Diagnostic delays negatively affect cardiac function. Of the predictive clinical features, carpal tunnel syndrome was frequent and its presence should lead to a more aggressive analysis for CAm in the appropriate clinical settings.

Background The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors.Methods We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed-MEDLINE, Embase, the Cochrane Library, Web of Science, and Education Resources Information Center, from Jan 1, 1990, to June 30, 2020, for studies with controlled evaluation designs that assessed multicomponent workplace wellness programmes. Investigators independently appraised the evidence and extracted the data. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. Pooled effects were calculated by inverse-variance random-effects meta-analysis. Potential sources of heterogeneity and study biases were evaluated. FindingsFrom 10 169 abstracts reviewed, 121 studies (82 [68%] randomised controlled trials and 39 [32%] quasiexperimental interventions) met the eligibility criteria. Most studies were done in North America (57 [47%]), and Europe, Australia, or New Zealand (36 [30%]). The median number of participants was 413•0 (IQR 124•0-904•0), and median duration of intervention was 9•0 months (4•5-18•0). Workplace wellness programmes improved fruit and vegetable consumption (0•27 servings per day [95% CI 0•16 to 0•37]), fruit consumption (0•20 servings per day [0•11 to 0•28]), body-mass index (-0•22 kg/m² [-0•28 to -0•17]), waist circumference (-1•47 cm [-1•96 to -0•98]), systolic blood pressure (-2•03 mm Hg [-3•16 to -0•89]), and LDL cholesterol (-5•18 mg/dL [-7•83 to -2•53]), and to a lesser extent improved total fat intake (-1•18% of daily energy intake [-1•78 to -0•58]), saturated fat intake (-0•70% of daily energy [-1•22 to -0•18]), bodyweight (-0•92 kg [-1•11 to -0•72]), diastolic blood pressure (-1•11 mm Hg [-1•78 to -0•44]), fasting blood glucose (-1•81 mg/dL [-3•33 to -0•28]), HDL cholesterol (1•11 mg/dL [0•48 to 1•74]), and triglycerides (-5•38 mg/dL [-9•18 to -1•59]). No significant benefits were observed for intake of vegetables (0•03 servings per day [95% CI -0•04 to 0•10]), fibre (0•26 g per day [-0•15 to 0•67]), polyunsaturated fat (-0•23% of daily energy [-0•59 to 0•13]), or for body fat (-0•80% [-1•80 to 0•21]), waist-to-hip ratio (-0•00 ratio [-0•01 to 0•00]), or lean mass (1•01 kg [-0•82 to 2•83]). Heterogeneity values ranged from 46•9% to 91•5%. Betweenstudy differences in outcomes were not significantly explained by study design, location, population, or similar factors in heterogeneity analyses.Interpretation Workplace wellness programmes are associated with improvements in specific dietary, anthropometric, and cardiometabolic risk indicators. The heterogeneity identified in study designs and results should be considered when using these programmes as strategies to improve cardiometabolic health.

Introduction: Worksites are promising venues for promoting health, given considerable time spent at work and opportunities for environmental change. Yet, the impact of worksite wellness programs (WWPs) on diet and adiposity, as well as the most relevant WWP components, are not established. Methods: Following MOOSE and PRISMA guidelines, we conducted a systematic review and meta-analysis of the impact of multi-component WWP trials (RCT or quasi-experimental) on diet and adiposity. Data were extracted in duplicate and pooled using inverse variance random effects meta-analysis. Pre-specified sources of heterogeneity (study design, world region, worksite type, duration, WWP components) were analyzed by meta-regression and subgroup analysis. Funnel plots, Begg’s, and Egger’s tests evaluated potential publication bias. Results: From 6612 abstracts, we identified 48 studies assessing WWPs and diet or adiposity. Most were in the US (54%) or Europe (23%), with diet (64%) and exercise/weight loss (20%) as main targets. Intervention components were variable (Figure). Most common outcomes were intakes of fruits and vegetables (F&V) (19 studies), total fat or fat subtypes (18), and dietary fiber (4); and BMI (35) and waist circumference (WC) (10). Median duration was 12 months (range: 1-48 mo). In pooled analyses, WWP increased intake of F&V, especially fruits (Figure). Significant effects were not identified for dietary fiber, total fat, or fat subtypes. WWP also reduced BMI (Figure) and WC (-2.03 cm, 95% CI:-3.88,-0.20). Trial duration significantly modified effects on BMI (<12 mo duration: -0.64 kg/m 2 ; 12+ mo: -0.16 kg/m 2 ; P-interaction=0.046); but not WC or F&V intake. Additional findings for heterogeneity, including WWP components, and publication bias will be presented. Conclusions: These novel findings support effectiveness of WWP for increasing F&V and reducing BMI and WC.

Background: Food taxes and subsidies are promising strategies for improving diets and reducing cardiometabolic diseases (CMD). Both dietary habits and CMD burdens are unequally distributed in the US, with major disparities by socioeconomic status (SES). Information on impacts of national food price policies on disparities is lacking. Aim: To estimate the impact on CMD deaths and health disparities in US adults of price interventions (taxes, subsidies) targeting 7 key dietary factors. Methods: Using nationally representative data, we conducted comparative risk assessment analysis to estimate the impact of a 10% price subsidy on fruits, vegetables, whole grains, and nuts and a 10% tax on processed meat, unprocessed red meat, and sugar-sweetened beverages, on CMD deaths and disparities in SES subgroups. We evaluated 18% (based on global price elasticity data) and 50% (based on recent experience from soda taxes in Mexico) greater price responsiveness in lowest vs. highest SES groups. Results: Each separate price intervention would reduce CMD deaths (Figure). Jointly subsidizing and taxing these 7 dietary factors (10% price change each) and assuming 18% greater price-responsiveness in lowest vs. highest SES, this intervention would prevent 5.27% of CMD deaths in those with <high school education (<HS), 6.27% among HS graduates and those with some college (SC), and 5.11% among college graduates (COL). Effects in each group were dependent on both baseline (current) diet and price responsiveness. Applying a 50% greater price-responsiveness, the corresponding values were 5.91% (<HS), 6.27% (SC), and 4.58% (COL). Conclusions: Introducing modest price changes on key dietary factors could reduce CMD burdens and improve disparities in the US. Policy-based strategies targeting disparities will require considering both baseline dietary habits as well as price responsiveness in specific population subgroups.