PurposeTo evaluate cardiovascular disease (CVD) risk factors among smokeless tobacco (ST) users. Exclusive ST users were compared to exclusive cigarette smokers and non-tobacco users. DesignCross-sectional study SampleData were used from 16,336 adult males who participated in one of the National Health and Nutrition Examination Surveys (NHANES) from 2003 to 2018. MeasuresBiochemically verified tobacco use, CVD risk factors (hypertension, cholesterol levels, BMI categories), physical activity, cotinine concentration, and sociodemographic variables. AnalysisWeighted analysis of the aggregate data was performed. ST users were compared with cigarette smokers and nontobacco users for their association with CVD risk factors. Associations were examined using univariate and multiple logistic regression with odds ratios (OR) and 95% confidence intervals (CI) reported. ResultsPrevalence of exclusive ST use was 4.4% whereas, exclusive smoking was 22.2%. Among ST users, 36.2% were hypertensive, 24.5% had high cholesterol levels, and most of them were overweight (31.1%) or obese (52.6%). ST users were more likely to have hypertension compared to smokers (aOR = 1.48, 95%CI: 1.12, 1.95) and nontobacco users (aOR = 1.41, 95%CI: 1.09, 1.83) adjusted for other covariates. ST users were twice more likely to be obese than nontobacco users (aOR = 2.18, 95%CI: 1.52, 3.11). ST users had significantly higher cotinine concentration than smokers. ConclusionStudy findings indicate substantial association of ST use among males with hypertension and obesity which are independent risk factors of CVD.
more »
« less
A Cross-Sectional Assessment of Dietary Patterns and Their Relationship to Hypertension and Obesity in Indonesia
ABSTRACT Background There is a marked increase in the intake of foods associated with higher risks for hypertension and obesity in Indonesia. However, studies assessing the relationship between dietary patterns and health outcomes are few. Objective The purpose of this study was to characterize dietary patterns and investigate their relationship with hypertension and obesity in Indonesia. Methods Exploratory factor analysis was used to derive dietary patterns from a brief food scanner filled by 31,160 respondents aged 15 y and older in the Indonesian Family Life Survey wave 5 (IFLS 5). Age- and gender-specific quintiles of consumption were created for each pattern and the association between quintiles of each dietary pattern and the odds for hypertension and obesity were assessed using multivariate logistic regression analyses. Results Two dietary patterns were identified: a modern dietary pattern characterized by fast foods, soft drinks, sweet snacks, and salty snacks and a traditional pattern characterized by fish, vegetables, and fruits. Younger age and being male were significantly correlated with higher consumption of the modern pattern (P < 0.0001 and P = 0.03, respectively). Analyses showed no association between hypertension and the modern pattern. However, the traditional pattern revealed lower odds for hypertension among those in the highest quintile compared with the lowest quintile (OR: 0.84; 95% CI: 0.74, 0.95; P-trend < 0.05). Individuals in the highest quintile of each dietary pattern had higher odds of obesity compared with those in the lowest quintile (modern pattern—OR: 1.31; 95% CI: 1.15, 1.49; P-trend < 0.00; traditional pattern—OR: 1.25; 95% CI: 1.10, 1.42; P-trend < 0.01). Conclusions More studies using gold-standard measures of dietary intake are needed to better understand the relationship between the modern dietary pattern and hypertension in Indonesia. Also, both modern and traditional dietary patterns in Indonesia may be energy dense, leading to higher risk for obesity.
more »
« less
- Award ID(s):
- 1826939
- PAR ID:
- 10357105
- Date Published:
- Journal Name:
- Current Developments in Nutrition
- Volume:
- 6
- Issue:
- 6
- ISSN:
- 2475-2991
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
BACKGROUND:Salt leaching into freshwater is an emerging global environmental health concern. We tested the associations between drinking water salinity and blood pressure, hypertension, and albuminuria. METHODS:We conducted a 2-year panel study in 2022 and 2023 with 434 observations among 327 Daasanach adults aged >18 years in northern Kenya. Water sources were analyzed for overall salinity and ionic composition (sodium; chloride; calcium, potassium, magnesium). We measured resting blood pressure and classified hypertension stage 1 and stage 2. Urine samples were analyzed for albuminuria (≥30 mg/g albumin-to-creatinine ratio). RESULTS:Drinking water salinity was driven by sodium-chloride (mean=162.6 mg/L, SD=77.1), with low concentrations of calcium, potassium, and magnesium (mean=45 mg/L, SD=13.5). Across 2022 and 2023, 40.1% of adults had at least hypertension stage 1, 13.5% had hypertension stage 2, and 42.2% had albuminuria. Using random effects linear and logistic panel regressions fully adjusted for confounders, each 100 mg/L of drinking water sodium-chloride was associated with 4.5 mm Hg (95% CI, 2.4–6.6) and 3.3 mm Hg (95% CI, 2.2–4.5) increases in systolic and diastolic blood pressure, 3.0× the odds of at least hypertension stage 1 (95% CI, 1.49–5.83), 3.6× the odds of hypertension stage 2 (95% CI, 1.93–6.81), and 2.0× the odds of albuminuria (95% CI, 1.28–3.06). Calcium, potassium, and magnesium were unassociated with any outcomes. Hypertension stage 2 (but not hypertension stage 1) was associated with 2.6× (95% CI, 1.19–5.77) the odds of albuminuria. CONCLUSIONS:Drinking water sodium-chloride was associated with resting blood pressure, hypertension, and albuminuria in a population with few traditional lifestyle risk factors for chronic disease. Measuring specific salts in water helps untangle associations with hypertension.more » « less
-
Introduction The average American diet is high in red and processed meats which increases one's risk for chronic diseases and requires more land and water to produce and yields greater greenhouse gases (GHG) compared to other protein foods. Reduction of red and processed meat intake, such as seen with the Dietary Approaches to Stop Hypertension (DASH diet), could benefit human and environmental health. Objective The objective of this study is to predict the environmental sustainability of the DASH diet by evaluating the GHG, land use, and water withdrawals from protein foods within the self-selected diets of people who were encouraged to follow the DASH diet. Methods Dietary data was collected from 380 Midwesterners aged 35-70 years old with hypertension using the Automated Self-Administered 24-Hour (ASA 24) Recall System. DASH diet adherence was measured using a nutrient-based DASH score. GHG, land use, and water withdrawals were obtained using Carnegie Mellon University's Economic Input-Output Life Cycle Assessment ( eiolca.net ) using the Purchaser model (cradle-to-consumer). Multiple linear regressions were used to view associations between individual DASH nutrient scores and environmental impacts of total, animal, and plant protein foods. Results Diets that met DASH diet guidelines, as indicated by higher individual DASH nutrient scores, were associated with less GHG and land use from total and animal protein foods but more GHG and land use from plant-protein foods, with a few exceptions. The pattern was not clear for water withdrawals. Diets with the greatest adherence had around 25–50% lower GHG and land use from total protein foods than diets with the lowest adherence. Changes may be due to decreased consumption of total and animal protein foods, selection of animal protein foods with lower environmental impacts, and increased consumption of plant protein foods. Conclusion Adhering to the DASH diet can promote the consumption of less environmentally demanding protein foods resulting in lower GHG and land use from protein foods. However, claims regarding the sustainability of the entire dietary pattern cannot be determined based off the current study. Regardless, it is evident that environmental impacts should be considered alongside health impacts when selecting, promoting, or recommending a dietary pattern.more » « less
-
BackgroundSocial-ecological trap theory highlights the potential for food systems and the social and environmental contexts within which they are situated to ‘trap’ individuals into a trajectory of specific nutritional outcomes when their physical or financial access to traditional foods is restricted, resulting in less healthy dietary patterns than those traditionally consumed. ObjectiveWhile social-ecological trap theory literature highlights the potential for these traps to result in four hypothesized dietary patterns, the presence and composition of such dietary patterns have not been explored in southwestern Madagascar. MethodsThis study employs innovative Weighted Overfit Latent Class Analysis methods to identify dietary patterns among individuals residing in southwestern Madagascar. The study used longitudinal cohort data collected from 2023 to 2024. ResultsFour dietary patterns were identified and characterized as (1) a traditional dietary pattern which included 35.9% (SD 11.1%) of the population, (2) a industrialized-transitioning dietary pattern which included 29.2% (SD 13.5%) of the population, (3) an traditional-undernourishing dietary pattern which included 16.3% (SD 5.2%) of the population, and (4) a industrialized-undernourishing dietary pattern which included 17.8% (SD 11.2%) of the population. The four dietary patterns identified aligned with three of the four patterns hypothesized to result from social-ecological traps. Those in the traditional dietary pattern consumed the most diverse diet and tended to be fishers who also often participated in crop-based agriculture. Those in the industrialized-transitioning dietary pattern consumed a greater proportion of their diet from market-source foods. Those in the traditional-undernourishing dietary pattern consumed the fewest calories and had the lowest level of food security. Lastly, those in the industrialized-undernourishing dietary pattern consumed 63% of their calories from rice and consumed more market-source foods than those in the traditional-undernourishing dietary pattern. ConclusionOf the four dietary patterns identified in southwestern Madagascar, two are characterized as higher-quality and two as undernourishing dietary patterns. Each dietary pattern comprises individuals of varying demographic and socio-economic status. Understanding dietary patterns and who follows them enables policymakers and public health practitioners to better understand who may be most affected by the impacts of social and ecological change on the food system, thereby improving the targeting of nutritional interventions.more » « less
-
Abstract ObjectivesStudies suggest that living at high altitude decreases obesity risk, but this research is limited to single‐country analyses. We examine the relationship between altitude and body mass index (BMI) among women living in a diverse sample of low‐ and middle‐income countries. Materials and MethodsUsing Demographic and Health Survey data from 1 583 456 reproductive age women (20–49 years) in 54 countries, we fit regression models predicting BMI and obesity by altitude controlling for a range of demographic factors—age, parity, breastfeeding status, wealth, and education. ResultsA mixed‐effects model with country‐level random intercepts and slopes predicts an overall −0.162 kg/m2(95% CI −0.220, −0.104) reduction in BMI and lower odds of obesity (OR 0.90, 95% CI 0.87, 0.95) for every 200 m increase in altitude. However, countries vary dramatically in whether they exhibit a negative or positive association between altitude and BMI (34 countries negative, 20 positive). Mixed findings also arise when examining odds of obesity. DiscussionWe show that past findings of declining obesity risk with altitude are not universal. Increasing altitude predicts slightly lower BMIs at the global level, but the relationship within individual countries varies in both strength and direction.more » « less
An official website of the United States government

