Danijela Gasevic

Global and regional estimates of COPD prevalence: Systematic review and meta-analysis

Background The burden of chronic obstructive pulmonary disease (COPD) across many world regions is high. We aim to estimate COPD prevalence and number of disease cases for the years 1990 and 2010 across world regions based on the best available evidence in publicly accessible scientific databases. Methods We conducted a systematic search of Medline, EMBASE and Global Health for original, population–based studies providing spirometry–based prevalence rates of COPD across the world from January 1990 to December 2014. Random effects meta–analysis was conducted on extracted crude prevalence rates of COPD, with overall summaries of the meta–estimates (and confidence intervals) reported separately for World Health Organization (WHO) regions, the World Banks income categories and settings (urban and rural). We developed a meta–regression epidemiological model that we used to estimate the prevalence of COPD in people aged 30 years or more. Findings Our search returned 37u2009472 publications. A total of 123 studies based on a spirometry–defined prevalence were retained for the review. From the meta–regression epidemiological model, we estimated about 227.3 million COPD cases in the year 1990 among people aged 30 years or more, corresponding to a global prevalence of 10.7% (95% confidence interval (CI) 7.3%–14.0%) in this age group. The number of COPD cases increased to 384 million in 2010, with a global prevalence of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven by global demographic changes. Across WHO regions, the highest prevalence was estimated in the Americas (13.3% in 1990 and 15.2% in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in 2010). The percentage increase in COPD cases between 1990 and 2010 was the highest in the Eastern Mediterranean region (118.7%), followed by the African region (102.1%), while the European region recorded the lowest increase (22.5%). In 1990, we estimated about 120.9 million COPD cases among urban dwellers (prevalence of 13.2%) and 106.3 million cases among rural dwellers (prevalence of 8.8%). In 2010, there were more than 230 million COPD cases among urban dwellers (prevalence of 13.6%) and 153.7 million among rural dwellers (prevalence of 9.7%). The overall prevalence in men aged 30 years or more was 14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–8.2%) in women. Conclusions Our findings suggest a high and growing prevalence of COPD, both globally and regionally. There is a paucity of studies in Africa, South East Asia and the Eastern Mediterranean region. There is a need for governments, policy makers and international organizations to consider strengthening collaborations to address COPD globally.

Determinants of changes in dietary patterns among Chinese immigrants: a cross-sectional analysis

BackgroundChinese individuals who have immigrated to a Western country initially tend to have a lower risk of cardiovascular disease (CVD) compared to people who are already living there. Some studies have found, however, that CVD risk increases over time in immigrants and that immigration to a western country is associated with changes in dietary patterns. This could have unfavourable effects on the risk of CVD. There is limited knowledge on the food patterns, awareness and knowledge about healthy nutrition among Chinese immigrants. The objective for this study is to explore changes in food patterns, and levels of awareness and knowledge of healthy nutrition by length of residence among Chinese immigrants to Canada.Methods120 Chinese individuals born in China but currently living in Canada completed an assessment on socio-demographic characteristics, changes in dietary patterns and variables of awareness and knowledge about healthy foods. With ordinal logistic regression the associations between the quartiles of length of residence and dietary patterns, variables of awareness and knowledge about healthy foods were explored, adjusting for age, sex, education and body mass index.ResultsMore than 50% of the participants reported increasing consumption of fruits and vegetables, decreasing the use of deep-frying after immigration. Increased awareness and knowledge about healthy foods was reported by more than 50% of the participants. Ordinal regression indicated that Chinese immigrants who lived in Canada the longest, compared to Chinese immigrants who lived in Canada the shortest, consumed significant greater portion sizes (OR: 9.9; 95% CI: 3.11 - 31.15), dined out more frequently (OR: 15.8; 95% CI: 5.0 - 49.85), and consumed convenience foods more often (OR: 3.5; 95% CI: 1.23 - 10.01).ConclusionsChinese immigrants reported some favourable changes in their dietary intake and greater awareness and more knowledge about healthy foods after immigration. However, an increase in portion size, an increased frequency of dining out and an increased consumption of convenience foods could indicate some unfavourable changes. These results suggest that health promotion strategies should build on the observed benefits of improved nutritional knowledge and target areas of portion size and convenience eating.

The association between triglyceride to high-density-lipoprotein cholesterol ratio and insulin resistance in a multiethnic primary prevention cohort

The objective was to explore the clinical utility of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio in predicting insulin resistance (IR) in 4 ethnic groups and the relationship between IR and TG/HDL-C in comparison to that with other lipid measures. Apparently healthy Aboriginals, Chinese, Europeans, and South Asians (N = 784) were assessed for sociodemographics, lifestyle, anthropometry, lipids, glucose, and insulin. The homeostasis model assessment of IR was used as a measure of IR. Compared with other lipid parameters, TG/HDL-C was the highest correlate of the homeostasis model assessment of IR (age and sex adjusted) in Aboriginals (r = 0.499, P < .001), Chinese (r = 0.432, P < .001), Europeans (r = 0.597, P < .001), and South Asians (0.372, P < .001). For a 1-unit increase in TG/HDL-C, the odds of being insulin resistant increased about 4 times (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.86-8.42; P < .001) in Aboriginals, 3.4 times in Chinese (OR, 3.44; 95% CI, 1.79-6.62; P < .001), 1.9 times in Europeans (OR, 1.94; 95% CI, 1.00-3.75; P = .049), and 1.8 times in South Asians (OR, 1.77; 95% CI, 0.91-3.45; P = .094) (age, sex, smoking, physical activity, body mass index, and waist circumference adjusted). Receiver operating characteristic curve analyses revealed areas under the curve (95% CI) of 0.777 (0.707-0.847) in Aboriginals, 0.723 (0.647-0.798) in Chinese, 0.752 (0.675-0.828) in Europeans, and 0.676 (0.590-0.762) in South Asians. Optimal cutoffs (sensitivity, specificity) of TG/HDL-C for identifying individuals with IR were 0.9 (93.0%, 51.9%), 1.1 (71.7%, 61.5%), 1.1 (73.5%, 70.9%), and 1.8 (52.0%, 77.9%) in Aboriginal, Chinese, European, and South Asian individuals, respectively. The TG/HDL-C ratio may be a good marker to identify insulin-resistant individuals of Aboriginal, Chinese, and European, but not South Asian, origin.

The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study

BACKGROUNDnPhysical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels.nnnMETHODSnIn this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering.nnnFINDINGSnBetween Jan 1, 2003, and Dec 31, 2010, 168u2008916 participants were enrolled, of whom 141u2008945 completed the IPAQ. Analyses were limited to the 130u2008843 participants without pre-existing CVD. Compared with low physical activity (<600 metabolic equivalents [MET]u2008×u2008minutes per week or <150 minutes per week of moderate intensity physical activity), moderate (600-3000 METu2008×u2008minutes or 150-750 minutes per week) and high physical activity (>3000 METu2008×u2008minutes or >750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74-0·87 and 0·65, 0·60-0·71; p<0·0001 for trend), and major CVD (0·86, 0·78-0·93; p<0·001 for trend). Higher physical activity was associated with lower risk of CVD and mortality in high-income, middle-income, and low-income countries. The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0% for mortality and 4·6% for major CVD, and for not meeting high physical activity was 13·0% for mortality and 9·5% for major CVD. Both recreational and non-recreational physical activity were associated with benefits.nnnINTERPRETATIONnHigher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age.nnnFUNDINGnPopulation Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario SPOR Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, GSK, Novartis, King Pharma, and national and local organisations in participating countries that are listed at the end of the Article.

The association between ownership of common household devices and obesity and diabetes in high, middle and low income countries

Background: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. Methods: We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55; diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33–4.25; diabetes: OR 1.97, 95% CI 1.53–2.53) and decreased through country income levels such that we did not detect an association in high income countries. Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.

Association of supermarket characteristics with the body mass index of their shoppers

BackgroundResearch on the built food environment and weight status has mostly focused on the presence/absence of food outlets while ignoring their internal features or where residents actually shop. We explored associations of distance travelled to supermarkets and supermarket characteristics with shoppers’ body mass index (BMI).MethodsShoppers (n=555) of five supermarkets situated in different income areas in the city were surveyed for food shopping habits, demographics, home postal code, height and weight. Associations of minimum distance to a supermarket (along road network, objectively measured using ArcGIS), its size, food variety and food basket price with shoppers’ BMI were investigated. The ‘food basket’ was defined as the mixture of several food items commonly consumed by residents and available in all supermarkets.ResultsSupermarkets ranged in total floor space (7500–135 000 square feet) and had similar varieties of fruits, vegetables and cereals. The majority of participants shopped at the surveyed supermarket more than once per week (mean range 1.2 ± 0.8 to 2.3 ± 2.1 times per week across the five supermarkets, p < 0.001), and identified it as their primary store for food (52% overall). Mean participant BMI of the five supermarkets ranged from 23.7 ± 4.3 kg/m2 to 27.1 ± 4.3 kg/m2 (p < 0.001). Median minimum distance from the shoppers’ residence to the supermarket they shopped at ranged from 0.96 (0.57, 2.31) km to 4.30 (2.83, 5.75) km (p < 0.001). A negative association was found between food basket price and BMI. There were no associations between BMI and minimum distance to the supermarket, or other supermarket characteristics. After adjusting for age, sex, dissemination area median individual income and car ownership, BMI of individuals who shopped at Store 1 and Store 2, the supermarkets with lowest price of the ‘food basket’, was 3.66 kg/m2 and 3.73 kg/m2 higher compared to their counterparts who shopped at the supermarket where the ‘food basket’ price was highest (p < 0.001).ConclusionsThe food basket price in supermarkets was inversely associated with BMI of their shoppers. Our results suggest that careful manipulation of food prices may be used as an intervention for decreasing BMI.

Total and high molecular weight adiponectin and ethnic-specific differences in adiposity and insulin resistance: a cross-sectional study

BackgroundEthnic-specific differences in insulin resistance (IR) are well described but the underlying mechanisms are unknown. Adiponectin is an insulin sensitizing adipocytokine that circulates as multiple isoforms, with high molecular weight (HMW) adiponectin associated with greatest insulin sensitivity. The objective of this study is to determine if plasma total and HMW adiponectin concentrations underlie ethnic-specific differences in IR.MethodsHealthy Canadian Aboriginal, Chinese, European, and South Asian adults (Nu2009=u2009634) were assessed for sociodemographics; lifestyle; fasting plasma insulin, glucose, and total and HMW adiponectin; and adiposity measures [BMI, waist circumference, waist-to-hip ratio, percent body fat, and subcutaneous and visceral adipose tissue (quantified by computed tomography)]. The homeostasis model assessment-insulin resistance (HOMA-IR) assessed IR.ResultsSouth Asians had the greatest HOMA-IR, followed by Aboriginals, Chinese, and Europeans (Pu2009<u20090.001). Plasma total and HMW adiponectin concentrations were lower in Chinese and South Asians than Aboriginal and Europeans (Pu2009<u20090.05). Total and HMW adiponectin were inversely associated with HOMA-IR (Pu2009<u20090.001). Ethnicity modified the relationship between HMW adiponectin and HOMA-IR with stronger effects observed in Aboriginals (Pu2009=u20090.001), Chinese (Pu2009=u20090.002), and South Asians (Pu2009=u20090.040) compared to Europeans. This was not observed for total adiponectin (Pu2009=u20090.431). At mean total adiponectin concentrations South Asians had higher HOMA-IR than Europeans (Pu2009<u20090.001).ConclusionsFor each given decrease in HMW adiponectin concentrations a greater increase in HOMA-IR is observed in Aboriginals, Chinese, and South Asians than Europeans. Ethnic-specific differences in HMW adiponectin may account for differences in IR.

The Association between the Built Environment and Dietary Intake-A Systematic Review

We reviewed the literature that examines the association between the built environment and diet. The MEDLINE electronic database was searched. Eligible articles must have been published between 2000 and 2013, in the English language, and must have been conducted among a population-based sample of adults older than 18 years of age. Twenty-four articles met the inclusion criteria. The majority of studies (over 70%) focused on fruit and vegetable consumption. Most studies (88%) found a statistically significant relationship between diet and some aspect of the built environment. However, the results across studies were not consistent. These inconsistencies may be attributable to methodological challenges, including differing definitions of neighbourhood, and inconsistent approaches to measuring built environment features and diet. In order to explore the complex relationship between built environment and peoples dietary behaviour, research design needs to be improved, and the items people actually buy need to be examined. In addition, more research is needed to investigate the causal pathways linking environmental factors and dietary intake.

Clinical usefulness of lipid ratios to identify men and women with metabolic syndrome: a cross-sectional study

BackgroundWaist circumference, a metabolic syndrome (MetSy) criterion, is not routinely measured in clinical practice making early identification of individuals with MetSy challenging. It has been argued that ratios of commonly measured parameters such as lipids and lipoproteins may be an acceptable alternative for identifying individuals with MetSy. The objective of our study was to explore clinical utility of lipid ratios to identify men and women with MetSy; and to explore the association between lipid ratios and the number of MetSy components.MethodsMen and women (Nu2009=u2009797) of Aboriginal, Chinese, European, and South Asian origin (35–60 years), recruited across ranges of body mass index (BMI), with no diagnosed cardiovascular disease (CVD) or on medications to treat CVD risk factors were assessed for anthropometrics, family history of CVD, MetSy components (waist circumference, blood pressure, glucose, triglycerides (TG), high-density-lipoprotein-cholesterol (HDL-C)), low-density-lipoprotein-cholesterol (LDL-C), nonHDL-C, and health-related behaviours.ResultsMean levels of lipid ratios significantly increased with increasing number of MetSy components in men and women (pu2009<u20090.05). After adjustment for age, ethnicity, smoking, alcohol consumption, physical activity, family history of CVD and BMI, (and menopausal status in women), all lipid ratios were associated with the number of MetSy components in men and women (Poisson regression, pu2009<u20090.001). Compared to the rest of the lipid ratios (ROC curve analysis), TG/HDL-C was best able to discriminate between individuals with and without MetSy (AUCu2009=u20090.869 (95% CI: 0.830, 0.908) men; AUCu2009=u20090.872 (95% CI: 0.832, 0.912) women). The discriminatory power of TC/HDL-C and nonHDL-C/HDL-C to identify individuals with MetSY was the same (for both ratios, AUCu2009=u20090.793 (95% CI: 0.744, 0.842) men; 0.818 (95% CI: 0.772, 0.864) women). Additionally, LDL-C/HDL-C was a good marker for women (AUCu2009=u20090.759 (95% CI: 0.706, 0.812)), but not for men (AUCu2009=u20090.689 (95% CI: 0.631, 0.748)). Based on a multiethnic sample, we identified TG/HDL-C cut-off values of 1.62 in men and 1.18 in women that were best able to discriminate between men and women with and without MetSY.ConclusionsOur results indicate that TG/HDL-C is a superior marker to identify men and women with MetSy compared to TC/HDL-C, LDL-C/HDL-C, and nonHDL-C/HDL-C.

A direct assessment of "obesogenic" built environments: challenges and recommendations.

This paper outlines the challenges faced during direct built environment (BE) assessments of 42 Canadian communities of various income and urbanization levels. In addition, we recommend options for overcoming such challenges during BE community assessments. Direct BE assessments were performed utilizing two distinct audit methods: (1) modified version of Irvine-Minnesota Inventory in which a paper version of an audit tool was used to assess BE features and (2) a Physical Activity and Nutrition Features audit tool, where the presence and positions of all environmental features of interest were recorded using a Global-Positioning-System (GPS) unit. This paper responds to the call for the need of creators and users of environmental audit tools to share experiences regarding the usability of tools for BE assessments. The outlined BE assessment challenges plus recommendations for overcoming them can help improve and refine the existing audit tools and aid researchers in future assessments of the BE.