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.

The coronavirus disease 2019 pandemic brought changes to almost every segment of our lives, including dietary habits. We present one among several studies, and the first on the Croatian population, aiming at investigating changes of food choice motives before and during the pandemic. The study was performed in June 2021 as an online-based survey, using a 36-item Food Choice Questionnaire applied for both the periods before and during the pandemic. The final sample consisted of 1232 adults living in Croatia. Sensory appeal was ranked as the number one most important food choice motive before, whereas health was ranked as the number one most important food choice motive during the pandemic. Ethical concern was reported as the least important food choice motive both before and during the pandemic. In women, natural content (p = 0.002), health, convenience, price, weight control, familiarity, and ethical concern (all p < 0.001) became more important during the pandemic, while price (p = 0.009), weight control, familiarity, and ethical concern (all p < 0.001) became more relevant for men. All together, these can be considered favorable changes toward optimal diets and may result in beneficial influences on health and lifestyle. Education strategies and efficiently tackling misinformation are prerequisites for informed food choice, which will ensure long-lasting positive effects of such changes.

Background The Kin-Antwerp project aimed at improving the quality of care provided to patients with diabetes in Kinshasa, the Democratic Republic of the Congo in Central Africa, including the digitalisation of routine clinical data to improve patients’ follow-up. We aim to analyse the data of a study population of Kin-Antwerp to characterise their demographic features, assess their achievement of glycemic target over time, and identify groups requiring prioritised attention. Methods We performed a secondary database analysis of routinely collected information from primary care patients with type 2 diabetes followed from 1991 to 2019. Data included demographics (age, sex), anthropometrics (weight, height), clinical parameters (blood pressure, plasma glucose), and anti-diabetic treatments. Achievement of glycemic target, defined as fasting plasma glucose < 126 mg/dL, over time was assessed using a multilevel mixed-effects logistic regression model. Results Our study population of patients with type 2 diabetes (N = 8976) comprised a higher proportion of women (67%) and patients between 40 and 65 years old (70.4%). At the first follow-up, most patients were on treatment with insulin (56.5%) and had glycemic levels under the target (79.9%). Women presented more often with obesity (27.4%) and high systolic blood pressure (41.8%) than men (8.6% and 37.0%, respectively). Patients had a median follow-up of 1.8 (interquartile range: 0.5–3.4) years. Overall, the odds of achieving glycemic target increased by 18.4% (odds ratio: 1.184, 95% CI: 1.130 to 1.239; p < 0.001) per year of follow-up. Stratified analyses suggested that the odds of achieving glycemic control over time increased among older patients (> 40 years), but not among younger patients (< 40 years). Conclusion In our study population, an overall poor glycemic control was observed albeit with a modest improvement in the achievement of glycemic target throughout patients’ follow-up. Younger patients may benefit from prioritised attention to achieve glycemic targets. Based on the information provided by the database, continue monitoring and improvement of the project Kin-Antwerp is recommended. Introducing further efforts to improve type 2 diabetes management should include robust glycemia-monitoring tools and haemoglobin A1c, as well as further outlining self-management strategies.

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ObjectivesThe widespread use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) by patients with chronic conditions raised early concerns on the potential exacerbation of COVID-19 severity and fatality. Previous studies addressing this question have used standard methods that may lead to biased estimates when analysing hospital data because of the presence of competing events and event-related dependency. We investigated the association of ACEIs/ARBs’ use with COVID-19 disease outcomes using time-to-event data in a multistate setting to account for competing events and minimise bias.SettingNationwide surveillance data from 119 Belgian hospitals.ParticipantsMedical records of 10 866 patients hospitalised from 14 March 2020to 14 June 2020 with a confirmed SARS-CoV-19 infection and information about ACEIs/ARBs’ use.Primary outcome measureMultistate, multivariate Cox-Markov models were used to estimate the hazards of patients transitioning through health states from admission to discharge or death, along with transition probabilities calculated by combining the baseline cumulative hazard and regression coefficients.ResultsAfter accounting for potential confounders, there was no discernable association between ACEIs/ARBs’ use and transfer to intensive care unit (ICU). Contrastingly, for patients without ICU transfer, ACEIs/ARBs’ use was associated with a modest increase in recovery (HR 1.07, 95% CI 1.01 to 1.13, p=0.027) and reduction in fatality (HR 0.83, 95% CI 0.75 to 0.93, p=0.001) transitions. For patients transferred to ICU admission, no evidence of an association between ACEIs/ARBs’ use and recovery (HR 1.16, 95% CI 0.97 to 1.38, p=0.098) or in-hospital death (HR 0.91, 95% CI 0.73 to 1.12, p=0.381) was observed. Male gender and older age were significantly associated with higher risk of ICU admission or death. Chronic cardiometabolic comorbidities were also associated with less recovery.ConclusionsFor the first time, a multistate model was used to address magnitude and direction of the association of ACEIs/ARBs’ use on COVID-19 progression. By minimising bias, this study provided a robust indication of a protective, although modest, association with recovery and survival.