The significant increase in worldwide morbidity and mortality from non-communicable diseases (NCDs) indicates that the efficacy of existing strategies addressing this crisis may need improvement. Early identification of the metabolic irregularities associated with the disease process may be a key to developing early intervention strategies. Unhealthy lifestyle behaviours are well established drivers of the development of several NCDs, but the impact of such behaviours on health can vary considerably between individuals. How can it be determined if an individual’s unique set of lifestyle behaviours is producing disease? Accumulating evidence suggests that lifestyle-associated activation of oxidative and inflammatory processes is primary driver of the cell and tissue damage which underpins the development of NCDs. However, the benefit of monitoring subclinical inflammation and oxidative activity has not yet been established. After reviewing relevant studies in this context, we suggest that quantification of oxidative stress and inflammatory biomarkers during the disease-free prodromal stage of NCD development may have clinical relevance as a timely indicator of the presence of subclinical metabolic changes, in the individual, portending the development of disease. Monitoring markers of oxidative and inflammatory activity may therefore enable earlier and more efficient strategies to both prevent NCD development and/or monitor the effectiveness of treatment.

/pdf/the-potential-benefit-of-monitoring-oxidative-stress-and-2p3vqs182o.pdf

The Potential Benefit of Monitoring Oxidative Stress and Inflammation in the Prevention of Non-Communicable Diseases (NCDs)

The aim of this cross-sectional study was to assess the health-related behaviors among university students, with emphasis on health sciences students from Croatia, Italy, Lebanon, Poland, Romania, Spain and Turkey. We included 6222 students in Medicine, Dentistry, Nursing, Pharmacy, Nutrition and Dietetics, Sports Sciences, Veterinary, and Economics enrolled between April 2018 and March 2020. We assessed dietary patterns, sleeping habits, physical activity and perceived stress among students by means of validated questionnaires. The median age ranged between 19 and 24 years, smoking prevalence between 12.0% and 35.4%, and body mass index (BMI) ranged between 21.1 and 23.2 kg/m2. Breakfast was less often and more often consumed daily in Turkey (36.7%), and Italy (75.7%), respectively. The highest Mediterranean diet score was recorded in Spain and Italy, and the lowest in Turkey, followed by students from Croatia, Lebanon, Poland and Romania. Sleep duration, physical activity and stress perception also differed between countries. Multivariable regression analysis revealed a small, but positive association between BMI and several characteristics, including age, female gender, smoking, physical activity, mobile phone use, and perceived stress. A negative association was found between BMI and sleep duration on non-working days. Self-rated health perception was positively associated with female gender, breakfast, physical activity, and time spent studying, and negatively with BMI, smoking and stress. Our results demonstrated diverse habits in students from different countries, some of which were less healthy than anticipated, given their educational background. Greater emphasis needs to be placed on improving the lifestyle of these adolescents and young adults, who will be tomorrow's healthcare workers.

How Healthy Are Health-Related Behaviors in University Students: The HOLISTic Study.

The COVID-19 pandemic has made it challenging for individuals and families to maintain a healthy lifestyle, quality of life, and well-being. Preliminary evidence have suggested that higher odds of both mortality and severity of the COVID-19 are closely associated to unhealthy lifestyle behaviors. Thus, in an effort to contribute to this challenging global situation, we joined a group of lifestyle medicine researchers and/or practitioners to provide scientifically sound information, recommendations, resources, and suggestions related to the main pillars of lifestyle medicine (healthy eating, physical activity, sleep, tobacco/alcohol, stress management, relationships, and planetary health) that may help health practitioners to support clients and patients maintain a healthy lifestyle during (and after) the COVID-19 crisis.

https://journals.sagepub.com/doi/pdf/10.1177/1559827620950276

Lifestyle Medicine During (and After) the COVID-19 Pandemic

Summary
Background

Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours such as diet, physical activity or weight control, despite the prediction by the World Health Organization that by 2020, two-thirds of disease worldwide will be the result of poor lifestyle choices. This gap in patient–clinician dialogue is perhaps the result of a lack of structured training in medical school surrounding the components of lifestyle medicine.



Context

Although Harvard Medical School does have a required course in nutrition, there are no requirements for the other components of lifestyle medicine, including physical activity, behaviour change and self-care.



Innovation

Since 2009 Harvard Medical School has addressed this absence in the curriculum by developing a student-led, faculty member-advised, parallel curriculum in lifestyle medicine. Medical student participants were invited to take part in anonymous questionnaires between 2009 and 2013, which gathered data about personal ability and attitude in counselling patients on lifestyle behaviours, as well as subjective data on the curriculum content and applications to effective medical practice.



Less than 50 per cent of US primary care doctors routinely provide guidance to their patients on lifestyle behaviours



Implication

Each year, students have pointed to a lack of lifestyle medicine knowledge because of a gap in the traditional curriculum surrounding topics such as physical activity, nutrition and behaviour-change strategies, and indicated that the inclusion of this knowledge and these skills was an important component of medical education. Although participation is currently voluntary, this is the first such curriculum of this type and addresses a critical gap in undergraduate medical education.

A parallel curriculum in lifestyle medicine.

The co-occurrence of two or more chronic medical conditions in an individual is defined as multimorbidity. Lifestyle factors, including poor dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption are key modifiable risk factors that play a role in the development of chronic medical conditions and potentially multimorbidity. The current study aimed to examine the level of physical activity among those with multimorbidity and its association with socio-demographic factors, clinical parameters, and health-related quality of life (HRQoL) among community-dwelling adults attending a primary care clinic in Singapore. This cross-sectional study was conducted among patients with multimorbidity between August 2014 and June 2016. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) Short Form. HRQoL was measured using the EuroQol-5 Dimension (EQ-5D-3 L). Data on clinical parameters including hemoglobin A1c (HbA1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure were collected from patient records. Multivariable logistic regression analysis and linear regression were performed to determine the association between IPAQ and clinical health outcomes, as well as HRQoL measures, respectively. In all, 932 respondents with multimorbidity were recruited for the study. Of these, 500 (53.8%) had low physical activity, 325 (35.0%) had moderate physical activity, while 104 (11.2%) had high physical activity. Respondents who were insufficiently active had significantly higher odds of being overweight/ obese (OR: 1.5, 95% confidence interval [CI]: 1.1–1.9, p = 0.01) as compared to those who were sufficiently physically active. The multiple linear regression model revealed that insufficient activity level was negatively associated with EQ-5D index score (β = − 0.05, p <  0.001) and the visual analogue scale (β = − 4.4, p <  0.001) measuring HRQoL as compared to sufficient activity levels in respondents with multimorbidity. The low levels of physical activity among patients with multimorbidity, and its association with overweight status and poorer HRQoL emphasizes the importance of increasing physical activity in this population. Family physicians treating patients with chronic diseases need to continue encouraging and helping individuals to initiate and maintain appropriate physical activity levels.

/pdf/patterns-of-physical-activity-and-health-related-quality-of-4scoqejwe0.pdf

Patterns of physical activity and health-related quality of life amongst patients with multimorbidity in a multi-ethnic Asian population

The leading causes of mortality worldwide are chronic non-communicable diseases (NCDs); cardiovascular disease (17 million), followed by cancer (7.6 million), respiratory disease (4.2 million) and diabetes (1.3 million) (1). The newly published Global Burden of Disease Study (2010) has systematically highlighted the epidemiological shift in morbidity and mortality resulting from infectious diseases and malnutrition, to NCDs (2). While we have gained approximately 10 years of life expectancy since 1970, we are spending more years living with injury and illness (2). Representing 63% of all deaths, most that die from NCDs are in the prime of their productive years (3). There is now overwhelming evidence that lifestyle factors such as poor dietary patterns, physical inactivity, tobacco use, excessive alcohol consumption and psychosocial factors, e.g. chronic stress and lack of social support and community, are key proximal factors in the pathogenesis and incidence of NCDs (4). Lifestyle factors may also be more distal stressors, including economic, political or a high density population (5). We define lifestyle-related diseases (LRDs) as diseases where the pathophysiology is significantly influenced by lifestyle factors and where a change in these aetiological factors can significantly improve prevention and treatment of the disease. The world’s population has more and more adopted an ‘unnatural’ environment to which it has not had a chance to adapt physiologically. This leads to numerous biological dysfunctions, probably stemming from a form of low-grade systemic inflammation, which underlies most chronic diseases and risk factors such as hyperlipidaemia and hypertension. The first sign of such an unadapted lifestyle accumulating allostatic load is often increased body weight through a hypercaloric diet and inadequate physical activity (6). It is imperative that we finally and systematically address the underlying causes of LRDs rather than superficially treating symptoms. Today, one in two Americans and Europeans is either overweight or obese (7). Average body mass indices have on average risen by as much as 2–2.5 kg/m per decade and is now 30 kg/m or higher in some countries (8). As humans, we are designed to move, yet we have never been more sedentary. Physical activity has decreased drastically over the past cetury, because of economic growth, digitalisation and urbanisation. Over 70% of people in much of the modern industrialised world are not achieving adequate levels of healthpromoting physical activity (7). The impact of poor lifestyle is not limited to physical diseases but also increases the risk for mental disorders such as depression and anxiety, which is increasing worldwide (9). The economic burden of poor lifestyle choices is no longer sustainable and is impossible to ignore. LRDs have been established as a clear threat not only to human health but also to development and economic growth (2). Paradoxically, however, it is the The leading causes of mortality and healthcare costs worldwide are chronic diseases, resulting from lifestyle and environmental factors. The economic burden of poor lifestyle choices is no longer sustainable and impossible to ignore. Most chronic diseases are preventable. To treat the causes of these diseases and to be successful in prevention, a strong focus must be placed on lifestyle medicine aspects. Lifestyle Medicine encompasses research, prevention, diagnosis and treatment of dysfunctions caused by a non-physiological lifestyle (lifestyle-related diseases, LRDs) and morbidogenic environments conducive to promoting such lifestyles. The ultimate goal and primary focus of Lifestyle Medicine is to promote healthier lives through salutary environments and healthier lifestyle choices. Treatment of LRDs includes nutritional, exercise, psychological, social, economic and environmental interventions. To successfully do this requires education, training and communication about Lifestyle Medicine at the professional and general public level, while avoiding the trap of ‘victim blaming’ of individuals whose lifestyles are influenced by circumstances beyond their control. Lifestylerelated Diseases are now the leading cause of death on the planet and modern medicine needs to address the underlying causes with a new medical speciality, lifestyle medicne

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijcp.12509

Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community

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Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community