Introduction: The public health problem of food insecurity also affects the elderly population. This study aimed to estimate the prevalence of household food insecurity and its associations with chronic disease and health-related quality of life characteristics in individuals ≥65 years of age living in the community in Portugal.Methods: The data were collected from the Epidemiology of Chronic Diseases Cohort Study 3 (EpiDoC3)—Promoting Food Security Study (2015–2016), which was the third evaluation wave of the EpiDoC and represented the Portuguese adult population. Food insecurity was assessed using a psychometric scale adapted from the Brazilian Food Insecurity Scale. The data on sociodemographic variables, chronic disease, and management of chronic disease were self-reported. Health-related quality of life were assessed using the European Quality of Life Survey (version validated for the Portuguese population). Logistic regression models were used to determine crude and adjusted odds ratios (for age group, gender, region, and education). The dependent variable was the perceived level of food security.Results: Among older adults, 23% were living in a food-insecure household. The odds of living in a food-insecure household were higher for individuals in the 70–74 years age group (odds ratio (OR) = 1.405, 95% confidence interval (CI) 1.392–1.417), females (OR = 1.545, 95% CI 1.534–1.556), those with less education (OR = 3.355, 95% CI 3.306–3.404), low income (OR = 4,150, 95% CI 4.091–4.210), and those reporting it was very difficult to live with the current income (OR = 16.665, 95% CI 16.482–16.851). The odds of having a chronic disease were also greater among individuals living in food-insecure households: diabetes mellitus (OR = 1.832, 95% CI 1.818–1.846), pulmonary diseases (OR = 1.628, 95% CI 1.606–1.651), cardiac disease (OR = 1.329, 95% CI 1.319–1.340), obesity (OR = 1.493, 95% CI 1.477–1.508), those who reduced their frequency of medical visits (OR = 4.381, 95% CI 4.334–4.428), and who stopped taking medication due to economic difficulties (OR = 5.477, 95% CI 5.422–5.532). Older adults in food-insecure households had lower health-related quality of life (OR = 0.212, 95% CI 0.210–0.214).Conclusions: Our findings indicated that food insecurity was significantly associated with economic factors, higher values for prevalence of chronic diseases, poor management of chronic diseases, and decreased health-related quality of life in older adults living in the community.

BackgroundFood insecurity is a limited or uncertain access to the adequate food and is a significant public health problem. We aimed to assess determinants of food insecurity and the corresponding health impact in Portugal, a southern European country that faced a severe economic crisis.MethodsData were derived from the Epidemiology of Chronic Diseases Cohort Study (EpiDoC), a population-based cohort of 10,661 individuals that were representative of the Portuguese adult population and followed since 2011. A cross-sectional analysis of the third wave of evaluation (EpiDoC 3) was performed between 2015 and 2016. Food insecurity was assessed with the household food insecurity psychometric scale. Socioeconomic, demographic, lifestyle, adherence to Mediterranean diet (MD), self-reported non-communicable disease, health-related quality of life (HRQoL) (EQ-5D-3L), physical function (HAQ score), and health resource consumption information was also collected.ResultsThe estimated proportion of food insecurity was 19.3% among a total of 5,653 participants. Food insecure households had low adherence to the MD (OR = 0.44; 95% IC 0.31–0.62). In addition, diabetes (OR = 1.69; 95% IC 1.20–2.40), rheumatic disease (OR = 1.67; 95% IC 1.07–2.60), and depression symptoms (OR = 1.50; 95% IC 1.09–2.06) were independently associated with food insecurity. On average, food insecure households had a lower HRQoL (OR = 0.18; 95% IC 0.11–0.31) and a higher disability (OR = 2.59; 95% IC 2.04–3.29). A significantly higher proportion of food insecure households reported being hospitalized (OR = 1.57; 95% IC 1.18–2.07) and had more public hospital medical appointments (OR = 1.48; 95% IC 1.12–1.94) in the previous 12 months.ConclusionWe found that food insecurity is highly prevalent in Portugal. Food insecurity was associated with low adherence to the MD, non-communicable chronic diseases, lower quality of life, and higher health resource consumption. Therefore, this study provides valuable insight into the relationship between food security and the diet and health of the population during an economic crisis.

RESUMOIntrodução: A esperança de vida está a aumentar em Portugal, contudo desconhece-se o estado de saúde dos idosos. Pretende-se determinar a prevalência de multimorbilidade, caracterizar estilos de vida e outros fatores relacionados com a saúde dos idosos. Material e Métodos: Efetuou-se uma avaliação transversal a 2393 adultos com 65 ou mais anos de idade, da coorte EpiDoC que é constituída por uma amostra representativa da população portuguesa. Os inquiridos responderam a um questionário estruturado através de uma entrevista telefónica, tendo-se recolhido dados socioeconómicos demográficos, estilo de vida, doenças crónicas e consumo de recursos em saúde. Análise de clusters foi realizada para a identificação de padrões alimentares. Efetuou-se análise descritiva e analítica para estimar a prevalência de multimorbilidade e fatores associados. ABSTRACT Introduction: Portuguese adults have a long lifespan, but it is unclear whether they live a healthy life in their final years. We aimed to determine the prevalence of multimorbidity and characterize lifestyle and other health outcomes among older Portuguese adults. Material and Methods:We performed a cross-sectional evaluation of 2393 adults, aged 65 and older, during the second wave of follow-up of the EpiDoC cohort, a population-based study involving long-term follow-up of a representative sample of the Portuguese population. Subjects completed a structured questionnaire during a telephone interview. Socioeconomic, demographic, lifestyle behaviours, chronic diseases, and health resources consumption were assessed. Cluster analysis was done to identify dietary patterns. Descriptive and analytic analysis was performed to estimate multimorbidity prevalence and its associated factors. Results: Multimorbidity prevalence among older adults was 78.3%, increased with age strata (72.8% for 65 -69 years to 83.4% for ≥ 80 years), and was highest in Azores (84.9%) and Alentejo (83.6%). The most common chronic diseases were hypertension (57.3%), rheumatic disease (51.9%), hypercholesterolemia (49.4%), and diabetes (22.7%). Depression symptoms were frequent (11.8%) and highest in the oldest strata. The mean health-related quality of life (EQ-5D-3L) score was 0.59 ± 0.38. Hospitalization in the previous 12 months was reported by 25.8% of individuals. Overall, 66.6% of older adults were physically inactive. 'Fruit and vegetables dietary pattern' was followed by 85.4% of individuals; however, regional inequalities were found (69% in Azores). Obesity prevalence was 22.3% overall and was highest among Azoreans (33%). Conclusion:The high prevalence of multimorbidity, combined with unhealthy lifestyle behaviours, suggests that the elderly population constitutes a vulnerable group warranting dedicated intervention.

Anxiety and depression in the elderly individuals have been studied around the world, and some authors consider them among the most serious problems faced by modern societies. With recent economic crisis—very important in Southern European countries—isolation, loneliness, and exclusion of the active society, mental problems are probably raising and associated with distinct factors. In this cross-sectional analysis, nested in a longitudinal population-based cohort study, we analyze anxiety and depression prevalence, and their related factors, in a representative cohort of Portuguese seniors. We used data retrieved from second wave of follow-up of EpiDoC Cohort—EpiDoC 2 study, which is composed by 10,661 adults, representative of adult Portuguese population. This study included all ≥65 years old EpiDoC 2 study participants, who responded to Hospital Anxiety and Depression Scale (HADS), n = 1,680. Sociodemographic, lifestyles, self-reported non-communicable diseases, health-related quality of life (EQ-5D-3D), physical function (HAQ), and health resources consumption data were collected. Anxiety and depression were assessed with HADS. Anxiety and depression prevalence were estimated. Multivariable logistic regression was used to assess anxiety and depression score determinants. The estimated prevalence of anxiety among Portuguese elderly is 9.6% and depression is 11.8%. Seniors with anxiety and seniors with depression have a higher probability to self-report higher levels of physical disability (OR = 3.10; 96% CI 2.12–4.52; OR = 3.08, 95% CI 2.29–4.14, respectively) and lower levels of quality of life (OR = 0.03, 95% CI 0.01–0.09; OR = 0.03, 95% CI 0.01–0.06, respectively). Female gender (OR = 2.77, 95% CI 1.53–5.00), low educational level (OR = 2.30, 95% CI 1.22–4.36), allergic (OR = 2.02, 95% CI 1.14–3.55), and rheumatic disease (OR = 2.92, 95% CI 1.74–4.90) were significantly and independently associated with the presence of anxiety symptoms. Physical inactivity (OR = 1.64, 95% CI 1.11–2.42) and low educational level (OR = 2.40, 95% CI 1.41–4.09) were significantly and independently associated with depression symptoms. Subjects that reported to drink alcohol daily or occasionally were negatively associated with depression symptoms. Anxiety and depression are frequent among Portuguese elderly. These prevalence rates suggest that preventing mental illness in senior population is a crucial need. A well-designed prevention strategy might have an effective action in raising the well-being of elderly.

A 14-Item Mediterranean Diet Adherence Screener (MEDAS) questionnaire was developed and validated in face-to-face interviews, but not via telephone. The aims of this study were to evaluate the validity and reliability of a telephone-administered version of the MEDAS as well as to validate the Portuguese version of the MEDAS questionnaire. A convenience community-based sample of adults (n = 224) participated in a three-stage survey. First, trained researchers administered MEDAS via a telephone. Second, the Portuguese version of Food Frequency Questionnaire (FFQ), and MEDAS were administered in a semi-structured face-to-face interview. Finally, MEDAS was again administered via telephone. The telephone-administered MEDAS questionnaire was compared with the face-to-face-version using several metrics. The telephone-administered MEDAS was significantly correlated with the face-to-face-administered MEDAS [r = 0.805, p < 0.001; interclass correlation coefficient (ICC) = 0.803, p < 0.001] and showed strong agreement (k = 0.60). The MEDAS scores that were obtained in the first and second telephone interviews were significantly correlated (r = 0.661, p < 0.001; ICC = 0.639, p < 0.001). The overall agreement between the Portuguese version of MEDAS and the FFQ-derived Mediterranean diet adherence score had a Cohen’s k = 0.39. The telephone-administered version of MEDAS is a valid tool for assessing the adherence to the Mediterranean diet and acquiring data for large population-based studies.

BackgroundAdequate sleep is essential for health. Both, short and long sleep durations are associated to worse quality of life and poor health outcomes. Portugal represents a specific population model, since according to European statistics it has high rates of chronic diseases like depression, hypertension, diabetes and stroke; and low quality of life as well as low index of physical activity, while in parallel it has some other good health indicators such as: low age-standardized mortality for both genders, nutrition in terms of energy and fruit consumption, smoking and alcohol, obesity and overweight prevalence. The aim of this study was to characterize health and chronic diseases, lifestyles and quality of life in subjects with short and long sleep duration.MethodsA population-based cross-sectional evaluation of the third wave of follow-up of the EpiDoC Cohort was carried between 2015-2016. A sample of 5,436 adults ≥18 years, representative of the national population, self-reported their daily total sleep time. Associations between short sleep duration (SSD ≤5h), long sleep duration (LSD≥9h) and independent variables were determined.ResultsThe prevalence for SSD was high (20.7%) and the LSD (5.9%) was low. Being older, with lower education, retired and unemployed were associated to SSD and LSD (p<0.01). Being obese was associated to SSD as well as hypertension, gastrointestinal disease and hypercholesterolemia (p<0.01). SSD and LSD, were associated with diabetes (p<0.01 and p=0.03) and depression (p<0.01 and p=0.02) respectively. Cardiovascular disease (p<0.01) was associated to LSD. Multimorbidity (p<0.01) was associated to SSD. Worse quality of life and bad physical function were associated to SSD and LSD, as well as being hospitalized in the previous 12 months (p<0.01).ConclusionsSocio-demographic, physical activity and chronic diseases were associated to reduction and extension of sleep duration. There was no association between rheumatic diseases and cancer with sleep duration, as found in other studies. This study emphasizes the burden of self-reported SSD for Portugal, its consequences to health and the need to increase sleep awareness campaigns enhancing the importance of sleep in health. Furthermore, it emphasizes that chronic diseases risks are dependent on multiple parameters which varying in different countries or regions, imply the need of regional studies and interventions.

BackgroundReducing health inequalities is a top priority of the public health agendas in Europe. The EPHE project aims to analyse the added value of a community-based interventional programme based on EPODE methodology, adapted for the reduction of socio-economic inequalities in childhood obesity. The interventions that will be implemented by this project focus on four energy balance-related behaviours (fruit and vegetable consumption, tap water intake, physical inactivity, sleep duration) and their determinants. This article presents the design of the effect evaluation of the EPHE project.Methods/DesignThis is a prospective two-year follow-up evaluation study, which will collect data on the energy balance-related behaviours and potential environmental determinants of 6–8 year olds, depending on the socio-economic status of the parents. For this purpose a parental self-reported questionnaire is constructed. This assesses the socio-economic status of the parents (5 items) and the dietary (12 items), sedentary (2 items) and sleeping (4 items) behaviour of the child. Alongside potential family-environmental determinants are assessed. The EPHE parental questionnaire will be disseminated in schools of a selected medium-sized city in seven European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands).DiscussionThis study will evaluate the effects of the EPHE community-based interventional programmes. Furthermore, it will provide evidence for children’s specific energy balance-related behaviours and family environmental determinants related to socio-economic inequalities, in seven European countries.

BackgroundThe increasing proportion of people growing old, demands expanded knowledge of how people can experience successful aging. Having a good life while growing old is dependent on several factors such as nutrition, physical health, the ability to perform activities of daily living, lifestyle and psychological health. Furthermore, unhealthy food intake is found to be a modifiable risk factor for depression in elderly people. To promote elderly’s health and wellbeing, the influence of nutrition, lifestyle, physical functioning, and social support on psychological distress needs exploring. Therefore, the purpose of this present study is to investigate the associations between psychological distress and diet patterns when adjusting for other life style behaviors, wellbeing, health status, physical functioning and social support in elderly people.MethodsThe present study is cross sectional, using data from wave three of the Nord-Trøndelag Health Study (2006–2008). Data include psychological distress measured by the Hospital Anxiety and Depression Scale (HADS), sociodemographic information, measurements of lifestyle behaviours (including diet patterns), wellbeing, health status, social support and physical functioning.ResultsThe sample consisted of 11,621 participants, 65 years or older. Cluster analysis categorized the participants in two food clusters based on similarities in food consumption (healthy N = 9128, unhealthy N = 2493). Stepwise multivariable linear regression analyses revealed that lesser psychological distress in the elderly was dependent on gender, diet, smoking, better scores on health and wellbeing, social support and less problems performing instrumental activities of daily living.ConclusionKnowledge about the influence of diet patterns in relation to psychological distress provide valuable insights into how society can promote healthy lifestyles to an ageing population, e.g. by increasing older people’s food knowledge.