Wojciech Bielecki

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.

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.

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.

Ten-Year Changes in the Prevalence and Socio-Demographic Determinants of Physical Activity among Polish Adults Aged 20 to 74 Years. Results of the National Multicenter Health Surveys WOBASZ (2003-2005) and WOBASZ II (2013-2014).

Introduction The aim of the study was to estimate ten-year changes in physical activity (PA) patterns and sociodemographic determinants among adult residents of Poland. Methods The study comprised two independent samples of randomly selected adults aged 20–74 years participating in the National Multicentre Health Survey WOBASZ (2003–2005; n = 14572) and WOBASZ II (2013–2014; n = 5694). In both surveys the measurements were performed by six academic centers in all 16 voivodships of Poland (108 measurement points in each survey). Sociodemographic data were collected by an interviewer-administered questionnaire in both surveys. Physical activity was assessed in three domains: leisure-time, occupational and commuting physical activity. Results Leisure-time PA changed substantially between the surveys (p<0.001). The prevalence of subjects being active on most days of week fell in both genders in the years 2003–2014 (37.4% vs 27.3% in men); 32.7% vs 28.3% in women. None or occasional activity increased from 49.6% to 56.8% in men, while remained stable in women (55.2% vs 54.9%). In both WOBASZ surveys the likelihood of physical inactivity was higher in less educated individuals, smokers and those living in large agglomerations (p<0.01). No significant changes were observed in occupational activity in men between the surveys, while in women percentage of sedentary work increased from 43.4% to % 49.4% (p<0.01). Commuting PA decreased significantly in both genders (p<0.001). About 79.3% of men and 71.3% of women reported no active commuting in the WOBASZ II survey. Conclusions The observed unfavourable changes in PA emphasize the need for novel intervention concepts in order to reverse this direction. Further detailed monitoring of PA patterns in Poland is of particular importance.

The effect of selected lifestyle factors and diet on mortality of men with documented physical fitness in the city of Łódź.

IntroductionIt is still uncertain if having at least moderate physical fitness is a necessary and sufficient condition for lowering the risk of death. The aforementioned statement constituted the basis for undertaking the study concerning the effect of particular health-related behaviours on the likelihood of survival in subjects with a moderate and high physical fitness.Materials and MethodsThe study sample, i.e. 204 men aged 30–59 years living in Łódź, Poland, was selected within the CINDI WHO Programme and examined over the years 1980–1990 and 2003–2004. In each subject approximate values of one week energy expenditures associated with performing physical exercise of at least moderate intensity (> 1000 kcal/week) were estimated. Physical efficiency in the study group was evaluated basing on the results of the submaximal effort test. Information about selected socio-demographic characteristics, consumption of alcohol, cigarette smoking and diet was gathered. The vital status of the examined sample was checked in 2009. The Cox proportional hazards regression model was used to identify factors which influence the survival of examined population.ResultsThe probability of death was more than fourfold higher in the case of individuals who eat “beef or pork meat”, as compared to those who consumed these products rarely or never. On the other hand, the subjects who declared regular consumption of yellow cheese had nearly fourfold lower death probability. Current smoking was found to be a significant negative risk factor while moderate consumption of beer a protective one. The level of physical fitness (VO2max) did not significantly influence mortality.ConclusionsThe results of the performed analyses indicate negative effect associated with consumption of beef/pork meat and smoking. Furthermore, the data pertaining to the consumption of yellow cheese as a potent protective factor for men’s health requires further verification. The possibility that it is some lifestyle proxy rather than a causal factor cannot be excluded.

OXTR polymorphism in depression and completed suicide—A study on a large population sample

In the light of contradictory results concerning OXTR polymorphism rs53576 and depression, we decided to verify the potential association between the two on 1) a large, ethnically homogenous sample of 1185 individuals who completed the Beck Depression Inventory (BDI), as well as on 2) a sample of 763 suicide victims. In the population sample, AA males showed significantly lower BDI scores (p=0.005, pcor=0.030). Exploratory analyses suggested that this effect was limited to a subgroup within 0-9 BDI score range (p=0.0007, U-Mann Whitney test), whereas no main effect on depressive symptoms (BDI>9) was found. In the suicide sample no association with rs53576 genotype was present. Exploratory analyses in suicides revealed higher blood alcohol concentration (BAC) among AA than GG/GA males (p=0.014, U-Mann Whitney test). Our results show that the OXTR rs53576 variant modulates the mood in male individuals and may positively correlate with alcohol intake among male suicides, but is not associated with suicide or depression. The study adds to the growing knowledge on rs53576 genotype characteristics.

The relationship between physical activity level and selected cardiovascular risk factors and mortality of males ≤ 50 years in Poland - the results of follow-up of participants of National Multicenter Health Survey WOBASZ.

OBJECTIVES The role of leisure-time physical activity in reducing all-cause and cardiovascular mortality is well explored. The knowledge on occupational and commuting physical activity continues to be ambiguous and misleading. The aim of the study is to assess the influence of different kinds of physical activity on cardiovascular mortality risk in men. MATERIAL AND METHODS Data analysis on physical activity level and other selected cardiovascular risk factors acquired from 3577 men in the age between 50-80 years who participated in the National Multicenter Health Survey WOBASZ (Wieloośrodkowe Ogólnopolskie Badanie Stanu Zdrowia), Poland (2003-2005) was linked with male mortality in 2004-2009. Data about causes of deaths were obtained from the Central Statistical Office and the Population Electronic Register. RESULTS Among males aged 50-59 years, the strongest risk factor was living in large settlements and provincial capitals as a place of residence and the most protective factor was occupational physical activity. In the age group 60-69 years and 70-80 years, the strongest protective effect was observed for leisure-time physical activity. In men aged between 70-80 years (unlike in the 50-59 years age group), the protective effect of large settlements and provincial capitals as a place of residence was noted. CONCLUSIONS Occupational physical activity significantly reduced cardiovascular mortality in men aged 50-69 years, while for leisure-time activity the positive effect was observed in age group 60-69 years and 70-80 years. On the other hand, for the inhabitants of large settlements and provincial capitals, significantly higher risk of cardiovascular mortality in the age group 50-69 years and lower risk in the age group ≥ 70 years was noted, both in comparison with smaller places of residence.

Trends in hypertension prevalence, awareness, treatment, and control among Polish adults 75 years and older during 2007–2014

BACKGROUND The aim of this study was to assess changes in the prevalence, awareness, and treatment of hypertension and its effectiveness between 2007 (WOBASZ Senior study) and 2013-2014 (WOBASZ II) in a sample of the Polish population over the age of 75 years. METHODS Sampling had three stages, stratified according to voivodeships, type of community, and gen-der. Finally, the WOBASZ II study included 467 persons (290 women and 177 men). For a comparison of the data, 1096 persons (538 women and 554 men) examined in the WOBASZ Senior study were used. RESULTS Systolic and diastolic blood pressures significantly decreased from 153.0 ± 23.9 mmHg to 142.9 ± 22.3 mmHg and from 85.2 ± 11.9 mmHg to 78.4 ± 11.3 mmHg, respectively, from 2007 to 2014 (p < 0.0001). Prevalence of hypertension among people included in WOBASZ studies slightly decreased from 83.8% to 77.9% (rate ratio [RR]: 0.95; 95% confidence interval [CI]: 0.78-1.16) in men, and from 75.4% to 71.8% (RR: 0.93; 95% CI: 0.8-1.09) in women. Hypertension awareness was improved from 59.2% to 72.9% (RR: 1.23; 95% CI: 0.97-1.56) in men, and from 74,8% to 93% (RR: 1.26; 95% CI: 1.01-1.58) in women. The proportion of men and women, with implemented hypertension treatment, increased from 48.4% to 61.1% (RR: 1.26; 95% CI: 1.01-1.58), and from 63.2% to 82.0% (RR: 1.3; 95% CI: 1.1-1.53), respectively. The effectiveness of the treatment was improved over two-fold, there was an increase from 10.3% to 26.8% (RR: 2.65; 95% CI: 1.81-3.89) in men, and from 13.8% to 33.5% in women (RR: 2.44; 95% CI: 1.81-3.3). CONCLUSIONS The prevalence of hypertension in Polish seniors remains high, but has decreased slightly in the perspective of the last 7 years. Although treatment and control has improved over the last decade, it remains below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Polish seniors should be intensified.

Prevalence, awareness, treatment and control of hypertension in the adult Polish population – Multi-center National Population Health Examination Surveys – WOBASZ studies

Introduction Hypertension is one of the main risk factors of cardiovascular diseases. The first aim of the study was to evaluate the prevalence, awareness and treatment of hypertension as well as treatment effectiveness (blood pressure < 140/90 mm Hg) in a representative sample of the Polish population over the age of 19, examined in the WOBASZ II program. The second aim was to assess the changes in these parameters between 2003–2005 (WOBASZ study) and 2013–2014 in adults aged 20–74. Material and methods Sampling was performed in three stages, stratified according to voivodeship (province), type of commune, and gender. Finally, the study included 6163 persons (3406 women and 2757 men) examined in the years 2013–2014 (aged ≥ 19 years). For comparison the data from 14 755 persons (7783 women and 6452 men aged 20–74 years) examined in the years 2003–2005 were used. Results In the years 2013–2014, the age-standardized prevalence of hypertension, awareness, treatment and control was 42.7%, 59.3%, 46.1%, and 23% respectively. In the last decade an increase in the prevalence of hypertension (relative ratio (RR) 1.12; 95% confidence interval (CI): 1.07–1.18), treatment (RR = 1.26; 95% CI: 1.17–1.36) and control (RR = 2.16; 95% CI: 1.9-12.45) was found. In contrast, the awareness decreased nonsignificantly (RR = 0.98; 95% CI: 0.92–1.05). Conclusions The prevalence of hypertension in Poland is high, and increased by about 12% in 10 years. Although the number of treated patients and blood pressure control improved nearly twofold over the last decade, this is still below expectations. Efforts to improve the diagnosis and effective treatment of hypertension in Poland should still be intensified.

Dietary acid load and cardiometabolic riskin the Polish adult population

BACKGROUND The potential influence of disorders of acid/base homeostasis on cardiovascular risk factors has been suggested. OBJECTIVES The aim of the study was to estimate the relationship between dietary acid load and the prevalence of cardiovascular disease and the prevalence and intensity of cardiovascular risk factors (i.e., hypertension, diabetes, overweight and obesity, dyslipidemia) in the Polish adult population. MATERIAL AND METHODS Data was derived from a cross-sectional survey of a random sample of 6,170 Polish residents aged 20+ (Multi-Center National Population Health Examination Survey, WOBASZ II study), including anthropometric and laboratory measurements, and estimates of nutrient intakes by 24-h recall. Dietary acid/ base load was assessed as potential renal acid load (PRAL) and net endogenous acid production (NEAP). RESULTS The median PRAL and NEAP values for the whole study population were: PRAL -3.85 mEq/day and NEAP 39.79 mEq/day. The prevalence of overweight and obesity, both in males and females, tended to decrease across tertiles of PRAL and to increase across tertiles of NEAP. In females, the values of several metabolic characteristics differed across tertiles of NEAP. After adjustment for age and waist circumference, these relationships did not persist, but the prevalence of diabetes was found to increase across tertiles of PRAL (p for trend <0.05) in females. CONCLUSIONS The dietary acid load in the Polish adult population was relatively low. There was no independent relationship between dietary acid load and cardiovascular disease and its risk factors in the population under study, except for the positive association between the PRAL value and diabetes prevalence in females.