S Goya Wannamethee’s research while affiliated with University College London and other places

Objective This study investigated the association of poor oral health with appetite loss and deterioration in appetite longitudinally in older adults. Design Cross-sectional and longitudinal observational study. Setting Data came from two population-based cohorts of older adults from the UK and USA. Participants The British Regional Heart Study (BRHS) included men (n=1348, age=79–87 years in 2016–2017 at baseline and 81–89 years in 2018–2019 at follow-up). The US Health, Aging and Body Composition (HABC) Study included men and women (n=2998, age=71–77 years in 1998–1999 at baseline and 73–79 years in 2000–2001 at follow-up). Objective and self-reported oral health measures were collected. Outcome measures Loss of appetite, at baseline and 2-year follow-up, was based on the Simplified Nutrition Assessment Questionnaire in the BRHS and self-reported appetite loss in the HABC Study. In the BRHS, changes in oral health over time were also assessed. Logistic regression models were adjusted for sociodemographic, behavioural and health-related factors. Results Cross-sectionally, poor self-rated oral health, dry mouth, eating or chewing difficulty, food avoidance and cumulative oral health problems were associated with appetite loss in both studies. Longitudinally, in the BRHS, dry mouth (OR=2.12 (95% CI=1.40 to 3.20)), eating or chewing difficulty (OR=1.59 (95% CI=1.02 to 2.48)), food avoidance (OR=1.75 (95% CI=1.16 to 2.65)) and cumulative oral health problems (OR=2.84 (95% CI=1.80 to 4.50)) at baseline were associated with sustained poor/deterioration in appetite over the follow-up, after full adjustment. In the HABC Study, self-rated oral health ((OR=1.13 (95% CI=1.01 to 1.27)), tooth loss (OR=1.78 (95% CI=1.15 to 2.76)), dry mouth (OR=1.76 (95% CI=1.02 to 3.03)), eating or chewing difficulty (OR=1.88 (95% CI=1.41 to 2.50)) and cumulative oral health problems (OR=1.89 (95% CI=1.33 to 2.70)) at baseline were associated with sustained poor/deterioration in appetite during follow-up. In the BRHS, sustained poor/deterioration in oral health markers (self-rated oral health, dry mouth, eating or chewing difficulty, food avoidance, loose denture/s) over the follow-up were associated with sustained poor/deterioration of appetite. Conclusion Oral health is a potentially important contributor to maintaining good appetite in older age.

Background Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings In 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

Background Cardiometabolic multimorbidity (CMM), defined as the co-occurrence of 2 or more cardiometabolic diseases, including myocardial infarction (MI), stroke, and type 2 diabetes (T2D), is an increasing public health challenge. Although poor diet is a known risk factor for a first cardiometabolic disease (FCMD), the relationship with subsequent occurrence of CMM is less studied. Objectives This study aims to investigate the prospective association between baseline adherence to the Mediterranean diet and the onset of CMM across various follow-up durations. Methods We used data from the European Prospective Investigation into Cancer-Norfolk cohort study of 21,900 adults, aged 40–79 free of prevalent MI, stroke, and T2D at baseline (1993–1997). A median-based Mediterranean diet score and a pyramid-based MDS (pyr-MDS) were used to measure baseline adherence to the Mediterranean diet. Multistate modeling was employed to investigate associations with the FCMD and the subsequent CMM event. Results Over the entire follow-up period of 21.4 y (median), we observed 5028 FCMD and 734 CMM events. Multistate analysis indicated that the association between baseline Mediterranean diet and the risk of CMM may be stronger in shorter follow-up durations. Particularly, baseline pyr-MDS was significantly associated with the risk of subsequent CMM transitioning from FCMD when follow-up durations were limited to 10 and 15 y, with hazard ratio (95% confidence interval) being 0.67 (0.53, 0.84) and 0.80 (0.70, 0.92) per SD increase in pyr-MDS, respectively. Additionally, we observed that the risk of CMM transitioning from FCMD was modified by social class across shorter to longer follow-ups, where the impact of baseline Mediterranean diet was only significant in nonmanual workers. Conclusions Baseline adherence to the Mediterranean diet was potentially associated with a lower risk of CMM transitioning from FCMD, particularly during shorter follow-up periods.

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension.

Purpose of Review To review the evidence on the relationship between daytime napping and obesity. Recent Findings There is concern that napping may be harmful to metabolic health. Prospective studies have shown long time daytime napping (> 1 h) is associated with increased diabetes risk which may be partly associated with obesity. Evidence from numerous cross-sectional studies and meta-analyses of cross-sectional studies have shown that long time napping (> 1 h) but not short time napping is associated with increased risk of obesity, and this is seen worldwide. Inference regarding the nature of association from cross-sectional studies is limited; it is suggested the association is bidirectional. Prospective studies on the association between daytime napping and obesity are few and results unclear. Summary Large longitudinal studies integrating daytime napping duration and night-time sleep behaviour and detailed information on lifestyle influences is needed to help elucidate further the associations of long time napping with obesity.

Background Social connections may impact the dynamic trajectory of frailty. Methods Using data from the British Regional Heart Study (BRHS) in the UK (n = 715), and the US Health, Aging and Body Composition (Health ABC) Study (n = 1256), we conducted multinominal regression analyses to examine the association of baseline and change in social engagement and loneliness with progression to pre-frailty and frailty, as well as their association with reversal to pre-frailty and robust status among older adults. Results A higher level of social engagement at baseline (BRHS: relative risk ratio (RRR) 0.69 [95%CI 0.55–0.85]; Health ABC: 0.56 [0.45-0.70]), as well as increase in social engagement (BRHS: 0.73, [0.59-0.90]; Health ABC: 0.51 [0.41–0.63]), were associated with a lower risk of developing frailty. In BRHS, a higher level of loneliness at baseline (1.42 [1.10–1.83]) and an increase in loneliness (1.50 [1.18–1.90]), increased the risk of developing frailty. For reversal of frailty, higher social engagement at baseline (Health ABC: 1.63 [1.08–2.47]) and an increase in social engagement (BRHS:1.74[1.18–2.50]; Health ABC: 1.79[1.17–.274]) were beneficial. Conclusion Social connections maybe potentially important and modifiable factors in both preventing and reversing progression of frailty in older adults.

Objectives Carotid intima-media thickness (CIMT) and carotid distensibility are markers of arterial change, however little is known of the prognostic value in incident HF. We aimed to assess this prospective association. Design Longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study Participants 1069 men aged 71-92 years, without a diagnosis of heart failure or myocardial infarction (MI) at baseline. Methods Between 2010-2012, participants completed a questionnaire, underwent a physical examination, and provided a fasting blood sample. CIMT and carotid artery distension were measured and carotid distensibility was calculated. Cox proportional hazards modelling was used to assess the multivariate-adjusted hazard ratios of incident HF by quartiles of CIMT and distensibility. Results Adjusted for age, social class, smoking, physical activity, alcohol status, BMI, use of statins and antihypertensives, prevalent diabetes mellitus and stroke, pulse pressure, and presence of atrial arrhythmias, lower carotid distensibility was associated with increased risk of incident HF (HR 2.55, 95% CI 1.24 to 5.24, p=0.01). The association persisted after further adjustment for CIMT and incident MI (HR 2.53, 95% CI 1.23 to 5.22, p=0.01). Higher CIMT was associated with increased risk of incident HF (HR 2.20, 95% CI 1.14 to 4.23, p=0.02). However, this was attenuated after adjustment for both CIMT and incident MI (HR 1.64, 95% CI 0.84 to 3.21, p=0.1). Conclusions: Low carotid artery distensibility, but not high carotid intima-media thickness (CIMT), was associated with an increased risk of incident heart failure, independent of the development of myocardial infarction.

Summary Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m²) and obesity (BMI ≥30 kg/m²). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

The aim of this study was to examine the extent to which neighborhood-level socioeconomic factors (objective and perceived) are associated with poor oral health in older adults over time, independent of individual socioeconomic position. Data for this cross-sectional and longitudinal observation study came from a socially and geographically representative cohort of men aged 71 to 92 y in 2010–12 ( n = 1,622), drawn from British general practices, which was followed up in 2018–19 (aged 78–98 y; N = 667). Dental measures at both times included number of teeth, periodontal pocket depth, self-rated oral health, and dry mouth. Neighborhood deprivation was based on Index of Multiple Deprivation (IMD) and a cumulative index measuring perceptions about local environment. Individual-level socioeconomic position was based on longest-held occupation. Multilevel and multivariate logistic regressions, adjusted for relevant sociodemographic, behavioral, and health-related factors, were performed to examine the relationships of dental measures with IMD and perceived neighborhood quality index, respectively. Cross-sectionally, risks of tooth loss, periodontal pockets, and dry mouth increased from IMD quintiles 1 to 5 (least to most deprived); odds ratios (ORs) for quintile 5 were 2.22 (95% confidence interval [CI], 1.41–3.51), 2.82 (95% CI, 1.72–4.64), and 1.51 (95% CI, 1.08–2.09), respectively, after adjusting for sociodemographic, behavioral, and health-related factors. Risks of increased pocket depth and dry mouth were significantly greater in quintile 5 (highest problems) of perceived neighborhood quality index compared to quintile 1. Over the 8-y follow-up, deterioration of dentition (tooth loss) was significantly higher in the most deprived IMD quintiles after full adjustment (OR for quintile 5 = 2.32; 95% CI, 1.09–4.89). Deterioration of dentition and dry mouth were significantly greater in quintile 5 of perceived neighborhood quality index. Neighborhood-level factors were associated with poor oral health in older age, both cross-sectionally and longitudinally, particularly with tooth loss, and dry mouth, independent of individual-level socioeconomic position.