Handbook of Urban Education

To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among older French adults and to assess the role of potential mediators, assessed repeatedly, of these associations. Population based cohort study. Dijon centre of Three-City study. 3982 (2410 (60.5%) women) French community dwellers aged 65 or over included during 1999-2001; participants were disability-free at baseline when health behaviours were assessed. Hierarchical indicator of disability (no, light, moderate, severe) combining data from three disability scales (mobility, instrumental activities of daily living, basic activities of daily living) assessed five times between 2001 and 2012. During the 12 year follow-up, 1236 participants (861 (69.7%) women) developed moderate or severe disability. Interval censored survival analyses (adjusted for age, sex, marital status, and education) showed low/intermediate physical activity (hazard ratio 1.72, 95% confidence interval 1.48 to 2.00), consuming fruit and vegetables less than once a day (1.24, 1.10 to 1.41), and current smoking/short term ex-smoking (1.26, 1.05 to 1.50) to be independently associated with an increased hazard of disability, whereas no robust association with alcohol consumption was found. The hazard of disability increased progressively with the number of unhealthy behaviours independently associated with disability (P<0.001); participants with three unhealthy behaviours had a 2.53 (1.86 to 3.43)-fold increased hazard of disability compared with those with none. Reverse causation bias was verified by excluding participants who developed disability in the first four years of follow-up; these analyses on 890 disability events yielded results similar to those in the main analysis. 30.5% of the association between the unhealthy behaviours score and disability was explained by body mass index, cognitive function, depressive symptoms, trauma, chronic conditions, and cardiovascular disease and its risk factors; the main contributors were chronic conditions and, to a lesser extent, depressive symptoms, trauma, and body mass index. An unhealthy lifestyle is associated with greater hazard of incident disability, and the hazard increases progressively with the number of unhealthy behaviours. Chronic conditions, depressive symptoms, trauma, and body mass index partially explained this association.

https://www.bmj.com/content/bmj/347/bmj.f4240.full.pdf

Unhealthy behaviours and disability in older adults: Three-City Dijon cohort study

Potential contributions of skeletal muscle contractile dysfunction to altered biomechanics in obesity.

Epidemic obesity has been observed in the last few years in the USA,1 as well as in Europe.2 Epidemic obesity is not only a problem in childhood and adulthood but it also extends into older ages. The prevalence of obesity in older people has dramatically increased in recent years: in the United States, more than 30% of men and women aged 60 years and over are obese. A significant increase in the prevalence of extreme degrees of obesity also has been observed in older ages.1

/pdf/obesity-in-the-elderly-an-emerging-health-issue-9orc6mxwgm.pdf

Obesity in the elderly: an emerging health issue.

Objective Adult obesity and inflammation have been associated with risk of colorectal cancer (CRC); however, less is known about how adolescent body mass index (BMI) and inflammation, as measured by erythrocyte sedimentation rate (ESR), relate to CRC risk. We sought to evaluate these associations in a cohort of 239 658 Swedish men who underwent compulsory military enlistment examinations in late adolescence (ages 16–20 years). Design At the time of the conscription assessment (1969–1976), height and weight were measured and ESR was assayed. By linkage to the national cancer registry, these conscripts were followed for CRC through 1 January 2010. Over an average of 35 years of follow-up, 885 cases of CRC occurred, including 501 colon cancers and 384 rectal cancers. Cox regression was used to estimate adjusted HRs and corresponding 95% CIs. Results Compared with normal weight (BMI 18.5 to 2 ) in late adolescence, upper overweight (BMI 27.5 to 2 ) was associated with a 2.08-fold higher risk of CRC (95% CI 1.40 to 3.07) and obesity (BMI 30+ kg/m 2 ) was associated with a 2.38-fold higher risk of CRC (95% CI 1.51 to 3.76) (p-trend: Conclusions Late-adolescent BMI and inflammation, as measured by ESR, may be independently associated with future CRC risk. Further research is needed to better understand how early-life exposures relate to CRC.

/pdf/adolescent-body-mass-index-and-erythrocyte-sedimentation-22x0ei6u0x.pdf

Adolescent body mass index and erythrocyte sedimentation rate in relation to colorectal cancer risk

Adiposity measures as predictors of long-term physical disability.

To analyse the relationship between body mass index (BMI) in middle-age and disability status in old-age using data from the Melbourne Collaborative Cohort Study (MCCS). A total of 41 514 participants enroled in the MCCS between 1990–1994. Height and weight were measured at baseline and disability, defined as limitations to self-care activities of daily living (ADLs) and self-care plus mobility activities, was identified at follow-up (2003–2007). In all, 6300 participants were <65 years at baseline, ⩾70 years at follow-up and not missing BMI at baseline or ADLs at follow-up. The association between BMI in six categories (BMI 18.5–22.5; 22.5–25; 25–27.5; 27.5–30; 30–35; 35+) and disability status was analysed using logistic regression. Models were stratified by sex, and sequentially adjusted for age, education, country of birth, then smoking, alcohol, fruit and vegetable intake, and physical activity. Adjusted odds ratios for composite self-care ADL and mobility limitations compared with BMI 18.5–22.5 kg m−2 were 1.73 (95%CI 1.14–2.64) for BMI 30–35 kg m−2 and 3.46 (1.78–6.73) for BMI 35+ kg m−2 in males. In females, adjusted odds ratios were 1.29 (1.00–1.68) for BMI 22.5–25 kg m−2, 1.74 (1.35–2.24) for BMI 25–27.5 kg m−2, 2.58 (1.98–3.36) for BMI 27.5–30 kg m−2, 2.74 (2.10–3.58) for BMI 30–35 kg m−2 and 4.21 (3.12–5.88) for BMI 35+ kg m−2. A graded relationship was observed between BMI and disability in males and females, across the continuum of BMI. These results highlight the importance of a healthy body weight at middle age in order to reduce the risk of disability in old age.

The relationship between body mass index prior to old age and disability in old age

The relationship between overweight and obesity prior to old age and later life disability

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Adiposity measures as predictors of long-term physical disability.

The relationship between body mass index prior to old age and disability in old age

The relationship between overweight and obesity prior to old age and later life disability