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The psychiatrist, the treatment of chronic renal failure, and the prolongation of life. 3. Abram H S The American journal of psychiatry 10.1176/ajp.128.12.1534
Prevalence of selected risk behaviors and chronic diseases--Behavioral Risk Factor Surveillance System (BRFSS), 39 steps communities, United States, 2005. Ramsey Fred,Ussery-Hall Ann,Garcia Danyael,McDonald Goldie,Easton Alyssa,Kambon Maisha,Balluz Lina,Garvin William,Vigeant Justin, Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002) PROBLEM:Behavioral risk factors (e.g., tobacco use, poor diet, and physical inactivity) can lead to chronic diseases. In 2005, of the 10 leading causes of death in the United States, seven (heart disease, cancer, stroke, chronic lower respiratory diseases, diabetes, Alzheimer's disease, and kidney disease) were attributable to chronic disease. Chronic diseases also adversely affect the quality of life of an estimated 90 million persons in the United States, resulting in illness, disability, extended pain and suffering, and major limitations in daily living. REPORTING PERIOD COVERED:2005. DESCRIPTION OF THE SYSTEM:CDC's Steps Program funds 40 selected U.S. communities to address six leading causes of death and disability and rising health-care costs in the United States: obesity, diabetes, asthma, physical inactivity, poor nutrition, and tobacco use. In 2005, a total of 39 Steps communities conducted a survey to collect adult health outcome data. The survey instrument was a modified version of the Behavioral Risk Factor Surveillance System (BRFSS) survey, a community-based, random-digit--dialing telephone survey with a multistage cluster design. The survey instrument collected information on health risk behaviors and preventive health practices among noninstitutionalized adults aged >/=18 years. RESULTS:Prevalence estimates of risk behaviors and chronic conditions varied among the 39 Steps communities that reported data for 2005. The proportion of the population that achieved Healthy People 2010 (HP 2010) objectives also varied among the communities. The estimated prevalence of obesity (defined as having a body mass index [BMI] of >/=30.0 kg/m(2) as calculated from self-reported weight and height) ranged from 15.6% to 44.0%. No communities reached the HP2010 objective of reducing the proportion of adults who are obese to 15.0%. The prevalence of diagnosed diabetes (excluding gestational diabetes) ranged from 4.3% to 16.6%. Eighteen communities achieved the HP2010 objective to increase the proportion of adults with diabetes who have at least an annual foot examination to 75.0%; five communities achieved the HP2010 objective to increase the proportion of adults with diabetes who have an annual dilated eye examination to 75.0%. The prevalence of reported asthma ranged from 7.0% to 17.6%. Among those who reported having asthma, the prevalence of having no symptoms of asthma during the preceding 30 days ranged from 15.4% to 40.3% for 10 communities with sufficient data for estimates. The prevalence of respondents who engaged in moderate physical activity for >/=30 minutes at least five times a week or who reported vigorous physical activity for >/=20 minutes at least three times a week ranged from 42.0% to 62.2%. The prevalence of consumption of fruits and vegetables at least five times a day ranged from 15.6% to 30.3%. The estimated prevalence among respondents aged >/=18 years who reported having smoked >/=100 cigarettes in their lifetime and who were current smokers on every day or some days at the time of the survey ranged from 11.0% to 39.7%. One community achieved the HP2010 objective to reduce the proportion of adults who smoke to 12.0%. Among smokers, the prevalence of having stopped smoking for >/=1 day as a result of trying to quit smoking during the previous 12 months ranged from 47.8% to 63.3% for 31 communities. No communities reached the HP2010 objective of increasing smoking cessation attempts by adult smokers to 75%. INTERPRETATION:The findings in this report indicate variations in health risk behaviors, chronic conditions, and use of preventive health screenings and health services. These findings underscore the continued need to evaluate intervention programs at the community level and to design and implement policies to reduce morbidity and mortality caused by chronic disease. PUBLIC HEALTH ACTION:Steps BRFSS data can be used to monitor the prevalence of specific health behaviors, diseases, conditions, and use of preventive health services. Steps Program staff at the national, state, local, and tribal levels can use BRFSS data to demonstrate accountability to stakeholders, monitor progress in meeting program objectives, focus programs on activities with the greatest promise of results, identify opportunities for strategic collaboration, and identify and disseminate successes and lessons learned.
Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Mozaffarian Dariush,Afshin Ashkan,Benowitz Neal L,Bittner Vera,Daniels Stephen R,Franch Harold A,Jacobs David R,Kraus William E,Kris-Etherton Penny M,Krummel Debra A,Popkin Barry M,Whitsel Laurie P,Zakai Neil A, Circulation BACKGROUND:Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. METHODS AND RESULTS:For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. CONCLUSIONS:This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action. 10.1161/CIR.0b013e318260a20b
A Large-Scale Multi-ancestry Genome-wide Study Accounting for Smoking Behavior Identifies Multiple Significant Loci for Blood Pressure. American journal of human genetics Genome-wide association analysis advanced understanding of blood pressure (BP), a major risk factor for vascular conditions such as coronary heart disease and stroke. Accounting for smoking behavior may help identify BP loci and extend our knowledge of its genetic architecture. We performed genome-wide association meta-analyses of systolic and diastolic BP incorporating gene-smoking interactions in 610,091 individuals. Stage 1 analysis examined ∼18.8 million SNPs and small insertion/deletion variants in 129,913 individuals from four ancestries (European, African, Asian, and Hispanic) with follow-up analysis of promising variants in 480,178 additional individuals from five ancestries. We identified 15 loci that were genome-wide significant (p < 5 × 10) in stage 1 and formally replicated in stage 2. A combined stage 1 and 2 meta-analysis identified 66 additional genome-wide significant loci (13, 35, and 18 loci in European, African, and trans-ancestry, respectively). A total of 56 known BP loci were also identified by our results (p < 5 × 10). Of the newly identified loci, ten showed significant interaction with smoking status, but none of them were replicated in stage 2. Several loci were identified in African ancestry, highlighting the importance of genetic studies in diverse populations. The identified loci show strong evidence for regulatory features and support shared pathophysiology with cardiometabolic and addiction traits. They also highlight a role in BP regulation for biological candidates such as modulators of vascular structure and function (CDKN1B, BCAR1-CFDP1, PXDN, EEA1), ciliopathies (SDCCAG8, RPGRIP1L), telomere maintenance (TNKS, PINX1, AKTIP), and central dopaminergic signaling (MSRA, EBF2). 10.1016/j.ajhg.2018.01.015
Behavioral science research in diabetes: lifestyle changes related to obesity, eating behavior, and physical activity. Wing R R,Goldstein M G,Acton K J,Birch L L,Jakicic J M,Sallis J F,Smith-West D,Jeffery R W,Surwit R S Diabetes care Lifestyle factors related to obesity, eating behavior, and physical activity play a major role in the prevention and treatment of type 2 diabetes. In recent years, there has been progress in the development of behavioral strategies to modify these lifestyle behaviors. Further research, however, is clearly needed, because the rates of obesity in our country are escalating, and changing behavior for the long term has proven to be very difficult. This review article, which grew out of a National Institute of Diabetes and Digestive and Kidney Diseases conference on behavioral science research in diabetes, identifies four key topics related to obesity and physical activity that should be given high priority in future research efforts: 1) environmental factors related to obesity, eating, and physical activity; 2) adoption and maintenance of healthful eating, physical activity, and weight; 3) etiology of eating and physical activity; and 4) multiple behavior changes. This review article discusses the significance of each of these four topics, briefly reviews prior research in each area, identifies barriers to progress, and makes specific research recommendations. 10.2337/diacare.24.1.117
Biochemical Urine Testing of Medication Adherence and Its Association With Clinical Markers in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT). Diabetes care OBJECTIVE:To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing, and to determine the association of nonadherence with baseline demographics, treatment targets, and complications. RESEARCH DESIGN AND METHODS:Analyses were performed of baseline data on 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to oral antidiabetics (OADs), antihypertensives, and statins was determined by analyzing baseline urine samples using liquid chromatography-tandem mass spectrometry. Primary outcomes were microvascular and macrovascular complications and treatment targets of LDL cholesterol, HbA, and blood pressure. These were assessed cross-sectionally at baseline. RESULTS:Overall, 89.3% of patients were identified as adherent. Adherence rates to OADs, antihypertensives, and statins were 95.7%, 92.0%, and 95.5%, respectively. The prevalence of microvascular (81.6% vs. 66.2%; = 0.029) and macrovascular complications (55.1% vs. 37.0%; = 0.014) was significantly higher in nonadherent patients. The percentage of patients who reached an LDL cholesterol target of ≤2.5 mmol/L was lower (67.4% vs. 81.1%; = 0.029) in nonadherent patients. Binary logistic regression indicated that higher BMI, current smoking, elevated serum LDL cholesterol, high HbA, presence of diabetic kidney disease, and presence of macrovascular disease were associated with nonadherence. CONCLUSIONS:Although medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in nonadherent patients, and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve adherence. 10.2337/dc20-2533
[Exercise prescription and nutrition therapy]. Shiota Masatoshi,Sone Ryoko,Matsuo Eriko,Matsubara Shigeru,Suzuki Masato Nihon rinsho. Japanese journal of clinical medicine In the report of World Health Organization, the leading global risks for mortality in the world are high blood pressure (12.8%), tobacco use (8.7%), high blood glucose (5.8%), physical inactivity (5.5%), and overweight and obesity (4.8%). Increased blood pressure levels cause the increased morbidity and mortality of chronic diseases, such as stroke, myocardial infarction, chronic kidney disease. Improving the high blood pressure is considered as common challenges around the world. Exercise prescription and nutrition therapy might be important non-pharmacologic therapies in the control of hypertension. Applying these therapies to the general population can help to prevent an increase in blood pressure and decrease elevated blood pressure levels for those with hypertension. Exercise prescription and nutrition therapy are discussed using the international guidelines.
[Lifestyle-related diseases: Dyslipidemia]. Moriyama Toshiki Nihon Jinzo Gakkai shi
[Lifestyle interventions for the management of early stage of chronic kidney disease]. Matsumoto Hiroshi,Nakao Toshiyuki Nihon rinsho. Japanese journal of clinical medicine A high sodium or protein intake aggravates kidney damage. Recent reports showed that obesity, low physical activity, or current smoking raises a risk for chronic kidney disease. Therefore, some lifestyle interventions, such as control of body weight, reduction of salt intake, and cessation of smoking, may prevent or delay the progression of chronic kidney disease.
The impact of lifestyle, measured with the HLPCQ questionnaire on the prevalence of metabolic syndrome in Poland: a multicenter study. Scientific reports Metabolic syndrome is one of the most common health problems for people around the world. The aim of our study was to assess the prevalence of metabolic syndrome among adults without prior diagnosis of cardiovascular disease, diabetes, and chronic kidney disease. We also plan to assess the influence of certain lifestyle components on prevalence of metabolic syndrome. The study involved cardiovascularly healthy patients undergoing lab tests, measurements, and the HLPCQ questionnaire (The Healthy Lifestyle and Personal Control Questionnaire). The data were used to diagnose metabolic syndrome. Out of 1044 patients from 10 primary care facilities, 23.3% met the metabolic syndrome criteria, showing a strong link with increased blood pressure, cholesterol, and fasting glucose. Lower scores in the Organized physical exercise subscale of the HLPCQ questionnaire were noted in those with metabolic syndrome. Comparing the subscale of HLPCQ questionnaire, the lower results in Organized physical exercise subscale were found among the participants with metabolic syndrome, both male and females. Metabolic syndrome, a significant risk factor for cardiovascular disease, should be screened for actively, even in apparently healthy populations. Results obtained in our study from analysis of HLPCQ show that screening for metabolic syndrome should be preceded by prevention based on regular physical activity and proper eating habits. 10.1038/s41598-024-60866-1
The Impact of Sedentary Behavior on Renal Function Decline in 132,123 Middle Aged and Older Adults: A Nationwide Cohort Study. Medical science monitor : international medical journal of experimental and clinical research BACKGROUND Prior studies suggest that sedentary behavior is a well-known risk factor for cardiometabolic diseases. However, the longitudinal association between overall siting time and kidney function decline is not known. MATERIAL AND METHODS We performed a nationwide prospective cohort study in individuals aged more than 40 years enrolled in the China Cardiometabolic Disease and Cancer Cohort (4C) study. A total of 132 123 individuals were included in this study. Sitting time was measured with the short version of the International Physical Activity Questionnaire (IPAQ). Kidney function decline was defined as an eGFR <60 mL/min/1.73 m² or more than a 30% decrease in eGFR from baseline. Multivariate Cox proportional hazards regression analyses were conducted to estimate the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of the relation between kidney function decline and sitting time. RESULTS During a mean follow-up of 3.8 years, 3890 (2.9%) participants experienced kidney function decline. Longer sitting time was significantly associated with the risk of kidney function decline (aHR, 1.136; 95% CI, 1.036-1.247, P=0.007, comparing participants with baseline sitting time in the lowest quartile with those in the highest quartile) after adjustment for potential confounders. CONCLUSIONS Longer sitting time was independently and prospectively associated with a higher risk of kidney function decline. Sedentary behavior might represent a modifiable risk factor for chronic kidney disease (CKD) prevention. 10.12659/MSM.941111
Consumption of whole grains, fruit and vegetables is not associated with indices of renal function in the population-based longitudinal Doetinchem study. Herber-Gast Gerrie-Cor M,Boersma Marijke,Verschuren W M Monique,Stehouwer Coen D A,Gansevoort Ron T,Bakker Stephan J L,Spijkerman Annemieke M W The British journal of nutrition Emerging evidence suggests that diet and renal function are related. Little is known, however, about the association of consumption of whole grains, fruit and vegetables with urinary albumin:creatinine ratio (ACR) and changes in estimated glomerular filtration rate (eGFR). We investigated this in a population-based cohort aged 26-65 years. Data were from 3787 participants from the Doetinchem cohort study, who were examined ≥3 times, 5 years apart. Consumption of food groups was assessed at each round with a validated FFQ. GFR was estimated at each round from routinely measured cystatin C and creatinine using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation. ACR was measured at the last round. Generalised estimated equation models were performed to examine associations with changes in eGFR. Linear regression was used to examine associations with ACR. Adjustments were made for covariates related to lifestyle, biological factors and diet. Mean baseline eGFR was 104·5 (sd 13·7) and mean annual decline was -0·95 (sd 0·67) ml/min per 1·73 m2 over a 15-year follow-up. A trend was observed towards slightly less annual decline in eGFR among those with higher consumption of whole grains (P=0·06). This association, however, was attenuated and no longer significant in multivariate models (P=0·29). Consumption of fruit and vegetables was not associated with changes in eGFR and urinary ACR. In conclusion, consumption of whole grains, fruit and vegetables is not associated with changes in eGFR and mean ACR. As this was the first longitudinal study into this association in the general population, and as results are only partially in line with related studies, further research is recommended. 10.1017/S0007114517001726
Long-term fish intake preserves kidney function in elderly individuals: the Ikaria study. Chrysohoou Christina,Pitsavos Christos,Panagiotakos Demosthenes,Skoumas John,Lazaros George,Oikonomou Evangelos,Galiatsatos Nikos,Striggou Marina,Xynogala Maria,Stefanadis Christodoulos Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation OBJECTIVES:The aim of this work was to evaluate the correlation between the amount of weekly fish intake and kidney function as measured by creatinine clearance (CCr) rate among elderly inhabitants of Ikaria Island, a place that has been related to an increased rate of longevity. METHODS:From June to October of 2009, 673 males and females, aged 65-100 years and long-term residents of Ikaria Island were enrolled. Of those, 328 (75 ± 7 years) were males and 339 (75 ± 6 years) were females. Nutritional habits, including fish intake, were evaluated using a validated, semi-frequent food questionnaire and the MedDietScore. Urea and creatinine were measured, and CCr rate was estimated by the Cockcroft-Gault formula. RESULTS:Eighty-four percent of participants reported fish consumption of more than 150 g/week; 35% had moderate to severe CCr (<60 mL). Crude analysis revealed that CCr rate was positively associated with fish intake (b ± SE per 100 g/day: 24 ± 9, P = .007); multiple linear regression analysis confirmed the previous finding (b ± SE per 100 g/day: 11 ± 2, P = .001) after adjusting for overall dietary habits through the MedDietScore and other potential confounders. Fish intake was positively associated with CCr. Furthermore, multi-adjusted logistic regression analysis showed that fish consumption of 100 g/day increased the likelihood by 121% of having a CCr greater than 60 mL (95% confidence interval 10%-343%). CONCLUSIONS:Long-term fish consumption was independently associated with improved kidney function among elderly individuals, a finding that extends the current knowledge regarding the benefits of fish intake on human health. 10.1053/j.jrn.2012.09.002
Daily behavioral and sleep patterns are associated with aging-induced male-specific disorders in individuals with reduced renal function. Experimental gerontology BACKGROUND:The development of aging-induced male-specific disorders is accelerated by impaired renal function. Although aging-induced male-specific disorders are clinically serious complications in individuals with reduced renal function, their practical management strategies remain obscure. The purpose of this cross-sectional study was to investigate the association between daily behavioral and sleep patterns and aging-induced male-specific disorders in individuals with reduced renal function. METHODS:Eighty men with glomerular filtration rate stage 2-4 (age, 67 ± 9 years), sedentary behavior and physical activity were assessed using a triaxial accelerometer. The mean sleep time was calculated from the sleep time during the accelerometer measurement. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Aging-induced male-specific disorders were assessed using the Aging Males' Symptoms Questionnaire (AMS). RESULTS:A lower moderate to vigorous-intensity physical activity (MVPA) time and a higher PSQI score were independently associated with a higher AMS score. Moreover, when the participants were divided into four groups according to the median MVPA values and the PSQI score (more or less than 6 points), the AMS score was the highest in those with a lower MVPA time and a higher PSQI score. In the mediation analysis, the PSQI score did not mediate a correlation between the MVPA time and AMS score. MVPA time also did not mediate a correlation between the PSQI and AMS scores. CONCLUSIONS:Collectively, these findings suggest that increasing MVPA time and improving sleep quality may contribute to attenuating aging-induced male-specific disorders in individuals with reduced renal function. 10.1016/j.exger.2022.111717
Effects of physical activity on the progression of diabetic nephropathy: a meta-analysis. Cai Zixin,Yang Yan,Zhang Jingjing Bioscience reports BACKGROUND:Diabetic nephropathy (DN) is an important microvascular complication of diabetes. Physical activity (PA) is part of a healthy lifestyle for diabetic patients; however, the role of PA in DN has not been clarified. Our aim was to conduct a meta-analysis to explore the association between PA and DN risk. METHODS:PubMed, Embase, Cochrane Library and Web of Science were systematically searched for articles examining PA in diabetic patients and its effect on renal function. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. The study protocol is registered with PROSPERO (CRD42020191379). RESULTS:A total of 38991 participants were identified from 18 studies. The results indicated that PA was associated with increases in the glomerular filtration rate (SMD = 0.01, 95% CI = [0.02-0.17]) and decreases in the urinary albumin creatinine ratio (SMD = -0.53, 95% CI: -0.72 to -0.34), rate of microalbuminuria (OR = 0.61, 95% CI = [0.46-0.81]), rate of acute kidney injury (OR = 0.02, 95% CI = [0.01-0.04]), rate of renal failure (OR = 0.71, 95% CI = [0.52-0.97]) and risk of DN in patients with Type 1 diabetes (OR = 0.67, 95% CI = [0.51-0.89]). CONCLUSIONS:This meta-analysis indicated that PA is effective for improving DN and slowing its progression; however, more high-quality randomized controlled trials are required on this topic. 10.1042/BSR20203624
Is it time for a lifestyle approach to the burden of chronic kidney disease? White Sarah Hypertension research : official journal of the Japanese Society of Hypertension 10.1038/hr.2012.190
Association of Diet Quality Indices with Longitudinal Changes in Kidney Function in U.S. Hispanics/Latinos: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Kidney360 Background:Recent studies suggest an association between diet quality and incident CKD. However, Hispanics/Latinos were under-represented in these studies. We examined the relationship of diet quality with change in kidney function in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods:Individuals who participated in HCHS/SOL visits 1 (2008-2011) and 2 (2014-2017) were analyzed (=9921). We used Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MeDS) scores as measures of dietary quality. Scores were calculated from two 24-hour dietary recalls administered at visit 1 and categorized into quartiles of each dietary score (higher quartiles correspond to a healthier diet). Kidney function was assessed at both visits using eGFR and urine albumin-creatinine ratio (UACR). Annualized change was computed as the difference in eGFR or UACR between visits divided by follow-up time in years. Weighted linear-regression models were used to examine the association between quartiles of each dietary quality index and annualized change in eGFR and UACR, adjusted for potential confounders. Results:At visit 1, the mean (SD) age of participants was 41 (0.28) years, and 56% were female. The baseline mean eGFR was 107.1 ml/min per 1.73 m, and baseline median UACR was 6.1 mg/g. On average, eGFR declined by 0.65 ml/min per 1.73 m per year, and UACR increased by 0.79 mg/g per year over a 6-year period. Lower AHEI-2010 quartiles were associated with eGFR decline in a dose-response manner ( trend=0.02). Higher AHEI-2010 quartiles showed a trend toward lower annualized change in UACR, but the result did not reach significance. Neither MeDS nor DASH scores were associated with eGFR decline or change in UACR. Conclusions:Unhealthy diet, assessed at baseline by AHEI-2010, was associated with kidney-function decline over 6 years. Improving the quality of foods and nutrients according to the AHEI-2010 may help maintain kidney function in the Hispanic/Latino community. 10.34067/KID.0004552020
Associations between physical activity and quality of life in a population-based sample of kidney cancer survivors. Trinh Linda,Plotnikoff Ronald C,Rhodes Ryan E,North Scott,Courneya Kerry S Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology BACKGROUND:Physical activity (PA) improves quality of life (QoL) in several cancer survivor groups, but no study to date has focused on kidney cancer survivors (KCS). The purpose of this study was to estimate the prevalence of PA in KCS and determine any associations with QoL. METHODS:All 1,985 KCS diagnosed between 1996 and 2010 identified through a Canadian provincial Registry were mailed a survey that consisted of the Godin Leisure Time Exercise Questionnaire and several Functional Assessment of Cancer Therapy QoL scales. Standard demographic and medical variables were also reported. RESULTS:Completed surveys were received from 703 (43%) of the 1,654 KCS that received the survey. Over half (56.3%) were completely sedentary (CS), 17.6% were insufficiently active, 11.9% were active within public health guidelines, and 14.1% exceeded public health guidelines. After adjustment for key demographic and medical covariates, analyses of covariance indicated a dose-response association between PA and most QoL outcomes from CS to within guidelines (WG) with no further improvements for exceeding guidelines. For the primary QoL outcome of patient-reported physical functioning, the overall difference between CS and WG was 8.6 points (95% CI: 4.2-12.9, P < 0.001) which exceeds the minimally important difference of 5.0 points for this scale. Few associations were moderated by demographic or medical variables. CONCLUSION:Over half of KCS are CS; however, even some PA may be beneficial for QoL. IMPACT:PA is a modifiable lifestyle factor that may have implications for QoL and disease outcomes in KCS. 10.1158/1055-9965.EPI-10-1319
Applying the Public Health Exposome Model to Improve Kidney Disease Outcomes for Patients and Populations. Linn Dawn M,O'Neal Pamela V Nephrology nursing journal : journal of the American Nephrology Nurses' Association The genome is insufficient for understanding chronic health conditions, such as kidney disease. Only a small portion of chronic disease incidence can be attributed to genetic causes, and the field of exposomics provides an opportunity to explore the impact of environmental exposures on kidney disease. The environment plays a significant role in lifestyle choices and the stressors or exposures the body encounters throughout life. Exposures influence genetic expression, thereby impacting health and wellbeing of individuals exposed. Stressors or exposures are common experiences that may lend to understanding health disparities in vulnerable populations because environments are shared among families, neighborhoods, and communities. The Public Health Exposome Model examines the interplay among individuals, their personal attributes, environments, stressors/exposures, moderating factors, and individual and population health outcomes. Applying this model to kidney disease, nephrology nurses can lead community-based efforts to uncover ways to improve health outcomes for individuals with kidney disease and reduce incidence risk for future generations, thereby improving population health outcomes.
Environmental impact on the onset of hypertension-induced end-stage renal disease. Anbarasu Kavitha,Verma Vinod Kumar,Beevi Syed Sultan,Reddy Velagala Satti International journal of environmental health research This study intends to assess the impact of environmental factors on the onset of hypertension-induced end-stage renal disease (ESRD) and to compare the level of oxidative stress with nonhypertensive diabetic ESRD. ESRD patients were evaluated along with healthy controls through questionnaire for demographic, nutritional and lifestyle variables. Oxidants were measured along with antioxidants. Multiple linear regression (MLR) models were applied to analyze association of studied variables with oxidants and antioxidants. Most of the hypertensive nephrosclerotic patients were residing in locality that was either closer to industrial belt or polluting water bodies, belonging to low socioeconomic status that invariably affected their lifestyle and nutritional status. Hypertensive ESRD patients showed more pronounced oxidative stress than diabetic ESRD. Several of the studied variables were significantly associated with oxidants and antioxidants. Demographic, nutritional and lifestyle variables appeared to have suggestive effect on the onset of hypertensive nephrosclerosis. 10.1080/09603123.2018.1491954
Effects of helping relationships on health-promoting lifestyles among patients with chronic kidney disease: A randomized controlled trial. International journal of nursing studies BACKGROUND:Healthy behaviors can slow the progression of chronic kidney disease. Professional healthcare providers deliver education, physical exercise programs, motivation consultations, and stage-tailored strategies for improving health behaviors, but their effectiveness reported mixed. The helping relationships of significant others based on the transtheoretical model have been shown to be beneficial in facilitating and practicing health-promoting behaviors. However, few studies have examined the effects of helping relationships on health-promoting behaviors among patients with chronic kidney disease. OBJECTIVES:The aim of this study was to examine the effects of the intervention strategies of significant others in their helping relationships with patients to advance stages of exercise and diet behaviors, and to improve health-promoting lifestyles. DESIGN:A randomized controlled study. SETTINGS:Two outpatient nephrology clinics in southern Taiwan. PARTICIPANTS:Sixty participants in each of the two groups. METHODS:Patients were randomly assigned to either the intervention group (n = 60) whose significant others received strategies for helping relationships for 12 months, or the control group (n = 60). The Stage of Change of Exercise and Diet Behaviors, and Health Promoting Lifestyle Profile-II Chinese version were assessed at baseline and 3, 6, 9, and 12 months after receiving the helping relationship interventions tailored to stage of change from significant others. RESULTS:Generalized estimating equation analyzes revealed that the intervention group, when compared to the control group, had significantly advanced stages of change in exercise and diet, and improvement in health-promoting lifestyle over time. Adult children and spouses were the most common significant others to help patients practice healthy behaviors, compared to previous studies where professional healthcare providers were the significant others. CONCLUSIONS:Individualized plans for healthy behaviors should take into consideration patients' readiness for adopting stage-tailored strategies of helping relationships of significant others to adhere to the health-promoting lifestyle. To promote a healthier lifestyle, significant others, such as spouses and adult children, should be included in treatment programs. 10.1016/j.ijnurstu.2021.104137
Maternal Diet Influences Fetal Growth but Not Fetal Kidney Volume in an Australian Indigenous Pregnancy Cohort. Lee Yu Qi,Lumbers Eugenie R,Schumacher Tracy L,Collins Clare E,Rae Kym M,Pringle Kirsty G,Gomeroi Gaaynggal Advisory Committee Nutrients Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the cohort ( = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative. 10.3390/nu13020569
The renal benefits of a healthy lifestyle. de Francisco Angél L M,Fresnedo Gema Fernández,Palomar Rosa,Piñera Celestino,Arias Manuel Kidney international. Supplement Over the next decade, the number of patients with end-stage renal disease requiring treatment by dialysis may double, and even developed nations will have difficulty coping with this alarming increase. There is an urgent need to highlight the importance of modifiable risk factors as a basis for treatment strategies to prevent the development and progression of chronic kidney disease (CKD). This should include active extension of our current understanding of a healthy lifestyle. 10.1111/j.1523-1755.2005.09901.x
Reversing the tide - diagnosis and prevention of T2DM in populations of African descent. Utumatwishima Jean N,Chung Stephanie T,Bentley Amy R,Udahogora Margaret,Sumner Anne E Nature reviews. Endocrinology Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene-environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent. 10.1038/nrendo.2017.127
Association of accelerometer-measured physical activity with kidney function in a Japanese population: the DOSANCO Health Study. Sasaki Sachiko,Nakamura Koshi,Ukawa Shigekazu,Okada Emiko,Amagasa Shiho,Inoue Shigeru,Kimura Takashi,Yoshimura Aya,Tanaka Aya,Nakagawa Takafumi,Imae Akihiro,Tamakoshi Akiko BMC nephrology BACKGROUND:Sedentary behavior and decreased physical activity are associated with reduced kidney function, yet most evidence is based on self-reported physical activity. This study investigated the association between accelerometer-based physical activity level and kidney function in a general Japanese population. METHODS:A cross-sectional study was conducted in 440 community-dwelling Japanese participants, aged 35-79 years. Time (min/d) was assessed for the following types of physical activity: sedentary behavior, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Kidney function was assessed using estimated glomerular filtration rate (eGFR). A linear regression model was employed to calculate the β coefficient of eGFR for a 60-min/d increase in sedentary behavior and LPA and a 10-min/d increase in MVPA. A logistic regression model was used to calculate the odds ratio for low eGFR (< 60 versus ≥60 mL/min/1.73m) for a 60-min/d or 10-min/d increase in each physical activity type. RESULTS:MVPA time and eGFR were positively associated in both men and women, after adjusting for age, body mass index, and other clinical characteristics (Men: β, 0.91; P = 0.021; Women: β, 0.70; P = 0.034). In women, sedentary behavior and eGFR were inversely associated after adjusting for the same factors (β, - 1.06; P = 0.048). The odds ratio (95% confidence interval) for low eGFR associated with a 60-min increase in sedentary behavior was 1.65 (1.07-2.55) after adjusting for the same factors in women. CONCLUSION:Longer sedentary behavior and shorter MVPA time were associated with lower kidney function in the Japanese population. 10.1186/s12882-021-02635-0
Effects of targeted interventions on lifestyle modifications of chronic kidney disease patients: randomized controlled trial. Teng Hsiu-Lan,Yen Miaofen,Fetzer Susan,Sung Junne-Ming,Hung Shih-Yuan Western journal of nursing research Targeting interventions to an individual's readiness to modify lifestyle factors, specifically diet and exercise behaviors, may delay chronic kidney disease (CKD) progression. This study examined the effects of a targeted Lifestyle Modification Program based on the readiness to change health-promotion lifestyle behaviors, renal protection knowledge, and physical indicators of patients with early CKD. A repeated-measures design randomized 160 CKD patients from four southern Taiwan outpatient nephrology clinics into control and intervention groups. Data were collected five times over a year with a participant retention rate of 64.4%. The intervention group demonstrated significant improvement with regard to diet behavior modifications. Compared with the control group, the intervention group showed a significant improving trend of renal function protection knowledge, stress management, and interpersonal relations. Targeted interventions for patients in the early phases of CKD promotes adherence to proper diet, exercise behavior, and positive lifestyle modifications. 10.1177/0193945913486202
Lifestyle factors associated with a rapid decline in the estimated glomerular filtration rate over two years in older adults with type 2 diabetes-Evidence from a large national database in Japan. PloS one BACKGROUND:The present study investigated lifestyle risk factors from metabolic syndrome-related lifestyles for a rapid decline in the estimated glomerular filtration rate (eGFR) among adults aged 40-74 years with treated and untreated type 2 diabetes. METHODS AND RESULTS:This study analyzed data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, encompassing the period from fiscal year (FY) 2017 to FY2020. We established FY2018 as our baseline year. The subjects of this study were adults aged 40-74 in FY2018(baseline) who had type 2 diabetes and underwent specific health checkups in FY2020. We excluded adults with a medical record of kidney dialysis between FY2017 and FY2018, records of suspected type 1 diabetes between FY2017 and FY2020, or a baseline eGFR >85 mL/min/1.73 m2 or missing eGFR data as of FY2020. Eventually we analyzed 573,860 individuals. The outcome variable was a rapid decline in eGFR (≥30%) during the follow-up. Exposure lifestyle factors included skipping breakfast, late-night dinners, regular smoking, a high alcohol intake, non-refreshing sleep, and a lack of habitual exercise. Logistic regression models were stratified by age (40-59 and 60-74 years) and baseline eGFR levels (60-85, 30-59, and <30 mL/min/1.73 m2). Covariates included sex, a history of heart disease, a history of stroke, a history of renal failure, anemia, low-density lipoprotein, systolic blood pressure, hemoglobin A1C, body mass index, antidiabetic medications, antihypertension drugs, lipid-lowering drugs, the oral adsorbent Kremezin, non-steroidal anti-inflammatory drugs, and drugs for the treatment of renal anemia. A rapid decline in eGFR was detected in approximately 1.3% of participants (7,683 cases). In the baseline eGFR >30 subgroups (60-85 or 30-59 mL/min/1.73 m2), skipping breakfast and regular smoking were associated with a rapid decline in eGFR in both age groups, while a lack of habitual exercise and late-night dinners in the 60-74 age group and non-refreshing sleep in the 40-59 age group were identified as risk factors. Additionally, skipping breakfast was a risk factor for a rapid decline in eGFR in the 60-74 age group regardless of baseline eGFR levels. In the baseline eGFR <30 mL/min/1.73 m2 subgroup, skipping breakfast and non-refreshed sleep were risk factors for a rapid decline in eGFR. CONCLUSIONS:We found specific lifestyle risk factors were associated with a rapid eGFR decline among people with type 2 diabetes from a nationwide database in Japan. The associations varied by baseline eGFR level, age, and sex. Lifestyle modifications may effectively prevent the aggravation of diabetic kidney disease. 10.1371/journal.pone.0295235
[Updates on Lifestyle-Related Diseases and Bone Metabolism. CKD-related osteoporosis]. Yamada Shinsuke,Inaba Masaaki Clinical calcium Chronic kidney disease (CKD) has a high mortality rate of cardiovascular disease (CVD) . As CKD-mineral and bone disorder (CKD-MBD) is the one of the major risk factors in CVD, it is necessary that CKD patients are controlled CKD-MBD appropriately as early as possible. However, it is difficulty that CKD-MBD condition is exactly diagnosed and controlled, because it presents various conditions according to the difference of patient's background such as having diabetes or stage of CKD. We will give an outline of the mechanism in CKD-MBD according to patient's condition and the association between CKD-MBD and vascular calcification. CliCa141116051613
Management of chronic kidney disease: primary health-care setting, self-care and multidisciplinary approach. Cueto-Manzano A M,Martínez-Ramírez H R,Cortés-Sanabria L Clinical nephrology INTRODUCTION:End-stage renal disease (ESRD) is a growing problem, particularly in developing countries. Factors closely related with lifestyle and dietary habits that negatively affect kidney function are rarely modified by isolated medical intervention. Therefore, the present study was designed to determine the effect of an educational program with a multidisciplinary health-care approach supported by self-help groups on the lifestyle and dietary habits of patients at high risk of developing chronic kidney disease (CKD). PATIENTS:51 patients with overweight/obesity, 45 with hypertension and 88 with Type 2 diabetes mellitus (DM2) from a Family Medicine Unit, who had failed to meet clinical practice recommendations, were studied over 6 months. Patients received educational intervention guided by a multidisciplinary health team for 4 weeks (including topics such as emotional management, nutritional patterns, exercise and health-related problems). Reinforcement of goals and group dynamics were performed every 3 months. Additionally, self-help groups were constituted during the first month, and functioned with free activities, selected by patients and supported by the health team, for the duration of the study. A lifestyle questionnaire was administered at baseline and the end of the study; clinical and biochemical evaluations were performed every 3 months. RESULTS:Baseline lifestyle and dietary habits were unhealthy in all groups, particularly with regard to diet and exercise, and clinical and biochemical variables were concordant with inadequate achievement of clinical practice recommendations. After 6 months experience within this program, many of the negative lifestyle characteristics significantly improved. All groups reported a notable improvement in nutritional and exercise habits, as well as in management of the emotions. Only diabetic and hypertensive patients significantly improved the knowledge of their disease and adherence to treatment. None of the groups managed to reduce smoking or to cut their alcohol intake habits; however, relatively few participants had displayed these behaviors at the start of the study. Compared to baseline, all the groups significantly reduced body mass index and waist circumference. Additionally, diabetics and overweight/ obese patients significantly reduced blood glucose and increased GFR, and hypertensive patients significantly decreased systolic blood pressure and tended, although not significantly, to increase GFR. Remarkably, all these changes were independent of drug treatment, because none of the therapeutic interventions that had been formerly prescribed by family physicians had been significantly changed by the end of the follow-up in any of the groups. CONCLUSIONS:The implementation of educational strategies comprising multiple interventions for patients, guided by health professionals (multidisciplinary teams including primary doctors, dietitians, nurses, social workers), and probably supported by self-help groups, may be very helpful in modifying negative lifestyle and dietary habits. Educational interventions by both doctors and patients should be adopted concurrently and may help to control the enormous and growing problem of ESRD. 10.5414/cnp74s099
Sedentary behavior and estimated nephron number in middle-aged and older adults with or without chronic kidney disease. Kosaki Keisei,Takahashi Kanako,Matsui Masahiro,Yoshioka Masaki,Mori Shoya,Nishitani Natsumi,Shibata Ai,Saito Chie,Kuro-O Makoto,Yamagata Kunihiro,Oka Koichiro,Maeda Seiji Experimental gerontology BACKGROUND:Excessive sedentary behavior may contribute to the pathogenesis of chronic kidney disease (CKD). The nephron index is a novel methodology for non-invasively estimating the number of functional nephrons, under the assumption that serum fibroblast growth factor 23 (FGF23) concentrations should correlate with phosphate excretion per nephron. The purpose of this study was to investigate the cross-sectional associations between daily sedentary time and the nephron index in middle-aged and older adults with or without CKD. METHODS:The daily time spent in sedentary behavior was assessed using a tri-axial accelerometer in 294 participants (182 non-CKD adults and 112 CKD patients). The nephron index value was calculated by measuring blood and spot urine phosphate and creatinine, together with serum FGF23 concentrations and estimated glomerular filtration rate. RESULTS:We observed that advancing age and CKD were associated with a progressive decrease in the nephron index value. Additionally, CKD patients with more sedentary time also had a greater nephron index decrease compared to those with less sedentary time (P < 0.05). Multiple linear regression analysis confirmed the independent association between sedentary time and the nephron index after adjusting for age, sex, presence of CKD, overweight/obesity, medication use, and total wear time (β = -0.13, P = 0.035). CONCLUSIONS:These cross-sectional findings suggest that age- or CKD-related decreases in the estimated nephron number (that is, the nephron index) may be accelerated by increased sedentary behavior. 10.1016/j.exger.2021.111531
Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review. PloS one A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot. There were 54 included articles, of which 23 were randomised controlled trials (RCTs). The main component of the intervention for the included studies was mobile applications (n = 23), with the majority being in the dialysis population (n = 22). The majority of eHealth interventions were reported to be feasible and acceptable to participants. However, there was limited evidence that they were efficacious in improving clinical outcomes with the exception of blood pressure, intradialytic weight gain, potassium, and sodium. Although eHealth interventions appear acceptable and feasible to participants, there is insufficient evidence to make recommendations for specific interventions to be implemented into clinical care. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption. 10.1371/journal.pone.0297107
Impact of modifiable healthy lifestyle adoption on lifetime gain from middle to older age. Age and ageing OBJECTIVE:this study explored whether the modification of selected lifestyles is likely to increase life expectancy from middle age onwards, regardless of the presence of major comorbidities. METHODS:we examined a prospective cohort of 20,373 men and 26,247 women aged 40-80 years. Eight modifiable lifestyle factors were assessed: consumption of fruit, fish and milk, walking and/or sports participation, body-mass index, smoking status, alcohol consumption and sleep duration. Modifiable healthy lifestyle factors scored one point each, for a maximum of eight points. The impact of modifiable healthy lifestyle adoption on lifetime gain during the ages of 40-102 years was analysed. FINDINGS:during the median 21 years of follow-up, 8,966 individuals (3,683 men and 5,283 women) died. Life expectancy at 40 years (95% confidence intervals) for 7-8 health lifestyle points was 46.8 (45.6-48.1) and 51.3 (50.0-52.6) years for men and women, respectively. The potential impact of modifiable healthy lifestyle adoption on lifetime gain persisted over the age of 80 years or more, in individuals with ≥5 factors (P < 0.001), particularly older men. The benefits were more pronounced among patients with major comorbidities, such as cardiovascular disease, cancer, hypertension, diabetes, kidney disease and those with multimorbidity throughout all age categories. CONCLUSION:adopting modifiable healthy lifestyles was associated with lifetime gain, even in individuals aged 80 years or more, regardless of the presence of any major comorbidities in each life stage since middle age. The findings imply the importance of improving the one's lifestyle for an increased lifespan, even among older patients and/or those with multimorbidity. 10.1093/ageing/afac080
Lifestyle recommendations to reduce the risk of kidney stones. Meschi Tiziana,Nouvenne Antonio,Borghi Loris The Urologic clinics of North America Kidney stones are increasingly common in wealthy industrialized countries. The most frequent form (80%) is idiopathic calcium stone disease. Eating habits and lifestyle have a direct effect on the lithogenic urinary risk factors and the pathogenesis of this condition. A diet characterized by a high intake of fluids, fruits, and vegetables; a low consumption of salt and protein; and a balanced intake of calcium, fats, and carbohydrates constitutes an efficacious approach to the prevention and treatment of this illness. A correct body weight, regular exercise, and a reduction in stressful life events are also useful preventive actions. 10.1016/j.ucl.2011.04.002
The Global Promise of Healthy Lifestyle and Social Connections for Better Health in People With Diabetes. Mozaffarian Dariush,Peñalvo José L American journal of kidney diseases : the official journal of the National Kidney Foundation 10.1053/j.ajkd.2016.04.009
The Effect of Diet on the Survival of Patients with Chronic Kidney Disease. Nutrients The prevalence of chronic kidney disease (CKD) is high and it is gradually increasing. Individuals with CKD should introduce appropriate measures to hamper the progression of kidney function deterioration as well as prevent the development or progression of CKD-related diseases. A kidney-friendly diet may help to protect kidneys from further damage. Patients with kidney damage should limit the intake of certain foods to reduce the accumulation of unexcreted metabolic products and also to protect against hypertension, proteinuria and other heart and bone health problems. Despite the fact that the influence of certain types of nutrients has been widely studied in relation to kidney function and overall health in CKD patients, there are few studies on the impact of a specific diet on their survival. Animal studies demonstrated prolonged survival of rats with CKD fed with protein-restricted diets. In humans, the results of studies are conflicting. Some of them indicate slowing down of the progression of kidney disease and reduction in proteinuria, but other underline significant worsening of patients' nutritional state, which can be dangerous. A recent systemic study revealed that a healthy diet comprising many fruits and vegetables, fish, legumes, whole grains, and fibers and also the cutting down on red meat, sodium, and refined sugar intake was associated with lower mortality in people with kidney disease. The aim of this paper is to review the results of studies concerning the impact of diet on the survival of CKD patients. 10.3390/nu9050495
Exercise in kidney disease and diabetes: time for action. Smith Alice C,Burton James O Journal of renal care Physical inactivity is well recognised as a major health issue in today's society. Regular exercise is important in maintaining health and preventing chronic disease, it is increasingly accepted as a valuable therapeutic intervention in many long-term conditions. Unfortunately the role of physical activity in renal disease has been largely overlooked and provision of exercise advice and rehabilitation programmes for kidney patients lags well behind that of cardiology and pulmonary services. Research indicates that exercise can impact positively upon many of the health issues associated with declining renal function and renal replacement therapy, as concluded by a recent Cochrane review on the topic. As exercise should be integral to the management of diabetes, the issue is particularly relevant for patients with diabetic kidney disease. This paper summarises what is known about the main effects of exercise training in chronic kidney disease and diabetic kidney disease, and suggests how adaptations in the attitudes and approaches of the multidisciplinary renal and diabetes healthcare teams can help patients to enjoy the diverse benefits of an appropriately active lifestyle. 10.1111/j.1755-6686.2012.00279.x
The effect of lifestyle on the mortality associated with respiratory diseases in the general population. Scientific reports Lifestyle factors, including smoking habit, diet, and physical activity, affect the prognosis of various diseases. We elucidated the effect of lifestyle factors and health status on deaths from respiratory diseases in the general Japanese population using data from a community health examination database. Data of the nationwide screening program of the Specific Health Check-up and Guidance System (Tokutei-Kenshin), targeting the general population in Japan, from 2008 to 2010 were analyzed. The underlying causes of death were coded according to the International Classification of Diseases (ICD)-10. The hazard ratios of the incidence of mortality associated with respiratory disease were estimated using the Cox regression model. This study included 664,926 participants aged 40-74 years, who were followed up for 7 years. There were 8051 deaths, including 1263 (15.69%) deaths from respiratory diseases. The independent risk factors of mortality associated with respiratory diseases were male sex, older age, low body mass index, no exercise habit, slow walking speed, no drinking habit, smoking history, history of cerebrovascular diseases, high hemoglobin A1c and uric acid levels, low low-density lipoprotein cholesterol level, and proteinuria. Aging and decline of physical activity are significant risk factors for mortality associated with respiratory diseases, regardless of the smoking status. 10.1038/s41598-023-34929-8
Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial. Díaz-López Andrés,Becerra-Tomás Nerea,Ruiz Verónica,Toledo Estefania,Babio Nancy,Corella Dolores,Fitó Montse,Romaguera Dora,Vioque Jesús,Alonso-Gómez Ángel M,Wärnberg Julia,Martínez J Alfredo,Serra-Majem Luís,Estruch Ramon,Tinahones Francisco J,Lapetra José,Pintó Xavier,Tur Josep A,López-Miranda José,Cano Ibañez Naomi,Delgado-Rodríguez Miguel,Matía-Martín Pilar,Daimiel Lidia,de Paz Jose Antonio,Vidal Josep,Vázquez Clotilde,Ruiz-Canela Miguel,Bulló Mònica,Sorlí José V,Goday Albert,Fiol Miquel,García-de-la-Hera Manoli,Tojal Sierra Lucas,Pérez-Farinós Napoleón,Zulet Maria Ángeles,Sánchez-Villegas Almudena,Sacanella Emilio,Fernández-García José Carlos,Santos-Lozano José Manuel,Gimenez-Gracia Miquel,Del Mar Bibiloni Maria,Diez-Espino Javier,Ortega-Azorin Carolina,Castañer Olga,Morey Marga,Torres-Collado Laura,Sorto Sanchez Carolina,Muñoz Miguel Ángel,Ros Emilio,Martinez-Gonzalez Miguel A,Salas-Salvadó Jordi, American journal of nephrology INTRODUCTION:Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function. METHODS:Randomized controlled "PREvención con DIeta MEDiterránea-Plus" (PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (n = 6,719) adults aged 55-75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (eGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired eGFR (<60 mL/min/1.73 m2) and micro- to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m2) to mildly impaired GFR (60 to <90 mL/min/1.73 m2) or micro- to macroalbuminuria. RESULTS:After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m2 in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m2; 95% CI: 0.15-1.02). There were no between-group differences in mean UACR or micro- to macroalbuminuria changes. Moderately/severely impaired eGFR incidence and reversion of moderately to mildly impaired GFR were 40% lower (HR 0.60; 0.44-0.82) and 92% higher (HR 1.92; 1.35-2.73), respectively, in the intervention group. CONCLUSIONS:The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults. 10.1159/000513664
Amount and pattern of physical activity and sedentary behavior are associated with kidney function and kidney damage: The Maastricht Study. Martens Remy J H,van der Berg Julianne D,Stehouwer Coen D A,Henry Ronald M A,Bosma Hans,Dagnelie Pieter C,van Dongen Martien C J M,Eussen Simone J P M,Schram Miranda T,Sep Simone J S,van der Kallen Carla J H,Schaper Nicolaas C,Savelberg Hans H C M,van der Sande Frank M,Kroon Abraham A,Kooman Jeroen P,Koster Annemarie PloS one BACKGROUND:Chronic kidney disease, which is defined as having a reduced kidney function (estimated glomerular filtration rate (eGFR)) and/or signs of kidney damage (albuminuria), is highly prevalent in Western society and is associated with adverse health outcomes, such as cardiovascular disease. This warrants a search for risk factors of lower eGFR and higher albuminuria. Physical activity and sedentary behavior may be such risk factors. OBJECTIVE:To examine associations of physical activity (total, high, low), sedentary time and sedentary behavior patterns (breaks, prolonged bouts, average bout duration) with eGFR and albuminuria. METHODS:We examined these associations in 2,258 participants of the Maastricht Study (average age 60.1±8.1 years; 51.3% men), who wore an accelerometer 24h/day on 7 consecutive days. Associations with continuous eGFR and categories of urinary albumin excretion (UAE; <15 [reference category], 15-<30, ≥30 mg/24h) were evaluated with linear regression analyses and multinomial logistic regression analyses, respectively. RESULTS:After adjustment for potential confounders, each extra hour of total physical activity was associated with a more favorable kidney function (betaeGFR = 2.30 (95%CI = 1.46; 3.14)), whereas each extra hour of sedentary behavior was associated with a more adverse kidney function (betaeGFR = -0.71 (-1.08; -0.35)). Also, compared to individuals with the lowest levels of total physical activity, individuals with the highest levels had less kidney damage (OR15-<30mg/24h = 0.63 (0.41; 0.96), OR≥30mg/24h = 0.84 (0.53; 1.35). An extra hour of sedentary behavior was associated with more kidney damage (OR15-<30 mg/24h = 1.11 (1.01; 1.22), OR≥30 mg/24h = 1.10 (0.99; 1.22)). Further, a highly sedentary pattern was associated with a more adverse kidney function, but no association was seen with kidney damage. CONCLUSIONS:Physical activity and sedentary behavior were associated with kidney function and kidney damage. Additionally, sedentary behavior patterns were associated with kidney function. Causal studies are required to examine whether this indeed implicates that prevention strategies should focus not only on increasing physical activity, but on reducing sedentary behavior as well. 10.1371/journal.pone.0195306
Combination of Risks of BMI and Health-Related Lifestyles on Kidney Function in the Prediabetic Japanese Population: A Prospective Cohort Study. International journal of environmental research and public health Diabetic overweight patients are more likely to show the progression of kidney damage than the general population. The majority of people in the early stages of kidney damage do not recognize the importance of risk modification, mainly due to the asymptomatic nature of the disease. This study aimed to examine specific risk combinations of lifestyle and BMI regarding the deterioration of kidney function and to explore whether there are gender-based differences among the prediabetic population. Prediabetic participants with normal kidney function were identified via annual health examination from April 2016 to March 2019. The information on health status and lifestyle was collected at enrollment. The study subjects were followed until March 2021 to observe the progression of kidney damage. There were 2241 participants enrolled in this study. Smoking (HR = 3.5, < 0.001), eating snacks (HR = 3.2, < 0.001), not engaging in regular exercise (HR = 2.9, < 0.001), and not having adequate sleep (HR = 3.0, < 0.001) showed accelerated risks for kidney damage progression among the prediabetic population in males. These lifestyle effects were not observed in females. In conclusion, risk-based modification of lifestyle behavior is important to prevent kidney function damage among the overweight prediabetic population in males. 10.3390/ijerph20075338
Importance of Management of Lifestyle-Related Diseases After Kidney Donation to Living Donors. Transplantation proceedings BACKGROUND:Living kidney transplant donors are classified as stage 3 chronic kidney disease after kidney donation. For this reason, we provide daily lifestyle guidance, such as blood pressure and weight management before surgery, and dietary counseling focused on salt restriction. We emphasize providing lifestyle guidance after kidney donation. METHOD:At Osaka Medical and Pharmaceutical University Hospital, living kidney donors are scheduled for their first postoperative visit 1 month after kidney donation, followed by regular checkups every 6 months after that, starting 3 months after the initial visit. When living kidney donors come to the Renal Replacement Therapy Selection Outpatient Clinic before kidney transplantation, we provide sufficient explanations of the potential risks that may arise after kidney donation and ensure that they understand the importance of regular postoperative checkups. Apart from cases where patients reside far away, and we ask another hospital to provide postoperative follow-up, we can achieve regular checkups for almost all cases. RESULTS:Eighty-four living kidney transplant donors are being followed up at Osaka Medical and Pharmaceutical University Hospital. The average age is 59.8 ± 11.8 years, showing a trend of aging. Among the donors under follow-up, 7 developed hyperlipidemia, 2 developed hypertension, and 1 developed diabetes as new-onset lifestyle diseases after kidney donation. CONCLUSION:The ability to empathize with and support the anxieties associated with kidney donation and build a strong relationship of trust with the donors has become a significant factor in achieving a high rate of regular checkups after kidney donation. As a result, it has led to early detection and intervention for donor diseases, contributing to the maintenance of their health. Managing lifestyle-related diseases after kidney donation is essential for living kidney donors. 10.1016/j.transproceed.2024.01.027
Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. Devins G M Advances in renal replacement therapy Chronic life-threatening and disabling conditions, such as end-stage renal disease (ESRD), introduce significant psychosocial stressors and adaptive demands. The concept of illness intrusiveness is introduced to represent the illness-induced disruptions to lifestyle, activities, and interests that can compromise psychosocial well-being and contribute to emotional distress in chronic disease. A theoretical model is presented to specify the nature, determinants, and psychosocial consequences of illness intrusiveness and the causal pathways through which these factors are interrelated. Evidence in support of this analysis is reviewed and includes relevant findings from several chronic conditions including renal failure. The article concludes with suggested strategies and tactics for minimizing illness intrusiveness in ESRD. It is hoped that effective minimization of illness intrusiveness can assist affected individuals in achieving a high quality of life. 10.1016/s1073-4449(12)80007-0
Averting comfortable lifestyle crises. Science progress How have climate change and diet shaped the evolution of human energy metabolism, and responses to vitamin C, fructose and uric acid? Through the last three millennia observant physicians have noted the association of inappropriate diets with increased incidence of obesity, heart disease, diabetes and cancer, and over the past 300 years doctors in the UK observed that overeating increased the incidence of these diseases. Anthropological studies of the Inuit culture in the mid-nineteenth century revealed that humans can survive and thrive in the virtual absence of dietary carbohydrate. In the 1960s, Cahill revealed the flexibility of human metabolism in response to partial and total starvation and demonstrated that type 2 diabetics were better adapted than healthy subjects to conserving protein during fasting. The potential role for brown adipose tissue thermogenesis in temperature maintenance and dietary calorie control was suggested by Rothwell and Stock from their experiments with 'cafeteria fed rats' in the 1980s. Recent advances in gene array studies and PET scanning support a role for this process in humans. The industrialisation of food processing in the twentieth century has led to increases in palatability and digestibility with a parallel loss of quality leading to overconsumption and the current obesity epidemic. The switch from animal to vegetable fats at the beginning of the twentieth century, followed by the rapid increase in sugar and fructose consumption from 1979 is mirrored by a steep increase in obesity in the 1980s, in the UK and USA. Containment of the obesity epidemic is compounded by the addictive properties of sugar which involve the same dopamine receptors in the pleasure centres of the brain as for cocaine, nicotine and alcohol. Of the many other toxic effects of excessive sugar consumption, immunocompromisation, kidney damage, atherosclerosis, oxidative stress and cancer are highlighted. The WHO and guidelines on sugar consumption include: alternative non-sugar sweeteners; toxic side-effects of aspartame. Stevia and xylitol as healthy sugar replacements; the role of food processing in dietary health; and beneficial effects of resistant starch in natural and processed foods. The rise of maize and soya-based vegetable oils have led to omega-6 fat overload and imbalance in the dietary ratio of omega-3 to omega-6 fats. This has led to toxicity studies with industrial trans fats; investigations on health risks associated with stress and comfort eating; and abdominal obesity. Other factors to consider are: diet, cholesterol and oxidative stress, as well as the new approaches to the chronology of eating and the health benefits of intermittent fasting. 10.3184/003685013X13743292107915
Can comprehensive lifestyle change alter the course of chronic kidney disease? Tuttle Katherine R,Sunwold Duane,Kramer Holly Seminars in nephrology Comprehensive lifestyle change can impact health favorably in many domains, from prevention and treatment of various diseases to improved functional status and quality of life. Although habitual behaviors clearly influence chronic kidney disease (CKD), lifestyle change often is not stressed in the clinical setting. The purpose of this review is to provide a critical appraisal of the scientific basis for effects of lifestyle on CKD and practical strategies that promote healthy behaviors. This review begins with a clinical case presentation to provide context for the scientific discussion. Dietary composition of macronutrients, particularly protein intake, is highlighted. Clinical evidence is presented for avoiding protein excess, a contemporary problem in the typical overeating environment of the developed world. Concomitant approaches to balancing intake of carbohydrates and fats also are presented. Integration of sodium reduction with macronutrient adjustment is reviewed within the framework of managing blood pressure in the setting of CKD. Considering the emerging body of evidence for obesity-related CKD and associated complications, weight control is addressed from the standpoint of decreasing calories and increasing exercise. Finally, effects of smoking and alcohol use on CKD are discussed. In the spirit of active participation, which is essential to lifestyle change, the discussion returns full circle to a concluding statement from the clinical case patient who provides his point of view on lifestyle change while living with CKD. 10.1016/j.semnephrol.2009.06.008
Impact of lifestyle on prevalence of kidney disease in Pima Indians in Mexico and the United States. Valencia Mauro E,Weil E Jennifer,Nelson Robert G,Esparza Julian,Schulz Leslie O,Ravussin Eric,Bennett Peter H Kidney international. Supplement Pima Indians in the United States and Mexico share a common genetic background but have very different lifestyles. Comparisons were made of the frequency of obesity, diabetes, hypertension, and kidney disease in these geographically separated but susceptible populations. Mexican Pimas had higher levels of physical activity, less obesity, and a lower prevalence of diabetes than their US Pima counterparts. Mean blood pressure rose with worsening glucose tolerance, and the prevalence of elevated urinary albumin excretion was higher in patients with diabetes than in those without, regardless of whether they lived in the United States or Mexico. These findings illustrate the importance of lifestyle in the development of diabetes and in the subsequent occurrence of diabetic kidney disease. 10.1111/j.1523-1755.2005.09724.x
Lifestyle behaviour change for preventing the progression of chronic kidney disease: a systematic review. Evangelidis Nicole,Craig Jonathan,Bauman Adrian,Manera Karine,Saglimbene Valeria,Tong Allison BMJ open OBJECTIVES:Modifying lifestyle can prevent the progression of chronic kidney disease (CKD) but the specific elements which lead to favourable behaviour change are not well understood. We aimed to identify and evaluate behaviour change techniques and functions in lifestyle interventions for preventing the progression of CKD. DESIGN:Systematic review. DATA SOURCES:MEDLINE, EMBASE, CINAHL and PsycINFO. ELIGIBILITY CRITERIA:Trials of lifestyle behaviour change interventions (including diet, physical activity, smoking and/or alcohol) published to September 2018 in adults with CKD stages 1-5. DATA EXTRACTION AND SYNTHESIS:Trial characteristics including population, sample size, study setting, intervention, comparator, outcomes and study duration, were extracted. Study quality was independently assessed by two reviewers using the Cochrane risk of bias tool. The Behaviour Change Technique Taxonomy v1 was used to identify behaviour change techniques (eg, goal setting) and the Health Behaviour Change Wheel was used to identify intervention functions (eg, education). Both were independently assessed by three reviewers. RESULTS:In total, 26 studies involving 4263 participants were included. Risk of bias was high or unclear in most studies. Interventions involved diet (11), physical activity (8) or general lifestyle (7). Education was the most frequently used function (21 interventions), followed by enablement (18), training (12), persuasion (4), environmental restructuring (4), modelling (2) and incentivisation (2). The most common behaviour change techniques were behavioural instruction (23 interventions), social support (16), behavioural demonstration (13), feedback on behaviour (12) and behavioural practice/rehearsal (12). Eighteen studies (69%) showed a significant improvement in at least one primary outcome, all of which included education, persuasion, modelling and incentivisation. CONCLUSION:Lifestyle behaviour change interventions for CKD patients frequently used education, goal setting, feedback, monitoring and social support. The most promising interventions included education and used a variety of intervention functions (persuasion, modelling and incentivisation). PROSPERO REGISTRATION NUMBER:CRD42019106053. 10.1136/bmjopen-2019-031625
The Effect of CKD on Associations between Lifestyle Factors and All-cause, Cancer, and Cardiovascular Mortality: A Population-based Cohort Study. Wakasugi Minako,Narita Ichiei,Iseki Kunitoshi,Asahi Koichi,Yamagata Kunihiro,Fujimoto Shouichi,Moriyama Toshiki,Konta Tsuneo,Tsuruya Kazuhiko,Kasahara Masato,Shibagaki Yugo,Kondo Masahide,Watanabe Tsuyoshi Internal medicine (Tokyo, Japan) Objective Results from previous studies on the dose-dependent effect of adhering to multiple lifestyle factors on all-cause mortality in patients with chronic kidney disease (CKD) are inconsistent, despite the reported dose-dependent effect in the general population. This study aimed to examine whether CKD modifies the dose-dependent effect of adhering to multiple lifestyle factors on mortality. Methods This population-based prospective cohort study targeted 262,011 men and women aged 40-74 years at baseline. Of these, 18.5% had CKD, which was defined as GFR <60 mL/min/1.73 m, ≥1+ proteinuria on urinalysis, or both. The following lifestyle behaviors were considered healthy: no smoking, body mass index <25 kg/m, moderate or lower alcohol consumption, regular exercise, and healthy eating habits. Healthy lifestyle scores were calculated by adding the total number of lifestyle factors for which each participant was at low risk. Cox proportional hazards models were used to examine associations between healthy lifestyle scores and all-cause, cancer, and cardiovascular mortality, and whether CKD modified these associations. Results During a median follow-up of 4.7 years, 3,471 participants died. The risks of all-cause and cancer mortality decreased as the number of five healthy lifestyle factors that were adhered to increased, irrespective of the CKD status. The risk of cardiovascular mortality, however, was modified by CKD (interaction p=0.07), and an unhealthy lifestyle and CKD synergistically increased cardiovascular mortality. Conclusion A healthy lifestyle can reduce the risk of all-cause and cancer death in patients with or without CKD, while the prevention of CKD is essential for reducing the risk of cardiovascular death. 10.2169/internalmedicine.6531-20
Chronic kidney disease as a cardiovascular risk factor. Carmena Rafael,Ascaso Juan F,Redon Josep Journal of hypertension : Chronic kidney disease (CKD) is a public health threat with impact in cardiovascular risk. All forms of cardiovascular disease and mortality are more common in CKD. Treatment of cardiovascular risk factors, hypertension, dyslipidemia and diabetes is essential for cardiovascular and kidney protection. CKD is a marker of high or very high cardiovascular risk and its presence require early treatment and specific goals. Lifestyle is a pivotal factor, stopping smoking, reducing weight in the overweight or obese, starting regular physical exercise and healthy dietary pattern are recommended. Office BP should be lowered towards 130/80 mmHg or even lower if tolerated with sodium restriction and single pill combination, including angiotensin system blocker. Out-of-office BP monitoring, mainly 24-h assessment, is recommended. Diabetes requires treatment from the moment of diagnosis, but prediabetes benefits with lifestyle changes and metformin in patients stage 2 and 3a. iSGLT2 and GLP-1RA are initially recommended in T2D patients with high or very high cardiovascular risk. Concerning dyslipidemia, for patients in stage 4, LDL-C 55 mg/dl or less (1.4 mmol/l) and an LDL-C reduction of 50% or less from baseline is recommended. In stage 3, LDL-C goal is 70 mg/dl or less (1.8 mmol/l) and an LDL-C. reduction of at least 50% from baseline. Statins are the lipid-lowering therapy of choice with or without ezetimibe. Higher doses of statins are required as GFR declines. Available evidence suggests that combined PCSK9 inhibitors with maximally tolerated dose of statins may have an emerging role in treatment of dyslipidemia in CKD patients. 10.1097/HJH.0000000000002506
Association of a Healthy Lifestyle, Life's Essential 8 Scores With Incident Macrovascular and Microvascular Disease Among Individuals With Type 2 Diabetes. Journal of the American Heart Association Background The association of a healthy lifestyle with the prognosis of type 2 diabetes remains uncertain. We aimed to evaluate the associations of a healthy lifestyle and a higher American Heart Association's Life's Essential 8 score with incident macrovascular and microvascular diseases in type 2 diabetes. Methods and Results A total of 13 543 participants with baseline type 2 diabetes and free of macrovascular and microvascular diseases from the UK Biobank were included. A healthy lifestyle was determined based on body mass index, smoking, alcohol consumption, physical activity, sleep duration, and diet. Life's Essential 8 scores were generated from 8 metrics according to the American Heart Association's cardiovascular health advisory, ranging from 0 to 100. During a median follow-up of 12.1 years, 3279 (24.2%) incident macrovascular diseases and 2557 (18.9%) microvascular diseases were documented. Compared with those with a poor lifestyle, participants with an ideal lifestyle had significantly lower risks of incident macrovascular disease (hazard ratio [HR], 0.46 [95% CI, 0.36-0.59]) and microvascular disease (HR, 0.60 [95% CI, 0.47-0.77]). Significantly lower risks of macrovascular disease (HR, 0.20 [95% CI, 0.05-0.79]) and microvascular disease (HR, 0.24 [95% CI, 0.06-0.98]) were also found in the high cardiovascular health group (Life's Essential 8 scores: 80-100), compared to the low cardiovascular health group (scores: 0-49). Adhering to an ideal lifestyle may prevent 37.0% of macrovascular disease and 24.7% of microvascular disease, and attaining a high cardiovascular health may prevent 71.9% of macrovascular disease and 67.5% of microvascular disease. Conclusions A healthy lifestyle and a higher Life's Essential 8 score were associated with lower risks of macrovascular and microvascular diseases among participants with type 2 diabetes. 10.1161/JAHA.122.029441
Multidisciplinary education and lifestyle camps for CKD patients and their closest family members: effects on disease progression, self-management and psychosocial condition-a retrospective cohort study. Polner Kálmán,Sallay Erika,Detrich Katalin,Haris Ágnes International urology and nephrology BACKGROUND:Multidisciplinary education including psychosocial care (MDE) may alleviate high burden of chronic kidney disease (CKD). Family support also has utmost importance, yet, MDE has rarely been provided jointly for patients and their relatives. METHODS:We organized intensive, 1-week-long boarding MDE and lifestyle camps for CKD stage III-V patients and their relatives and assessed the rate of CKD progression, proportion of participants' home-based dialysis choice, transplant activity, and improvement of their coping and attitude evaluated by written narratives. Outcome was compared to 40 controls with similarly advanced CKD, under standard of care on our outpatient clinic. RESULTS:In 60 predialysis patients, serum creatinine 12 months before participation was 281 [IQR 122] µmol/l, right before MDE 356 [IQR 141] µmol/l, 12 months after MDE 388 [IQR 284] µmol/l, eGFR decreased from 18.5 [IQR 10] ml/min to 14.0 [IQR 7] ml/min and 13.0 [IQR 8] ml/min, respectively. Twelve months' changes before and after MDE differed significantly (p = 0.005 for creatinine; p = 0.003 for eGFR). Decreased progression was found in comparison to controls (p = 0.004; 0.016, respectively) as well. During follow-up, MDE patients compared to controls chose PD as dialysis modality more often (p = 0.004), and were more active in renal transplantation (p = 0.026). Based on narratives, MDE enhanced participants' disease-specific knowledge and ability for coping. It also improved sympathy, helpfulness, and the mutual responsibilities of family members. CONCLUSIONS:Our unique MDE programme with participation of the closest relatives enhanced the effectiveness of education and strengthened family support, which contributed to favorable CKD outcome, increased activity in home-based dialysis selection and transplant activity. 10.1007/s11255-021-02948-x
Modification of diet, exercise and lifestyle (MODEL) study: a randomised controlled trial protocol. BMJ open INTRODUCTION:Most cardiovascular disease (CVD)-related events could be prevented or substantially delayed with improved diet and lifestyle. Providing information on structural vascular disease may improve CVD risk factor management, but its impact on lifestyle change remains unclear. This study aims to determine whether providing visualisation and pictorial representation of structural vascular disease (abdominal aortic calcification (AAC)) can result in healthful diet and lifestyle change. METHODS AND ANALYSIS:This study, including men and women aged 60-80 years, is a 12-week, two-arm, multisite randomised controlled trial. At baseline, all participants will have AAC assessed from a lateral spine image captured using a bone densitometer. Participants will then be randomised to receive their AAC results at baseline (intervention group) or a usual care control group that will receive their results at 12 weeks. All participants will receive information about routinely assessed CVD risk factors and standardised (video) diet and lifestyle advice with three simple goals: (1) increase fruit and vegetable (FV) intake by at least one serve per day, (2) improve other aspects of the diet and (3) reduce sitting time and increase physical activity. Clinical assessments will be performed at baseline and 12 weeks. OUTCOMES:The primary outcome is a change in serum carotenoid concentrations as an objective measure of FV intake. The study design, procedures and treatment of data will adhere to Standard Protocol Items for Randomized Trials guidelines. ETHICS AND DISSEMINATION:Ethics approval for this study has been granted by the Edith Cowan University and the Deakin University Human Research Ethics Committees (Project Numbers: 20513 HODGSON and 2019-220, respectively). Results of this study will be published in peer-reviewed academic journals and presented in scientific meetings and conferences. Information regarding consent, confidentiality, access to data, ancillary and post-trial care and dissemination policy has been disclosed in the participant information form. TRIAL REGISTRATION NUMBER:Australian New Zealand Clinical Trial Registry (ACTRN12618001087246). 10.1136/bmjopen-2019-036366
Fruit for thought: lifestyle interventions to reduce the risk of future chronic kidney disease. Lees Jennifer S,Mark Patrick B Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 10.1093/ndt/gfaa266
Associations between Differential Aging and Lifestyle, Environment, Current, and Future Health Conditions: Findings from Canadian Longitudinal Study on Aging. Gerontology INTRODUCTION:An aging population will bring a pressing challenge for the healthcare system. Insights into promoting healthy longevity can be gained by quantifying the biological aging process and understanding the roles of modifiable lifestyle and environmental factors, and chronic disease conditions. METHODS:We developed a biological age (BioAge) index by applying multiple state-of-art machine learning models based on easily accessible blood test data from the Canadian Longitudinal Study of Aging (CLSA). The BioAge gap, which is the difference between BioAge index and chronological age, was used to quantify the differential aging, i.e., the difference between biological and chronological age, of the CLSA participants. We further investigated the associations between the BioAge gap and lifestyle, environmental factors, and current and future health conditions. RESULTS:BioAge gap had strong associations with existing adverse health conditions (e.g., cancers, cardiovascular diseases, diabetes, and kidney diseases) and future disease onset (e.g., Parkinson's disease, diabetes, and kidney diseases). We identified that frequent consumption of processed meat, pork, beef, and chicken, poor outcomes in nutritional risk screening, cigarette smoking, exposure to passive smoking are associated with positive BioAge gap ("older" BioAge than expected). We also identified several modifiable factors, including eating fruits, legumes, vegetables, related to negative BioAge gap ("younger" BioAge than expected). CONCLUSIONS:Our study shows that a BioAge index based on easily accessible blood tests has the potential to quantify the differential biological aging process that can be associated with current and future adverse health events. The identified risk and protective factors for differential aging indicated by BioAge gap are informative for future research and guidelines to promote healthy longevity. 10.1159/000534015
Sedentary Behavior and Change in Kidney Function: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Kidney360 BACKGROUND:There is accumulating evidence linking prolonged sedentary time to adverse health outcomes. The effect of sedentary behavior on kidney function has not been evaluated in US Hispanics/Latinos, a population disproportionately affected by CKD. METHODS:We evaluated the association between accelerometer-measured (1 week) sedentary time at baseline and kidney function among 7134 adults without CKD at entry in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who completed a baseline visit with accelerometry (2008-2011) and a follow-up visit (2014-2017). Outcomes included: () change in kidney function (eGFR and urine albumin-to-creatinine ratio, ACR), () incident low eGFR (eGFR <60 ml/min per 1.73 m and eGFR decline ≥1 ml/min per year), and () incident albuminuria (ACR ≥17 mg/g in men or ≥25 mg/g in women). Linear regression using survey procedures was used to evaluate change in kidney function (eGFR and ACR), and Poisson regression with robust variance was used to evaluate incident low eGFR and albuminuria. RESULTS:The median sedentary time was 12 hours/d. Over a median follow-up of 6.1 years, the mean relative change in eGFR was -0.50% per year, and there were 167 incident low eGFR events. On multivariable analysis, each 1 hour increase in sedentary time was associated with a longitudinal decline in eGFR (-0.06% per year, 95% CI, -0.10 to -0.02). There was a significant interaction with sex, and on stratified analyses, higher sedentary time was associated with eGFR decline in women but not men. There was no association between sedentary time and the other outcomes. CONCLUSIONS:Sedentary time was associated with a small longitudinal decline in eGFR, which could have important implications in a population that experiences a disproportionate burden of CKD but further investigation is needed. 10.34067/KID.0006202020
Diabetes, Hypertension, and the Mediating Role of Lifestyle: A Cross-Sectional Analysis in a Large Cohort of Adults. American journal of preventive medicine INTRODUCTION:Whether diabetes is associated with hypertension risk remains controversial, potentially owing to the confounding effect of lifestyle. This study aims to analyze the association between diabetes and hypertension in adults and the mediating impacts of lifestyle. METHODS:A cohort of Spanish workers (aged 18-64 years) insured by an occupational risk prevention company participated in this nationwide cross-sectional study between 2012 and 2016 (data analysis was performed in 2021). Participants' lifestyle‒related factors-BMI, sleeping hours, alcohol, smoking, and physical activity-were assessed, and the prevalence of hypertension and diabetes was registered. RESULTS:A total of 451,157 participants (33.1% women, aged 44.5 [SD=9.2] years, 3.2% with diabetes, and 29.3% with hypertension) with complete data for all variables were assessed. Having diabetes was associated with a higher prevalence of hypertension even after adjusting for all lifestyle-related factors (OR=1.44, 95% CI=1.43, 1.48), and people with diabetes and hypertension had a higher prevalence of mild kidney function impairment than people with diabetes alone (OR=1.06, 95% CI=1.01, 1.13). However, people with diabetes and an optimal lifestyle-normal weight and sleeping hours, absent-to-little alcohol drinking, nonsmoking, and regular physical activity-presented a prevalence of hypertension comparable with that of those without diabetes (OR=1.00, 95% CI=0.71, 1.32). In separate analyses among people with diabetes, an optimal lifestyle was associated with a lower prevalence of hypertension than the worse-opposite-lifestyle (OR=0.29, 95% CI=0.18, 0.53). The lifestyle-related factors showing the strongest inverse association with adjusted risk of hypertension were normal weight (OR=0.49, 95% CI=0.42, 0.53 versus overweight/obesity) and regular physical activity (OR=0.79, 95% CI=0.74, 0.82 versus inactivity). CONCLUSIONS:Diabetes is positively and largely independently associated with hypertension risk. Yet, a healthy lifestyle can attenuate this association. 10.1016/j.amepre.2022.01.014
Lifestyle modification and progressive renal failure. Ritz Eberhard,Schwenger Vedat Nephrology (Carlton, Vic.) There is increasing evidence that lifestyle factors impact on the risk of developing chronic kidney disease (CKD) and the risk of progression of CKD. Equally important is the consideration that patients with CKD are more likely to die from cardiovascular disease than to reach the stage of end-stage renal failure. It is advantageous that manoeuvres that interfere with progression at the same time also reduce the risk of cardiovascular events. Lifestyle factors that aggravate progression include, among others, smoking, obesity and dietary salt intake. Alcohol consumption, according to some preliminary information, has a bimodal relationship to cardiovascular risk and progression, with moderate consumption being protective. 10.1111/j.1440-1797.2005.00439.x
Causal effects of physical activity or sedentary behaviors on kidney function: an integrated population-scale observational analysis and Mendelian randomization study. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association BACKGROUND:An investigation into the causality of the effects of physical activity and specific sedentary activities on kidney function in the general population is warranted. METHODS:In this observational cohort study, first, the clinical associations of the prevalence of stages 3-5 chronic kidney disease (CKD) and the estimated glomerular filtration rate (eGFR) with physical activity, determined by self-report or objective wrist-band accelerometer results, and sedentary activities (watching television, using a computer and driving) were investigated in 329 758 UK Biobank participants. To assess causality, a two-sample Mendelian randomization (MR) analysis was performed to investigate the associations of a genetic predisposition to physical activity and a sedentary lifestyle with the risk of kidney function impairment in an independent CKDGen genome-wide association study (N = 567 460). The findings were replicated with the 321 024 UK White British Biobank participants in the allele-score-based one-sample MR. RESULTS:A higher degree of self-reported or accelerometer-determined moderate-to-vigorous physical activity was associated with a higher eGFR, while a longer time spent watching television was significantly associated with a lower eGFR and a higher prevalence of CKD. The two-sample MR demonstrated that the genetic predisposition to a higher degree of physical activity was associated with a lower risk of CKD and a higher eGFR, while the genetically predicted television watching duration was associated with a higher risk of CKD and a lower eGFR. The other sedentary behaviors yielded inconsistent results. The findings were similarly replicated in the one-sample MR. CONCLUSION:Physical activity and television watching causally affect kidney function in the general population. 10.1093/ndt/gfab153
Short-term Healthy Lifestyle Intervention and Long-term Behavior Change After Kidney Transplantation: Findings From the CAVIAR Study. American journal of kidney diseases : the official journal of the National Kidney Foundation 10.1053/j.ajkd.2022.08.020
Lifestyle issues and genitourinary tumours. Sommer Frank,Klotz Theo,Schmitz-Dräger Bernd J World journal of urology A variety of lifestyle factors, including physical activity, artificial sweeteners, alcohol consumption and smoking, have been reported to contribute to the risk of developing urological malignancies. A great number of epidemiological studies suggest that sports and physical activity may have a preventive influence on genitourinary tumours, especially on the incidence of prostate cancer. Smoking appears to be the most relevant lifestyle factor significantly increasing both incidence and mortality from bladder cancer. Furthermore, there is evidence implicating an association between tobacco use and kidney cancer. In contrast, prostate and testicular cancers are unlikely to be linked to tobacco use. As far as alcohol is concerned, most studies indicate that neither amount nor type of alcohol seems to be clearly associated with a risk of developing urological malignancies. However, some more recent cohort studies suggest a moderately increased risk for prostate and bladder cancer for specific types of alcohol. On the other hand, there is evidence that moderate alcohol consumption may even protect women from developing renal cancer. Since the introduction of artificial sweeteners, reports of potential cancer risks have circulated periodically through the mass media. The wide distribution of these agents and the fact that mostly combinations of the different compounds are added to a broad variety of food, drinks, drugs, and hygiene products complicates a systematic analysis of their potential impact on the development of urological malignancies. Nevertheless, so far not a single study has convincingly demonstrated a statistically significant risk of bladder cancer due to the consumption of artificial sweeteners. This survey demonstrates that the individual assessment of lifestyle factors not only may identify groups with an increased risk for urological malignancies but also clearly displays a potential for tumour prevention. 10.1007/s00345-003-0379-3
The association between changes in lifestyle behaviors and the incidence of chronic kidney disease (CKD) in middle-aged and older men. Michishita Ryoma,Matsuda Takuro,Kawakami Shotaro,Tanaka Satoshi,Kiyonaga Akira,Tanaka Hiroaki,Morito Natsumi,Higaki Yasuki Journal of epidemiology BACKGROUND:This study was designed to evaluate whether changes in lifestyle behaviors are correlated with the incidence of chronic kidney disease (CKD). METHODS:The subjects consisted of 316 men without a history of cardiovascular disease, stroke, or renal dysfunction or dialysis treatment. The following lifestyle behaviors were evaluated using a standardized self-administered questionnaire: habitual moderate exercise, daily physical activity, walking speed, eating speed, late-night dinner, bedtime snacking, skipping breakfast, and drinking and smoking habits. The subjects were divided into four categories according to the change in each lifestyle behavior from baseline to the end of follow-up (healthy-healthy, unhealthy-healthy, healthy-unhealthy and unhealthy-unhealthy). RESULTS:A multivariate analysis showed that, with respect to habitual moderate exercise and late-night dinner, maintaining an unhealthy lifestyle resulted in a significantly higher odds ratio (OR) for the incidence of CKD than maintaining a lifestyle (OR 8.94; 95% confidence interval [CI], 1.10-15.40 for habitual moderate exercise and OR 4.00; 95% CI, 1.38-11.57 for late-night dinner). In addition, with respect to bedtime snacking, the change from a healthy to an unhealthy lifestyle and maintaining an unhealthy lifestyle resulted in significantly higher OR for incidence of CKD than maintaining a healthy lifestyle (OR 4.44; 95% CI, 1.05-13.93 for healthy-unhealthy group and OR 11.02; 95% CI, 2.83-26.69 for unhealthy-unhealthy group). CONCLUSIONS:The results of the present study suggest that the lack of habitual moderate exercise, late-night dinner, and bedtime snacking may increase the risk of CKD. 10.1016/j.je.2016.08.013
Lifestyle interventions for preventing and ameliorating CKD in primary and secondary care. Kelly Jaimon T,Su Guobin,Carrero Juan-Jesus Current opinion in nephrology and hypertension PURPOSE OF REVIEW:Despite the growth in chronic kidney disease (CKD) epidemics, evidence-based lifestyle recommendations for primary prevention of CKD are limited by reliance on observational studies and predominantly pilot clinical trials. RECENT FINDINGS:Emerging data have shown lifestyle modification strategies for primary CKD prevention with the most evidence favoring a healthy dietary pattern (rich in fruit, vegetables, potassium and have a higher plant-based to animal protein ratio), and diet low in sodium, being physically active, avoiding tobacco smoking, moderating alcohol consumption and maintaining a healthy body weight. The way these behavioral interventions can be implemented in practice should consider their synergistic benefit as well as mechanisms to facilitate long-term behavior change. Sustaining long-term behavior change remains a challenge in practice, particularly due to a lack of healthcare resources and behavior relapse. Some suggestions to mitigate this include ensuring adequate time is spent in intervention codesign and planning, utilizing adaptive trial/intervention designs with regular intervention tailoring for intervention dose, intensity, duration, and modality. SUMMARY:A number of modifiable lifestyle behaviors consistently associate with developing CKD in the community. The current evidence base, despite its inherent limitations, may inform both public health recommendations and clinical practice. 10.1097/MNH.0000000000000745
Sedentary behavior and kidney function in adults: a narrative review. Wiener klinische Wochenschrift There is increasing evidence for an association between SB and CKD, an emerging public health problem particularly affecting old people. For this reason a systematic literature search was carried out in Embase and PubMed (Jan 2000-Dec 2018) looking for an association between SB and kidney function. A total of 10 studies met the inclusion criteria (7 cross-sectional and 3 longitudinal investigations). A sedentary lifestyle was positively and independently of several confounders related to an impaired kidney function (chronic kidney disease or decrease of glomerular filtration rate), particularly in cross-sectional studies; however, more studies are needed to further establish the current evidence and to explore the exact independent mechanisms of sedentary behavior in relation to kidney function. Due to the inconsistency of the few longitudinal studies, future investigations are required to explore if SB is prospectively associated with a higher risk of developing CKD. 10.1007/s00508-020-01673-2
Self-reported childhood adversity, unhealthy lifestyle and risk of new-onset chronic kidney disease in later life: A prospective cohort study. Social science & medicine (1982) BACKGROUND:The prospective relation of childhood adversity with the risk of chronic kidney disease (CKD) remains unclear. We aimed to investigate the association of childhood adversity with new-onset CKD and examine the potential modifications by unhealthy lifestyle on this association. METHODS:A total of 115,453 adults without prior CKD at baseline were included from UK Biobank (2006-2010). Childhood adversity was retrospectively evaluated through online Childhood Trauma Screener in 2016. Six common lifestyle factors including smoking, body mass index, sleep, diet, physical activity and alcohol consumption, were combined into an unhealthy lifestyle score. New-onset CKD was the primary outcome. RESULT:The average age of participants in the study was 55.3 (SD, 7.7) years, and 39.3% of them were male. During a median follow-up duration of 14.1 years, 1905 participants developed new-onset CKD. Childhood adversity was significantly positively related with the risk of new-onset CKD in dose-response pattern. Each additional type of childhood adversity was associated with a 12% increment in the risk of developing CKD (adjusted hazard ratio (HR)1.12; 95% CI 1.08, 1.16). Among participants with high unhealthy lifestyle score, those with 4-5 types of childhood adversity increased the 1.73-fold risk of incident CKD (95% CI 1.17, 2.54) compared with those free of any childhood adversity. However, no statistically significant interaction was observed between unhealthy lifestyle and childhood adversity for new-onset CKD (P interaction = 0.734). CONCLUSIONS:Childhood adversity was significantly associated with an increased risk of new-onset CKD in a dose-response pattern regardless of unhealthy lifestyle. 10.1016/j.socscimed.2023.116510
Sociodemographic and lifestyle determinants of multimorbidity among community-dwelling older adults: findings from 346,760 SHARE participants. BMC geriatrics BACKGROUND:This study aimed to investigate the prevalence of multimorbidity and its associated factors among the older population in China to propose policy recommendations for the management of chronic diseases in older adults. METHODS:This study was conducted based on the 2021 Shenzhen Healthy Ageing Research (SHARE), and involved analysis of 346,760 participants aged 65 or older. Multimorbidity is defined as the presence of two or more clinically diagnosed or non self-reported chronic diseases among the eight chronic diseases surveyed in an individual. The Logistic analysis was adopted to explore the potential associated factors of multimorbidity. RESULTS:The prevalences of obesity, hypertension, diabetes, anemia, chronic kidney disease, hyperuricemia, dyslipidemia and fatty liver disease were 10.41%, 62.09%, 24.21%, 12.78%, 6.14%, 20.52%, 44.32%, and 33.25%, respectively. The prevalence of multimorbidity was 63.46%. The mean count of chronic diseases per participant was 2.14. Logistic regression indicated that gender, age, marriage status, lifestyle (smoking status, drinking status, and physical activity), and socioeconomic status (household registration, education level, payment method of medical expenses) were the common predictors of multimorbidity for older adults, among which, being women, married, or engaged in physical activity was found to be a relative determinant as a protective factor for multimorbidity after the other covariates were controlled. CONCLUSION:Multimorbidity is prevalent among older adults in Chinese. Guideline development, clinical management,and public intervention should target a group of diseases instead of a single condition. 10.1186/s12877-023-04128-1
Association of Sedentary Lifestyle with All-Cause and Cause-Specific Mortality in Adults with Reduced Kidney Function. Kidney360 10.34067/KID.0000000000000313
Impact of Lifestyle Modification on Diabetic Kidney Disease. Onyenwenyi Chijoke,Ricardo Ana C Current diabetes reports Kidney disease is common in patients with type 1 and type 2 diabetes mellitus and is associated with adverse health outcomes, including progression to end-stage renal disease. In the general population, adherence to a healthy lifestyle is known to reduce the risk of cardiovascular events and death. Among individuals with diabetic kidney disease, modifications in lifestyle factors, including diet, physical activity, smoking habits, and body mass index, represent a promising cost-effective therapeutic adjunct to pharmacologic treatment of kidney disease incidence and progression. 10.1007/s11892-015-0632-3
Association of Nutrition Education and Its Interaction with Lifestyle Factors on Kidney Function Parameters and Cardiovascular Risk Factors among Chronic Kidney Disease Patients in Taiwan. Kurniawan Adi-Lukas,Yang Ya-Lan,Chin Mei-Yun,Hsu Chien-Yeh,Paramastri Rathi,Lee Hsiu-An,Ni Po-Yuan,Chao Jane Nutrients We evaluated the interactive effects of nutrition education (NE) and lifestyle factors on kidney function parameters and cardiovascular risk factors among chronic kidney disease (CKD) patients. This cross-sectional cohort study recruited 2176 CKD stages 3-5 patients aged > 20 years from Integrated Chronic Kidney Disease Care Network, Shuang Ho Hospital, Taiwan between December 2008 and April 2019. The multivariable regression analysis was performed to investigate the interactive effects of NE with lifestyle factors on kidney function parameters and cardiovascular risk factors. Relative excess risk due to interaction (RERI) and attributable proportion (AP) were applied to assess additive interaction. Patients who were smoking or physically inactive but received NE had better estimated glomerular filtration rate (eGFR) (β: 3.83, 95% CI: 1.17-6.49 or β: 3.67, 95% CI: 2.04-5.29) compared to those without NE. Patients with smoking and NE significantly reduced risks for having high glycated hemoglobin A (HbA) by 47%, high low-density lipoprotein cholesterol (LDL-C) by 38%, and high corrected calcium (C-Ca) by 50% compared to those without NE. Moreover, NE and smoking or inactive physical activity exhibited an excess risk of high C-Ca (RERI: 0.47, 95% CI: 0.09-0.85 for smoking or RERI: 0.46, 95% CI: 0.01-0.90 and AP: 0.51, 95% CI: 0.03-0.99 for physical activity). Our study suggests that CKD patients who were enrolled in the NE program had better kidney function. Thus, NE could be associated with slowing kidney function decline and improving cardiovascular risk factors. 10.3390/nu13020298
Healthy lifestyle reduces incidence of trace/positive proteinuria and rapid kidney function decline after 2 years: from the Japan Ningen Dock study. Okada Rieko,Tsushita Kazuyo,Wakai Kenji,Kato Kiminori,Wada Takashi,Shinohara Yukito Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association BACKGROUND:Lifestyle modification is recommended for subjects with trace proteinuria during health checkups. However, whether overall healthy lifestyle reduces the incidence of trace/positive proteinuria or rapid decline in estimated glomerular filtration rate (eGFR) is not clarified. METHODS:A total of 451 534 people (277 494 men and 174 040 women) ages 20-79 years with negative proteinuria were included. The number of three healthy lifestyle factors (LFs) was assessed: noncurrent smoking, healthy eating habits (late dinner, snacking and skipping breakfast <3 times/week) and body mass index <25. The incidence of trace (±) and positive (≥1+) proteinuria by the dipstick method and eGFR decline ≥20% over 2 years were compared with the number of healthy LFs. RESULTS:The incidence of trace/positive proteinuria and rapid eGFR decline decreased with an increasing number of healthy LFs as follows: odds ratios (ORs) for trace proteinuria, 0.91 [95% confidence interval (CI) 0.86-0.96], 0.82 (0.78-0.87) and 0.72 (0.68-0.77); ORs for positive proteinuria, 0.76 (95% CI 0.67-0.86), 0.56 (0.50-0.63) and 0.46 (0.40-0.53); and ORs for an eGFR decline ≥20%, 0.93 (95% CI 0.82-1.05), 0.90 (0.79-1.02) and 0.81 (0.70-0.93) for those with one, two and three healthy LFs compared with those with none of the three healthy LFs, respectively. Overall, subjects with a healthy lifestyle showed 28, 54 and 19% reduced risk of developing trace proteinuria, positive proteinuria and eGFR decline ≥20%, respectively, compared with those with an unhealthy lifestyle after 2 years. This association was similarly observed even among subjects without hypertension (HT) or diabetes mellitus (DM). CONCLUSIONS:Subjects with an overall healthy lifestyle showed a lower incidence of trace/positive proteinuria by dipstick test and rapid eGFR decline over 2 years in a nationwide general population. Thus lifestyle modification should be recommended for subjects with trace proteinuria during health checkups, even for subjects without HT or DM. 10.1093/ndt/gfaa224
Health-related quality of life and lifestyle changes in patients with chronic kidney disease and hyperkalaemia: Real-world data from the US, five European countries and China. Grandy Susan,Jackson James,Moon Rebecca,Bluff Daniel,Palaka Eirini International journal of clinical practice BACKGROUND:Chronic kidney disease patients have impaired health-related quality of life and an increased risk of hyperkalaemia. AIMS:The objective was to evaluate the impact of hyperkalaemia on health-related quality of life, and investigate lifestyle change recommendations, in these patients. METHODS:The Adelphi Real World Chronic Kidney Disease Specific Programme™ was used. Data were collected from physicians and patients with non-dialysis dependent stage 3a, 3b and 4 chronic kidney disease from the US, France, Germany, Spain, Italy, the UK and China. Patients completed the Kidney Disease Quality of Life Instrument and EuroQol-5D-3L. Analyses compared data between hyperkalaemic (serum potassium >5.0 mmol/L) and normokalaemic (serum potassium 3.5-5.0 mmol/L) patients. RESULTS:Overall, 1149 patients were included (hyperkalaemic: n = 216, normokalaemic: n = 933; US: n = 376, Europe: n = 490, China: n = 283). Hyperkalaemic vs normokalaemic patients experienced more symptoms (P < .001) and had numerically lower scores, indicating poorer health-related quality of life, in all Kidney Disease Quality of Life domains, with significant differences for three/five domains. Hyperkalaemic patients reported numerically lower EuroQol-5D-3L utility index and visual analogue scores, indicating poorer health status, than normokalaemic patients. A higher proportion of hyperkalaemic than normokalaemic patients were recommended to reduce dietary potassium (P < .05). More normokalaemic than hyperkalaemic patients reported making a radical change in five/six recommended lifestyle changes, with the difference significant for four/six recommendations. CONCLUSIONS:Hyperkalaemia is associated with an incremental impairment of the health-related quality of life in chronic kidney disease patients. A better understanding of the impact of hyperkalaemia in these patients could improve patient outcomes. 10.1111/ijcp.14326
Potassium Homeostasis: The Knowns, the Unknowns, and the Health Benefits. Physiology (Bethesda, Md.) Potassium homeostasis has a very high priority because of its importance for membrane potential. Although extracellular K is only 2% of total body K, our physiology was evolutionarily tuned for a high-K, low-Na diet. We review how multiple systems interface to accomplish fine K balance and the consequences for health and disease. 10.1152/physiol.00022.2016
Effects of exercise and lifestyle intervention on oxidative stress in chronic kidney disease. Small David M,Beetham Kassia S,Howden Erin J,Briskey David R,Johnson David W,Isbel Nicole M,Gobe Glenda C,Coombes Jeff S Redox report : communications in free radical research OBJECTIVES:Determine the effects of a 12-month exercise and lifestyle intervention program on changes in plasma biomarkers of oxidative stress in pre-dialysis chronic kidney disease (CKD) patients. METHODS:A total of 136 stage 3-4 CKD patients were randomized to receive standard nephrological care with (N = 72) or without (N = 64) a lifestyle and exercise intervention for 12 months. Plasma total F-isoprostanes (IsoP), glutathione peroxidase (GPX) activity, total antioxidant capacity (TAC), anthropometric and biochemical data were collected at baseline and at 12 months. RESULTS:There were no significant differences between groups at baseline. There were no significant differences in changes for standard care and lifestyle intervention, respectively, in IsoP (p = 0.88), GPX (p = 0.87), or TAC (p = 0.56). Patients identified as having high IsoP at baseline (>250 pg/mL) had a greater decrease in IsoP with lifestyle intervention compared to standard care; however, the difference was not statistically significant (p = 0.06). There was no difference in the change in kidney function (eGFR) between standard care and lifestyle intervention (p = 0.33). DISCUSSION:Exercise and lifestyle modification in stage 3-4 CKD did not produce changes in systemic biomarkers of oxidative stress over a 12-month period, but patients with high IsoP may benefit most from the addition of intervention to standard care. 10.1080/13510002.2016.1276314
Dietary and Lifestyle Risk Factors Associated with Incident Kidney Stones in Men and Women. Ferraro Pietro Manuel,Taylor Eric N,Gambaro Giovanni,Curhan Gary C The Journal of urology PURPOSE:Several dietary and lifestyle factors are associated with a higher risk of kidney stones. We estimated the population attributable fraction and the number needed to prevent for modifiable risk factors, including body mass index, fluid intake, DASH (Dietary Approaches to Stop Hypertension) style diet, dietary calcium intake and sugar sweetened beverage intake. MATERIALS AND METHODS:We used data on the HPFS (Health Professionals Follow-Up Study) cohort and the NHS (Nurses' Health Study) I and II cohorts. Information was obtained from validated questionnaires. Poisson regression models adjusted for potential confounders were used to estimate the association of each risk factor with the development of incident kidney stones and calculate the population attributable fraction and the number needed to prevent. RESULTS:The study included 192,126 participants who contributed a total of 3,259,313 person-years of followup, during which an incident kidney stone developed in 6,449 participants. All modifiable risk factors were independently associated with incident stones in each cohort. The population attributable fraction ranged from 4.4% for a higher intake of sugar sweetened beverages to 26.0% for a lower fluid intake. The population attributable fraction for all 5 risk factors combined was 57.0% in HPFS, 55.2% in NHS I and 55.1% in NHS II. The number needed to prevent during 10 years ranged from 67 for lower fluid intake to 556 for lower dietary calcium intake. CONCLUSIONS:Five modifiable risk factors accounted for more than 50% of incident kidney stones in 3 large prospective cohorts. Assuming a causal relation, our estimates suggest that preventive measures aimed at reducing those factors could substantially decrease the burden of kidney stones in the general population. 10.1016/j.juro.2017.03.124
Do Lifestyle Factors Including Smoking, Alcohol, and Exercise Impact Your Risk of Developing Kidney Stone Disease? Outcomes of a Systematic Review. Jones Patrick,Karim Sulaiman Sadaf,Gamage Kithmini N,Tokas Theodoras,Jamnadass Enakshee,Somani Bhaskar K Journal of endourology With a rise in the incidence of stone disease, more research is needed to understand the lifestyle factors associated with it. We evaluate available evidence for association of smoking, alcohol, and exercise with kidney stone disease (KSD). A systematic literature search was conducted in CINAHL, EMBASE, Ovid Medline, Cochrane Library, Scopus, Clinicaltrials.gov, and Google Scholar. Different keywords were "smoking," "cigarette," "alcohol," "spirits," "exercise," "physical activity," "training," "kidney stone," "stone disease," "nephrolithiasis," "urolithiasis," "renal stone," and "urinary stone." The main outcome of interest was the role of smoking, alcohol, and exercise in the development of KSD. A total of 4921 articles were found on searching the databases, of which 14 met the criteria for inclusion in the final review. Studies assessed the following risk factors, physical activity ( = 6), alcohol ( = 6), and smoking ( = 9), and included 17,511 patients. The relationship of physical activity with KSD appears to be equivocal. In addition, only one study demonstrated a decreased risk of nephrolithiasis with alcohol consumption. On the contrary, four studies found a significant association between smoking and renal stone formation. While smoking is one behavioral factor that seems to have some association with KSD, no clear effect of alcohol and physical activity has been demonstrated. To avoid KSD, awareness of the possible detrimental role of smoking should be considered and patients should remain vigilant about the importance of hydration with physical activity. While this represents the most appropriate guidance from the evidence available, at present there remain insufficient data to truly reveal the relationship between these three factors and KSD. 10.1089/end.2020.0378
Prevalence, risk-inducing lifestyle, and perceived susceptibility to kidney diseases by gender among Nigerians residents in South Western Nigeria. African health sciences BACKGROUND:Kidney disease (KD) is increasingly recognized as a major public health problem worldwide with rising incidence and prevalence. Early identification of KD risk factors will slow down progression to kidney failure and death. OBJECTIVE:To determine the prevalence, risk-inducing lifestyle and perceived susceptibility among Nigerians in South-western Nigeria. METHODS:A pretested structured questionnaire was employed to draw information on socio-demographic, knowledge, risk-inducing lifestyle and perceived susceptibility to conventional risk factors of KD from 1757 residents aged ≥15 years. RESULTS:The mean age of the respondents was 47.61±13.0 years with a male-female ratio of 1.13:1. Knowledge of KD was low (mean score 2.29; 95% CI: 2.18, 2.32). The prevalence of some established KD risk factors was regular use of herbal medications, 26.8% and physical inactivity, 70.0%. Females with factors such as use of herbal drink [RRR: 1.56; CI=1.06-2.30; p=0.02] and smoking [RRR: 2.72; CI=1.37-5.37; p=0.00] predicted increased odds of perceived susceptibility to KD than their male counterparts. CONCLUSION:The prevalence of KD risk-inducing lifestyles was high. More emphasis should be placed on effective public health programmes towards behavioural change in order to adopt lifestyle modification as well as to reduce the tendency to develop KD. 10.4314/ahs.v20i2.40
Modifiable Lifestyle Behaviors and CKD Progression: A Narrative Review. Kidney360 Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current CKD management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis-dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption, and tobacco use on the progression of CKD, as measured by decline in GFR, incident ESKD, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow-up and small sample sizes, and meta-analyses were limited because the studies were sparse and had heterogeneous classifications of behaviors and/or referent groups and of CKD progression. Further research should be done to determine optimal methods to assess behaviors to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the effect of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, BP control, and survival. 10.34067/KID.0003122021
Relationship between modifiable lifestyle factors and chronic kidney disease: a bibliometric analysis of top-cited publications from 2011 to 2020. BMC nephrology BACKGROUND:Chronic kidney disease (CKD) affects 8 to 16% of the world's population and is one of the top ten important drivers of increasing disease burden. Apart from genetic predisposition, lifestyle factors greatly contribute to the incidence and progression of CKD. The current bibliometric analysis aims to characterize the current focus and emerging trends of the research about the impact of modifiable lifestyle factors on CKD. METHODS:We searched articles addressing the impact of modifiable lifestyle factors on the incidence and/or progression of CKD, published between 2011 and 2020, from the Science Citation Index Expanded (SCIE) database. An adjusted citation index, which considered both the original citation count and publication year, was derived for the selection of most-cited publications. Publishing trends, co-authorship network, keywords, and research hotspots were analyzed and visualized. RESULTS:Among the top 100 most influential articles, 32 were narrative reviews, 16 systematic reviews and/or meta-analysis, 44 clinical research, and 8 basic research. The United States occupied a dominant position in the perspective of article numbers and international partnerships, followed by European countries. The modifiable factors that drew the most and constant attention over the decade were diet or nutrition management reported in 63 papers, followed by obesity or body mass index (n = 27), and physical activity or exercises (n = 8). Alcohol consumption, fish oil, chain fatty-acids, and water-soluble vitamins were emerging hotspots identified in the recent most cited publications. CONCLUSIONS:Based on the bibliometric analysis of the most influential articles, our study provides a comprehensive description of publishing trends and research focus over a decade in the field of lifestyle factors' impact on CKD. Diet, obesity, and physical activity were factors receiving the most attention in this topic. 10.1186/s12882-022-02745-3
Community Nutrition and Lifestyle Medicine for Kidney Health: Awareness of the Social Determinants of Health in Renal Nutrition. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation 10.1053/j.jrn.2023.05.003
Associations Between Lifestyle Factors and Reduced Kidney Function in US Older Adults: NHANES 1999-2016. Chang Horng-Jinh,Lin Kuan-Reng,Lin Meng-Te,Chang Junn-Liang International journal of public health This study aimed to evaluate the associations between lifestyle factors and the estimated glomerular filtration rate (eGFR) levels in older adults by analyzing the United States National Health and Nutrition Examination Survey data (1999-2016). A total of 10,052 eligible participants were divided into two groups: reduced eGFR group (eGFR < 60 ml/min/1.73 m) and normal group (eGFR ≥ 60 ml/min/1.73 m). The primary factors were physical activity, alcohol consumption, smoking, and comorbidities. Multivariable analysis revealed that older age, proteinuria, cardiovascular disease, diabetes, hyperuricemia, and hypertension were significantly associated with higher odds of reduced kidney function. Sufficient physical activity, current alcohol consumption, and being a current smoker were significantly associated with lower odds of reduced kidney function. However, subgroup analysis by sex revealed that the effects of proteinuria, current alcohol consumption, and sufficient physical activity were sex-specific. Several risk and beneficial factors for reduced kidney function in adults aged 65 and above in the United States were identified, but some of them might be sex-specific. Further studies are warranted to confirm these findings in other populations and countries. 10.3389/ijph.2021.1603966
Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC nephrology 10.1186/s12882-021-02618-1
Risk and lifestyle factors associated to chronic kidney disease. López-Heydeck Sandra Maricruz,Robles-Navarro Julio Basilio,Montenegro-Morales Laura Patricia,Garduño-García José de Jesús,López-Arriaga Jerónimo Amado Revista medica del Instituto Mexicano del Seguro Social Lifestyle has a determining influence on the progression of a chronic kidney disease (CKD), which starts with some kidney damage, that can remain and progress by the influence of risk factors and accumulate subsequent injury of kidney damage throughout life. It is more common in adults and frequently remains hidden from routine analysis, but if it can be detected early, treatment and healthy lifestyle can be applied, which would allow stopping or lengthening the progress of kidney damage, in order to avoid the need of a renal transplant or dialysis. The objective of this work was to show the possible lifestyles to apply, such as visits to the doctor, not smoking, have intense to moderate physical activity, consume enough vegetables and fruits, avoid diets high in carbohydrates and lipids. To carry out this review, it was obtained literature from databases between 1980 and 2017, freely accessible, using keywords like “chronic kidney disease (CKD)”, “lifestyle” and “risk factors”, and its equivalents in Spanish. 10.24875/RMIMSS.M20000035
City planning policies to support health and sustainability: an international comparison of policy indicators for 25 cities. The Lancet. Global health City planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Content analysis identified strengths, limitations, and gaps in policies, allowing us to draw comparisons between cities. We found that despite common policy rhetoric endorsing healthy and sustainable cities, there was a paucity of measurable policy targets in place to achieve these aspirations. Some policies were inconsistent with public health evidence, which sets up barriers to achieving healthy and sustainable urban environments. There is an urgent need to build capacity for health-enhancing city planning policy and governance, particularly in low-income and middle-income countries. 10.1016/S2214-109X(22)00069-9
Association of Smoking Initiation and Cessation Across the Life Course and Cancer Mortality: Prospective Study of 410 000 US Adults. JAMA oncology 10.1001/jamaoncol.2021.4949
Effect of Structured, Moderate Exercise on Kidney Function Decline in Sedentary Older Adults: An Ancillary Analysis of the LIFE Study Randomized Clinical Trial. JAMA internal medicine Importance:Observational evidence suggests that higher physical activity is associated with slower kidney function decline; however, to our knowledge, no large trial has evaluated whether activity and exercise can ameliorate kidney function decline in older adults. Objective:To evaluate whether a moderate-intensity exercise intervention can affect the rate of estimated glomerular filtration rate per cystatin C (eGFRCysC) change in older adults. Design, Setting, and Participants:This ancillary analysis of the Lifestyle Interventions and Independence For Elders randomized clinical trial enrolled 1199 community-dwelling, sedentary adults aged 70 to 89 years with mobility limitations and available blood specimens. The original trial was conducted across 8 academic centers in the US from February 2010 through December 2013. Data for this study were analyzed from March 29, 2021, to February 28, 2022. Interventions:Structured, 2-year, partially supervised, moderate-intensity physical activity and exercise (strength, flexibility) intervention compared with a health education control intervention with 2-year follow-up. Physical activity was measured by step count and minutes of moderate-intensity activity using accelerometers. Main Outcomes and Measures:The primary outcome was change in eGFRCysC. Rapid eGFRCysC decline was defined by the high tertile threshold of 6.7%/y. Results:Among the 1199 participants in the analysis, the mean (SD) age was 78.9 (5.2) years, and 800 (66.7%) were women. At baseline, the 2 groups were well balanced by age, comorbidity, and baseline eGFRCysC. The physical activity and exercise intervention resulted in statistically significantly lower decline in eGFRCysC over 2 years compared with the health education arm (mean difference, 0.96 mL/min/1.73 m2; 95% CI, 0.02-1.91 mL/min/1.73 m2) and lower odds of rapid eGFRCysC decline (odds ratio, 0.79; 95% CI, 0.65-0.97). Conclusions and Relevance:Results of this ancillary analysis of a randomized clinical trial showed that when compared with health education, a physical activity and exercise intervention slowed the rate of decline in eGFRCysC among community-dwelling sedentary older adults. Clinicians should consider targeted recommendation of physical activity and moderate-intensity exercise for older adults as a treatment to slow decline in eGFRCysC. Trial Registration:ClinicalTrials.gov Identifier: NCT01072500. 10.1001/jamainternmed.2022.1449
A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. Circulation A growing appreciation of the pathophysiological interrelatedness of metabolic risk factors such as obesity and diabetes, chronic kidney disease, and cardiovascular disease has led to the conceptualization of cardiovascular-kidney-metabolic syndrome. The confluence of metabolic risk factors and chronic kidney disease within cardiovascular-kidney-metabolic syndrome is strongly linked to risk for adverse cardiovascular and kidney outcomes. In addition, there are unique management considerations for individuals with established cardiovascular disease and coexisting metabolic risk factors, chronic kidney disease, or both. An extensive body of literature supports our scientific understanding of, and approach to, prevention and management for individuals with cardiovascular-kidney-metabolic syndrome. However, there are critical gaps in knowledge related to cardiovascular-kidney-metabolic syndrome in terms of mechanisms of disease development, heterogeneity within clinical phenotypes, interplay between social determinants of health and biological risk factors, and accurate assessments of disease incidence in the context of competing risks. There are also key limitations in the data supporting the clinical care for cardiovascular-kidney-metabolic syndrome, particularly in terms of early-life prevention, screening for risk factors, interdisciplinary care models, optimal strategies for supporting lifestyle modification and weight loss, targeting of emerging cardioprotective and kidney-protective therapies, management of patients with both cardiovascular disease and chronic kidney disease, and the impact of systematically assessing and addressing social determinants of health. This scientific statement uses a crosswalk of major guidelines, in addition to a review of the scientific literature, to summarize the evidence and fundamental gaps related to the science, screening, prevention, and management of cardiovascular-kidney-metabolic syndrome. 10.1161/CIR.0000000000001186
Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nature reviews. Clinical oncology Over the past several decades, the incidence of early-onset cancers, often defined as cancers diagnosed in adults <50 years of age, in the breast, colorectum, endometrium, oesophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid has increased in multiple countries. Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. Evidence suggests an aetiological role of risk factor exposures in early life and young adulthood. Since the mid-20th century, substantial multigenerational changes in the exposome have occurred (including changes in diet, lifestyle, obesity, environment and the microbiome, all of which might interact with genomic and/or genetic susceptibilities). However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical. In this Review, we describe changes in the incidence of early-onset cancers globally and suggest measures that are likely to reduce the burden of cancers and other chronic non-communicable diseases. 10.1038/s41571-022-00672-8
Chronic inflammation in the etiology of disease across the life span. Nature medicine Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI. 10.1038/s41591-019-0675-0