Magdalena Kwaśniewska

Epidemiology of physical inactivity in Poland: prevalence and determinants in a former communist country in socioeconomic transition.

OBJECTIVES The aim of this study was to identify physical activity patterns and determinants of physical inactivity in a representative sample of Polish adults. STUDY DESIGN A cross-sectional analysis of 14 769 randomly selected individuals (52.7% women and 47.3% men) aged 20-74 years participating in the National Polish Health Survey, WOBASZ (2002-2005). METHODS Sociodemographic and lifestyle details were collected. Assessment of physical activity was based on selected questions from the CINDI Health Monitor Questionnaire. RESULTS Approximately 35% of Polish adults are not physically active in leisure time, whilst 39.5% declare sufficient level of leisure-time physical activity. Leisure-time inactivity is significantly less likely in persons aged <35 years, those with university education and those living in rural areas. Almost 48% of men and 28.4% of women employed full- or part-time report highly active work, whilst sedentary work is reported by 42.7% of women and 30.2% of men. Low occupational activity is more prevalent in young adults, persons with university education and those living in large urban areas. Nearly 67% of the entire working population report no active commuting. CONCLUSIONS There is a need to promote various forms of physical activity, with special attention on active commuting and leisure-time activities across both genders and all age groups. Public health policies and programmes should focus on substantial differences between various sociodemographic groups.

Socio-demographic and lifestyle correlates of commuting activity in Poland.

OBJECTIVES The aim of this study is to analyse the epidemiology of active transportation and to investigate the relationship between commuting physical activity (PA) and socio-demographic and lifestyle characteristics in Poland. METHODS A cross sectional analysis was conducted among 7280 randomly selected individuals (3747 men and 3533 women) aged 20-74 years participating in the National Multicentre Health Survey WOBASZ (2002-2005). Socio-demographic, smoking and physical activity details were assessed by an interviewer-administered questionnaire. RESULTS Only 36% of the participants (30% men and 42% of women) are active commuters. Moreover, 55.4% of them spend less than 15 min/day on walking or cycling. The highest risk of commuting inactivity was noticed among residents of large urban settings, with university education, the highest income and low occupational PA in both genders. Smoking and leisure-time PA were not significantly associated with commuting activity. CONCLUSIONS Active commuting is not common in Poland. There are several differences in commuting patterns as compared with the US or Western European populations. Due to important differences between various socio-demographic groups, future interventions should be specific for the targeted subpopulations.

Commuting physical activity and prevalence of metabolic disorders in Poland

OBJECTIVES The aim of this study was to examine the relationship between walking or cycling to work and prevalence of metabolic syndrome (MetS) and its components. METHODS Cross-sectional analysis of 6401 randomly selected individuals (3297 men and 3104 women) aged 20-74 years, who participated in the National Multicentre Health Survey WOBASZ, Poland (2002-2005). Commuting physical activity (PA) was assessed by asking about type and time spent on transportation to/from work using an interviewer-administered questionnaire. Weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), triglycerides (TG) and high-density cholesterol, (HDL-C) were measured by standard methods. MetS was defined according to the NCEP-ATP III and IDF criteria. RESULTS Active commuting was associated with decreased likelihood of abdominal obesity (WC≥94 cm), lower HDL-C and elevated TG in men and abdominal obesity (WC≥80 cm) in women. In a subgroup of postmenopausal women (n=317) active commuting was favourably associated with abdominal obesity, low HDL-C and elevated FPG. Prevalence of MetS was significantly lower among those who spent above 30 min/day daily on walking/cycling to work than among other gender subgroups. CONCLUSION Increasing of commuting PA level may have an important influence on reducing the prevalence of metabolic disorders.

Smoking status, the menopausal transition, and metabolic syndrome in women.

ObjectiveData on the relationship between tobacco use and metabolic risk among women with regard to their menopause status are scarce. This study assessed the prevalence of metabolic disorders in relation to smoking status in premenopausal and postmenopausal women. MethodsA cross-sectional analysis of 7,462 randomly selected women aged 20 to 74 years who are participating in the WOBASZ (Polish National Multicentre Health Survey) was carried out. Lifestyle and menopause status details were collected via an interviewer-administered questionnaire. Weight, height, waist circumference, blood pressure, fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels were measured by standard methods. Metabolic syndrome (MetS) was defined according to the International Diabetes Federation criteria. ResultsThe prevalence of MetS was 3.3-fold higher among postmenopausal than premenopausal women. Regardless of menopause status, the prevalence of central obesity was significantly higher among never and past smokers versus current smokers (P < 0.001). Past smoking was associated with a significantly higher probability of elevated blood pressure, fasting plasma glucose, and MetS (P < 0.05). However, premenopausal never and past smokers had a substantially lower prevalence of decreased HDL-C than did current smokers. Among postmenopausal nonsmoking women, high levels of leisure time and commuting physical activity were associated with a reduced likelihood of MetS (P < 0.01). Making an additional adjustment for calorie consumption did not substantially influence the results. ConclusionsExcept for HDL-C level, not smoking is associated with an unfavorable metabolic profile in women, regardless of menopause status. High level of physical activity may reduce the prevalence of MetS among never and past smokers after the menopausal transition.

Long-Term Effect of Different Physical Activity Levels on Subclinical Atherosclerosis in Middle-Aged Men: A 25-Year Prospective Study

Background The purpose of the study was to investigate the influence of lifetime physical activity (PA) on selected indices of atherosclerosis in longitudinal observation of middle-aged men. Methods The subject of the study was a cohort of 101 men (mean age 59,7±9,0 years), free of cardiovascular symptoms and treatment, participating in follow-up examinations in the years 1985/90-2011/12. Self-report PA was assessed by interviewer-administered Seven-Day PA Recall and Historical PA questionnaire. Subclinical atherosclerosis was measured by assessing the coronary artery calcification (CAC) according to Agatstons method using multi-slice computed tomography; the carotid intima-media thickness (IMT) using high-resolution B-mode ultrasound; and the reactive hyperemia index (RHI) using peripheral arterial tonometry (EndoPAT2000). The participants were initially divided into three groups according to tertiles of exercise-related energy expenditure (EE) in kcal/week at baseline, i.e. <2050 (low-to-moderate; n = 33), 2050–3840 (high; n = 34), >3840 (very high; n = 34). Results The low-to-moderate, high and very high PA groups were comparable in terms of age and atherosclerosis risk factors at baseline. No linear relationship was found between PA and CAC, IMT and RHI. Men who maintained low-to-moderate (n = 26), high (n = 21) and very high (n = 15) PA level had the mean CAC of 286.1±361.9, 10.7±28.9, and 106.1±278.3 (p<0.001 for low-to moderate vs high; p<0.05 for low-to-moderate vs very high); the mean IMT of 0.751±0.19 mm, 0,641±0.26 mm, and 0.750±0.60 mm (p>0.05); and the mean RHI of 1.69±0.4, 2.00±0.4, and 2.13±0.5 (p for trend = 0.050), respectively. No cases of CAC>400, IMT ≥0.9 and RHI<1.67 were noted only among men with maintained high PA level. At final examination men with high and very high PA had more favorable cardiometabolic profile than men with lower PA. Conclusions Maintaining regular high PA level through young and middle adulthood may protect against atherosclerosis as measured by CAC, IMT and RHI.

Multi-centre National Population Health Examination Survey (WOBASZ II study): assumptions, methods, and implementation.

BACKGROUND Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in developed countries. Despite the progress in diagnostics and treatment, it is expected that CVD will still be the main cause of death worldwide until at least 2030. From 1991 CVD mortality in Poland systematically decreased, but it is still higher than the average in Western Europe. In 2013 CVDs were the cause of 46% of all deaths in Poland (40.9% in men and 51.1% in women) and 26.9% of deaths among persons under 65 years of age. The epidemiologic assessment of prevalence, control and treatment of CVD risk factors, and monitoring of healthy behaviour and morbidity due to diseases like coronary artery disease, hypertension and diabetes is very important for health policy planning. The WOBASZ II is the newest Polish population based survey, performed in 2013-2014 to evaluate prevalence, control, treatment, and morbidity. The study was the continuation of WOBASZ (2003-2005). AIM To describe the goals and methods of the WOBASZ II study and to present the results of the recruitment. METHODS The WOBASZ II study was planned as a cross-sectional survey of a random sample of Polish residents aged over 20 years. The selection, using the National Identity Card Registry of the Ministry of Internal Affairs, was made as a three-stage sampling, stratified according to administrative units (voivodeships), type of urbanisation (commune), and gender. The study protocol consisted of a questionnaire used in face-to-face interviews, physical examination, and blood samples. WOBASZ II was coordinated by the Department of Epidemiology, Cardiovascular Diseases Prevention and Health Promotion of the Institute of Cardiology in Warsaw in cooperation with medical universities in Gdansk, Katowice, Krakow, Lodz, and Poznan. RESULTS Out of 15,120 persons, 1557 persons were not eligible. Out of eligible persons, 6170 (2760 men and 3410 women) were examined (the response rate 45.5%). The highest response rates were observed in Warminsko-Mazurskie (64.2%), Zachodniopomorskie (58.1%), and Kujawsko-Pomorskie (53.1%). CONCLUSIONS The importance of the WOBASZ study for the monitoring of the health state of Polish society, and for the as-sessment of prophylaxis efficiency and treatment of CVD and metabolic diseases, as well as for the evaluation of the actions in the field of health promotion, is difficult to overstate.

Association between tea and coffee consumption and prevalence of metabolic syndrome in Poland – results from the WOBASZ II study (2013–2014)

Abstract The study aimed to assess a relationship between tea and coffee consumption and metabolic syndrome (MetS). Cross-sectional study of a random sample of total Polish population was done (The WOBASZ II Study), and the present analysis included 5146 participants at age 20 years and above. Tea and coffee consumption was assessed by 24-h recall method. MetS was defined according to IDF/NHLBI/AHA criteria. After adjustment for covariates, coffee consumption was related to blood pressure and HDL cholesterol, and moderate drinkers had 17% lower odds of MetS compared with non-drinkers (OR = 0.83, 95%CI = 0.72–0.97). Tea consumption was related to some components but not to MetS in general. Inverse association between coffee consumption and MetS may reflect the content of the antioxidants that offer cardiovascular protection. However, weak relation of tea with components of MetS points toward the potential importance of composition of polyphenols and the types of tea consumed.

Are dietary habits of the Polish population consistent with the recommendations for prevention of cardiovascular disease? — WOBASZ II project

BACKGROUND Diet is a modifiable risk factor for cardiovascular disease (CVD). AIM To assess diet quality in the adult Polish population, taking into consideration consumption of various nutrients as well as the total diet quality. METHODS Within the frame of the National Multicentre Health Survey (WOBASZ II), a random sample of the whole Polish population aged 20 years and above was screened during the years 2013-2014. Dietary habits were assessed in 5690 subjects (2554 men and 3136 women). Nutrient intakes were compared to the Dietary Reference Intakes. Total diet quality was measured using the Healthy Diet Indicator (HDI) score, based on the World Health Organisation recommendations for CVD prevention, that includes 7 nutrients (saturated and polyunsaturated fatty acids, cholesterol, protein, dietary fibre, fruits and vegetables, free sugars) and ranges from 0 (the least healthy diet) to 7 (the healthiest diet). RESULTS The studied group was characterised by a high prevalence of overweight and obesity (69% in men vs. 59% in women), hypercholesterolaemia (56% vs. 55%, respectively), hypertension (50% vs. 42%), and diabetes (12% vs. 10%). At the same time, a significant percentage of Poles had improper dietary habits. A low fat and low cholesterol diet was reported by only 8% and a low calorie diet by 1% of the respondents. Adding salt to already seasoned dishes was reported by 27% of men and 18% of women, and 56% and 30% of them, respectively, consumed meat products with visible fat. The diet of most adult Polish citizens was found to be not balanced. Vitamins A, C, E, B1, B2, B6, and B12, protein, dietary cholesterol and fruits/vegetables were consumed in recommended doses only by 44-80% of the respondents. The recommended intake of fat, saturated and polyunsaturated fatty acids, which significantly affect lipid levels, was found in 18-37% of the respondents. Dietary intakes of folate and minerals important for the prevention of hypertension were insufficient. The desired level of folate intake was found only in 13-26% of the respondents, and that of magnesium, calcium and potassium in 5-36% of them. The average HDI value was about 3.2 (out of the maximum of 7). A healthy diet (5-7 points) was noted in 15% of adult Poles. Most subjects (60%) were characterised by a low quality diet (0-3 points). Nevertheless, about 55% of respondents believed that their diet was appropriate. CONCLUSIONS The quality of dietary habits of the majority of the adult Polish population falls far short of the recommendations relevant for CVD prevention.

Epidemiology of physical activity in adult Polish population in the second decade of the 21st century. Results of the NATPOL 2011 study

ObjectivesThe aim of the study was to assess physical activity (PA) level in a representative sample of Polish adults.Materials and MethodsA cross-sectional analysis was performed among 2413 randomly selected individuals (51.5% women) aged 18–79 years, who participated in the Nationwide Study of Occurrence of Risk Factors of Cardiovascular Diseases NATPOL 2011 (March–July 2011). The study procedures consisted of a questionnaire as well as of anthropometric, blood pressure and biochemical measurements. Leisure-time, occupational and commuting PA were assessed by the use of a questionnaire interview.ResultsAbout 48.2% of adults do exercise for at least 30 minutes on most days of a week. About 11% of the respondents declare a sedentary lifestyle. About 26.5% of working population report hard physical work, while sedentary work is reported by 47.6% of the employed participants. Active commuting is declared by 27.3% of working/studying population. About 47.2%, 36.6%, and 15.3% spend < 15, 15–30, and > 30 min per day, respectively, on this kind of PA.ConclusionsPA level of more than half of Polish adults is still not satisfactory. Promotion of an active lifestyle should concern mainly leisure-time and commuting PA with paying special attention to substantial differences in various socio-demographic groups.

Effective protection from exposure to environmental tobacco smoke in Poland: The World Health Organization perspective

Tobacco is the single greatest preventable cause of death in the world today, killing approximately half of the people who use it. Several strategies have been proved to reduce tobacco use. However, more than 50 years after the health effects of smoking were scientifically proven, and more than 20 years after evidence confirmed the hazards from exposure to second-hand smoke, few countries have implemented effective and recognized strategies to control the tobacco epidemic. This paper summarizes the World Health Organization recommendations for effective protection from exposure to environmental tobacco smoke along with the existing tobacco control programs and legislation in force in Poland.