How will the COVID-19 pandemic shape the future of meat consumption?

Since its recent onset, the COVID-19 pandemic has altered the daily lives of millions around the world. One area particularly affected is our diets, with food supply chain disruptions, media coverage of food safety issues and restaurant closures all influencing consumer dietary behaviour. Given this situation, we pose a timely question - what is the impact of the current pandemic on longer-term meat consumption patterns? This issue is pertinent given accumulating evidence that overconsumption of meat, particularly red meat, is associated with negative environmental and health outcomes. Here, we discuss how the current pandemic has already begun to shift public awareness of illnesses linked to animals and has resulted in short-term changes in patterns of meat consumption. Past zoonotic outbreaks, such as SARS and swine flu, are also referred to, and we find that these led to similar short-term reductions in meat intake, a shift in the type of meat chosen and longer-lasting impacts on consumer perceptions of the health risks associated with meat. We conclude that, if immediate changes in eating patterns as a result of COVID-19 are retained in the longer term, one possible opportunity to emerge from the current pandemic may be a shift away from overconsumption of meat, leading to potential health and environmental benefits in the longer term.

Halal cultivated meat: an untapped opportunity.

The global Halal food market is forecast to reach US$1.67 trillion by 2025, growing to meet the dietary demands of a rapidly increasing Muslim population, set to comprise 30% of the global population by mid-century. Meat consumption levels are increasing in many Muslim countries, with important implications for health and environmental sustainability. Alt protein products are currently being manufactured and positioned as one possible solution to reduce the environmental impact of meat consumption, yet, little is currently known about the Halal status of these products, nor the extent to which they appeal to Muslim consumers in emerging markets in Asia and Africa. Here, we explore key considerations regarding the acceptability of alt protein products for Muslim consumers, explore Halal certification requirements in the context of cultivated meat, and examine some unique beliefs within the Islamic faith that may support, as well as impede, widespread adoption of alt protein among the 2.8 billion Muslims of the future.

Weqaya: a population-wide cardiovascular screening program in Abu Dhabi, United Arab Emirates.

OBJECTIVES: We sought to determine cardiovascular risk factor prevalence rates among adults in Abu Dhabi, United Arab Emirates. METHODS: We used self-reported indicators, anthropometric measures, and blood tests to screen 50 ,138 adults aged 18 years or older taking part in a population-wide cardiovascular screening program. RESULTS: Participants' mean age was 36.82 years (SD = 14.3); 43% were men. Risk factor prevalence rates were as follows: obesity, 35%; overweight, 32%; central obesity, 55%; diabetes, 18%; prediabetes, 27%; dyslipidemia, 44%; and hypertension, 23.1%. In addition, 26% of men were smokers, compared with 0.8% of women. Age-standardized diabetes and prediabetes rates were 25% and 30%, respectively, and age-standardized rates of obesity and overweight were 41% and 34%. CONCLUSIONS: This population-wide cardiovascular screening program demonstrated a high cardiovascular burden for our small sample in Abu Dhabi. The data form a baseline against which interventions can be implemented and progress monitored as part of the population-wide Abu Dhabi Cardiovascular Disease Program.

A profile and approach to chronic disease in Abu Dhabi.

As a country, the United Arab Emirates has developed very rapidly from a developing country with a largely nomadic population, to a modern and wealthy country with a Western lifestyle. This economic progress has brought undoubted social benefits and opportunities for UAE citizens, including a high and increasing life expectancy. However, rapid modernization and urbanization have contributed to a significant problem with chronic diseases, particularly obesity-related cardiovascular risk. In response the Health Authority of Abu Dhabi has significantly strengthened its data systems to better assess the baseline and measure the impact of targeted interventions. The unique population-level Weqaya Programme for UAE Nationals living in Abu Dhabi has recruited more than 94% of adults into a screening programme for the rapid identification of those at risk and the deployment of targeted interventions to control that risk. This article describes the burden of non-communicable disease in Abu Dhabi, and the efforts made by the Health Authority of Abu Dhabi to tackle this burden including the development of a whole population cardiovascular screening programme changes to health policy, particularly in terms of lifestyle and behaviour change, and empowerment of the community to enable individuals to make healthier choices. In addition, recommendations have been made for global responsibility for tackling chronic disease.

Barriers to breast cancer screening and treatment among women in Emirate of Abu Dhabi.

OBJECTIVES: The objectives of this study were to explore attitudes and beliefs among major national groups of women resident in the Emirate of Abu Dhabi (EAD) in relation to breast cancer screening and treatment. DESIGN: A qualitative study utilizing age and nationality specific focus group discussions and interviews in all parts of EAD. SETTING: Study was conducted among women living in various areas of EAD during April-September 2009. PARTICIPANTS: A total of 329 participants divided into four nationality groups and categorized into two functional groups (well women and regular screeners) were included in this study and participated in 46 focus groups and 30 personal interviews. RESULTS: Some differences in beliefs, perceptions and opinions related to stated causes of breast cancer, preferences regarding breast care services, financial considerations, trust in health services and cultural attitudes towards breast cancer were observed across nationality and age groups. CONCLUSIONS: New information has been obtained that will shape more focused awareness messages, emphasizing on decreasing fear and shame, discouraging use of cauterization and herbal preparations in delaying care, and activating the role of older female peers in favor of breast screening. Ensuring a sufficient number of trained female health care providers and devising creative approaches to ensure preventive health care costs to reimburse non-nationals are structural changes to the health care system which may further improve breast health for all women in EAD.

Analysis of common methodological flaws in the highest cited e-cigarette epidemiology research.

The prevalence of vaping, also known as using e-cigarettes, vapes and vape pens, has prompted a demand for reliable, evidence-based research. However, published literature on the topic of vaping often raises concerns, characterized by serious flaws and a failure to adhere to accepted scientific methodologies. In this narrative review, we analyze popular vaping studies published in medical journals that purport to evaluate the association of vaping and smoking cessation, smoking initiation or health outcomes. We analyzed 24 included studies to identify the questions they claimed to address, stated methods, manner of implementation, discussions, and stated conclusions. After critical appraisal, we noted a multiplicity of flaws in these studies, and identified patterns as to the nature of such flaws. Many studies lacked a clear hypothesis statement: to the extent that a hypothesis could be inferred, the methods were not tailored to address the question of interest. Moreover, main outcome measures were poorly identified, and data analysis was further complicated by failure to control for confounding factors. The body of literature on "gateway" theory for the initiation of smoking was particularly unreliable. Overall, the results and discussion contained numerous unreliable assertions due to poor methods, including data collection that lacked relevance, and assertions that were unfounded. Many researchers claimed to find a causal association while not supporting such findings with meaningful data: the discussions and conclusions of such studies were, therefore, misleading. Herein, we identify the common flaws in the study design, methodology, and implementation found in published vaping studies. We present our summary recommendations for future vaping research. Our aim is to prompt future researchers to adhere to scientific methods to produce more reliable findings and conclusions in the field of vaping research.

A scoping review of studies on the health impact of electronic nicotine delivery systems.

We conducted a scoping review of studies on health outcomes from electronic nicotine delivery systems (ENDS). The objective was to identify, narratively synthesize, assess the strength and quality of evidence and critically appraise studies that have reported disease end points associated with the use of ENDS. We included published literature on the health impact of ENDS from 01/01/2015 until 01/02/2020 following the PRISMA guidelines using PubMed, Embase, Scopus and Google Scholar. The database search identified 755 studies, and other sources 265; 37 studies met final eligibility criteria. Levels of evidence included 24(65%) cross-sectional, one (2.7%) case-control and six (16%) case studies, four (11%) cohort studies, one (2.7%) randomized controlled trial (RCT) and one (2.7%) meta-analysis; 27(73%) studies reported only on harms, eight (22%) reported on benefits, two (2%) on benefits and harms. Quality ratings were poor in 20 (54%), fair in 9(24%) and good in 8(22%) of studies. In our review, ENDS was not shown to be causative for harmful cardiovascular disease (CVD) outcomes and shown to be beneficial for hypertensive patients. Switching from cigarettes to e-cigarettes resulted in reduced exacerbations of chronic obstructive pulmonary disease (COPD), with no evidence of long-term deterioration in lung function. Mental Health, cancer and mortality were not adequately studied to form any consensus. Our review has not demonstrated ENDS to be causative of harmful CVD outcomes; furthermore switching from cigarettes to e-cigarettes was associated with improved hypertensive control and reduced exacerbations of COPD, with no evidence of increased asthma risk or long-term respiratory harm. Mental health, cancer and mortality outcomes have not been adequately studied to form a conclusion. Overall, the findings of our review did not provide evidence to counter the consensus held by many that ENDS use is safer than the risks posed from smoking cigarettes.

Genome-wide association study identifies genes for biomarkers of cardiovascular disease: serum urate and dyslipidemia.

Many common diseases are accompanied by disturbances in biochemical traits. Identifying the genetic determinants could provide novel insights into disease mechanisms and reveal avenues for developing new therapies. Here, we report a genome-wide association analysis for commonly measured serum and urine biochemical traits. As part of the WTCCC, 500,000 SNPs genome wide were genotyped in 1955 hypertensive individuals characterized for 25 serum and urine biochemical traits. For each trait, we assessed association with individual SNPs, adjusting for age, sex, and BMI. Lipid measurements were further examined in a meta-analysis of genome-wide data from a type 2 diabetes scan. The most promising associations were examined in two epidemiological cohorts. We discovered association between serum urate and SLC2A9, a glucose transporter (p = 2 x 10(-15)) and confirmed this in two independent cohorts, GRAPHIC study (p = 9 x 10(-15)) and TwinsUK (p = 8 x 10(-19)). The odds ratio for hyperuricaemia (defined as urate >0.4 mMol/l) is 1.89 (95% CI = 1.36-2.61) per copy of common allele. We also replicated many genes previously associated with serum lipids and found previously recognized association between LDL levels and SNPs close to genes encoding PSRC1 and CELSR2 (p = 1 x 10(-7)). The common allele was associated with a 6% increase in nonfasting serum LDL. This region showed increased association in the meta-analysis (p = 4 x 10(-14)). This finding provides a potential biological mechanism for the recent association of this same allele of the same SNP with increased risk of coronary disease.

Incidence of aetiological subtypes of stroke in a multi-ethnic population based study: the South London Stroke Register.

BACKGROUND: Stroke risk is higher in black ethnic groups compared with white. Although risk factors for stroke are known to differ between these populations, few population studies have reported on the risk of aetiological stroke subtypes in black ethnic populations. METHODS: Ethnic group differences in incidence of first ever ischaemic stroke by aetiological subtype were investigated with the South London Stroke Register (SLSR). The SLSR is a population based stroke register covering a multi-ethnic inner city population of 271,871 inhabitants comprising 63% white, 28% black and 9% other ethnic group. A modified pathophysiological Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification of stroke was used to estimate patterns of aetiological subtype and stroke was subtyped into large artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), other aetiology (OTH), undetermined (UND) and multiple possible or concurrent aetiologies (CONC). RESULTS: Between September 1999 and August 2006, 1181 patients with first ever ischaemic stroke were included in the study. Mean age was 71.4 years, 51% were female and 71% were white patients, 20% were black patients, 6% were other and 3% were of unknown ethnic group. The distribution of the aetiological subtypes was as follows: LAA, 109 (9.3%); CE, 325 (27.8%); SVO, 316 (27.0%); OTH, 40 (3.4%); UND, 283 (24.2%) and CONC, 96 (8.2%). The annual age adjusted incidence rate per 100,000 was for total ischaemic stroke 101.2 (95% CI 82.4 to 122.9) in men and 75.1 (95% CI 59.1 to 94.1) in women; for LAA 10.4 (95% CI 5.1 to 18.9) in men and 6.8 (95% CI 2.7 to 14.2) in women; for CE 23.0 (95% CI 14.6 to 34.5) in men and 21.5 (95% CI 13.4 to 32.8) in women; and for SVO 30.3 (95% CI 20.5 to 43.2) in men and 20.3 (95% CI 12.5 to 31.3) in women. The overall incidence rate ratio (IRR) for black patients was 1.25 (1.07 to 1.46), for black Caribbean (BC) patients 1.31 (1.09 to 1.58), for black African (BA) patients 1.22 (0.93 to 1.61) and for other ethnic groups 1.24 (0.96 to 1.61). IRRs for black ethnic groups as well as for BA and BC were significantly higher for SVO in both sexes, for OTH in black patients for females and in BA for males and females compared with the white ethnic group; IRRs for other ethnic groups compared with white patients were higher for SVO in females and for UND in males. INTERPRETATION: Independent important differences in risk of stroke between different ethnic populations strengthen the evidence base for studying genetic susceptibility and environmental influences in ethnic groups separately.

Communicating health through health footprints.

The depth and scale of challenges posed by noncommunicable diseases such as diabetes mellitus and cardiovascular disease are now well known and clearly documented. Reducing the 4 key risk factors has been shown to reduce premature mortality and morbidity by 70% globally. The authors consider how affirmative action can be driven to reduce these risk factors through Health Footprints, targeted interventions within specific domains of consumption, on the basis of an assessment of the negative health effect of specific choices, with the goal of driving healthy choices and improving health. In this article, the authors propose a methodology that ties together insight from public health, behavioral economics, marketing, and health communication. They offer 3 specific examples for affirmative action: a Pigovian tax on unhealthy foods, group-level interventions on the basis of sharing key health data, and personalized prevention tailored to specific individuals. In addition, they discuss the approach to implementation, including the role of an apex coordinating organization in setting standards for data and ethics, and evaluation of the effect of interventions to drive continuous improvement.

Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Study.

Objective: To investigate healthcare costs and contributors to costs for multiple chronic conditions (MCCs), common clusters of conditions and their impact on cost and utilization. Methods: This was a cross-sectional analysis of US financial claims data representative of the US population, including Medicare, Medicaid, and Commercial insurance claims in 2015. Outcome measures included healthcare costs and contributors; ranking of clusters of conditions according to frequency, strength of association and unsupervised (k-means) analysis; the impact of clustering on costs and contributors to costs. Results: Of 1,878,951 patients, 931,045(49.6%) had MCCs, 56.5% weighted to the US population. Mean age was 53.0 years (SD16.7); 393,121(42.20%) were male. Mean annual healthcare spending was $12,601, ranging from $4,385 (2 conditions) to $33,874 (11 conditions), with spending increasing by 22-fold for inpatient services, 6-fold for outpatient services, 4.5-fold for generic drugs, and 4.2-fold for branded drugs. Cluster ranking using the 3 methodologies yielded similar results: highest ranked clusters included metabolic syndrome (12.2% of US insured patients), age related diseases (7.7%), renal failure (5.6%), respiratory disorders (4.5%), cardiovascular disease(CVD) (4.3%), cancers (4.1-4.3%), mental health-related clusters (1.0-1.5%), and HIV/AIDS (0.2%). Highest spending was in HIV/AIDS clusters ($48,293), mental health-related clusters ($38,952-$40,637), renal disease ($38,551), and CVD ($37,155); with 89.9% of spending on outpatient and inpatient care combined, and 10.1% on medication. Conclusion and Relevance: Over 57% of insured patients in the US may have MCCs. MCC Clustering is frequent and is associated with healthcare utilization. The findings favor health system redesign toward a multiple condition approach for clusters of chronic conditions, alongside other cost-containment measures for MCCs.

The novel genetic variant predisposing to coronary artery disease in the region of the PSRC1 and CELSR2 genes on chromosome 1 associates with serum cholesterol.

Through genome-wide association studies, we have recently identified seven novel loci that confer a substantial increase in risk for coronary artery disease (CAD). Elucidating the mechanisms by which these loci affect CAD risk could have important clinical utility. Here, we investigated whether these loci act through mechanisms involving traditional cardiovascular risk factors. We genotyped 2,037 adult individuals from 520 nuclear families characterised for body mass index, waist-hip ratio, 24-h ambulatory blood pressure, total cholesterol, high-density lipoprotein cholesterol and glucose for the lead single nucleotide polymorphisms (SNPs) in the seven CAD-associated loci. SNP rs599839, representing the locus in the vicinity of the PSRC1 and CELSR2 genes on chromosome 1p13.3, showed a strong association with total cholesterol. The CAD-associated risk allele A of rs599839 (allele frequency 0.78) was associated with a 0.17-mmol/l (95% CI 0.10 to 0.24 mmol/l) higher serum cholesterol level per allele copy (P = 3.84 x 10(-6)). The association of the A allele with higher total cholesterol was confirmed in an independent cohort (n = 847) of healthy adults (P = 1.0 x 10(-4)) and related to an effect on low-density lipoprotein (LDL) cholesterol (P = 8.56 x 10(-5)). An association of rs599839 with LDL cholesterol was also shown in 1,090 cases with myocardial infarction (P = 0.0026). None of the other variants showed a strong association with the measured cardiovascular risk factors, suggesting that these loci act through other mechanisms. However, the novel CAD-associated locus in the vicinity of the PSRC1 and CELSR2 genes on chromosome 1 probably enhances CAD risk through an effect on plasma LDL cholesterol. The findings support further investigation of the role of these genes in cholesterol metabolism and coronary risk.

Physical activity is associated with improvements in other lifestyle behaviours.

INTRODUCTION: We tested whether physical activity (PA) engagement is subsequently associated with additional health-promoting behaviours in a large-scale, real-world programme leveraging technology and behavioural science to reward healthy lifestyle behaviours. METHODS: In this observational, longitudinal study, we compared participants' verified and self-reported health behaviours prior to and following their first verified engagement in PA recorded on the Vitality programme between 2014 and 2017. RESULTS: Of 34 061 participants, the mean duration in the programme was 40.1 (SD 12.6) months, and the median time until the first PA was 13.1 (SD 16.6) months, with a mean age of 42.0 (SD 11.1) years and 14 881 (43.7%) being male. Baseline weekly PA minutes were mean 62.8 (SD 129.7), 98 (SD 26.0) and 282.9 (SD 230.0) for the low, moderate and high groups, respectively. In the 12 months following the first PA, the low group increased weekly active minutes by 156% (40 (95% CI 28.6 to 51.0) to 102 (95% CI 94.5 to 109.8)); the moderate group increased weekly active minutes by 60% (85.0 (95% CI 76.4 to 93.5) to 136 (95% CI 130.2 to 141.8)); and no change was seen for the high group. Overall, individuals exhibited an increase of 26% in their weekly active minutes from an average of 130 min (95% CI 121.2 to 139.4) to 164 min (95% CI 157.5 to 169.8). Overall, fruit and vegetable daily servings increased from 2.7 (95% CI 2.6 to 2.8) to 2.9 (95% CI 2.9 to 3.0); Kessler Stress Scores decreased from 17.4 (95% CI 17.2 to 17.6) to 17.0 (95% CI 16.9 to 17.1); sedentary hours decreased from 11.3 (95% CI 11.1 to 11.5) to 10.8 (95% CI 10.7 to 11.0); alcohol consumption decreased from 1.8 (95% CI 1.7 to 2.0) to 1.6 (95% CI 1.5 to 1.7) weekly units; sleep increased with borderline significance from 7.1 (95% CI 7.06 to 7.16) to 7.2 (95% CI 7.13 to 7.20) hours/night. CONCLUSIONS: PA and other health-promoting behaviours improved in parallel. PA was followed by improvements in other health-promoting behaviour.

The impact of short-term incentives on physical activity in a UK behavioural incentives programme.

This observational study investigates whether the provision of ongoing short-term-incentives for verified physical activity increases and sustains levels of physical activity. We compared UK members at baseline (years 1 and 2) prior to Vitality's Active Rewards (VAR) intervention commencing (year 3) and follow-up (year 4) for verified, self-reported (encompassing additional physical activities), mortality relative risk and satisfaction with physical activity. Members were categorised into low-active, medium-active and high-active by tertiles of baseline physical activity. Of 11,881 participants, 6477(54.5%) were male, with mean age 39.7(SD 9.8) years. At follow-up, annual active days had increased by 56% overall [60.8(59.7-61.9)-94.8(93.0-96.5)]; 554% in low-active [8.5(8.3-8.7)-47.1(44.7-49.5)]; 205% in medium-active [39.8(39.4-40.2)-81.4(78.7-84.1)] and 17% in high-active members [131.7(129.9-133.5)-153.7(150.7-156.7)] (all p < 0.001). Annual weeks of attaining international physical activity recommendations increased by 19% overall [22.2(42.8%)-26.4(50.8%)] and by 316% for low-active members [4.9(9.5%)-15.5(29.8%)]. Self-reported active minutes/week increased by 45% overall [1423(139.4-145.2)-207.0(201.8-212.3)] and 712% in low-active members [20.1(19.3-21.0)-143.2(134.6-151.9)]. Happiness with exercise levels also increased from 1985(49.4%) to 3414(84.9%) members (all p < 0.001). The relative risk of mortality from a lack of physical activity reduced by 7% for low-active members [from 0.99 to 0.92], 5% for medium-active [0.94-0.89] and 3% for high-active [0.89-0.86](p < 0.001) and by 0.02% for each additional year of age (p = 0.02). This large-scale, real-world, short-term-incentives intervention led to a dramatic increase in physical activity which was sustained for, and still increasing after, two years. If applied at broader level, this approach could considerably aid progress towards WHO targets in its Global Action Plan for Physical Activity.

Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns.

OBJECTIVE: To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN: Retrospective cross-sectional study. SETTING: Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS: 192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS: We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS: 61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS: In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

The global burden of multiple chronic conditions: A narrative review.

Globally, approximately one in three of all adults suffer from multiple chronic conditions (MCCs). This review provides a comprehensive overview of the resulting epidemiological, economic and patient burden. There is no agreed taxonomy for MCCs, with several terms used interchangeably and no agreed definition, resulting in up to three-fold variation in prevalence rates: from 16% to 58% in UK studies, 26% in US studies and 9.4% in Urban South Asians. Certain conditions cluster together more frequently than expected, with associations of up to three-fold, e.g. depression associated with stroke and with Alzheimer's disease, and communicable conditions such as TB and HIV/AIDS associated with diabetes and CVD, respectively. Clusters are important as they may be highly amenable to large improvements in health and cost outcomes through relatively simple shifts in healthcare delivery. Healthcare expenditures greatly increase, sometimes exponentially, with each additional chronic condition with greater specialist physician access, emergency department presentations and hospital admissions. The patient burden includes a deterioration of quality of life, out of pocket expenses, medication adherence, inability to work, symptom control and a high toll on carers. This high burden from MCCs is further projected to increase. Recommendations for interventions include reaching consensus on the taxonomy of MCC, greater emphasis on MCCs research, primary prevention to achieve compression of morbidity, a shift of health systems and policies towards a multiple-condition framework, changes in healthcare payment mechanisms to facilitate this change and shifts in health and epidemiological databases to include MCCs.

Preventive Interventions for the Second Half of Life: A Systematic Review.

OBJECTIVE: Recent improvements in life expectancy globally require intensified focus on noncommunicable diseases and age-related conditions. The purpose of this article is to inform the development of age-specific prevention guidelines for adults aged 50 and above, which are currently lacking. DATA SOURCE: PubMed, Cochrane database, and Google Scholar and explicit outreach to experts in the field. STUDY INCLUSION AND EXCLUSION CRITERIA: Meta-analyses, intervention-based, and prospective cohort studies that reported all-cause mortality, disease-specific mortality, or morbidity in adults were included. DATA EXTRACTION: A systematic review was undertaken in 2015 using search terms of a combination of and "intervention," "mortality," "reduction," "improvement," "death," and "morbidity." DATA SYNTHESIS: Interventions were categorized according to the Center for Evidence-Based Medicine Level of Evidence framework. RESULTS: A summary table reports for each intervention the impact, strength of evidence, initiation, duration, and details of the intervention. Age-decade-specific preventive recommendations have been proposed relating to physical activity, diet, tobacco and alcohol use, medication adherence, screening and vaccination, and mental and cognitive health. CONCLUSION: Clear recommendations have been made according to the existing evidence base, but further research investment is needed to fill the many gaps. Further, personalized approaches to healthy aging complemented by population-wide approaches and broader cross-sector partnerships will help to ensure greater longevity is an opportunity, rather than a burden, for society.

Health and Well-Being Metrics in Business: The Value of Integrated Reporting.

OBJECTIVE: Health and well-being (HWB) are material to sustainable business performance. Yet, corporate reporting largely lacks the intentional inclusion of HWB metrics. This brief report presents an argument for inclusion of HWB metrics into existing standards for corporate reporting. METHODS AND RESULTS: A Core Scorecard and a Comprehensive Scorecard, designed by a team of subject matter experts, based on available evidence of effectiveness, and organized around the categories of Governance, Management, and Evidence of Success, may be integrated into corporate reporting efforts. CONCLUSIONS: Pursuit of corporate integrated reporting requires corporate governance and ethical leadership and values that ultimately align with environmental, social, and economic performance. Agreement on metrics that intentionally include HWB may allow for integrated reporting that has the potential to yield significant value for business and society alike.