Search results for: physical activity guidelines

Authors: Sherine Farrag

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Magnetic resonance imaging (MRI) presents safety hazards, with the general physical environment. The principal hazard of the MRI is the presence of static magnetic fields. Proper architectural design of MRI’s room ensure environment and health care staff safety. This research paper presents an easy approach for numerical computation of fringe static magnetic fields. Iso-gauss line of different MR intensities (0.3, 0.5, 1, 1.5 Tesla) was mapped and a polynomial function of the 7th degree was generated and tested. Matlab script was successfully applied for MRI SMF mapping. This method can be valid for any kind of commercial scanner because it requires only the knowledge of the MR scanner room map with iso-gauss lines. Results help to develop guidelines to guide healthcare architects to design of a safer Magnetic resonance imaging suite.

Keywords: designing MRI suite, MRI safety, radiology occupational exposure, static magnetic fields

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Authors: Celeste E. van Rinsum, Sanne M. P. L. Gerards, Geert M. Rutten, Ien A. M. van de Goor, Stef P. J. Kremers

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Combined lifestyle interventions have shown to be effective in changing and maintaining behavioral lifestyle changes and reducing overweight and obesity. A lifestyle coach is expected to promote lifestyle changes in adults related to physical activity and diet. The present Coaching on Lifestyle (CooL) study examined participants’ physical activity level, dietary behavioral, and motivational changes immediately after the intervention and at 1.5 years after baseline. In CooL intervention a lifestyle coach coaches individuals from eighteen years and older with (a high risk of) obesity in group and individual sessions. In addition a process evaluation was conducted in order to examine the implementation process and to be able to interpret the changes within the participants. This action-oriented research has a pre-post design. Participants of the CooL intervention (N = 200) completed three questionnaires: at baseline, immediately after the intervention (on average after 44 weeks), and at 1.5 years after baseline. T-tests and linear regressions were conducted to test self-reported changes in physical activity (IPAQ), dietary behaviors, their quality of motivation for physical activity (BREQ-3) and for diet (REBS), body mass index (BMI), and quality of life (EQ-5D-3L). For the process evaluation, we used individual and group interviews, observations and document analyses to gain insight in the implementation process (e.g. the recruitment) and how the intervention was valued by the participants, lifestyle coaches, and referrers. The study is currently ongoing and therefore the results presented here are preliminary. On average, the participants that finished the intervention and those that have completed the long-term measurement improved their level of vigorous-intense physical activity, sedentary behavior, sugar-sweetened beverage consumption and BMI. Mixed results were observed in motivational regulation for physical activity and nutrition. Moreover, an improvement on the quality of life dimension anxiety/depression was found, also in the long-term. All the other constructs did not show significant change over time. The results of the process evaluation have shown that recruitment of clients was difficult. Participants evaluated the intervention positively and the lifestyle coaches have continuously adapted the structure and contents of the intervention throughout the study period, based on their experiences and feedback from research. Preliminary results indicate that the CooL-intervention may have beneficial effects on overweight and obese participants in terms of energy balance-related behaviors, weight reduction, and quality of life. Recruitment of participants and embedding the position of the lifestyle coach in traditional care structures is challenging.

Keywords: combined lifestyle intervention, effect evaluation, lifestyle coaching, process evaluation, overweight, the Netherlands

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Authors: Bita Rabbani, Hossein Chiti, Faranak Sharifi, Saeedeh Mazloomzadeh

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Background: Lifestyle modifications, especially improving nutritional patterns and increasing physical activity, are the most important factors in preventing obesity and metabolic syndrome in children and adolescents. For this purpose, the following interventional study was designed to investigate the effects of educational programs for students, as well as changes in diet and physical activity, on obesity and components of the metabolic syndrome. Methods: This study is part of an interventional research project (elementary school) conducted on all students of Sama schools in Zanjan and Abhar in three levels of elementary, middle, and high school, including 1000 individuals in Zanjan (intervention group) and 1000 individuals (control group) in Abhar in 2011. Interventions were based on educating students, teachers, and parents, changes in food services, and physical activity. We primarily measured anthropometric indices, fasting blood sugar, lipid profiles, and blood pressure and completed standard nutrition and physical activity questionnaires. Also, blood insulin levels were randomly measured in a number of students. Data analysis was done by SPSS software version 16.0. Results: Overall, 589 individuals (252 male, 337 female) entered the case group, and 803 individuals (344 male, 459 female) entered the control group. After two years of intervention, mean waist circumference (63.8 ± 10.9) and diastolic BP (63.8 ± 10.4) were significantly lower; however, mean systolic BP (10.1.0 ± 12.5), food score (25.0 ± 5.0) and drinking score (12.1 ± 2.3) were higher in the intervention group (p<0.001). Comparing components of metabolic syndrome between the second year and at time of recruitment within the intervention group showed that although number of overweight/obese individuals, individuals with hypertriglyceridemia and high LDL increased, abdominal obesity, high BP, hyperglycemia, and insulin resistance decreased (p<0.001). On the other hand, in the control group, number of individuals with high BP increased significantly. Conclusion: The prevalence of abdominal obesity and hypertension, which are two major components of metabolic syndrome, are much higher in our study than in other regions of country. However, interventions for modification of diet and increase in physical activity are effective in lowering their prevalence.

Keywords: metabolic syndrome, obesity, life style, nutrition, hypertension

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Authors: Howard Gomwe, Eunice Seekoe

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There is arguably dearth of literature regarding body physical fitness and body composition amongst primary schools in South Africa. For this reason, the study is aimed at investigating and accessing how body composition relates to physical fitness amongst learners between 9 – 14 years of age in the Eastern Cape Province of South Africa. In order to achieve this, a school-based cross-sectional survey was carried out among 876 primary school learners aged 9 to14 years. Body composition indicators were measured and/or calculated, whilst physical fitness was evaluated by a 20 m shuttle run, push-ups, sit and reach as well as sit-ups, according to the EUROFIT fitness standards. Out of 876 participants, a total of 870 were retained. Of these, 351 (40.34%) were boys and 519 (59.66%) were girls. The average age of learners was 11.04 ± 1.50 years, with boys having a importantly (p = 0.002) higher average age (M = 11.24; SD = 1.51 years) as compared to that of girls (M = 10.91; SD = 1.48 years). The non-parametric Spearman Rho correlation coefficients revealed several significant and negative relationships between body composition measurements with physical fitness characteristics, which were stronger in girls than in boys. The findings advocate for policy makers and responsible authorities to initiate the development of policies and interventions targeted at encouraging physical activity and healthy promotion among primary school learners in South Africa, especially in girls.

Keywords: BMI, body composition, physical fitness, children

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Authors: Adela Penesova, Zofia Radikova, Boris Bajer, Andrea Havranova, Miroslav Vlcek

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Background: The aim of our study was to compare the effect of intensified lifestyle intervention on insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Fibroblast growth factor (FGF) 21 after 8 weeks of lifestyle intervention. Methods: A group of 43 obese patients (13M/30F; 43.0±12.4 years; BMI (body mass index) 31.2±6.3 kg/m2 participated in a weight loss interventional program (NCT02325804) following an 8-week hypocaloric diet (-30% energy expenditure) and physical activity 150 minutes/week. Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices according to Matsuda and Cederholm were calculated (ISImat and ISIced). Plasma ALT, AST, Fetuin-A, FGF 21, and physical fitness were measured. Results: The average reduction of body weight was 6.8±4.9 kg (0-15 kg; p=0.0006), accompanied with a significant reduction of body fat amount of fat mass (p=0.03), and waist circumference (p=0.02). Insulin sensitivity has been improved (IR HOMA 2.71±3.90 vs 1.24±0.83; p=0.01; ISIMat 6.64±4.38 vs 8.93±5.36 p ≤ 0.001). Total, LDL cholesterol, and triglycerides decreased (p=0.05, p=0.04, p=0.04, respectively). Physical fitness significantly improved after intervention (as measure VO2 max (maximal oxygen uptake) (p ≤ 0.001). ALT decreased significantly (0.44±0.26 vs post 0.33±0.18 ukat/l, p=0.004); however, AST not (pre 0.40±0.15 vs 0.35±0.09 ukat/l, p=0.07). Hepatokine Fetuin-A significantly decreased after intervention (43.1±10.8 vs 32.6±8.6 ng/ml, p < 0.001); however, FGF 21 levels tended to decrease (146±152 vs 132±164 pg/ml, p=0.07). Conclusion: 8-weeks of diet and physical activity intervention program in obese otherwise healthy subjects led to an improvement of insulin resistance parameters and liver marker profiles, as well as increased physical fitness. This study was supported by grants APVV 15-0228; VEGA 2/0161/16.

Keywords: obesity, diet, exercice, insulin sensitivity

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Authors: Promil Mehra, Nanthi Bolan, Jack Desbiolles, Risha Gupta

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Agricultural practices affect the soil physical and chemical properties, which in turn influence the soil microorganisms as a function of the soil biological environment. On the return to conventional tillage (CT) from continuing no-till (NT) cropping system, a very little information is available from the impact caused by the intermittent tillage on the soil biochemical properties from a short-term (2-year) study period. Therefore, the contribution made by different microorganisms (fungal, bacteria) was also investigated in order to find out the effective changes in the soil microbial activity under a South Australian dryland faring system. This study was conducted to understand the impact of microbial dynamics on the soil organic carbon (SOC) under NT and CT systems when treated with different levels of mulching (0, 2.5 and 5 t/ha). Our results demonstrated that from the incubation experiment the cumulative CO2 emitted from CT system was 34.5% higher than NT system. Relatively, the respiration from surface layer (0-10 cm) was significantly (P<0.05) higher by 8.5% and 15.8 from CT; 8% and 18.9% from NT system w.r.t 10-20 and 20-30 cm respectively. Further, the dehydrogenase enzyme activity (DHA) and microbial biomass carbon (MBC) were both significantly lower (P<0.05) under CT, i.e., 7.4%, 7.2%, 6.0% (DHA) and 19.7%, 15.7%, 4% (MBC) across the different mulching levels (0, 2.5, 5 t/ha) respectively. In general, it was found that from both the tillage system the enzyme activity and MBC decreased with the increase in depth (0-10, 10-20 and 20-30 cm) and with the increase in mulching rate (0, 2.5 and 5 t/ha). From the perspective of microbial stress, there was 28.6% higher stress under CT system compared to NT system. Whereas, the microbial activity of different microorganisms like fungal and bacterial activities were determined by substrate-induced inhibition respiration using antibiotics like cycloheximide (16 mg/gm of soil) and streptomycin sulphate (14 mg/gm of soil), by trapping the CO2 using an alkali (0.5 M NaOH) solution. The microbial activities were confirmed through platting technique, where it was that found bacterial activities were 46.2% and 38.9% higher than fungal activity under CT and NT system. In conclusion, it was expected that changes in the relative abundance and activity of different microorganisms (bacteria and fungi) under different tillage systems could significantly affect the C cycling and storage due to its unique structures and differential interactions with the soil physical properties.

Keywords: tillage, soil respiration, MBC, fungal-bacterial activity

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Authors: Abhishek Oswal

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Background: Inconsistencies between the guidelines for childhood asthma can pose a diagnostic challenge to clinicians. NICE guidelines are the most commonly followed guidelines in primary care in the UK; they state that to be diagnosed with asthma, a child must be more than 5 years old and must have objective evidence of the disease. When diagnoses are coded in general practice (GP), these guidelines may be superseded by communications from secondary care. Hence it is imperative that diagnoses are correct, as per up to date guidelines and evidence, as this affects follow up and management both in primary and secondary care. Methods: A snapshot audit at a general practice surgery was undertaken of children (less than 16 years old) with a coded diagnosis of 'asthma', to review the age at diagnosis and whether any objective evidence of asthma was documented at diagnosis. 50 cases of asthma in children presenting to the emergency department (ED) were then audited to review the age at presentation, whether there was evidence of previous asthma diagnosis and whether the patient was discharged from ED. A repeat audit is planned in ED this winter. Results: In a GP surgery, there were 83 coded cases of asthma in children. 51 children (61%) were diagnosed under 5, with 9 children (11%) who had objective evidence of asthma documented at diagnosis. In ED, 50 cases were collected, of which 4 were excluded as they were referred to the other services, or for incorrect coding. Of the 46 remaining, 27 diagnoses confirmed to NICE guidelines (59%). 33 children (72%) were discharged from ED. Discussion: The most likely reason for the apparent low rate of a correct diagnosis is the significant challenge of obtaining objective evidence of asthma in children. There were a number of patients who were diagnosed from secondary care services and then coded as 'asthma' in GP, without having objective documented evidence. The electronic patient record (EPR) system used in our emergency department (ED) did not allow coding of 'suspected diagnosis' or of 'viral induced wheeze'. This may have led to incorrect diagnoses coded in primary care, of children who had no confirmed diagnosis of asthma. We look forward to the re-audit, as the EPR system has been updated to allow suspected diagnoses. In contrast to the NICE guidelines used here, British Thoracic Society (BTS) guidelines allow for a trial of treatment and subsequent confirmation of diagnosis without objective evidence. It is possible that some of the cases which have been classified as incorrect in this audit may still meet other guidelines. Conclusion: The diagnosis of asthma in children is challenging. Incorrect diagnoses may be related to clinical pressures and the provision of services to allow compliance with NICE guidelines. Consensus statements between the various groups would also aid the decision-making process and diagnostic dilemmas that clinicians face, to allow more consistent care of the patient.

Keywords: asthma, diagnosis, primary care, emergency department, guidelines, audit

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Authors: Theresa N. Uzor

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The word cardiovascular fitness is a topic of much interest to people of Nigeria, especially during this time, some heart diseases run in families. Cardiovascular fitness is the ability of the heart and lungs to supply-rich blood to the working muscle tissues. This type of fitness is a health-related component of physical fitness that is brought about by sustained physical activity such as plyometric training. Plyometric is a form of advanced fitness training that uses fast muscular contractions to improve power and speed in the sports performance by coaches and athletes. Plyometric training involves a rapid stretching of muscle (eccentric phase) immediately followed by a concentric or shortening action of the same muscle and connective tissue. However, the most basic example of true plyometric training is running and can be safe for a wide variety of populations. This paper focused on building cardiovascular health through Plyometric Training. The centre focus of the article is cardiovascular fitness and plyometric training with factors of cardiovascular fitness. Plyometric training at any age provides multiple benefits even beyond weight control and weight loss, decrease the risk of cardiovascular diseases, stroke, high blood pressure, diabetes, and other diseases, among other benefits of plyometric training to cardiovascular fitness. Participation in plyometric training will increase metabolism of an individual, thereby burning more calories even when at rest and reduces weight is also among the benefits of plyometric training. Some guidelines were recommended for planning plyometric training programme to minimise the chance of injury. With plyometric training in Nigeria, fortune can change for good, especially now that there has been an increase in cardiovascular diseases within the society for great savings would be saved.

Keywords: aerobic, cardiovascular, concentric, stretch-shortening cycle, plyometric

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Authors: Prerna Mohan Saxena, Avni Joshi, Raju K Parasher

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Disability is a state of decreased functioning associated with disease, disorder, injury, or other health condition, which in the context of one’s environment is experienced as an impairment, activity limitation, or participation restriction. With the concept of disability evolving over the years, the current ICF model of disability has integrated this concept into a comprehensive whole of multiple dimensions of human functioning, including biological, psychological, social, and environmental aspects. Wheelchair basketball is one of the greatest examples of adapted sports for the disabled. Through this study, we aim to evaluate the functional performance and self-esteem levels in differently-abled pediatric wheelchair basketball players, providing an insight on their abilities and deficits and how they can be worked on at a larger level to improve overall performance. The study was conducted on 9 pediatric wheelchair basketball players at Amar Jyoti school for inclusive education Delhi their physical performance was assessed using a battery of tests, and physical self esteem was assessed using the Physical self-description instrument (PSDQ-S). Results showed that 9 participants age ranged between 10-21 years, mostly males with BMI ranging between 16.7 to 28.9 kg/m2 most of them had the experience of 5 to 6 years of playing the sport. The data showed physical performance in accordance to years of experience of playing, physical self esteem showed a different perspective, with experience players scoring less on it. This study supports a multidimensional construct of physical performance and physical self-esteem, suggesting that both may be applied on the wheelchair basketball players at competitive levels.

Keywords: ase series, physical performance, physical self-esteem, wheelchair basketball

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Authors: Mawarni Mohamed, Sharifah Shahira A. Hamid

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Leisure time is an important component to offset the sedentary lifestyle of the people. Women tend to benefit from leisure activities not only to reduce stress but also to provide opportunities for well-being and self-satisfaction. This study was conducted to investigate body composition and leisure time use among women in Selangor from the influences of community settlement. A total of 419 women aged 18-65 years were selected to participate in this study. Descriptive statistics, t-test and ANOVA were used to analyze the level of physical activity and the relationship between leisure-time use and body composition were made to analyze the physical lifestyles. The results showed that women with normal body composition seem to be involved in more passive activities than women with less weight gain and obesity. Thus, the study recommended that the government and other health and recreational agencies should develop more places and activities suitable for leisure preference for women in their community settlement so they become more interested to engage in more active recreational and physical activities.

Keywords: body composition, community settlement, leisure time, physical lifestyles

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Authors: Lovro Štefan

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The main purpose of the present study was to investigate the associations between the overweight/obesity status and lifestyle factors. In this cross-sectional study, participants were 1950 urban secondary-school students (54.7% of female students) aged 17-18 years old. Dependent variable was body-mass index status derived from self-reported height and weight. The outcome was binarised, where participants with value <25 kg/m2 were collapsed into „normal“, while those ≥25 kg/m2 into „overweight/obesity“ category. Independent variables were gender, type of school, physical activity, sedentary behaviour, self-rated health, self-perceived socioeconomic status and psychological distress. The associations between the dependent and independent variables were analyzed by using multiple logistic regression analysis. In the univariate model, being overweight/obese was significantly associated with being a male student (OR 0.31; 95% CI 0.23 to 0.42), attending a vocational school (OR 1.87; 95% CI 1.42 to 2.48), not meeting the recommendations for moderate-to-vigorous physical activity (OR 0.44; 95% CI 0.22 to 0.88), more time spending in sedentary behaviour (OR 1.53; 95% CI 1.07 to 2.19), poor self-rated health (OR 0.35, 95% CI 0.20 to 0.56) and lower socioeconomic status (OR 0.63; 95% CI 0.48 to 0.84). In the multivariate model, the same associations occured between the dependent and independent variable. In both models, psychological distress was not associated with being overweight/obese. In conclusion, our findings suggest, that lifestyle factors are independently associated with body-mass index

Keywords: body mass index, secondary-school students, Croatia, physical activity, sedentary behaviour, logistic regression

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Authors: Cecilia Elisabeth Fåhraeus

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In 2016, this author conducted a study on agricultural livelihoods in urban and peri-urban low-income settings in Lusaka, Zambia. The overarching aim was to determine the impact of physical space on agricultural activities, with a particular emphasis on geographical distinctions between urban and peri-urban environments. Agricultural activities among the areas’ residents were mapped through questionnaires, interviews and observations, and included variables such as type of activity and product; degree of marketization; inputs; location of production, storage and vending; labour distribution; production constraints, and associated mobility patterns, among others. The study confirmed that spatial idiosyncrasies of urban and peri-urban environments both enabled and constrained agricultural activity, but not always as anticipated. There were also cross-cutting issues on which physical space appeared to have a limited impact.

Keywords: agricultural production systems, geography, low-income settlements, Lusaka, peri-urban, urban

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Authors: N. S. Risqina, G. Edijanti, P. S. Nurita, L. Endang, R. A. Siti, R. Tri

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Skin is an important and vital organs and also as a mirror of health and life. Facial skin care is one of the main emphasis to get the beautiful, healthy, and fresh skin. Potentially antioxidant phenolic compounds shows, antimutagen, antitumor, anti-inflammatory, and anti-cancer. Flavonoids are a group of polyphenolic compounds that have the nature of free radicals, inhibiting the oxidative and hydrolytic enzymes as well as anti-inflammatory. Bitter melon (Momordica charantia Linn) is a plant that contains flavonoids, and phenolic antioxidant activity. Bitter melon has strong antioxidant activity that can counteract the free radicals.These compounds can prevent free radicals that cause premature aging. Gel masks including depth cleansing is the cosmetics which work in depth and could raise the dead skin cells. Measurement of antioxidant activity of the extract and gel mask is done by using the immersion method of DPPH. IC50 value of ethanol extract of bitter melon fruit of 287.932 ppm. The preparation of gel mask bitter melon fruit extract, necessary to test the effectiveness of antioxidants using DPPH method is done by measuring the inhibition of DPPH and using UV spectrophotometer at the wavelength of maximum DPPH solution. Tests conducted at the beginning and end of the evaluation (day 0 and day 28). The purpose of this study is to determine the antioxidant activity of the bitter melon's extract and to determine the antioxidant activity of ethanol extract gel mask pare in varying concentrations, ie 1xIC100 (0.295%), 2xIC100 (0.590%) and 4xIC100 (1.180%). Evaluation of physical properties of the preparation on (Day-0,7,14,21, and 28) and evaluation of antioxidant activity (day 0 and 28). Data were analyzed using One Way ANOVA to determine differences in the physical properties of each formula. The statistical results showed that differences in the formula and storage time affects the adhesion, dispersive power, dry time and pH it is shown on a significant value of p <0.05, but longer storage does not affect the pH because the significance value p> 0,05. The antioxidant test showed that there are differences in antioxidant activity in all formulas. Measurement of antioxidant activity of bitter melon fruit extract gel mask on day 0 with a concentration of 0.295%, 0.590%, and 1.180%, respectively, are 124,209.277 ppm, ppm 83819.223 and 47323.592 ppm, whereas day 28 consecutive 130 411, 495 ppm, and 53239.806 95561.645 ppm ppm. The Conclusions drawn that there are antioxidant activity in preparation gel mask of bitter melon fruit extract. The antioxidant activity of bitter melon fruit extract gel mask on the day 0 with a concentration of 0.295%, 0.590%, and 1.180%, respectively, are 124,209.277 ppm, ppm 83819.223 and 47323.592 ppm, whereas on day 28 of antioxidant activity gel mask bitter melon fruit extract with a concentration of 0.295%, 0.590%, and 1.180% in succession, namely: 130,411.495 ppm, ppm 95561.645 and 53239.806 ppm.

Keywords: antioxdant, bitter melon, gel mask, IC50

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Authors: Shubeska Stratrova S., Muca A., Panovska S. Clinic of endocrinology, diabetes, metabolic disorders, Medical Faculty, Skopje, N. Macedonia

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Rationale: Obese subjects have a high energy density diet, low physical activity levels, a sedentary lifestyle, as well as eating disorders, which are considered important risk factors for the development of obesity. Methods: In order to discover the imbalance of energy intake and energy expenditure in obese women (W), two groups of examinees answered questionnaires regarding nutrition and physical activity: 1st group of women with normal body mass index (BMI <25 kg/m²) and 2nd group of obese women with BMI >30 kg/m². Results: 61.11% of obese W from the 2nd group reported good appetite, which was higher than the 1st group (45%). In 55.56% W, frustrations were a provocation for over nutrition. In the 2nd group, 38.89% W ate too much compared to 9.09% W from the 1st group. In the ²ⁿᵈ group, 35.29% W reported consuming food rarely and too much, while 29.41% W reported consuming food often and too much. All examinees from the ²ⁿᵈ group had consumed food in less than 5 hours, compared to only 8.33% W from the ¹ⁿᵈ group and had consumed hyper-caloric food. Consumption of fruits and vegetables was lower in the 2nd group compared to the 1st group. Half of the subjects in the 2nd group were physically inactive, compared to only 8% in the 1st group. All of the examinees in the 2nd group walked for less than 3 hours a day, compared to 54% in the 1st group. In the 2nd group, 67% W reported watching TV very often, 39% reported watching TV longer than 3 hours, which is significantly higher than 8.33% W in the 1st group. Overall, 81.25% of examinees from the 2nd group reported sitting for more than 3 hours a day, which is significantly more compared to the 1st group (45.45%). Conclusions: Obese women are less physically active, have a sedentary lifestyle, good appetite, and consume too much hyper-caloric food very often.

Keywords: (W) obese women, BMI(Body mass Index), nutrition, hyper-caloric food

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Authors: Elaine Yee Sing Wong, Jonine Jancey, Andy H. Lee, Anthony P. James

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Singapore has a rapidly aging population, where the majority of older women aged 50 years and above, are physically inactive and have unhealthy dietary habits, placing them at ‘high risk’ of non-communicable diseases. Given the multiplicity of less than optimal dietary habits and high levels of physical inactivity among Singaporean women, it is imperative to develop appropriate lifestyle interventions at recreational centres to enhance both their physical and nutritional knowledge, as well as provide them with the opportunity to develop skills to support behaviour change. To the best of our knowledge, this proposed study is the first physical activity and nutrition cluster randomised controlled trial conducted in Singapore for older women. Findings from this study may provide insights and recommendations for policy makers and key stakeholders to create new healthy living, recreational centres with supportive environments. This 6-month community-based cluster randomised controlled trial will involve the implementation and evaluation of physical activity and nutrition program for community dwelling Singaporean women, who currently attend recreational centres to promote social leisure activities in their local neighbourhood. The intervention will include dietary education and counselling sessions, physical activity classes, and telephone contact by certified fitness instructors and qualified nutritionists. Social Cognitive Theory with Motivational Interviewing will inform the development of strategies to support health behaviour change. Sixty recreational centres located in Singapore will be randomly selected from five major geographical districts and randomly allocated to the intervention (n=30) or control (n=30) cluster. A sample of 600 (intervention n=300; control n=300) women aged 50 years and above will then be recruited from these recreational centres. The control clusters will only undergo pre and post data collection and will not receive the intervention. It is hypothesised that by the end of the intervention, the intervention group participants (n = 300) compared to the control group (n = 300), will show significant improvements in the following variables: lipid profile, body mass index, physical activity and dietary behaviour, anthropometry, mental and physical health. Data collection will be examined and compared via the Statistical Package for the Social Science version 23. Descriptive and summary statistics will be used to quantify participants’ characteristics and outcome variables. Multi-variable mixed regression analyses will be used to confirm the effects of the proposed health intervention, taking into account the repeated measures and the clustering of the observations. The research protocol was approved by the Curtin University Human Research Ethics Committee (approval number: HRE2016-0366). The study has been registered with the Australian and New Zealand Clinical Trial Registry (12617001022358).

Keywords: community based, healthy aging, intervention, nutrition, older women, physical activity

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Authors: Jocelyn Floresca

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This paper aimed to present the by-product of the introduction of environmental ecology awareness on a formal education level utilizing the program course of Physical Education, particularly in the tertiary level. It is based on the premise that the radical need for environmental protection may not only necessarily be the work of people in the pure sciences but also deemed necessary to look into more avenues of the school setting particularly in the field of Physical Education. In the Philippines, most schools’ Physical Education focuses on the advancement of sports, fitness and wellness which are mostly done in the confines of a closed building. The paper dwells into the introduction of Physical Education as an outdoor recreation activity where in the participants of the study had the opportunity to indulge in activities undertaken outside the confines of buildings and going into large areas of the environment. It looked into the individual participant’s environmental social behaviour and effects on the participant’s perceptions in terms of the set objectives of Physical Education before and after the study’s intervention. The study utilized the formal course in Physical Education on nature walks, mountaineering and bird watching as interventions to gain perceptions and understanding. The introduction of the environmental ecology activities as a formal Physical Education course has resulted in deeper awareness that led to understanding the need to protect the environment, appreciation of the value of natural areas and acquiring behaviour for a sustainable use of the environment during the practice of Physical Education. Also, prior to the introduction of environmental ecology in Physical Education as a formal study; participants have no knowledge of what dwells in the identified sites of intervention. Whereas after the study, participants were able to identify various species of birds and plants found in the sites of the study that may lead to further conservation of the particular species.

Keywords: appreciation, conservation, environmental ecology, outdoor

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Authors: A. E. Buyken, D. J. Mela, P. Dussort, I. T. Johnson, I. A. Macdonald, A. Piekarz, J. D. Stowell, F. Brouns

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Recently a number of renewed dietary guidelines have been published by various health authorities. The aim of the present work was 1) to review the processes (systematic approach/review, inclusion of public consultation) and methodological approaches used to identify and select the underpinning evidence base for the established recommendations for total carbohydrate (CHO), fiber and sugar consumption, and 2) examine how differences in the methods and processes applied may have influenced the final recommendations. A search of WHO, US, Canada, Australia and European sources identified 13 authoritative dietary guidelines with the desired detailed information. Each of these guidelines was evaluated for its scientific basis (types and grading of the evidence) and the processes by which the guidelines were developed Based on the data retrieved the following conclusions can be drawn: 1) Generally, a relatively high total CHO and fiber intake and limited intake of sugars (added or free) is recommended. 2) Even where recommendations are quite similar, the specific, justifications for quantitative/qualitative recommendations differ across authorities. 3) Differences appear to be due to inconsistencies in underlying definitions of CHO exposure and in the concurrent appraisal of CHO-providing foods and nutrients as well the choice and number of health outcomes selected for the evidence appraisal. 4) Differences in the selected articles, time frames or data aggregation method appeared to be of rather minor influence. From this assessment, the main recommendations are for: 1) more explicit quantitative justifications for numerical guidelines and communication of uncertainty; and 2) greater international harmonization, particularly with regard to underlying definitions of exposures and range of relevant nutrition-related outcomes.

Keywords: carbohydrates, dietary fibres, dietary guidelines, recommendations, sugars

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Authors: Giovanni Menichini, Salvatore Giacomo Morano, Gloria Terenzi, Luca Salvatori, Maurizio Orlando

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The “Guidelines for Risk Classification, Safety Assessment, and Structural Health Monitoring of Existing Bridges” were recently approved by the Italian Government to define technical standards for managing the national network of existing bridges. These guidelines provide a framework for risk mitigation and safety assessment of bridges, which are essential elements of the built environment and form the basis for the operation of transport systems. Within the guideline framework, a workflow based on three main points was proposed: (1) risk-based, i.e., based on typical parameters of hazard, vulnerability, and exposure; (2) multi-level, i.e., including six assessment levels of increasing complexity; and (3) multirisk, i.e., assessing structural/foundational, seismic, hydrological, and landslide risks. The paper focuses on applying the Italian Guidelines to specific case studies, aiming to identify the parameters that predominantly influence the determination of the “class of attention”. The significance of each parameter is determined via sensitivity analysis. Additionally, recommendations for enhancing the process of assigning the class of attention are proposed.

Keywords: bridge safety assessment, Italian guidelines implementation, risk classification, structural health monitoring

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Authors: Howard Gomwe, Eunice Seekoe, Philemon Lyoka, Chioneso Show Marange, Dennyford Mafa

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There is arguably a lack of literature regarding body physical fitness and body composition amongst primary school learners in South Africa. For this reason, the study is aimed at investigating and accessing how body composition relates to physical fitness amongst primary school learners in the Eastern Cape Province of South Africa. In order to achieve this, a school-based cross-sectional survey was carried out among 876 primary school learners aged 9 to 14 years. Body composition indicators were measured and/or calculated, whilst physical fitness was evaluated according to the EUROFIT fitness standards by a 20 m shuttle run, push-ups, sit and reach as well as sit-ups. Out of 876 participants, a total of 870 were retained. Of these, 351 (40.34%) were boys, and 519 (59.66%) were girls. The average age of learners was 11.04 ± 1.50 years, with boys having a significantly (p = 0.002) higher mean age (M = 11.24; SD = 1.51 years) as compared to that of girls (M = 10.91; SD = 1.48 years). The non-parametric Spearman Rho correlation coefficients revealed several significant and negative relationships between body composition measurements with physical fitness characteristics, which were stronger in girls than in boys. The findings advocate for policymakers and responsible authorities to initiate the development of policies and interventions targeted at encouraging physical activity and health promotion among primary school learners in South Africa, especially in girls.

Keywords: BMI, body composition, body fat, children, physical fitness, primary school

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Authors: Jemma McGourty, Brid Delahunt, Fiona Hackett, Sharon Courtney, Richard English, Graham Russell, Sinéad O’Connor

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Fundamental Movement Skills (FMS) mastery is considered essential for children’s ongoing, meaningful engagement in Physical Activity (PA). There has been a dearth of Irish research on baseline FMS and their development by means of intervention in young primary school children. In addition, as children’s participation in PA is heavily influenced by both parents and teachers, it is imperative to understand their attitudes and perceptions towards PA participation and its’ promotion in children. The ‘Fun, Move, Play’ Project investigated the effect of a 6-week play based PA intervention on primary school children’s (aged 6-8 years) FMS while also exploring the attitudes and perceptions of their parents and teachers towards PA participation. The FMS intervention utilised a pre-post quasi-experimental design to determine the effect of a 6-week play based PA intervention (devised from the iCoach Kids Programme) on 176 primary school children’s FMS (N = 176: 90 girls and 86 boys; M = 7.2 years; SD = 0.48). Objective measures of 7 FMS (run, skip, vertical jump, static balance, stationary dribble, catch, kick) were made using a combination of the TGMD2 and Get Skilled, Get Active resources. One hundred parents (87 mothers; 13 fathers; M=36 years; SD=5.45) and 90 teachers (67 females; 23 males) completed surveys investigating their attitudes and perceptions towards PA participation. In addition, 19 of these parents and 9 of these teachers participated in semi-structured qualitative interviews to explore, in more depth, their views and perceptions of PA participation. Both the FMS data set and survey responses were analysed using SPSS version 23, using appropriate statistical analysis. A thematic analysis framework was used to analyse the qualitative findings. A significant improvement was observed in the children’s overall FMS score pre-post intervention (t = 16.67; df = 175; p < 0.001), while there were also significant improvements in each of the seven individual FMS measured in the children, pre-post intervention. Findings from the parent surveys and interviews indicated that parents had positive attitudes towards PA, viewed it as important and supported their child’s PA participation. However, a lack of knowledge regarding the amount and intensity of PA that children should participate in emerged as a recurrent finding. Also, there was a significant positive correlation between the PA levels of parents’ and their children (r = .41; n = 100; p < .001). Arising from the teachers’ surveys and interviews was a positive attitude towards PA and the impact that it has on a child’s health and well-being. They also reported feeling more confident teaching certain aspects of the PE curriculum (games and sports) compared to others (gymnastics, dance), where they appreciate working with specialist practitioners. Conclusion: A short-term PA intervention has a positive effect on children’s FMS. While parents are supportive of their child’s PA participation, there is a knowledge gap regarding National PA guidelines for children. Teachers appreciate the importance of PA in children, but face a number of challenges in its implementation and promotion.

Keywords: fundamental movement skills, parents attitudes to physical activity, short-term intervention, teachers attitudes to physical activity

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Authors: Michelle Eichinger, Upali Nanda

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Behavior choices during college years can establish the pattern of lifelong healthy living. Nearly 1/3rd of American college students are either overweight (25 < BMI < 30) or obese (BMI > 30). In addition, overweight/obesity contributes to depression, which is a rising epidemic among college students, affecting academic performance and college drop-out rates. Overweight and obesity result in an imbalance of energy consumption (diet) and energy expenditure (physical activity). Overweight/obesity is a significant contributor to heart disease, diabetes, stroke, physical disabilities and some cancers, which are the leading causes of death and disease in the US. There has been a significant increase in obesity and obesity-related disorders such as type 2 diabetes, hypertension, and dyslipidemia among people in their teens and 20s. Historically, the evidence-based interventions for obesity prevention focused on changing the health behavior at the individual level and aimed at increasing awareness and educating people about nutrition and physical activity. However, it became evident that the environmental context of where people live, work and learn was interdependent to healthy behavior change. As a result, a comprehensive approach was required to include altering the social and built environment to support healthy living. College campus provides opportunities to support lifestyle behavior and form a health-promoting culture based on some key point of decisions such as stairs/ elevator, walk/ bike/ car, high-caloric and fast foods/balanced and nutrient-rich foods etc. At each point of decision, design, can help/hinder the healthier choice. For example, stair well design and motivational signage support physical activity; grocery store/market proximity influence healthy eating etc. There is a need to collate the vast information that is in planning and public health domains on a range of successful point of decision prompts, and translate it into architectural guidelines that help define the edge condition for critical point of decision prompts. This research study aims to address healthy behaviors through the built environment with the questions, how can we make the healthy choice an easy choice through the design of critical point of decision prompts? Our hypothesis is that well-designed point of decision prompts in the built environment of college campuses can promote healthier choices by students, which can directly impact mental and physical health related to obesity. This presentation will introduce a combined health and architectural framework aimed to influence healthy behaviors through design applied for college campuses. The premise behind developing our concept, point-of-decision design (PODD), is healthy decision-making can be built into, or afforded by our physical environments. Using effective design intervention strategies at these 'points-of-decision' on college campuses to make the healthy decision the default decision can be instrumental in positively impacting health at the population level. With our model, we aim to advance health research by utilizing point-of-decision design to impact student health via core sectors of influences within college settings, such as campus facilities and transportation. We will demonstrate how these domains influence patterns/trends in healthy eating and active living behaviors among students. how these domains influence patterns/trends in healthy eating and active living behaviors among students.

Keywords: architecture and health promotion, college campus, design strategies, health in built environment

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Authors: Ruhizal Roosli, Julaihi Wahid, Abu Hassan Abu Bakar, Faizal Baharum

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This paper reports on the progress of a study on the reconstruction project after the ‘Yellow Flood’ disaster in Kelantan, Malaysia. Malaysia still does not have guidelines to build housing after a disaster especially in disaster-prone areas. At the international level, many guidelines have been prepared that is found suitable for post-disaster housing. Which guidelines can be adapted that best describes the situation in Malaysia? It was reported that the houses should be built on stilts, which can withstand certain level of impact during flooding. Unfortunately, until today no specific guideline was available to assist homeowners to rebuild their homes after disaster. In addition, there is also no clear operational procedure to monitor the progress of this construction work. This research is an effort to promoting resilient housing; safety and security; and secure tenure in a prone area. At the end of this study, key lessons will be emerged from the review process and data analysis. These inputs will then have influenced to the content that will be developed and presented as guidelines. An overall objective is to support humanitarian responses to disaster and conflicts for resilience house construction to flood prone area. Interviews with the field based staff were from recent post-disaster housing workforce (disaster management mechanism in Malaysia especially in Kelantan). The respondents were selected based on their experiences in disaster response particularly related to housing provision. These key lessons are perhaps the best practical (operational and technical) guidelines comparing to other International cases to be adapted to the national situations.

Keywords: disaster, guideline, housing, Malaysia, reconstruction

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Authors: Inayat Shah, Muhammad Omar Malik, Ghareeb Alshuwaier, Ronald H. Baxendale

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Background: The balance between angiogenesis and angiostasis is important in growth and developmental processes in the body. Angiogenic and angiostatic mediators control this balance. Endostatin is one of the prominent angiostatic mediators. The marked angiostatic effect of endostatin includes inhibiting endothelial cell migration, proliferation and apoptosis. Physical activity decreases the risk and development of many angiogenesis related health problems including atherosclerosis and numerous cancers. Physiological influences of different physical activities on plasma endostatin concentration are controversial and not completely clear. Moreover, correlation of physical characteristics and metabolic predictors during physical activity on circulating endostatin is indistinct and poorly speculated. The study aimed to determine the effects of mild, moderate and vigorous exercise on the concentration of endostatin in plasma. Methodology: 22 participants, 16 males (age = 30.6 ± 7.8 years) and 6 females (age = 26.5 ± 5 years) were recruited. Weekly session of different intensities exercise based on the predicted maximum heart of the participants [60%(low), 70% (moderate) and 80% (vigorous)] were carried out. The duration and work rate for each participant was determined through sub-maximal exercise. Standardization of the session was done on total energy expenditure of the participants per session. One pre exercise and two post exercise samples were taken at intervals of 10 and 60 minutes. Results: Pre-exercise mean endostatin was 101 ± 20 ng/dl. Low intensity exercise insignificantly decreased the endostatin concentration in plasma at 10 and 60 minutes 97 ± 20 ng/dl (p= 0.5), 98 ± 23 ng/dl (p= 0.8)). However, moderate (p= 0.022, 0.004) and vigorous intensities (p ≤ 0.001, 0.02) increased the endostatin concentrations significantly at both 10 and 60 minutes intervals respectively. The effects were not significantly influenced by gender, exercise mode (walking vs. running), components of exercise (HR, Speed, Gradients, distance, duration) or metabolism during exercise (VO₂ max, VCO₂, RER, energy expenditure, rate of carbohydrate or fats oxidation). Conclusion: Low intensity exercises did not influence endostatin concentration. However, moderate to high intensity exercises significantly increase endostatin concentration and may have potential benefits.

Keywords: angiogenesis, exercise, endostatin, physical activity

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Authors: Howard Gomwe, Eunice Seekoe, Philemon Lyoka, Chioneso Show Marange, Dennyford Mafa

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Background: This study was designed to assess PA levels and sedentary behavior among primary school learners in the Eastern Cape province of South Africa. Methods: A cross-sectional study was adopted to assess the patterns and levels of PA and sedentary behavior using the Physical Activity Questionnaire for Older Children (PAQ-C). Results: Using complete case analysis, 870 randomly selected participants (boys = 351 and girls = 519) aged 9 to 14 years were retained. The sample comprised of primary school learners, both boys and girls; aged 9-14 years old, who were randomly selected from rural, urban and peri-urban areas in the Eastern Cape Province of South Africa. Overly, the sample had a mean PAQ-C score of 2.33 ± 0.43. The mean of PA in boys was significantly higher (p = 0.003) in comparison with the girls. The 13 to 14 age group had a significantly higher PA level (p = 0.014). Learners from urban areas (n = 136; 77.3%) engaged more in sedentary behaviour as compared to those from rural areas (n = 252; 54.9%). Conclusion: The findings demonstrated low levels of PA and high engagement of sedentary behavior, which have negative implications on the health, growth and development of children. The study, therefore, recommends relevant stakeholders to implement interventions aimed to promote the increase in PA and reduction in sedentary behaviors for primary school learners in the Eastern Cape province in South Africa.

Keywords: learners, physical activity, sedentary behavior, south Africa

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Authors: Agburuga Obi, Madumere Akuego Jane

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This paper explores the important role sports can play in the promotion of good health and prevention of diseases. Technological advancements in today’s world has come along with some difficulties to man. This is because work formally done by man has been taken over by machines, thus, man has become sedentary. This has created a lot of health problems to man such as cardiovascular diseases, diabetes, cancer, obesity, and osteoporosis. To nip this ugly situation in the bud, the following recommendations are made: specific measures should be taken to raise the awareness within the government, key sectors and the population of the diverse benefits or physical activity and sports and the risk and costs of inactivity, provision of equipment, facilities for sports and recreational activities in every community, participation in physical activities in sports if not on daily basis at least thrice a week.

Keywords: physical activities, sport, good health, prevention, diseases

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Authors: Christos Lampropoulos, Maria Konsta, Ifigenia Apostolou, Vicky Dradaki, Tamta Sirbilatze, Irini Dri, Christina Kordali, Vaggelis Lambas, Kostas Argyros, Georgios Mavras

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Objectives: Mediterranean diet has been associated with lower incidence of cardiovascular disease and cancer. The purpose of our study was to examine the hypothesis that Mediterranean diet may protect against mortality and reduce admission duration in elderly, hospitalized patients. Methods: Sample population included 150 patients (78 men, 72 women, mean age 80±8.2). The following data were taken into account in analysis: anthropometric and laboratory data, dietary habits (MedDiet score), patients’ nutritional status [Mini Nutritional Assessment (MNA) score], physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were mortality (from admission until 6 months afterwards) and duration of admission, compared to national guidelines for closed consolidated medical expenses. Logistic regression and linear regression analysis were performed in order to identify independent predictors for mortality and admission duration difference respectively. Results: According to MNA, nutrition was normal in 54/150 (36%) of patients, 46/150 (30.7%) of them were at risk of malnutrition and the rest 50/150 (33.3%) were malnourished. After performing multivariate logistic regression analysis we found that the odds of death decreased 30% per each unit increase of MedDiet score (OR=0.7, 95% CI:0.6-0.8, p < 0.0001). Patients with cancer-related admission were 37.7 times more likely to die, compared to those with infection (OR=37.7, 95% CI:4.4-325, p=0.001). According to multivariate linear regression analysis, admission duration was inversely related to Mediterranean diet, since it is decreased 0.18 days on average for each unit increase of MedDiet score (b:-0.18, 95% CI:-0.33 - -0.035, p=0.02). Additionally, the duration of current admission increased on average 0.83 days for each previous hospital admission (b:0.83, 95% CI:0.5-1.16, p<0.0001). The admission duration of patients with cancer was on average 4.5 days higher than the patients who admitted due to infection (b:4.5, 95% CI:0.9-8, p=0.015). Conclusion: Mediterranean diet adequately protects elderly, hospitalized patients against mortality and reduces the duration of hospitalization.

Keywords: Mediterranean diet, malnutrition, nutritional status, prognostic factors for mortality

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Authors: Mohammed Amin, Debra Kerr, Yacoba Atiase, Andrea Driscoll

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Background: Physical activity (PA) is a major component of diabetes self-care management; although this is often stressed to patients, many adults with Type 2 Diabetes Mellitus (T2DM)lead sedentary lifestyles, and barriers exist for uptake of PA. Aim: To explore opinions of healthcare professionals about barriers to PA for adults with T2DM in Ghana. Methods: This qualitative descriptive study included 13healthcare professionals (3 Physiotherapists, 3 exercise physiologists, 3 nurses, and 4 physicians) who provide care to individuals with T2DM in Ghana. Data was collected by semi-structured interviews. The social cognitive theory guided the design of the interview schedule. Data was analysed using thematic analysis. Results: Four main themeswere identified: 1) Individual-related factors, 2) Interpersonal factors, 3) Environment-related factors, and 4) Health system-related factors. Fear of injury, existing co-morbidities, and lack of time make it difficult for people with T2DM to engage in PA. Lack of family support, fear of social ridicule, and cultural beliefs prevent uptake of PA. Poorly designed community spaces, including safe walkways and lack of exercise facilities, inhibit PA participation. Few physical therapists and physical therapy centres exist to support PA participation among people with T2DM. Some nurses and doctors lack adequate knowledge to deliver proper PA education to clients, thereby making clients lack the needed support. Conclusion: Adults with T2DM may be restricted from partaking in PA arising from personal and external factors. This study has identified that barriers to exercise need consideration when designing PA programs that aim to improve health outcomes for people with T2DM in Ghana.

Keywords: type 2 diabetes, physical activity, exercise, ghana, qualitative, barriers

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Authors: U. Harel, E. Carmeli

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The Purpose was to measure differences in activity patterns between major league adult and U-21 soccer players. Four U-21 players and four adult team players were evaluated using a repeated measures technique. All eight players were affiliated with the Maccabi Haifa soccer club from the Israeli professional and U-21major leagues, depending on the player’s age. GPS sensors were attached to the players during five consecutive games to identify patterns regarding running distance and speed according to the field positions. There was no significant difference in the total running distances covered by two age groups. When measuring running speed, an advantage was observed in the adult group when comparing two players from different age groups that played the same position. Differences in activity patterns were evident between adult and U-21 major league soccer players. Furthermore, differences in within group activity pattern emerged between the positions under investigation. These findings provide valuable knowledge that may serve the principle of training specificity.

Keywords: physical fitness, soccer, positional differences, GPS, training specificity

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Authors: Helge Rupprich, Elke Knisel

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In a time of mediazation and reduced physical movement, it is important to change passivity (akinesa) into physical activity to improve health. The approach is to encourage children, junior athletes, recreational athletes, and semi-professional athletes to do sports while attending a top sport event. The concept has the slogan: get out off your seat and move! A top sport event of a series of professional beach volleyball tournaments with 330.000 life viewers, 13,70 million cumulative reach viewers and 215,13 million advertising contacts is used as framework for different sports didactic approaches, social integrative approaches and migration valuations. An important aim is to use the big radiant power of the top sport event to extract active participants from the viewers of the top sport event. Even if it is the goal to improve physical activity, it is necessary to differentiate between the didactic approaches. The first approach contains psycho motoric exercises with children (N=158) between two and five years which was used in the project ‘largest sandbox of the city’. The second approach is social integration and promotion of activity of students (N=54) in the form of a student beach volleyball tournament. The third approach is activity in companies. It is based on the idea of health motivation of employees (N=62) in a big beach volleyball tournament. Fourth approach is to improve the sports leisure time activities of recreational athletes (N=292) in different beach volleyball tournaments. Fifthly approach is to build a foreign friendly measure which is implemented in junior athlete training with the French and German junior national team (N=16). Sixthly approach is to give semi professional athletes a tournament to develop their relation to active life. Seventh approach is social integration for disadvantaged people (N=123) in form of training with professional athletes. The top sport beach volleyball tournament had 80 athletes (N=80) and 34.000 viewers. In sum 785 athletes (N=785) did sports in 13 days. Over 34.000 viewers where counted in the first three days of top sport event. The project was evaluated positively by the City of Dresden, Politics of Saxony and the participants and will be continued in Dresden and expanded for the season 2015 in Jena.

Keywords: beach volleyball, event, sports didactic, sports project

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Authors: Christos E. Lampropoulos, Maria Konsta, Vicky Dradaki, Irini Dri, Tamta Sirbilatze, Ifigenia Apostolou, Christina Kordali, Konstantina Panouria, Kostas Argyros, Georgios Mavras

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Malnutrition in hospitalized patients is related to increased morbidity and mortality. Purpose of our study was to assess nutritional status of hospitalized, elderly patients with various nutritional scores and to detect unfavorable prognostic factors, related to increased mortality and extended duration of admission. Methods: 150 patients (78 men, 72 women, mean age 80±8.2) were included in this cross-sectional study. Nutritional status was assessed by Mini Nutritional Assessment (MNA full, short-form), Malnutrition Universal Screening Tool (MUST) and short Nutritional Appetite Questionnaire (sNAQ). The following data were incorporated in analysis: Anthropometric and laboratory data, physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, dietary habits and mediterranean diet (assessed by MedDiet score), cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were the mortality (from admission until 6 months afterwards) and duration of admission, compared to national guidelines for closed consolidated medical expenses. Mann-Whitney two-sample statistics or t-test was used for group comparisons and Spearman or Pearson coefficients for testing correlation between variables. Results: Normal nutrition was assessed in 54/150 (36%), 92/150 (61.3%) and in 106/150 (70.7%) of patients, according to full MNA, MUST and sNAQ questionnaires respectively. Mortality rate was 20.7% (31/150 patients). The patients who died until 6 months after admission had lower BMI (24±4.4 vs 26±4.8, p=0.04) and albumin levels (2.9±0.7 vs 3.4±0.7, p=0.002), significantly lower full MNA (14.5±7.3 vs 20.7±6, p<0.0001) and short-form MNA scores (7.3±4.2 vs 10.5±3.4, p=0.0002) compared to non-dead one. In contrast, the aforementioned patients had higher MUST (2.5±1.8 vs 0.5±1.02, p=<0.0001) and sNAQ scores (2.9±2.4 vs 1.1±1.3, p<0.0001). Additionally, they showed significantly lower MedDiet (23.5±4.3 vs 31.1±5.6, p<0.0001) and IPAQ scores (37.2±156.2 vs 516.5±1241.7, p<0.0001) compared to remaining one. These patients had extended hospitalization [5 (0-13) days vs 0 (-1-3) days, p=0.001]. Patients who admitted due to cancer depicted higher mortality rate (10/13, 77%), compared to those who admitted due to infections (12/73, 18%), stroke (4/15, 27%) or other causes (4/49, 8%) (p<0.0001). Extension of hospitalization was negatively correlated to both full (Spearman r=-0.35, p<0.0001) and short-form MNA (Spearman r=-0.33, p<0.0001) and positively correlated to MUST (Spearman r=0.34, p<0.0001) and sNAQ (Spearman r=0.3, p=0.0002). Additionally, the extension was inversely related to MedDiet score (Spearman r=-0.35, p<0.0001), IPAQ score (Spearman r=-0.34, p<0.0001), albumin levels (Pearson r=-0.36, p<0.0001), Ht (Pearson r=-0.2, p=0.02) and Hb (Pearson r=-0.18, p=0.02). Conclusion: A great proportion of elderly, hospitalized patients are malnourished or at risk of malnutrition. All nutritional scores, physical activity and albumin are significantly related to mortality and increased hospitalization.

Keywords: dietary habits, duration of admission, malnutrition, prognostic factors for mortality

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