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The purpose of this paper is to improve the quality of monitoring of risk factors that predict the likelihood of people with severe mental illness (SMI) developing cardiovascular disease (CVD), diabetes and obesity, major contributors to poor physical health and risk of premature mortality.

The first phase of the AQuA “Don’t just screen-intervene” initiative supported five specialised community-based Early Intervention for Psychosis services in North West England to assess the effectiveness of monitoring of cardiometabolic risk in their patients using standards derived from the Lester Positive Cardiometabolic Health Resource, a nationally acknowledged framework for people with psychosis receiving antipsychotic medication. The initial findings formed the basis for a quality improvement programme which ran from November 2012 until May 2013.

By the end of a six month quality improvement programme the likelihood of a patient receiving a comprehensive cardiometabolic risk screening (evidenced by recorded measurement of body mass index or waist circumference, blood pressure, blood glucose and lipid profile, assessment of smoking status and enquiry of relevant family history) had increased from 10 to between 63 and 80 per cent.

Cardiometabolic risk monitoring from the onset of psychosis and its treatment can be improved utilising quality improvement methodology in real-world specialist mental health services. Earlier identification and treatment of risk factors that predict higher rates of obesity, diabetes and SMI may help people with SMI avoid life-restricting and life-shortening physical disorders.

Given the National Audit of Schizophrenia findings of inadequate screening in those with established SMI alongside evidence that CVD risk can emerge early in the course of psychosis, a group of early intervention in psychosis services in North West England decided to examine this aspect of their routine clinical practice. This service evaluation describes the effectiveness of a quality improvement programme based on the Lester Positive Cardiometabolic Health Resource (referred to as Lester resource henceforth) to improve the effectiveness of monitoring of risk factors that predict the likelihood of people experiencing psychosis and schizophrenia developing CVD diabetes and obesity.

A combination of social disadvantage and unhealthy lifestyles, adverse cardiometabolic impacts of antipsychotic medication and inequitable access to physical healthcare combine to put people with SMI at particular risk from CVD, the single biggest cause of premature death, and much more common than suicide (Brown et al., 2010). Despite higher rates of potentially modifiable CVD risk factors (De Hert et al., 2009) people with SMI appear to be missing out on opportunities to actively prevent conditions like CVD and diabetes compared to the general population.

People with SMI such as schizophrenia die 15-20 years earlier on average than the general population. Around 20 per cent of premature deaths can be explained by suicide and injury, but the remainder arise from a variety of natural causes such as CVD, chronic obstructive pulmonary disorder and certain cancers and infections (Nordentoft et al., 2013). The authors worked with five mental health trusts in the North West of England covering a sample of over 500 cases within early intervention services.

The purpose of this paper is to evaluate the association between food consumption classified by the degree of processing and cardiometabolic risk factors in a population at risk of cardiovascular disease.

A cross-sectional study conducted with 325 adults and elderlies who present a cardiovascular risk factor. The food consumption was evaluated by a 24 h dietary recall, and it was classified according to the NOVA classification.

Individuals who presented a higher consumption of processed and ultra-processed food had a higher prevalence of abdominal obesity, waist/hip ratio (PR = 1.005; p-value = 0.049), waist circumference (PR = 1.003; p-value = 0.02) and high total cholesterol (PR = 1.008; p-value = 0.047), while ultra-processed had a higher prevalence of excess weight (PR = 1.004; p-value = 0.04), and abdominal obesity, waist/hip ratio (PR = 1.005; p-value = 0.04), waist circumference (PR = 1.004; p-value = 0.004) and waist/height ratio (PR = 1.003; p-value = 0.03).

An association was found between the degree of food processing and cardiometabolic risk factors, even in a population that already has a risk factor for cardiovascular disease, reinforcing the importance of personalized nutrition orientation that considers the profile of the target population as well as types of meals.

Food processing in itself can influence cardiometabolic risk and, as far as is known, no study has evaluated food processing in individuals who already have some type of cardiovascular risk. Also, consumption was assessed by the degree of processing between meals.

Workplace health promotion enables the dissemination of health-related information to a large portion of society and provides a vehicle for translating results of efficacy studies to effective lifestyle interventions under less controlled real-world conditions. To achieve effectiveness there needs to be a systematic approach to the design, implementation, and evaluation of workplace health promotion interventions. The purpose of this paper is to describe the development of a workplace programme in a mining and steel making town in regional South Australia.

The Precede-Proceed model (PPM) was used as a framework to design the development, implementation, and evaluation of the programme.

Quality of life issues and antecedents of modifiable behavioural and environmental factors to be targeted by interventions were identified. Relevant socio-behavioural theories were used to guide intervention development and evaluation. An intervention programme was planned to enable the delivery of educational and skills-development strategies by peers within structured organisational work units.

This research utilises the PPM to develop, implement, and evaluate intervention strategies targeting the development of diabetes and cardiometabolic risk in a remotely located workplace population. Novel to this approach is the utilisation of the entire PPM in the research; the multiple baseline, interrupted time series design of the study; and its application in a workplace environment noted for increased health risk factors, within a community at high risk of development of type 2 diabetes.

The purpose of this paper is to examine the associations of dietary patterns with sociodemographic and lifestyle characteristics in a cardiometabolic risk population.

In this cross-sectional study data from 295 (n=123 men/172 women, 42±16 years) participants in a Cardiovascular Health Care Program were included. After a 24-hour recall interview the dietary patterns were determined using principal component analysis. Sociodemographic, clinical and lifestyle data were collected by medical records.

Subjects with diabetes and hypertension had a higher adherence in the “traditional” pattern (rice, beans, tubers, oils and meats). Poisson regression models showed that male subjects with low schooling and smokers had greater adherence to the “traditional” pattern. Also, students, women, and those with higher schooling and sleeping =7 h/night showed higher adherence to healthy patterns (whole grains, nuts, fruits and dairy). Women, young adults and those with higher schooling and fewer sleep hours had greater adherence to healthy dietary patterns. Those with low schooling and unhealthy lifestyle showed more adherence to the “traditional” pattern.

The results indicate the importance to personalized nutritional therapy and education against cardiometabolic risk, considering the dietary patterns specific to each population.

Socioeconomic and lifestyle characteristics can influence dietary patterns and this is one of the few studies that investigated this relationship performing principal component analysis.

The study describes the design, implementation and evaluation of an employer-sponsored health screening program – Employee Health and Wellness Program (EHWP) – in an academic healthcare system in Pakistan.

One year after implementation, RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework was used to evaluate and report participant- and organizational-level indicators of success.

Of the 5,286 invited employees, 4,523 (86%) completed blood work and 1809 (34%) completed health risk assessment (reach). Of the 915 (51%) who required referrals, 3% were referred for new diagnoses of diabetes, hepatitis C or severe anemia; 63% for elevated 10-year risk of cardiometabolic diseases (cardiovascular disease and diabetes); and 25% for counseling for depression, obesity or smoking cessation (effectiveness). Employees' barriers to enrollment were explored (adoption). While institutional costs were considered nominal (USD 20/employee), organizational barriers were identified (implementation). Finally, 97% of users reported interest in enrollment if EHWP was offered again (maintenance).

In a country with minimal focus on adult preventive care, the study reports the impact of an employer-offered wellness program that identified new risk factors and offered a referral for ongoing care. Employees reported a positive experience and were willing to re-enroll. Using the RE-AIM framework, the study has defined indicators in the real-world setting that can be used effectively by other institutions to start such a program.

This study aims to assess the association of Healthy Eating Index (HEI) with levels of fasting blood sugar (FBS) and lipid profile in normoglycemic and elevated FBS patients.

This case-control study was conducted on 144 participants, namely, 72 normoglycemic subjects (FBS < 100 mg/dl) and 72 high-glycemic patients (FBS ≥ 100 mg/dl) aged 20–60 years of age, who were selected from the nutrition and diet clinics in Tehran city. The dietary intake was collected by using a validated food frequency questionnaire to determine the HEI score.

The mean±SD age and body mass index of participants were 47.1 ± 12.7 years and 29.6 ± 6.0 kg/m², respectively. The median (interquartile range) of HEI scores in the normoglycemic group and the high-glycemia group were 19.34 (15.24–24.31) and 16.53 (13.35–24.07), respectively. In the overall population, the findings of the multi-variable linear regression model indicated a positive association between the HEI score and high-density lipoprotein-cholesterol (HDL-C) (ß = 0.34; 95%CI: 0.05–0.64, P = 0.01). However, there is no significant association between HEI and HDL-C in normoglycemic (ß = 0.19; 95%CI: −0.31, 0.69, P = 0.45) and hyperglycemic subjects (ß = 0.28; 95%CI: −0.10–0.66, P = 0.15). Furthermore, the association of HEI with levels of FBS, triglycerides (TGs) and low-density lipoprotein-cholesterol (LDL-C) was not significant in any of the analyzed groups, including the total population, normoglycemic individuals and hyperglycemic subjects.

This study was the first study to assess the role of HEI and its components with levels of FBS and lipid profile in normoglycemic and hyperglycemic individuals in Iran. The findings suggested that higher adherence to HEI may be associated with an increase in the HDL-C level. However, HEI could not predict FBS, TGs and LDL-C levels in the adult population.

This study aims to determine the relationship between body mass index (BMI) and Global Registry of Acute Coronary Events (GRACE) risk score in patients diagnosed with acute coronary syndrome (ACS) and to evaluate the results in this context.

This was a prospective cohort study of ACS patients admitted to a cardiac care unit in high specialization hospital's cardiology service. The study included 140 men aged >35 years who were diagnosed with ACS.

The mean age of the individuals participating in the study was 61.4 ± 10.9 years old. The mean BMI of the individuals was 25.3 ± 6.6 kg/m², and the mean value of the waist/hip ratio was 0.85 ± 0.01. Individuals were divided into four quarters according to the GRACE score. It was determined that individuals with the highest GRACE score were very underweight or morbidly obese according to their BMI values (p = 0.04).

It has been observed that there is a U-shaped relationship between the GRACE score and the BMI in individuals diagnosed with ACS. The risk of death of ACS patients with very high or very low BMI values was found to be close to each other. Although there is a relationship between BMI and GRACE score, it is concluded that it is insufficient to determine the risk in coronary disease alone, and body fat distribution should be examined together with BMI.

This paper aims to overview the need for tobacco harm reduction, the consumer products that facilitate tobacco harm reduction and the barriers to its implementation. The worldwide endemic of tobacco smoking results in the death of over seven million smokers a year. Cigarette quit rates are very low, from 3%–12%, and relapse rates are high, from 75%–80% in the first six months and 30%–40% even after one year of abstinence. In addition, some smokers do not desire to quit. Cigarette substitution in tobacco harm reduction is one strategy that may reduce the burden of morbidity and mortality.

This review examines the displacement of smoking through substitution of non-combustible low-risk products such as snus, heated tobacco products and e-cigarettes.

Toxicological testing, population studies, clinical trials and randomized controlled trials demonstrate the potential reductions in exposures for smokers. Many barriers impede the implementation of product substitution in tobacco harm reduction. These products have been subjected to regulatory bans and heavy taxation and are rejected by smokers and society based on misperceptions about nicotine, sensational media headlines and unsubstantiated fears of youth addiction. These barriers will need to be addressed if tobacco harm reduction is to make the maximum impact on the tobacco endemic.

This review provides the rationale for tobacco harm reduction, evaluates the current products available and identifies the barriers to implementation.

In the state of Hawaii, it has been shown that certain ethnic minority groups, such as Filipinos and Pacific Islanders, suffer disproportionally high rates of cardiovascular disease, evidence that local health-care systems and governing bodies fail to equally extend the human right to health to all. This study aims to examine whether these ethnic health disparities in cardiovascular disease persist even within an already globally disadvantaged group, the houseless population of Hawaii.

A retrospective chart review of records from Hawaii Houseless Outreach and Medical Education Project clinic sites from 2016 to 2020 was performed to gather patient demographics and reported histories of type II diabetes, obesity, hyperlipidemia, hypertension and other cardiovascular disease diagnoses. Reported disease prevalence rates were compared between larger ethnic categories as well as ethnic subgroups.

Unexpectedly, the data revealed lower reported prevalence rates of most cardiometabolic diseases among the houseless compared to the general population. However, multiple ethnic health disparities were identified, including higher rates of diabetes and obesity among Native Hawaiians and other Pacific Islanders and higher rates of hypertension among Filipinos and Asians overall. The findings suggest that even within a generally disadvantaged houseless population, disparities in health outcomes persist between ethnic groups and that ethnocultural considerations are just as important in caring for this vulnerable population.

To the best of the authors’ knowledge, this is the first comprehensive study focusing on ethnic health disparities in cardiovascular disease and the structural processes that contribute to them, among a houseless population in the ethnically diverse state of Hawaii.

The purpose of this paper is to determine the prevalence of general and abdominal obesity among adolescents attending independent schools in Qatar.

A school-based cross-sectional study was conducted in November-December 2013 in 23 secondary schools. A total of 1,161 students aged 14 to 19 year olds were randomly selected using a multistage stratified cluster random sampling technique. Body weight, height and waist circumference (WC) were measured using standard protocol. The International Obesity Task Force (IOTF) age- and sex-specific body mass index (BMI) reference were used to define overweight and obesity. Abdominal obesity (AO) was defined by waist to height ratio (WHtR ≥ 0.5) and by sex- and age-specific WC cut-off values.

The prevalence of overweight and obesity among the study population was 20.6 and 20.7%, respectively. The highest rate of overweight and obesity was observed among boys, and the youngest age group. The rate of obesity defined by either WC/or WHtR was higher than that assessed by BMI. The prevalence of AO assessed by WC and WHtR was 48.8 and 46.9%, respectively. The rate of AO was significantly higher (p < 0.05) among boys compared to girls for both assessment criteria. The proportion of adolescents with AO (WHtR ≥ 0.5) according to BMI was 17.3%, 80.8% and 97.1% for adolescents with normal, overweight and obesity had AO, respectively. Being male was significantly associated with higher odds of having both general obesity and AO.

The study revealed a high prevalence of general and abdominal obesity in adolescents in Qatar. Waist measures appear to be an important indicator in identifying adolescents at risk and should be included as screening tools for cardiometabolic risk.