International Journal of Behavioral Nutrition and Physical Activity最新文献

Background: Low physical activity (LPA) is a leading risk factor for type 2 diabetes mellitus (T2DM). We examine the temporal and spatial trends in the burden of T2DM attributable to LPA at the global, regional, and country scales.

Methods: Data were obtained from the Global Burden of Disease Study 2021. The numbers of deaths and disability-adjusted life years (DALYs) of LPA-related T2DM, and the corresponding age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were compared across regions and countries by age, sex, and sociodemographic index (SDI). The annual percentage changes (EAPCs) in the ASMR or ASDR were calculated to quantify temporal trends from 1990 to 2021. We also quantified the relationship between SDI and the ASMR and ASDR of T2DM attributable to LPA.

Results: Globally, the number of T2DM deaths and DALYs attributable to LPA were approximately 0.15 million and 5.52 million respectively in 2021, which more than doubled compared to 1990. Over the past 32 years, the global EAPCs of ASMR and ASDR were 0.26 (95% CI: 0.20, 0.31) and 0.97 (95% CI: 0.93, 1.02), respectively. The ASMR or ASDR had a reverse U-shaped relationship with the SDI, with the most severe burden observed in the low-middle and middle SDI regions. The age group older than 60 years had the highest rate of DALYs for LPA-related T2DM in 2021, while the 25-44 age group showed the largest increase between 1990 and 2021.

Conclusions: Over the past 32 years, the global burden of LPA-related T2DM has continued to increase at an alarming rate in almost all countries, particularly in regions with low-middle and middle SDI. Substantial increases in national action are urgently needed to target elder populations especially in low-middle and middle SDI regions, and special efforts should be made to promote physical activity in young adults with LPA.

Background: Although physical activity (PA) has been linked to cognitive health, the nuanced relationships between different dimensions of PA and cognitive impairment remain inconclusive. This study investigated associations between late-life PA levels, midlife-to-late-life activity patterns, and cognitive impairment in Chinese older adults, considering potential moderation by apolipoprotein E (APOE) ε4 genotype.

Methods: We analyzed baseline data from 6,899 participants (median age 68 years, 55.78% female) in the West China Health and Aging Cohort study, with 6,575 participants having APOE genotyping data. Late-life PA and midlife-to-late-life activity patterns were assessed using the Global Physical Activity Questionnaire and a standardized question, respectively. Cognitive function was evaluated using the Chinese version of Mini-Mental State Examination. Logistic regression models were used to examine associations.

Results: Compared to low PA level, moderate (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.55 ~ 0.99) and high PA levels (OR = 0.60, 95%CI = 0.48 ~ 0.75) were associated with lower risk of cognitive impairment. Engaging in work-, transport-, recreation-related, and moderate-intensity PA were each significantly associated with lower cognitive impairment risk. Maintaining activity levels from midlife to late life was associated with lower cognitive impairment risk compared to decreasing levels (OR = 0.75, 95%CI = 0.60 ~ 0.94). These associations were more pronounced in APOE ε4 non-carriers, with an interaction observed between APOE ε4 genotype and recreation-related PA (P-value = 0.04).

Conclusions: Our findings underscore the multifaceted benefits of PA in mitigating cognitive impairment risk among older Chinese adults. Public health strategies should focus on promoting overall late-life PA levels, especially moderate-intensity PA, and maintaining activity levels comparable to midlife, with potential for personalized interventions based on genetic risk profiles.

Background: Supportive policy is an important component of a whole-systems approach to increasing physical activity and reducing inequalities. There is a growing body of literature surrounding the design and effectiveness of national policy approaches to physical activity, but evidence related to local-level approaches is lacking. The aim of this study was to examine 'what works', and identify factors underpinning change, focused on work to embed physical activity in local policy and practice in Bradford, UK.

Methods: A mixed-methods case study approach involved collecting data from cross-sectoral stakeholders directly or indirectly engaged in the physical activity agenda in Bradford over a period of three years (2021-2024). Data collection included focus groups, semi-structured interviews, researcher observations of key workshops and meetings, and surveys at two time-points (December 2021 and January 2024). Qualitative data were analysed using reflexive thematic analysis. Quantitative data were analysed using descriptive and inferential statistics.

Results: Four themes were identified which embody conditions that appear to be critical for working towards physical activity being embedded in local policy & practice within the Bradford District. These included: collaboration and sector integration, co-productive working, governance and leadership, and cultivating a learning culture. The process of co-producing a district-wide strategy for physical activity was key to facilitating shared ownership of the physical activity agenda across different levels of the system, and for supporting and maintaining cross-sectoral collaboration. On average, survey respondents connected with four more local organisations in relation to the physical activity agenda in January 2024 than in December 2021.

Conclusion: Taking a partnership approach, and fostering a culture of evidence-informed decision making, is key to embedding physical activity into policy and practice at a local level. Investing time to understand the aims and values of each partner, and potential synergies and tensions between them, can support the development of a positive and productive collaboration and, subsequently, more effective whole-system delivery and population-level increases in physical activity.

Background: Although evening screen time is thought to impair subsequent sleep, current measures are limited to questionnaires which seem unlikely to accurately assess screen time in youth. Given the ubiquitous nature of digital devices, improving measurement of screen time is required before related health effects can be appropriately determined. The aim of this study was to objectively quantify screen time before sleep using video camera footage.

Methods: This repeated-measures observational study in healthy adolescents (11-14 years) from Dunedin, New Zealand measured screen time on four evenings over one week in the home environment from March-December 2021. Wearable and stationary PatrolEyes video cameras captured screen time from two hours before bedtime until sleep and manually coded for device type (phone, tablet, laptop computer, desktop computer, handheld gaming console, gaming console, television and other) and screen activity (watching, listening, reading, educational/creative, browsing, communication, social media, video gaming, multitasking) using a reliable coding schedule (κ ≥ 0.8). Descriptive findings are reported.

Findings: Among the 83 participants (mean 12.3 [SD 1.0] years, 42% female, 52% New Zealand European, 37% Māori [indigenous]), 82 used screens in the two hours before bed on 308 of 344 (90%) nights for a mean of 54.4 min (SD 25.5). Televisions (median 37 min, 56% of nights), phones (19 min, 64% nights), and multitasking using multiple devices (19 min, 48% nights) were most commonly used (> 75% of adolescents). Once in bed but before trying to sleep, 58% of adolescents engaged in screen time for 17 (26.3) minutes on 36% of nights. The most common screen activities were watching (32.5%), social media (26.5%) and communication (20.5%). Even after attempting sleep, 32.5% of participants used screens for 8.0 min (median) on 16% of nights, mostly listening on phones.

Conclusions: Objective video cameras offer detailed insight into evening screen habits, capturing frequency, content, and duration. Youth frequently engage with screens before bed and throughout the night on a range of activities, despite recommendations to restrict screen time prior to sleep.

Trial registration: Australian New Zealand Clinical Trials Registry (anzctr.org.au), AACTRN12621000193875, Registered 23 February 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380926&isReview=true .

Background: Effective evidence-based physical activity and nutrition interventions to prevent overweight and obesity and support healthy child development need to be sustained within Early Childhood Education and Care (ECEC) services. Despite this, little is known about factors that influence sustainability of these programs in ECEC settings. Therefore, the aim of this study was to describe the factors related to sustainability of physical activity and nutrition interventions in ECEC settings and examine their association with ECEC service characteristics.

Methods: A cross-sectional study was undertaken with a nationally representative sample of 473 Australian ECEC services. Factors related to the sustainability of ECEC-based physical activity and nutrition interventions were assessed using the validated Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C), measuring Outer Contextual Factors, Inner Contextual Factors, Processes and Characteristics of the Intervention domains for interventions that supervisors reported as currently implementing. Participants responded using a 5-point Likert scale, with responses ranging from 1 (completely disagree) to 5 (completely agree). Domain scores were calculated for each service by averaging item responses. Linear regression models between ECEC service characteristics and the IMPRESS-C domains were undertaken.

Results: Data from 473 Australian childcare services nationally found that the domains: Processes ( $\overline{x}$ =3.78, SD = 0.64), consisting of partnership/engagement and training/support/supervision; and Outer Contextual Factors ( $\overline{x}$ =3.93, SD = 0.63), including policy and legislation, and socio-political context had the lowest mean scores indicating they may likely be barriers to sustainability. Linear regression analyses revealed no statistically significant associations between examined factors and ECEC service characteristics. There was a statistically significant association between the number of years services delivered their interventions and the Characteristics of the Intervention domain (p = 0.035) suggesting that this domain may influence sustainability of programs.

Conclusions: This study suggests that factors related to the Processes and Outer Contextual Factors domains had the lowest scores and as such, strategies to support the sustainability of physical activity and nutrition interventions implemented in ECEC settings may need to consider how to best address these factors.

Background: The purpose of this study is to explore the association between class-level factors, such as lesson start time, class size, lesson location, PE content, and PE context, and student engagement in moderate-to-vigorous physical activity (MVPA) during PE lessons in both elementary and middle schools.

Methods: A total of 284 PE lessons from ten schools in Shanghai, Eastern China, were included in the study. Students' MVPA during PE lessons was recorded using accelerometry, and lesson context was evaluated using the System for Observing Fitness Instruction Time (SOFIT). Mixed linear regression analysis was applied to assess the association between class-level factors and MVPA during elementary and middle school PE lessons.

Results: Students in elementary school spent 40.3 ± 8.1% of PE lesson time in MVPA, while middle school students spent 40.5 ± 7.1%. Significant relationships were found between MVPA and class-level factors like lesson location, PE content, and PE context. Specifically, elementary school students recorded a higher percentage of MVPA during lessons with team games, individual games, individual activities, and more time spent on skill practice and game play context. In middle schools, higher MVPA was connected to outdoor lessons, a focus on individual games, and more time devoted to fitness context.

Conclusions: Class-level factors may affect students' MVPA differently depending on the school level, and these modifiable factors should be targeted to increase MVPA time in elementary and middle school PE classes. Future studies should investigate ways to modify these factors, strategically plan lesson time across different contexts, and optimizing PE content to boost MVPA in PE lessons.

Background: Online grocery shopping is a growing source of food purchases in many countries. We investigated the effect of nudging consumers towards purchases of lower sodium products using a web browser extension.

Methods: This trial was conducted among individuals with hypertension who shopped for their groceries online in Australia. From July 2021 to June 2023, participants were randomised to use the SaltSwitch Online Grocery Shopping web browser extension or continue their usual grocery shopping for 12 weeks. The SaltSwitch extension modified a retailer's online shopping interface to suggest similar but lower sodium alternative products to those initially selected. The primary outcome was the difference in mean sodium density (mg sodium per 1000 kcal of energy) of packaged food purchases between the intervention and control groups.

Results: We randomised 185 participants of average age 56.0 (SD 11.0) years. Most were women (64%), White (89%), had BMI > 25 kg/m² (91%), and were taking anti-hypertensive medication (83%). Demographic and medical characteristics were similar across the randomised groups. 182 (98%) completed the trial. Over the 12-week intervention, the sodium density of groceries purchased by the intervention group compared to the control group was 204 mg/1000 kcal lower (95%CI, -352 to -56) (P = 0.01). The reduction in sodium density of purchases was apparent in weeks 1-4 and sustained through the end of the trial. 86% of participants in the intervention group made at least one switch to a lower sodium product. There were no detectable effects on blood pressure, spot urine sodium concentration, or other secondary outcomes across the 12-week study period.

Conclusions: Online shopping platforms provide a novel opportunity to support purchases of lower sodium foods. While the reductions in sodium density of purchases were moderate in size, population health benefits could nonetheless be large if they were sustained over time and at scale, with large and growing numbers of online grocery shoppers and a high prevalence of elevated blood pressure amongst adults.

Trial registration: ACTRN12621000642886.

Background: Continuous glucose monitoring (CGM) holds potential as a precision public health intervention, offering personalised insights into how diet and physical activity affect glucose levels. Nevertheless, the efficacy of using CGM in populations with and without diabetes to support behaviour change and behaviour-driven outcomes remains unclear. This systematic review and meta-analysis examines whether using CGM-based feedback to support behaviour change affects glycaemic, anthropometric, and behavioural outcomes in adults with and without diabetes.

Methods: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Elsevier Embase, EBSCOhost PsycINFO, and ProQuest Dissertations & Theses Global were searched through January 2024. Eligible studies were randomised controlled trials in adults that implemented CGM-based feedback in at least one study arm compared to a control without CGM feedback. Dual screening, data extraction, and bias assessment were conducted independently. Mean differences in outcomes between intervention and comparison groups were analysed using generic inverse variance models and random effects. Robustness of pooled estimates from random-effects models was considered with sensitivity and subgroup analyses.

Results: Twenty-five clinical trials with 2996 participants were included. Most studies were conducted in adults with type 2 diabetes (n = 17/25; 68%), followed by type 1 diabetes (n = 3/25, 12%), gestational diabetes (n = 3/25, 12%), and obesity (n = 3/25, 12%). Eleven (44%) studies reported CGM-affiliated conflicts of interest. Interventions incorporating CGM-based feedback reduced HbA1c by 0.28% (95% CI 0.15, 0.42, p < 0.001; I² = 88%), and increased time in range by 7.4% (95% CI 2.0, 12.8, p < 0.008; I² = 80.5%) compared to arms without CGM, with non-significant effects on time above range, BMI, and weight. Sensitivity analyses showed consistent mean differences in HbA1c across different conditions, and differences between subgroups were non-significant. Only 4/25 studies evaluated the effect of CGM on dietary changes; 5/25 evaluated physical activity.

Conclusions: This evidence synthesis found favourable, though modest, effects of CGM-based feedback on glycaemic control in adults with and without diabetes. Further research is needed to establish the behaviours and behavioural mechanisms driving the observed effects across diverse populations.

Trial registration: CRD42024514135.