Lifestyle medicine (Hoboken, N.J.)最新文献

There is a rising burden of lifestyle-related non-communicable disease across all age groups around the world that is reaching epidemic proportions. Over half (58%) of the UK population over 60 is living with one or more long-term conditions,¹ and this prevalence is expected to increase significantly in the next decade. By their very nature, lifestyle-related conditions have an insidious onset and a protracted period of morbidity that negatively impacts quality of life. This places significant pressure on individuals, health systems, economies and society.

The current pandemic has highlighted how significantly more vulnerable people with long-term conditions are to other health challenges. Those living with diabetes and obesity have a higher risk of attending hospital and an increased case-fatality rate for COVID-19 when compared to non-diabetic and non-obese individuals of the same age.² Self-care and personal lifestyle behaviours that improve metabolic health could lead to better health outcomes from infectious disease and, as previously highlighted in this journal, at a population level are an important aspect of pandemic preparedness.³

A key question for healthcare practitioners and healthcare systems today is how to turn the tide on lifestyle-related conditions in a way that is person-centred. This challenge is even more prescient now in the context of the post-COVID era, as virtual care has quickly become the new normal.

There are more than 139 definitions of self-care in the academic literature.⁴ The Self Care Forum UK describes self-care as ‘the actions that individuals take for themselves, on behalf of and with others in order to develop, protect, maintain and improve their health, well-being or wellness.’⁵

The World Health Organisation (WHO) and the International Self-Care Foundation (ISF) have varying definitions of self-care. Perhaps more helpful is to conceptualise self-care as a series of activities, which can be conveniently grouped into the seven pillars of self-care⁶ as follows: (1) knowledge and health literacy, (2) mental well-being, (3) physical activity, (4) healthy eating, (5) risk avoidance, (6) good hygiene practices and (7) the rational service use of products and services.⁷ These bear very clear resemblance and overlap to the six pillars of lifestyle medicine such that the antecedents and interventions are closely related: (1) healthy eating, (2) physical activity, (3) avoiding toxins, (4) managing stress, (5) sleep and (6) nurturing relationships.⁸

Until recently, self-care was not much talked about in the context of healthcare. It was often implied that self-caring was tantamount to ‘no care’ due to an abdication of responsibility by health professionals, leaving patients to ‘fend for themselves’ w

Acid suppression is the accepted treatment for gastroesophageal reflux disease, despite being ineffective in one third of patients. Certain conditions presenting as reflux may later be attributed to food allergy (infant cow's milk allergy; eosinophilic esophagitis), but the role of food allergy in adult reflux disease has rarely been investigated. The mechanisms of gastroesophageal reflux disease are examined to explore potential subgroups within the population, such as undisclosed food allergy, which may determine the responsiveness to treatment. The relevant literature was searched systematically using ProQuest Dialog, yielding 113 papers that were evaluated for quality. The extracted evidence was formed into a mechanistic diagram representing the processes of disease. As yet, insufficient research exists to evaluate the relationship between food allergies and reflux in adults. Of significance, however, is the potential for multiple variables to affect the integrity of the esophageal mucosa, thereby allowing symptoms to emerge which are independent of acid exposure. Where nonacidic drivers of inflammation exist, acid suppression is unlikely to offer adequate symptom resolution and may serve to explain the high proportion of nonresponders in this group. The review concludes that symptoms of gastroesophageal reflux may emerge in response to the coexistence of physiological reflux and esophageal mucosal inflammation. The latter may arise due to reflux-induced acid erosion, or due to alternative endogenous sources of inflammation. When a patient presents with refractory reflux and a history of allergic disease, the role of antigen-induced inflammation should be considered for further investigation. Nonallergic individuals presenting with refractory reflux symptoms may benefit from further analysis of relevant co-morbidities that have the capacity to compromise mucosal integrity, including obesity or psychological stress. The identification of specific mediators of inflammation in refractory reflux disease may enable the development of personalized treatment regimes which improve outcomes and reduce the reliance on acid suppressants.

Cardiometabolic diseases (CMDs) are the most common, noncommunicable diseases that claim many lives every year. CMDs have great impact on public health, often driving the attention of healthcare resources to prevent and treat them. CMDs include cardiovascular diseases, type 2 diabetes mellitus, metabolic syndrome, and obesity. Deep understanding of the root causes and pathogenic factors of CMDs would help in their effective prevention and treatment. Metabolomic profiling of biosamples usually sheds light on the metabolic biomarkers and the involved pathways. Metabolomic analysis to identify CMDs metabotypes revealed that they share similar metabolic signatures and metabolic pathways. These metabolic pathways may indicate the presence of insulin resistance, mitochondrial dysfunction, low-grade inflammation, and dysbiotic gut microbiota. This study is aimed to review the literature on the common metabolic biomarkers of CMDs as well as the shared pathways that can be targeted by dietary interventions and pharmacologic treatment.