Melanie Nichols

Cardiovascular disease in Europe 2014: epidemiological update

This overview provides a Europe-wide update on the current burden of cardiovascular disease, and specifically of coronary heart disease and stroke. Cardiovascular disease continues to cause a large proportion of deaths and disability in Europe, and places a substantial burden on the health care systems and economies of Europe. The overall picture, and the distribution of the burden, continues to evolve in a developing Europe. There have been major improvements in recent years on many measures of cardiovascular disease; however, these improvements have not been universal, and substantial inequalities persist.

Cardiovascular disease in Europe — epidemiological update 2015

This article provides an update for 2015 on the burden of cardiovascular disease (CVD), with a particular focus on coronary heart disease (CHD) and stroke, across the countries of Europe. Cardiovascular disease is still the most common cause of death within Europe, causing almost two times as many deaths as cancer across the continent. Although there is clear evidence, where data are available, that mortality from CHD and stroke has decreased substantially over the last 5-10 years, there are still large inequalities found between European countries, in both current rates of death and the rate at which these decreases have occurred. Similarly, rates of treatment, particularly surgical intervention, differ widely between those countries for which data are available, indicating a range of inequalities between them. This is also the first time in the series that we use the 2013 European Standard Population (ESP) to calculate age-standardized death rates (ASDRs). This new standard results in ASDRs around two times as large as the 1976 ESP for CVD conditions such as CHD but changes little the relative rankings of countries according to ASDR.

Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program

BACKGROUND There is growing evidence that community-based interventions can reduce childhood obesity in older children. OBJECTIVE We aimed to determine the effectiveness of the Romp & Chomp intervention in reducing obesity and promoting healthy eating and active play in children aged 0-5 y. DESIGN Romp & Chomp was a community-wide, multisetting, multistrategy intervention conducted in Australia from 2004 to 2008. The intervention occurred in a large regional city (Geelong) with a target group of 12,000 children and focused on community capacity building and environmental (political, sociocultural, and physical) changes to increase healthy eating and active play in early-childhood care and educational settings. The evaluation was repeat cross-sectional with a quasiexperimental design and comparison sample. Main outcome measures were body mass index (BMI), standardized BMI (zBMI; according to the Centers for Disease Control and Prevention 2000 reference charts), and prevalence of overweight/obesity and obesity-related behaviors in children aged 2 and 3.5 y. RESULTS After the intervention there was a significantly lower mean weight, BMI, and zBMI in the 3.5-y-old subsample and a significantly lower prevalence of overweight/obesity in both the 2- and 3.5-y-old subsamples (by 2.5 and 3.4 percentage points, respectively) than in the comparison sample (a difference of 0.7 percentage points; P < 0.05) compared with baseline values. Intervention child-behavioral data showed a significantly lower intake of packaged snacks (by 0.23 serving), fruit juice (0.52 serving), and cordial (0.43 serving) than that in the comparison sample (all P < 0.05). CONCLUSION A community-wide multisetting, multistrategy intervention in early-childhood settings can reduce childhood obesity and improve young childrens diets. This trial was registered with the Australian Clinical Trials Registry at anzctr.org.au as ACTRN12607000374460.

Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009

Aims Recent decades have seen very large declines in coronary heart disease (CHD) mortality across most of Europe, partly due to declines in risk factors such as smoking. Cardiovascular diseases (predominantly CHD and stroke), remain, however, the main cause of death in most European countries, and many risk factors for CHD, particularly obesity, have been increasing substantially over the same period. It is hypothesized that observed reductions in CHD mortality have occurred largely within older age groups, and that rates in younger groups may be plateauing or increasing as the gains from reduced smoking rates are increasingly cancelled out by increasing rates of obesity and diabetes. The aim of this study was to examine sex-specific trends in CHD mortality between 1980 and 2009 in the European Union (EU) and compare trends between adult age groups. Methods Sex-specific data from the WHO global mortality database were analysed using the joinpoint software to examine trends and significant changes in trends in age-standardized mortality rates. Specific age groups analysed were: under 45, 45–54, 55–64, and 65 years and over. The number and location of significant joinpoints for each country by sex and age group was determined (maximum of 3) using a log-linear model, and the annual percentage change within each segment calculated. Average annual percentage change overall (1980–2009) and separately for each decade were calculated with respect to the underlying joinpoint model. Results Recent CHD rates are now less than half what they were in the early 1980s in many countries, in younger adult age groups as well as in the population overall. Trends in mortality rates vary markedly between EU countries, but less so between age groups and sexes within countries. Fifteen countries showed evidence of a recent plateauing of trends in at least one age group for men, as did 12 countries for women. This did not, however, appear to be any more common in younger age groups compared with older adults. There was little evidence to support the hypothesis that mortality rates have recently begun to plateau in younger age groups in the EU as a whole, although such plateaus and even a small number of increases in CHD mortality in younger subpopulations were observed in a minority of countries. Conclusion There is limited evidence to support the hypothesis that CHD mortality rates in younger age groups in the member states of the EU have been more likely to plateau than in older age groups. There are, however, substantial and persistent inequalities between countries. It remains vitally important for the whole EU to monitor and work towards reducing preventable risk factors for CHD and other chronic conditions to promote wellbeing and equity across the region.

CardioPulse, Cardiovascular disease in Europe 2014: epidemiological update, Heart disease and stroke decline in Europe, Estimating an individual person's course of coronary artery calcification, The CardioScape Project, In memoriam

This paper provides an update for 2014 on the burden of cardiovascular disease (CVD), and in particular coronary heart disease (CHD) and stroke, across the countries of Europe. Cardiovascular disease causes more deaths among Europeans than any other condition, and in many countries still causes more than twice as many deaths as cancer. There is clear evidence in most countries with available data that mortality and casefatality rates from CHD and stroke have decreased substantially over the last 5–10 years but at differing rates. The differing recent trends have therefore led to increasing inequalities in the burden of CVD between countries. For some Eastern European countries, including Russia and Ukraine, the mortality rate for CHD for 55–60 year olds is greater than the equivalent rate in France for people 20 years older.

Assessing the intake of obesity-related foods and beverages in young children: comparison of a simple population survey with 24 hr-recall

BackgroundWith an increasing focus on obesity prevention there is a need for simple, valid tools to assess dietary indicators that may be the targets of intervention programs. The objective of this study was to determine the relative validity of previous day dietary intake using a newly developed parent-proxy questionnaire (EPAQ) for two to five year old children.MethodsA convenience sample of participants (n = 90) recruited through preschools and the community in Geelong, Australia provided dietary data for their child via EPAQ and interviewer-administered 24-hour dietary recall (24 hr-recall). Comparison of mean food and beverage group servings between the EPAQ and 24 hr-recall was conducted and Spearman rank correlations were computed to examine the association between the two methods.ResultsMean servings of food/beverage groups were comparable between methods for all groups except water, and significant correlations were found between the servings of food and beverages using the EPAQ and 24-hr recall methods (ranging from 0.57 to 0.88).ConclusionThe EPAQ is a simple and useful population-level tool for estimating the intake of obesity-related foods and beverages in children aged two to five years. When compared with 24-hour recall data, the EPAQ produced an acceptable level of relative validity and this short survey has application for population monitoring and the evaluation of population-based obesity prevention interventions for young children.

Relationship between raised BMI and sugar sweetened beverage and high fat food consumption among children

Longitudinal evidence of relationships between unhealthy diets and BMI in children is crucial for appropriately targeting obesity prevention activities. The objective was to determine the relationship between frequency of consumption of sugar sweetened beverages (SSBs) and high fat foods (HFFs) and body weight in Australian children aged from 4 to 10 years.

What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels.

Objective To estimate the impact of achieving alternative average population alcohol consumption levels on chronic disease mortality in England. Design A macro-simulation model was built to simultaneously estimate the number of deaths from coronary heart disease, stroke, hypertensive disease, diabetes, liver cirrhosis, epilepsy and five cancers that would be averted or delayed annually as a result of changes in alcohol consumption among English adults. Counterfactual scenarios assessed the impact on alcohol-related mortalities of changing (1) the median alcohol consumption of drinkers and (2) the percentage of non-drinkers. Data sources Risk relationships were drawn from published meta-analyses. Age- and sex-specific distributions of alcohol consumption (grams per day) for the English population in 2006 were drawn from the General Household Survey 2006, and age-, sex- and cause-specific mortality data for 2006 were provided by the Office for National Statistics. Results The optimum median consumption level for drinkers in the model was 5 g/day (about half a unit), which would avert or delay 4579 (2544 to 6590) deaths per year. Approximately equal numbers of deaths from cancers and liver disease would be delayed or averted (∼2800 for each), while there was a small increase in cardiovascular mortality. The model showed no benefit in terms of reduced mortality when the proportion of non-drinkers in the population was increased. Conclusions Current government recommendations for alcohol consumption are well above the level likely to minimise chronic disease. Public health targets should aim for a reduction in population alcohol consumption in order to reduce chronic disease mortality.

Decreasing trends in overweight and obesity among an Australian population of preschool children

Background:After several decades of increasing prevalence, recent evidence suggests a levelling of obesity rates in some groups, although little is known about trends in children under 5 years of age.Aim:To investigate the prevalence, trends and sociodemographic correlates of overweight and obesity in Australian preschool children between 1999 and 2007.Methods:Child anthropometric and demographic data were extracted from records of routine maternal and child health consultations for children aged 2 and 3.5 years in the Australian state of Victoria. Data were analysed for prevalence of overweight and obesity (according to International Obesity Task Force definitions), trends in prevalence from 1999 to 2007 and sociodemographic correlates of prevalence and trends.Results:Complete data were available for 129 266 2-year-old children and 96 164 3.5-year-old children from 41 local government areas across Victoria. Combined prevalence of overweight and obesity decreased significantly between 1999 and 2007 in 3.5-year-old children (by 3.1% points from 18.5 to 15.4%) and in 2-year-old children (1.1% point decrease from 13.5 to 12.4%). There was no accompanying increase in rates of underweight. Decreases were more pronounced in areas of lower socioeconomic status (SES). Prevalence of both overweight and obesity was consistently higher across time in the older group of children, in the lowest quartile of SES and among girls.Conclusions:Prevalence of overweight and obesity in preschool children in Victoria has decreased significantly between 1999 and 2007, whereas socioeconomic disparities have narrowed. Further research is needed to understand the reasons for the decreasing prevalence, and to better evaluate existing and emerging health promotion initiatives. Such evidence will be important to build on the findings of this study and to transfer lessons learnt to other population groups.

Obesity prevention in the family day care setting: impact of the Romp & Chomp intervention on opportunities for children's physical activity and healthy eating.

BACKGROUND The Romp & Chomp intervention reduced the prevalence of overweight/obesity in pre-school children in Geelong, Victoria, Australia through an intervention promoting healthy eating and active play in early childhood settings. This study aims to determine if the intervention successfully created more health promoting family day care (FDC) environments. METHODS The evaluation had a cross-sectional, quasi-experimental design with the intervention FDC service in Geelong and a comparison sample from 17 FDC services across Victoria. A 45-item questionnaire capturing nutrition- and physical activity-related aspects of the policy, socio-cultural and physical environments of the FDC service was completed by FDC care providers (in 2008) in the intervention (n= 28) and comparison (n= 223) samples. RESULTS Select results showed intervention children spent less time in screen-based activities (P= 0.03), organized active play (P < 0.001) and free inside play (P= 0.03) than comparison children. There were more rules related to healthy eating (P < 0.001), more care provider practices that supported childrens positive meal experiences (P < 0.001), fewer unhealthy food items allowed (P= 0.05), higher odds of staff being trained in nutrition (P= 0.04) and physical activity (P < 0.001), lower odds of having set minimum times for outside (P < 0.001) and organized (P= 0.01) active play, and of rewarding children with food (P < 0.001). CONCLUSIONS Romp & Chomp improved the FDC service to one that discourages sedentary behaviours and promotes opportunities for children to eat nutritious foods. Ongoing investment to increase childrens physical activity within the setting and improving the capacity and health literacy of care providers is required to extend and sustain the improvements.