Nicholas Grubic

Addressing unhealthy movement behaviors in adolescence could reduce socioeconomic inequalities in adult cardiovascular disease (CVD) risk. Among 6608 adolescents enrolled in the Add Health cohort (1994-1995) and followed into adulthood (2016-2018), movement behaviors (physical activity, screen time, sleep) were classified as healthy or unhealthy based on adherence to the 24-Hour Movement Guidelines. Parental education and family financial hardship captured socioeconomic position (SEP). The outcome was 30-year CVD risk in adulthood. G-formula-based causal decomposition quantified changes in socioeconomic inequalities under 2 interventional scenarios: (1) eliminating unhealthy movement behaviors across the population and (2) equalizing the low-SEP group’s movement behavior distributions to match the high-SEP group. Adolescents whose parents did not graduate from college/university had a higher adult CVD risk than those whose parents did (risk difference [RD]: 6.9%, relative risk [RR]: 1.73). Eliminating all unhealthy movement behaviors reduced the RD to 4.9% (–2.0% absolute change), while the RR remained similar (1.76). Eliminating unhealthy levels of physical activity produced the largest absolute reduction (–1.7%), with negligible reductions for screen time (–0.2%) and sleep (–0.2%). The equalization scenario had minimal impact, and results were similar for family financial hardship. Whole-population interventions targeting unhealthy adolescent movement behaviors, particularly physical activity, may reduce absolute socioeconomic inequalities in adult CVD risk.

Background: Hypertension is a common, modifiable risk factor for cardiovascular disease with an increasing occurrence in young adults. We examined the association of lower‐than‐normal kidney function with incident hypertension in young adults (aged 18–39 years) compared with middle‐aged (aged 40–49 years) and older adults (aged 50–65 years). Methods: We conducted a historical cohort study of 7.8 million individuals (3.7 million aged 18–39 years) using linked provincial health care data sets from Ontario, Canada, between 2008 and 2021. Cox models were used to examine the association of categorized estimated glomerular filtration rate (eGFR) (60–100 mL/min per 1.73 m ² ) and incident hypertension, stratified by age (18–39, 40–49, and 50–65 years). Results: Among our cohort (mean age, 40.4 years; mean eGFR, 104.9 mL /min), a total of 170 905 (4.6%) individuals developed hypertension among young adults, compared with 279 937 (15.3%) in those aged 40 to 49 years and 588 195 (25.2%) in those aged 50 to 65 years. The adjusted rates of hypertension increased with an eGFR of <100 mL/min, increasing step wise as eGFR declined, and occurred at a higher relative eGFR in young adults compared with older age groups. Among young adults who developed hypertension, cardiovascular events were 6‐ to 10‐fold more common and were more likely with minor eGFR reductions. Conclusions: Minor reductions in eGFR in younger adults are associated with new‐onset hypertension and a higher risk of cardiovascular consequences, suggesting early identification, monitoring, and management may be beneficial.

Objectives: Considering growing food insecurity and diet-related inequalities, Canada has introduced a national school food program (SFP). International studies have shown the benefits of SFPs for student diets, but their potential to reduce differences in dietary intake and diet quality (dietary inequalities) has not been studied. This study examines the associations of existing SFPs with dietary intake and inequalities among elementary students in Canada. Methods: Data from 1442 grade 4–6 students (9–12 years of age) from 26 schools in underserved communities reported foods and beverages consumed in the past 24 h and whether these were provided as part of an SFP, brought from home, or obtained elsewhere. Inequalities in dietary intake (vegetables and fruit, milk and alternatives, free sugars, sodium) and overall diet quality of students who accessed vs. did not access SFPs were quantified using Gini coefficients. Results: Students who accessed SFPs ( n = 181) reported consuming more vegetables and fruit, more milk and alternatives, and diets of better quality, compared to their peers who did not access SFPs ( n = 1261). These differences were especially pronounced among students from less affluent households. Lower inequalities in the consumption of vegetables and fruit (difference in Gini coefficients = 0.072, 95% CI 0.026–0.116), free sugars (0.055, 95% CI 0.004–0.090), and diet quality (0.019, 95% CI 0.007–0.029) were observed among students who accessed SFPs vs. those who did not. Conclusion: SFPs may play an important role in improving the diets of Canadian children and reducing inequalities in dietary intake, thus highlighting their potential in promoting equitable health outcomes.