDL-c (pre-obese) (p<0.05). Multivariate ordinal logistic regression analyses showed that IGF-1 SDS (OR=1.94; 95%CI: 1.21-3.11), TBF (OR=1.37; 95%CI: 1.21-1.54) were predictors of nutritional status (p<0.001). FBG (OR=42.39; 95%CI: 2.31-77.2) and UA (OR=1.03; 95%CI: 1.01-1.05) were predictors of IR (p<0.001). CONCLUSIONS: IGF-1 SDS and TBF were predictors of nutritional status. Further studies are required to clarify the role of IGF-1 in pathophysiology of obesity and its comorbidities.

Association between inflammation, oxidative stress, vitamin D, copper and zinc with pre-obesity and obesity in school children from the city of Podgorica, Montenegro.

Background Childhood obesity is a serious health condition with increasing rates worldwide. The aim of this study was to investigate the association between inflammation, oxidative stress, vitamin D, copper and zinc in pre-obese and obese children compared to controls. Methods The study involved 202 children aged 7-15 years (63.9% boys), randomly chosen from 10 elementary schools in Podgorica, Montenegro. Participants were divided into three groups according to their nutritional status (International Obesity Task Force [IOTF] criteria): normal-weight (42.1%), pre-obese (40.6%) and obese (17.3%). Serum biochemical analyses were performed (C-reactive protein [CRP], retinol-binding protein [RBP], total antioxidant status [TAS], total vitamin D [VD], copper and zinc). Results Serum TAS and CRP concentrations were higher in pre-obese and obese children compared to controls (p < 0.001). Serum VD concentrations were lower in pre-obese and obese children compared to their normal-weight peers (p = 0.027 and p = 0.054, respectively). Copper, zinc and RBP concentrations did not differ significantly among the groups (p > 0.05). In pre-obese and obese children, a positive correlation was found between CRP and copper (r = 0.305, p = 0.011 and r = 0.440, p = 0.013, respectively), and TAS and RBP (r = 0.528, p < 0.001 and r = 0.434, p = 0.015, respectively). Standard regression analyses showed that CRP and TAS increase (p < 0.001) whereas VD decreases (p = 0.011) with the body mass index (BMI). Conclusions We show that pre-obesity and obesity in childhood are positively associated with oxidative stress and inflammation, and inversely associated with VD status. Copper and zinc concentrations were not associated with excess fat in children.

Prevalence of and contributing factors for overweight and obesity among Montenegrin schoolchildren.

BACKGROUND: Newly emerging Western style economic systems provide new opportunities to study the prevalence and predictors of childhood obesity. We also provide for the first time a national study of childhood obesity using all three international anthropometric criteria. METHODS: The sample included 4097 Montenegrin children, 2076 boys (50.7%) and 2021 girls. Anthropometric measurements were performed in school. The questionnaire for parents included questions on 24 potential contributing factors for childhood obesity. Nutritional status was assessed according to World Health Organization, US Center for Disease Prevention and Control and International Obesity Task Force (IOTF) criteria. RESULTS: Overall percentage of Montenegrin children who are overweight or obese (IOTF) is 22.9% of which 5.3% are obese (7.0% boys vs. 3.5% girls). We found 10 factors to be independently associated with child obesity. Positive relations [odds ratio (95% confidence interval)] were found with maternal obesity [2.05 (1.68-2.51)], paternal obesity [1.67 (1.32-2.10)], paternal employment [1.40 (1.12-1.74)], maternal smoking [1.32 (1.08-1.61)], obesity at birth [1.33 (1.04-1.70)] and computer game playing [per hour--1.11 (1.00-1.24)]. Negative relations were found with female gender [0.64 (0.53-0.78)], the number of siblings [0.88 (0.78-0.98)], birth order [0.73 (0.64-0.83)] and age [0.92 (0.88-0.98)]. CONCLUSION: One out of four Montenegrin children is overweight, with two times more frequent obesity among boys compared with girls. Some previously salient predictors did not appear salient in this sample. To enable worldwide comparability, we propose the use of all three childhood obesity criteria in national studies.

Blood pressure among rural Montenegrin children in relation to poverty and gender.

BACKGROUND: Health inequalities may begin during childhood. The aim of this study was to investigate the main effect of poverty and its interactive effect with gender on children's blood pressure. METHODS: The study was performed in two elementary schools from a rural region near Podgorica, the capital of Montenegro. A questionnaire including questions on family monthly income, children's physical activity and the consumption of junk food was self-administered by parents of 434 children (223 boys and 211 girls) aged 6-13 years. Children's poverty level was assessed using the recommendations from the National Study on Poverty in Montenegro. Children's body weight and height were measured and body mass index-for-gender-and-age percentile was calculated. An oscillometric monitor was used for measurement of children's resting blood pressure in school. RESULTS: A two-factorial analysis of variance with body mass index percentile, physical activity and junk food as covariates showed an interaction of gender and poverty on children's blood pressure, pointing to synergy between poverty and female gender, with statistical significance for raised diastolic pressure (F = 5.462; P = 0.021). Neither physical activity nor the consumption of junk food explained the interactive effect of poverty and gender on blood pressure. CONCLUSION: We show that poverty is linked to elevated blood pressure for girls but not boys, and this effect is statistically significant for diastolic pressure. The results are discussed in the light of gender differences in stress and coping that are endemic to poverty.