Obesity and other health determinants across Europe: the EURALIM project

A review of harmonization methods for studying dietary patterns

Data harmonization is the process by which each of the variables from different research studies are standardized to similar units resulting in comparable datasets. These data may be integrated for more powerful and accurate examination and prediction of outcomes for use in the intelligent and smart electronic health software programs and systems. Prospective harmonization is performed when researchers create guidelines for gathering and managing the data before data collection begins. In contrast, retrospective harmonization is performed by pooling previously collected data from various studies using expert domain knowledge to identify and translate variables. In nutritional epidemiology, dietary data harmonization is often necessary to construct the nutrient and food databases necessary to answer complex research questions and develop effective public health policy. In this paper, we review methods for effective data harmonization, including developing a harmonization plan, which common standards already exist for harmonization, and defining variables needed to harmonize datasets. Currently, several large-scale studies maintain harmonized nutrient databases, especially in Europe, and steps have been proposed to inform the retrospective harmonization process. As an example, data harmonization methods are applied to several U.S longitudinal diet datasets. Based on our review, considerations for future dietary data harmonization include user agreements for sharing private data among participating studies, defining variables and data dictionaries that accurately map variables among studies, and the use of secure data storage servers to maintain privacy. These considerations establish necessary components of harmonized data for smart health applications which can promote healthier eating and provide greater insights into the effect of dietary patterns on health.

Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranean countries: An ancillary study of the ASAS-COMOSPA project

OBJECTIVES

The objectives of this study were: (1) to compare the prevalence of cardiovascular disease and cardiovascular risk factors among different phenotypes of spondyloarthritis (SpA); (2) to assess the differences in cardiovascular disease and cardiovascular risk factors between two geographical areas, i.e. Northern Europe vs. Mediterranean region; (3) to identify potential predictive factors for high Framingham Risk Score regarding disease features in SpA and geographical area.

METHODS

Ancillary analysis of the international, multicentric, observational, cross-sectional ASAS-COMOSPA study. Cardiovascular disease and cardiovascular risk factors were compared depending on SpA phenotype and geographical regions. Potential factors associated with higher cardiovascular risk (i.e. Framingham Risk Score) were determined by a multiple logistic regression.

RESULTS

The most frequent cardiovascular risk factor and cardiovascular disease were smoking (31.2%) and ischemic heart disease (3.2%), respectively. Regarding SpA phenotype, axial SpA patients showed significantly lower prevalence (P<0.05) of hypertension (19.2% vs. 33.8% vs. 26.6% for axial, peripheral and mixed phenotypes, respectively), type 2 diabetes mellitus (4.3% vs. 8.5% vs. 7.4%), dyslipidemia (13.9% vs. 28.4% vs. 15.2%) and ischemic heart disease (2.4% vs. 7.0% vs. 3.2%). Regarding geographical area, a higher frequency of hypertension (34.7% vs. 19.4%,), dyslipidemia (19.3% vs. 14.4%), obesity (29.3% vs. 20.7%) and ischemic heart disease (6.2% vs. 1.8%) was observed for Northern Europe vs. Mediterranean Region, respectively.

CONCLUSIONS

Our results suggest that SpA phenotype and geographical area are associated with the prevalence of cardiovascular risk factors and the cardiovascular risk itself, observed in patients in the ASAS-COMOSPA cohort.

Influence of acquired obesity on coronary vessel wall late gadolinium enhancement in discordant monozygote twins

Objectives

The aim of this study was to investigate the impact of BMI on late gadolinium enhancement (LGE) of the coronary artery wall in identical monozygous twins discordant for BMI. Coronary LGE represents a useful parameter for the detection and quantification of atherosclerotic coronary vessel wall disease.

Methods

Thirteen monozygote female twin pairs (n = 26) with significantly different BMIs (>1.6 kg/m2) were recruited out of >10,000 twin pairs (TwinsUK Registry). A coronary 3D-T2prep-TFE MR angiogram and 3D-IR-TFE vessel wall scan were performed prior to and following the administration of 0.2 mmol/kg of Gd-DTPA on a 1.5 T MR scanner. The number of enhancing coronary segments and contrast to noise ratios (CNRs) of the coronary wall were quantified.

Results

An increase in BMI was associated with an increased number of enhancing coronary segments (5.3 ± 1.5 vs. 3.5 ± 1.6, p < 0.0001) and increased coronary wall enhancement (6.1 ± 1.1 vs. 4.8 ± 0.9, p = 0.0027) compared to matched twins with lower BMI.

Conclusions

This study in monozygous twins indicates that acquired factors predisposing to obesity, including lifestyle and environmental factors, result in increased LGE of the coronary arteries, potentially reflecting an increase in coronary atherosclerosis in this female study population.

Key points

• BMI-discordant twins allow the investigation of the influence of lifestyle factors independent from genetic confounders.

• Only thirteen obesity-discordant twins were identified underlining the strong genetic component of BMI.

• In female twins, a BMI increase is associated with increased coronary late gadolinium enhancement.

• Increased late gadolinium enhancement in the coronary vessel wall potentially reflects increased atherosclerosis.

Electronic supplementary material

The online version of this article (doi:10.1007/s00330-016-4616-8) contains supplementary material, which is available to authorized users.

[Population characteristics of metabolic syndrome components in 25-64-year-old males of an average urbanized Siberian town]

AIM

To establish the population characteristics of the components of metabolic syndrome (MS) in the age range of 25-64-year-old males in an average urbanized Siberian town.

MATERIALS AND METHODS

A cross-sectional epidemiological survey was conducted in a representative sample of the electorate of a Tyumen administrative district among 1000 males, with 250 being in each of 4 life decades (25-34, 35-44, 45-54, and 55-64 years). There were 850 (85%) responses. The IDF criteria (2005) were used to evaluate MS.

RESULTS

In the Tyumen open population of 25-64-year-old men, the population characteristics of systolic blood pressure (BP) and waist circumference (WC) were shifted to the right in the normal distribution range, which determined the high prevalence of hypertension and abdominal obesity (AO). In the 25-64-year-old men with the high prevalence of hypertension (a standardized rate of 59.8%) and AO (a standardized rate of 42.6%), the age was positively related to systolic BP in the third to fifth decades of life, diastolic BP, and WC at all ages.

CONCLUSION

Examining the epidemiological situation regarding the prevalence of MS components necessitates the elaboration of a scientifically sound prevention program in the specific conditions of an average urbanized Siberian town.

Statistical approaches to harmonize data on cognitive measures in systematic reviews are rarely reported

OBJECTIVES

To identify statistical methods for harmonization, the procedures aimed at achieving the comparability of previously collected data, which could be used in the context of summary data and individual participant data meta-analysis of cognitive measures.

STUDY DESIGN AND SETTING

Environmental scan methods were used to conduct two reviews to identify (1) studies that quantitatively combined data on cognition and (2) general literature on statistical methods for data harmonization. Search results were rapidly screened to identify articles of relevance.

RESULTS

All 33 meta-analyses combining cognition measures either restricted their analyses to a subset of studies using a common measure or combined standardized effect sizes across studies; none reported their harmonization steps before producing summary effects. In the second scan, three general classes of statistical harmonization models were identified (1) standardization methods, (2) latent variable models, and (3) multiple imputation models; few publications compared methods.

CONCLUSION

Although it is an implicit part of conducting a meta-analysis or pooled analysis, the methods used to assess inferential equivalence of complex constructs are rarely reported or discussed. Progress in this area will be supported by guidelines for the conduct and reporting of the data harmonization and integration and by evaluating and developing statistical approaches to harmonization.

COSMIC (Cohort Studies of Memory in an International Consortium): an international consortium to identify risk and protective factors and biomarkers of cognitive ageing and dementia in diverse ethnic and sociocultural groups

BACKGROUND

A large number of longitudinal studies of population-based ageing cohorts are in progress internationally, but the insights from these studies into the risk and protective factors for cognitive ageing and conditions like mild cognitive impairment and dementia have been inconsistent. Some of the problems confounding this research can be reduced by harmonising and pooling data across studies. COSMIC (Cohort Studies of Memory in an International Consortium) aims to harmonise data from international cohort studies of cognitive ageing, in order to better understand the determinants of cognitive ageing and neurocognitive disorders.

METHODS/DESIGN

Longitudinal studies of cognitive ageing and dementia with at least 500 individuals aged 60 years or over are eligible and invited to be members of COSMIC. There are currently 17 member studies, from regions that include Asia, Australia, Europe, and North America. A Research Steering Committee has been established, two meetings of study leaders held, and a website developed. The initial attempts at harmonising key variables like neuropsychological test scores are in progress.

DISCUSSION

The challenges of international consortia like COSMIC include efficient communication among members, extended use of resources, and data harmonisation. Successful harmonisation will facilitate projects investigating rates of cognitive decline, risk and protective factors for mild cognitive impairment, and biomarkers of mild cognitive impairment and dementia. Extended implications of COSMIC could include standardised ways of collecting and reporting data, and a rich cognitive ageing database being made available to other researchers. COSMIC could potentially transform our understanding of the epidemiology of cognitive ageing, and have a world-wide impact on promoting successful ageing.

The relationship of epicardial adipose tissue thickness to clinical and biochemical features in women with polycystic ovary syndrome

The amount of epicardial adipose tissue (EAT), a component of body visceral adiposity, has been linked to the presence and severity of cardiovascular disease through multiple mechanisms. Polycystic ovary syndrome (PCOS) is characterized by insulin resistance and subclinical inflammation, which participate in the mechanism of atherosclerosis. We searched if the patients with PCOS have increased EAT thickness (EATT), along with its relation to the measures of adiposity and insulin sensitivity. A total of 41 subjects with PCOS and 46 age and body mass index (BMI) matched healthy controls were enrolled. EAT was measured by echocardiography above the free wall of the right ventricle. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) formula, and plasma adiponectin level was measured by ELISA. Compared to healthy controls EATT and HOMA-IR score were significantly higher (p=0.0001 for both) while plasma adiponectin concentration was significantly lower (p=0.048) in women with PCOS. EATT correlated positively with total cholesterol, triglyceride, luteinizing hormone (LH) and negatively with sex hormon binding globuline (p<0.05 for all), whereas it displayed no correlation to plasma adiponectin level (p=0.924). Triglyceride level was the significant determinant of EATT in logistic regression analysis (p=0.035). Thickness of the EAT is increased in patients with PCOS in conjunction with hyperandrogenity. Prospective studies are required to identify the relation of EAT and cardiovascular risk in patients with PCOS.

Invited commentary: consolidating data harmonization--how to obtain quality and applicability?

It is recognized that very large sample sizes capable of providing adequate statistical power are required to properly investigate and understand the role and interaction of genetic, lifestyle, and environmental factors in modulating the risk and progression of chronic diseases. However, very few one-off studies provide access to very large numbers of participants, and the collection of high-quality data necessitates a major investment of resources. The scientific community is thus increasingly engaged in collaborative efforts to facilitate harmonization and synthesis of data across studies. Complementary harmonization approaches may be adopted to support these efforts. In the current issue of the American Journal of Epidemiology, Hamilton et al. (Am J Epidemiol. 2011;174(3):253-260) present the consensus measures for Phenotypes and eXposures (PhenX) Toolkit, which promotes the use of identical data collection tools and procedures to support harmonization across emerging studies. Data synthesis is greatly facilitated by the use of common measures and procedures. However, the "stringent" criteria required by PhenX can limit its utilization. The opportunity to make use of rigorous but more "flexible" harmonization approaches should also be considered.

Lipid Profile in Relation to Anthropometric Measurements among College Male Students in Riyadh, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Anthropometric measurements can easily reflect any changes in the lipid concentration in the human body.

OBJECTIVES

The present work is aimed at studying lipid profile and its relation to anthropometric measurements in college males from Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

This study was conducted from September 2006 to December 2008. 333 students aged 18-35 years of Riyadh College of Health Science - male section - participated in the study. Anthropometric measurements including weight, height, waist and hip circumferences were measured. Body Mass Index (BMI) was calculated. Fasting blood sugar and lipid profile including total cholesterol (TC), Low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL) and triglycerides (TG) were estimated. Socio-demographic data were collected from a questionnaire.

RESULTS

Mean TC level was 4.227 ± 0.869 mmol/l, while for LDL, HDL and TG were 2.57 ± 0.724, 1.360 ± 0.545 and 1.385 ± 0.731 mmol/l, respectively. Mean TC level did not differ significantly across weight groups except among obese patients. Mean HDL, LDL and TG did not differ significantly among different groups at 5% level of significance. There was positive, statistically non-significant correlation between age and BMI. The correlation between age and all lipid parameters were statistically non-significant. There was positive correlation between BMI and TC and LDL, while there was a negative correlation between BMI and HDL. There was no correlation between BMI and triglycerides.

CONCLUSION

BMI, waist and hip circumferences all increase with age. The level of TC, LDL and TG go high with increase in age and BMI.

Quality, quantity and harmony: the DataSHaPER approach to integrating data across bioclinical studies

BACKGROUND

Vast sample sizes are often essential in the quest to disentangle the complex interplay of the genetic, lifestyle, environmental and social factors that determine the aetiology and progression of chronic diseases. The pooling of information between studies is therefore of central importance to contemporary bioscience. However, there are many technical, ethico-legal and scientific challenges to be overcome if an effective, valid, pooled analysis is to be achieved. Perhaps most critically, any data that are to be analysed in this way must be adequately 'harmonized'. This implies that the collection and recording of information and data must be done in a manner that is sufficiently similar in the different studies to allow valid synthesis to take place.

METHODS

This conceptual article describes the origins, purpose and scientific foundations of the DataSHaPER (DataSchema and Harmonization Platform for Epidemiological Research; http://www.datashaper.org), which has been created by a multidisciplinary consortium of experts that was pulled together and coordinated by three international organizations: P³G (Public Population Project in Genomics), PHOEBE (Promoting Harmonization of Epidemiological Biobanks in Europe) and CPT (Canadian Partnership for Tomorrow Project).

RESULTS

The DataSHaPER provides a flexible, structured approach to the harmonization and pooling of information between studies. Its two primary components, the 'DataSchema' and 'Harmonization Platforms', together support the preparation of effective data-collection protocols and provide a central reference to facilitate harmonization. The DataSHaPER supports both 'prospective' and 'retrospective' harmonization.

CONCLUSION

It is hoped that this article will encourage readers to investigate the project further: the more the research groups and studies are actively involved, the more effective the DataSHaPER programme will ultimately be.

Epidemiology of cardiovascular diseases in women in Europe

Cardiovascular diseases, defined as diseases of the heart and circulatory system are the main cause of mortality, morbidity and hospitalisation in women all over Europe. Evaluation of descriptive epidemiology of cardiovascular disease and its risk factors in the European women cannot ignore the extraordinary changes in the economic and political profile of the continent that occurred in the past 20 years. A keynote is requested by the knowledge that the Eastern female populations currently appear to be the less protected from cardiovascular disease (CVD; both coronary heart disease (CHD) and stroke) and its risk factors and require major efforts in public health for both primary prevention and risk factors and events treatment. Another important piece of information is that the traditional geographical differences in CHD indicating an advantage of Southern European women in comparison with other European ones is less evident than in the past, owing to the levelling off regarding the differences in risk factors associated lifestyles. The figures for prevalence of epidemic risk factors, such as smoking, physical inactivity, overweight and obesity, high blood pressure and cholesterol levels indicate an urgent need to implement public health interest as well as investments on the whole spectrum of CVD manifestations in terms of risk factors and events.

Obesity, overweight, and weight gain over adult life are main determinants of elevated hs-CRP in a cohort of Mediterranean women

BACKGROUND/OBJECTIVES

Body mass index (BMI), waist circumference (WC), body weight modification, and rate of weight increase over 10 years were evaluated in relation to high-sensitive C-reactive protein (hs-CRP) to assess the association of cross-sectional or longitudinal estimates of obesity/overweight with levels of circulating CRP, a well established and standardized marker of low-grade inflammation, in relation to cardiovascular risk.

SUBJECTS

This study included a subgroup of 390 menopausal women participating in a large currently ongoing epidemiological study (Progetto Atena; N=5062).

RESULTS

At the final visit, women in the third tertile of BMI, compared with those in the first tertile, showed the following odds ratio (OR) of having high hs-CRP values: III vs I tertile OR, 3.55; 95% confidence interval, 1.94-6.49, P<0.001, adjusted for age, and metabolic syndrome. Similar results were obtained when we evaluated women in the third tertile of WC, or those in the highest group of estimated weight increase, relative to their weight at age 20 years or in the group of highest rate of weight increase over 10 years of observation (weight at the final visit-weight at the baseline visit divided by time in months between visits).

CONCLUSIONS

The independent relations between different markers of overweight/obesity and elevated hs-CRP consistently indicate that high (above 1.5 mg l(-1), median) hs-CRP is a major biochemical counterpart of cross-sectional or longitudinal estimates of increased adipose tissue mass.

Intestinal permeability in patients with chronic liver diseases: Its relationship with the aetiology and the entity of liver damage

BACKGROUND

Alteration in intestinal permeability may be an important factor in the pathogenesis of both the progression of some chronic liver diseases and the onset of some complications in patients with liver cirrhosis.

AIMS

To investigate the relationships between intestinal permeability, portal hypertension, alcohol use, plasma levels of pro-inflammatory cytokines, and nitric oxide, expressed as s-nitrosothiols, and nitrite levels in patients with various types and degrees of chronic liver diseases.

METHODS

134 healthy volunteers and 83 patients with chronic liver damage entered the study. Intestinal permeability was assessed with the lactulose/mannitol test. Plasma levels of tumour necrosis factor-alpha, interleukin-6, and nitrite and total s-nitrosothiols were determined.

RESULTS

Intestinal permeability was altered in patients with advanced liver disease and impaired in 15-35% of patients without cirrhosis. Independent factors for intestinal permeability alteration were age, portal hypertension, alcohol use, and diabetes. Plasma levels of inflammatory cytokines and nitrosothiols were significantly higher in patients with altered intestinal permeability.

CONCLUSIONS

An intestinal permeability evaluation in patients with chronic liver diseases might clarify the significance of intestinal permeability in the pathophysiology of both the progression of liver damage, and the occurrence of complications that accompany liver cirrhosis.

Visceral adiposity and arterial stiffness: echocardiographic epicardial fat thickness reflects, better than waist circumference, carotid arterial stiffness in a large population of hypertensives

AIMS

Relationship between obesity and cardiovascular (CV) disease depends not only on the amount of body fat, but also on its distribution. For example, individuals with increased fat accumulation in the abdominal region have atherogenic lipid profiles and are at increased CV risk. The loss of elasticity in medium and large arteries is an early manifestation of atherosclerosis. The aim of this study was to evaluate whether echocardiographic epicardial adipose tissue, an index of cardiac adiposity, is related to carotid stiffness and carotid intima-media thickness (IMT), indexes of subclinical atherosclerosis, better than waist circumference in hypertensive patients.

METHODS AND RESULTS

We studied 459 patients with Grade I and II essential hypertension who were referred to our outpatient clinic over a period from May 2007 to March 2008. The population was first sorted by waist circumference and then by epicardial fat < or = 7 or >7 mm. We measured epicardial fat thickness, waist circumference, carotid artery stiffness, and carotid IMT in all patients. Patients divided according to waist circumference showed no statistical differences in carotid artery stiffness between the two groups. Subjects with epicardial fat >7 mm were older, had higher systolic, diastolic, and pulse pressure, increased left ventricular mass index, carotid IMT, diastolic parameters, and stiffness parameters compared with those with epicardial fat < or = 7 mm (P < 0.001). A positive correlation was found between epicardial fat and age, pulse pressure, stiffness parameters, carotid IMT, systolic blood pressure, and duration of hypertension, and a negative correlation was found with diastolic parameters. Age, carotid IMT, and stiffness parameters were independently related to epicardial fat.

CONCLUSION

Our findings indicate that epicardial fat reflects carotid artery stiffness in hypertension-induced organ damage.

Preventive potential of body mass reduction to lower cardiovascular risk: the Italian Progetto CUORE study

OBJECTIVE

To estimate effects of weight change on incidence of major cardiovascular events in the Italian population-based Progetto CUORE.

METHODS

Prospective observation in 12 Italian population-based cohorts on etiology of cardiovascular disease. Twenty-thousand six-hundred-forty-seven men and women aged 35-69 years without previous CVD, examined at baseline between 1984 and 1993 and followed for median time 8.5 years, with validated first cardiovascular events. Standardised anthropometric variables, lifestyle and biochemical risk factors for CVD; major cardiovascular events as end-points.

RESULTS

Linear regression between BMI and major CVD risk factors was combined with Cox coefficients from a prediction model of CVD, CHD and stroke using major risk factors as dependent variables. Estimated cardiovascular risk reductions with BMI lowered by 1 to 3 U were: for men 3.8% to 10.9% for all cardiovascular events, 4.2% to 12.1% for CHD, and 2.3% to 6.9% for stroke; for women 2.8% to 8.1% for all cardiovascular events, 3.4% to 9.8% for CHD, and 2.1% to 6.2% for stroke.

CONCLUSIONS

Body weight level influences cardiovascular disease risk in the Italian population.

Obesity prevalence from a European perspective: a systematic review

Background

Obesity has been recognised as an important contributing factor in the development of various diseases, but comparative data on this condition are limited. We therefore aimed to identify and discuss current epidemiological data on the prevalence of obesity in European countries.

Methods

We identified relevant published studies by means of a MEDLINE search (1990–2008) supplemented by information obtained from regulatory agencies. We only included surveys that used direct measures of weight and height and were representative of each country's overall population.

Results

In Europe, the prevalence of obesity (body mass index ≥ 30 kg/m²) in men ranged from 4.0% to 28.3% and in women from 6.2% to 36.5%. We observed considerable geographic variation, with prevalence rates in Central, Eastern, and Southern Europe being higher than those in Western and Northern Europe.

Conclusion

In Europe, obesity has reached epidemic proportions. The data presented in our review emphasise the need for effective therapeutic and preventive strategies.

The importance of harmonizing food composition data across Europe

OBJECTIVE

To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment.

RESULTS

The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations.

CONCLUSIONS

Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.

Factors associated with obesity in an adult Mediterranean population: influence on plasma lipid profile

OBJECTIVE

The aim of the study was to identify factors associated with obesity, and their influence on plasma lipid profile in an adult Mediterranean population.

DESIGN

The data were obtained from a cross-sectional epidemiological survey.

SETTING

The study population resided in Andalusia, a western Mediterranean region in southern Spain.

SUBJECTS

The survey was carried out with a random sample of 3421 subjects (1747 men, 1674 women) between 25 and 60 years of age. Blood samples were obtained for biochemical assays in a random subsample of 340 subjects (167 men, 173 women).

INTERVENTIONS

Food consumption was assessed by 48-h recall. Height, weight, triceps, biceps, subscapular and suprailiac skinfolds, mid-upper arm, waist (WC) and hip circumferences, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were measured. Information about lifestyles was obtained with a questionnaire.

RESULTS

Of the adult population we studied, 18.9% were obese (body mass index [BMI] > or = 30 kg/m2). A larger proportion of men than women were overweight, but the opposite was found for obesity. Mean plasma lipid values were not modified significantly by obesity or lifestyle factors, and were within the normal range. Sex, age, physical exercise and lower educational level were associated directly with the risk of obesity, and smoking was associated inversely with the risk of obesity. In obese smokers WC and waist-hip ratio were larger, and levels of HDL-cholesterol were lower (p < 0.05) than in obese nonsmokers. Glucemia was higher in obese persons who consumed alcohol (p < 0.05) than in obese persons who did not consume alcohol. The risk of hypercholesterolemia and high levels of LDL-cholesterol was associated only with age, and the risk of low levels of HDL-cholesterol was associated only with high WC.

CONCLUSION

Our results provide an estimate of the prevalence of obesity in the adult population in southern Spain, and of the associated factors. Sex, age, leisure-time physical exercise and educational level appear to influence obesity. Only age and WC but not BMI were associated with a risk of dyslipidemia. No dietary associations were observed between energy or macronutrient intake and plasma lipid concentrations in overweight or obese persons.

Prevalence of renal impairment and its association with cardiovascular risk factors in a general population: results of the Swiss SAPALDIA study

BACKGROUND

Impaired renal function is evolving as an independent marker of the risk of cardiovascular morbidity and mortality. Little is known about the prevalence of impaired renal function and its relationship to cardiovascular risk factors in the Swiss general population.

METHODS

SAPALDIA comprises a random sample of the Swiss population established in 1991, originally to investigate the health effects of long-term exposure to air pollution. Participants were reassessed in 2002/3 and blood measurements were obtained (n = 6317). Renal function was estimated using the Cockcroft-Gault equation and the modified MDRD (four-component) equation incorporating age, race, gender and serum creatinine level.

RESULTS

The estimated prevalence of impaired renal function [estimated glomerular filtration rate <60 ml/min/1.73 m(2)] differed substantially between men and women, particularly at higher ages, and amounted to 13% [95% confidence interval (CI) 10-16%] and 36% (95% CI 32-40%) in men and women, respectively, of 65 years or older. Smoking, obesity, blood lipid levels, high systolic blood pressure and hyperuricaemia were all more common in men when compared with women. These cardiovascular risk factors were also associated independently with creatinine in both women and men. Women were less likely to receive cardiovascular drugs, in particular angiotensin-converting enzyme inhibitors and beta-blockers, when compared with men of the same age.

CONCLUSION

Moderate renal impairment seems to be prevalent in the general population, with an apparent excess in females which is not explained by conventional cardiovascular risk factors. The unexpected finding questions the validity of the prediction equations, in particular in females.

Épidémiologie actuelle de la lithiase rénale en France

Nephrolithiasis is a frequent disease that affects about 10% of people in western countries. The prevalence of calcium oxalate stones has been constantly increasing during the past fifty years in France as well as in other industrialized countries. Stone composition varies depending to gender and age of patients and also underlines the role of other risk factors and associated pathologies such as body mass index and diabetes mellitus. The decrease in struvite frequency in female patients is the result of a significantly improved diagnostic and treatment of urinary tract infections by urea-splitting bacteria. In contrast, the increasing occurrence of weddellite calculi in stone forming women aged more than 50 years could be the consequence of post-menopausal therapy. A high prevalence of uric acid was found in overweight and obese stone formers and in diabetic ones as well. Another important finding was the increased occurrence with time of calcium oxalate stones formed from papillary Randall's plaques, especially in young patients. Nutritional risk factors for stone disease are well known: they include excessive consumption of animal proteins, sodium chloride and rapidly absorbed glucides, and insufficient dietary intake of fruits and potassium-rich vegetables, which provide an alkaline load. As a consequence, an excessive production of hydrogen ions may induce several urinary disorders including low urine pH, high urine calcium and uric acid excretion and low urine citrate excretion. Excess in calorie intake, high chocolate consumption inducing hyperoxaluria and low water intake are other factors, which favour excessive urine concentration of solutes. Restoring the dietary balance is the first advice to prevent stone recurrence. However, the striking increase of some types of calculi, such as calcium oxalate stones developed from Randall's plaque, should alert to peculiar lithogenetic risk factors and suggests that specific advices should be given to prevent stone formation.

Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study

BACKGROUND

Progressive nutritional depletion has been reported during hospital stay. This prospective study compared the proportion of nutritional risk at hospital admission in three European countries and further evaluated nutritional risk at late versus early phase of hospitalization in one hospital.

METHODS

Nutritional risk was determined in Geneva, Switzerland (n = 652), Berlin, Germany (n = 621) and Nice, France (n = 107) at hospital admission, and during hospital stay (0-100 d) in Nice (n = 527) by the Nutritional Risk Index (NRI) = (1.519 x serum albumin, g/l)+41.7 x (present weight/usual weight). NRI score of >100: no risk (NR); 97.5-100: mild risk; 83.5-97.5: moderate risk (MR); 83.5: severe risk (SR). Logistic regressions were used to determine the odds ratios (OR) between MR or SR and length of hospital stay (LOS) 16d compared to 1-15 d or nutritional assessment at 16-100 d compared to 1-15 d of hospitalization.

RESULTS

Patients, assessed at hospital admission, who were hospitalized >16d were more likely (P < 0.001) to be at MR (OR 2.0, CI 1.4-3.0) or SR (OR 3.3, CI 1.7-6.2) than patients hospitalized 1-15 d. Nice patients assessed at 16-100 d were more likely (P < 0.001) to be at MR (OR 5.4, CI 2.1-14.3) and SR (OR 14.7, CI 5.4-40.0) than patients assessed at 1-15 d of hospitalization.

CONCLUSIONS

The risk of MR or SR by NRI was greater in patients assessed during hospitalization than in patients assessed at hospital admission, which suggests that patients evaluated later during hospitalization are at greater risk than patients evaluated in the early phase of hospitalization. Ongoing assessment during hospitalization seems important to identify patients who are at increased risk for complications.

The obesity epidemic as harbinger of a metabolic disorder epidemic: trends in overweight, hypercholesterolemia, and diabetes treatment in Geneva, Switzerland, 1993-2003

Increases in obesity, hypercholesterolemia, and diabetes may be under way in Europe. We have reported the only data available from the 1990s for continuous monitoring of chronic disease risk factors in random samples of a general European population. In random surveys (1993-2003) of 6164 men and 6107 women in Geneva, overweight and obesity combined increased in both men and women; hypercholesterolemia prevalence also rose; diabetes treatment increased in men. Only population-based interventions can prevent the impending epidemic of obesity-related disorders.

Comparison of fat-free mass and body fat in Swiss and American adults

OBJECTIVE

No current studies have compared North American with European body composition parameters, i.e., fat-free mass (FFM), body fat (BF), and percentage of BF (%BF) in large populations. This study compared FFM, BF, and %BF values derived from two bioelectrical impedance analysis (BIA) equations (Geneva and National Health and Nutrition Examination Survey [NHANES]) in Swiss subjects and compared FFM, BF, and %BF values of white Swiss with those of white North American adults with the same BIA equations.

METHODS

Healthy adults (3714 men and 3199 women), ages 20 to 79 y, in Switzerland were measured by single-frequency BIA and compared with means and standard deviations for body mass index and body composition parameters obtained from the NHANES III study (United States; n = 2538 men, 2862 women). FFM was calculated with the Geneva and NHANES equations.

RESULTS

Mean FFMGENEVA values did not differ from FFMNHANES values in men but was significantly lower (-1.5 kg) in women. FFM and BF values in American men, who weighed 4.2 to 12.0 kg more than the Swiss men, were significantly higher (+2.1 to +6.0 kg and +1.5 to +6.4 kg, respectively) than those in the Swiss men. FFM and BF values in American women, who weighed 2.3 to 12.1 kg more than the Swiss women, were significantly higher (+1.3 to +2.1 kg and +4.8 to +11.8 kg, respectively, except FFM in subjects ages 20 to 29 y and BF in those ages 70 to 79 y) than FFMGENEVA values in Swiss women. FFM in American women was significantly lower (+1.3 and +1.9 kg) and non-significantly higher than FFMNHANES in Swiss women.

CONCLUSION

NHANES and Geneva BIA equations estimate body composition equally well in men, but further research is necessary to determine the discrepancies in FFM between BIA equations in women. The greater weight of the American subjects yielded higher values for FFM, BF, and %BF in American than in Swiss men and women.

Dietary and socio-economic factors associated with overweight and obesity in a southern French population

OBJECTIVE

To investigate the socio-economic and dietary factors associated with overweight and obesity, respectively, in southern France.

DESIGN

Cross-sectional analysis of socio-economic, lifestyle and nutritional characteristics of a representative population sample. A questionnaire elicited information on anthropometric measurements, socio-economic factors, physical activity, tobacco use, and alcohol and food intakes. Non-parametric tests, multiple linear regression models and correspondence factorial analysis (CFA) were used to estimate the association of the various factors with overweight and obesity.

SETTING

French Southwest and Mediterranean areas.

SUBJECTS

In total, 1169 subjects (578 women and 552 men), aged 30-77 years, were recruited at random.

RESULTS

Overweight and obesity were associated with age and education in both genders, reproductive factors in women and tobacco use in men. A few dietary factors were identified (high energy intake and low intake of carbohydrates), but all these variables explained little of the variation (18.5% in women and 14.6% in men). The CFA further investigated the association of lifestyle and nutritional factors, giving more weight to nutritional behaviour for overweight men and women. Factors for obesity differed from those for overweight by being different in men and women, possibly related to psychological behaviour, and there were fewer of them, suggesting an insufficient coverage by the usual questionnaires.

CONCLUSIONS

Overweight and obesity appear as two different entities. Energy imbalance induced by various lifestyle factors plays a major role in the development of overweight, whereas obesity represents a more complex entity where psychological and genetic factors that are difficult to assess may be more important. General nutritional guidelines appear more adapted to the prevention of overweight than to that of obesity, and individual counselling to the prevention of obesity.

Fish-seafood consumption, obesity, and risk of type 2 diabetes: an ecological study

OBJECTIVES

There is substantial evidence that type 2 diabetes increases with the degree and duration of obesity. This study was conducted to examine the association, at the international level, between fish and seafood consumption and the prevalence of type 2 diabetes, taking into account the prevalence of obesity.

METHODS

An ecological study of 41 countries in five continents with different socio-demographic characteristics and sanitary conditions was carried out. Data on the prevalence of diabetes and obesity as well as food balance sheets were collected from websites. Correlations between the variables studied were followed by an exploration of their interaction.

RESULTS

After adjustment for total energy intake, there was a significant correlation (rho=0.81, P<0.0001) between the prevalence of type 2 diabetes in the 20- to 44- and 45- to 64-year age groups. Type 2 diabetes in the 45- to 64-year age group was about 5 times higher than in the 20- to 44-year age group. Obesity was positively associated with type 2 diabetes in both age groups (rho=0.39; P=0.012 and rho=0.48; P=0.002 in the 20- to 44- and 45- to 64-year age groups, respectively). An interaction effect was found between diabetes, obesity and total fish and seafood consumption. In countries with low fish and seafood consumption, the prevalence of type 2 diabetes increased significantly with obesity (0.8 +/- 0.3% vs. 2.5 +/- 1.8%; P=0.002 and 3.3 +/- 2.6% vs. 11.0 +/- 3.9%; P<0.0001 for the 20- to 44- and 45- to 64-year age groups, respectively). In countries with a greater prevalence of obesity, there was evidence of significantly reduced type 2 diabetes with high fish and seafood consumption (2.5 +/- 1.8% vs. 0.9 +/- 0.7%; P=0.007 and 11.0 +/- 3.9% vs. 6.2 +/- 4.1%; P=0.041 for the 20- to 44- and 45- to 64-year age groups, respectively).

CONCLUSION

The results of this study suggest that high fish and seafood intake may reduce the risk of type 2 diabetes in populations with a high prevalence of obesity.

Aging, physical activity and height-normalized body composition parameters

BACKGROUND & AIM

Regular physical activity prevents or limits weight gain, and gain in body mass index (BMI) and decreases mortality. The aims of the study in healthy adults were to determine the differences in fat-free mass index (FFMI) (kg/m(2)) and body fat mass index (BFMI) between age groups and determine the association between physical activity and FFMI and BFMI.

METHODS

Caucasian men (n=3549) and women (n=3184) between 18 and 98 years, were classified as either sedentary or physically active (at least 3h per week at moderate or high-intensity level activity). FFMI and BFMI were measured by 50 kHz bioelectrical impedance analysis.

RESULTS

BFMI was significantly higher (P<0.05) in sedentary than physically active subjects and the differences became progressively greater with age. The physically active subjects were significantly less likely to have a low or high FFMI (logistic regression, P<0.001), and a high or very high BFMI (P<0.001), and more likely to have low BFMI (P<0.001) compared to sedentary adults. In contrast with fat-free mass, which was lower in older subjects, the height-normalized FFMI was stable with age until 74 years and lower thereafter. Significantly higher BFMIs were noted in older subjects.

CONCLUSION

Physically active subjects are less likely to have low or high FFMI, and high or very high BFMI, and more likely to have low BFMI. In contrast to common claim that fat-free mass decreases with age, we found that FFMI was stable until 74 years. The use of FFMI and BFMI permits comparison of subjects with different heights and age.

Educational Level and Stroke Mortality

BACKGROUND AND PURPOSE

Variations between countries in occupational differences in stroke mortality were observed among men during the 1980s. This study estimates the magnitude of differences in stroke mortality by educational level among men and women aged >or=30 years in 10 European populations during the 1990s.

METHODS

Longitudinal data from mortality registries were obtained for 10 European populations, namely Finland, Norway, Denmark, England/Wales, Belgium, Switzerland, Austria, Turin (Italy), Barcelona (Spain), and Madrid (Spain). Rate ratios (RRs) were calculated to assess the association between educational level and stroke mortality. The life table method was used to estimate the impact of stroke mortality on educational differences in life expectancy.

RESULTS

Differences in stroke mortality according to educational level were of a similar magnitude in most populations. However, larger educational differences were observed in Austria. Overall, educational differences in stroke mortality were of similar size among men (RR, 1.27; 95% CI, 1.24 to 1.30) and women (RR, 1.29; 95% CI, 1.27 to 1.32). Educational differences in stroke mortality persisted at all ages in all populations, although they generally decreased with age. Eliminating these differences would on average reduce educational differences in life expectancy by 7% among men and 14% among women.

CONCLUSIONS

Educational differences in stroke mortality were observed across Europe during the 1990s. Risk factors such as hypertension and smoking may explain part of these differences in several countries. Other factors, such as socioeconomic differences in healthcare utilization and childhood socioeconomic conditions, may have contributed to educational differences in stroke mortality across Europe.

Weight control and the management of obesity after menopause: the role of physical activity

BACKGROUND

Postmenopausal women have an increased tendency for gaining weight. The declines of endogenous estrogen, together with physical inactivity, are probably the major causes of this phenomenon. Postmenopausal overweight and obesity leads to increased rates of hypertension, diabetes mellitus, coronary artery disease, and all cause mortality. Additional consequences may include hormone-dependent cancer, gallstones, nephrolithiasis, and osteoarthritis. Weight loss can reverse many of these complications, reduce the number and dosages of medications used, and improve longevity. This difficult task requires lifestyle modification.

OBJECTIVES

To review the current information about the effects of physical activity on postmenopausal weight gain and its consequences and to provide basic strategies to treat obesity during the menopause transition.

METHODS

A Medline search together with a manual search of selected articles.

CONCLUSION

Several options for weight loss are available, yet lifestyle modification is essential in managing postmenopausal obesity and overweight. While this demands dietary and behavioral changes, a major element of this modification is regular physical activity, which reduces obesity-related morbidity and mortality. The amendment to a healthier lifestyle is achievable at the postmenopausal years. All medical personnel should advocate against overweight and obesity and provide tools for their management.

Association of obesity and central fat distribution with carotid artery wall thickening in middle-aged women

BACKGROUND AND PURPOSE

The association between obesity and atherosclerotic disease is controversial. In the present analysis, we evaluated whether common carotid intima-media thickness (IMT) and area, 2 markers of preclinical atherosclerosis, were increased in obese subjects.

METHODS

More than 5000 middle-aged women (n=5062; age, 30 to 69 years) living in the area of Naples, Southern Italy, were recruited for a prospective, currently ongoing study on the etiology of cardiovascular disease and cancer in the female population (the Progetto ATENA study). A subsample of 310 participants underwent high-resolution B-mode ultrasound examination, and the IMTs, intima-media areas, and lumen diameters of common carotid arteries were measured with a semiautomated computerized program. Subjects were divided into 3 groups on the basis of the recently published obesity guidelines for body mass index (BMI), a marker of general obesity, and tertiles of waist-to-hip ratio (WHR), a marker of regional obesity.

RESULTS

Women with a BMI >/=30 kg/m(2) showed higher systolic and diastolic blood pressures, triglycerides, and fasting glucose and insulin, as well as lower high-density lipoprotein concentrations, than subjects with lower BMI. A gradual increase in common carotid IMT and intima-media area was observed when lean women (0.94+/-0.01 mm and 19.8+/-0.5 mm(2), respectively) were compared with overweight (0.98+/-0.01 mm and 21.0+/-0.4 mm(2)) and obese (1.02+/-0.02 mm and 22.6+/-0.8 mm(2), P<0.005 for linear trend) individuals. Similarly, women in the highest tertile of WHR (>0.85) had adverse risk factor profiles and thicker carotid intima-media complex than those in the first 2 tertiles (P<0.01 and P<0.05 for IMT and intima-media area, respectively). In multivariate analyses, BMI and WHR were significant predictors of carotid wall thickness, independently of other traditional and nontraditional cardiovascular risk factors (age, blood pressure, lipid abnormalities, fasting insulin).

CONCLUSIONS

The present results indicate a graded and independent association between general and abdominal obesity-reflected by high BMI and WHR-and carotid artery wall thickening in a population of middle-aged women.

Fat-free mass index and fat mass index percentiles in Caucasians aged 18-98 y

OBJECTIVE

To determine reference values for fat-free mass index (FFMI) and fat mass index (FMI) in a large Caucasian group of apparently healthy subjects, as a function of age and gender and to develop percentile distribution for these two parameters.

DESIGN

Cross-sectional study in which bioelectrical impedance analysis (50 kHz) was measured (using tetrapolar electrodes and cross-validated formulae by dual-energy X-ray absorptiometry in order to calculate FFMI (fat-free mass/height squared) and FMI (fat mass/height squared).

SUBJECTS

A total of 5635 apparently healthy adults from a mixed non-randomly selected Caucasian population in Switzerland (2986 men and 2649 women), varying in age from 24 to 98 y.

RESULTS

The median FFMI (18-34 y) were 18.9 kg/m(2) in young males and 15.4 kg/m(2) in young females. No difference with age in males and a modest increase in females were observed. The median FMI was 4.0 kg/m(2) in males and 5.5 kg/m(2) in females. From young to elderly age categories, FMI progressively rose by an average of 55% in males and 62% in females, compared to an increase in body mass index (BMI) of 9 and 19% respectively.

CONCLUSIONS

Reference intervals for FFMI and FMI could be of practical value for the clinical evaluation of a deficit in fat-free mass with or without excess fat mass (sarcopenic obesity) for a given age category, complementing the classical concept of body mass index (BMI) in a more qualitative manner. In contrast to BMI, similar reference ranges seems to be utilizable for FFMI with advancing age, in particular in men.

Nutrition status in patients younger and older than 60 y at hospital admission: a controlled population study in 995 subjects

OBJECTIVE

Body weight and body mass index are easily obtainable indicators of nutrition status but do not provide information on changes in fat-free mass (FFM) and fat mass with age. In this prospective controlled study, we investigated whether body composition measurements were useful in identifying moderately or severely depleted patients, as judged by the Subjective Global Assessment at hospital admission. In addition, the subjects were grouped by age (< or =60 and >60 y) to determine whether there was an effect of aging on the prevalence of malnutrition.

METHODS

Nine hundred ninety-five consecutive patients were evaluated for malnutrition by body mass index, serum albumin, Subjective Global Assessment, and 50-kHz bioelectrical impedance analysis and compared with 995 age- and height-matched healthy volunteers for FFM and fat mass.

RESULTS

A body mass index less than 20 kg/m(2) was found in 17.3% of patients. Low albumin (< or =34.9 g/L) was found in 14.9% of all patients and 23.7% of those older than 60 y. In contrast, 23.1% and 38.3% of all patients were severely and moderately depleted, respectively, according to the Subjective Global Assessment. FFM was significantly lower in severely depleted men and women and moderately depleted women (P < or = 0.001), and fat mass was significantly higher (P < or = 0.05) in well-nourished patients than in volunteers. Patients older than 60 y had lower FFM and higher fat mass than did patients 60 y or younger or volunteers (P < or = 0.001).

CONCLUSION

The prevalence of malnutrition was greater in patients older than 60 y than in those 60 y and younger. Patients classified as severely depleted according to the Subjective Global Assessment were depleted of FFM. Body composition measurement can help to identify patients with low FFM and high fat mass.

Secular increases in body fat percentage in male children of Zaragoza, Spain, 1980-1995

BACKGROUND

Data on temporal changes on total body fat percentage (TBF%) are scarce, and no such data are known to exist in Spain. The aim of our study was to describe secular increases in TBF% in male children and adolescents of Zaragoza, Spain, from 1980 to 1995.

METHODS

The samples analyzed in the present study have been included in two cross-sectional surveys conducted in 1980 and 1995. The samples selected for the 1980 and 1995 surveys comprised 1553 and 701 male children with ages ranging from 6.0 to 14.9 years. Weight, height, and four skinfold thicknesses were measured. From these measurements we have calculated TBF%.

RESULTS

Concerning body mass index (BMI), we have observed significant increases from 8.5 to 11.5 years, ranging in this age group from 0.80 to 1.45 kg/m(2). TBF% showed significant increases at all age groups, with percentage increases of 2.46% at 13.5 years and 6.03% at 11.5 years.

CONCLUSIONS

We have shown a secular increase in TBF% in children aged 6.0 to 15.0 years that is greater than the increase in BMI. The similarity of our findings for both relative weight and skinfold thickness, even with less significant differences for BMI, suggests that, in children of Zaragoza, Spain, adiposity has increased during the 1980-1995 period.

Gender specific associations of the Trp64Arg mutation in the beta3-adrenergic receptor gene with obesity-related phenotypes in a Mediterranean population: interaction with a common lipoprotein lipase gene variation

OBJECTIVE

To investigate the association between the Trp64Arg beta3-adrenergic receptor (ADRB3) mutation and obesity-related phenotypes in a Mediterranean Spanish population considering the effect of other genetic and environmental factors. DESIGN AND SUBJECT: Cross-sectional study in 1063 (476 men and 587 women) randomly selected from this population (aged: 18-68 years).

MEASUREMENTS

Anthropometric (weight, height and waist-to-hip ratio), blood pressure, biochemical (lipids, fasting glucose, and uric acid), life-style variables, and the Trp64Arg, HindIII-Lipoprotein lipase (LPL) and apolipoprotein E polymorphism.

RESULTS

Frequency of the Arg64 allele was low (0.051; 95% CI: 0.042-0.060). We found gender-specific associations between the Trp64Arg mutation and obesity related phenotypes. In men, carriers of the Arg64 variant had higher body mass index (BMI) (27.63 +/- 3.81 vs. 26.34 +/- 3.57 kg m-2, P=0.049) and total cholesterol (5.85 +/- 1.45 vs. 5.28 +/- 1.06 mmol L-1; P=0.011) compared with wild-type individuals. Logistic regression analysis, revealed that the risk of overweight was two times higher in male carriers of the Arg64 allele. In women, the Arg64 variant was only associated with higher fasting glucose (P=0.031). These genotype effects persisted after adjustment for age, genetic and life-style variables. For the LPL polymorphism, the H-/H- genotype was associated with lower BMI and with lower risk of overweight (OR: 0.49; 95% CI: 0.30-0.81) in both men and women. However, after adjustment for covariates, these associations only remained statistically significant (P < 0.02) in women. Moreover, in women, a statistically significant interaction (P=0.026) between the LPL and the ADRB3 gene loci in determining BMI was found. Thus, the Arg64 allele was associated with a higher BMI only in H+/H+ women.

CONCLUSIONS

The Trp64Arg mutation was associated with BMI and lipids in men. In women, an additional gene-gene interaction with the LPL-HindIII polymorphism may explain the results.

Site-specific atherosclerotic plaques in the carotid arteries of middle-aged women from southern Italy: associations with traditional risk factors and oxidation markers

BACKGROUND AND PURPOSE

Studies on cardiovascular disease have preferentially involved men because of the lower frequency of the disease in preelderly women. The aim of this analysis was to examine, with the use of a standardized ultrasound protocol, a cohort of women to differentiate early atherosclerotic lesions in different carotid segments in relation to traditional (lipoprotein abnormalities, high blood pressure, cigarette smoking) and nontraditional (oxidation markers) cardiovascular risk factors.

METHODS

More than 5000 clinically healthy, middle-aged women (n=5062; age range, 30 to 69 years) living in the area of Naples in southern Italy participated in the Progetto Atena, a population-based study on the etiology of cardiovascular disease and cancer in the female population. A subsample of 310 participants underwent high-resolution B-mode ultrasound to assess intima-media thickness of common carotid artery and carotid bifurcation.

RESULTS

Early atherosclerotic plaques (intima-media thickness >1.2 mm) were detected within the common carotid arteries in 37 women, in the carotid bifurcations in 77 women, and in both sites in 91 women. After age adjustment, common carotid plaques were found to be associated with higher systolic blood pressure (143 versus 138 mm Hg; P<0.05) and higher body mass index (29 versus 27 kg/m(2); P<0.01), while lesions at the carotid bifurcations were associated with higher LDL cholesterol (4.3 versus 3.8 mmol/L; P<0.01) and with smoking habit. Multivariate odds ratios for the presence of common carotid plaques were related to antibodies against oxidized LDL (odds ratio, 2.72; 95% CI, 1.46 to 5.07), and those for plaques at the bifurcation were related to lipid peroxides (odds ratio, 1.90; 95% CI, 1.04 to 3.47), and both relationships were independent of age, LDL cholesterol concentrations, body mass index, smoking habit, and systolic blood pressure.

CONCLUSIONS

In a cohort of clinically healthy, middle-aged women, we found a site-specific association of traditional risk factors and oxidation markers with early atherosclerotic lesions in arterial segments differing in geometry, shear stress, extracellular matrix composition, and cell type populations.

[Prevalence of obesity in the population assisted at primary health care services in Girona, 1995-1999]

OBJECTIVES

To estimate the prevalence of obesity and overweight in the population of Girona (Spain) between 1995 and 1999 and to divide the prevalences in geographical areas according to age and sex.

METHODS

Height and weight were directly measures in 24,554 health care consumers older than 14 years (10,595 men and 13,959 women) treated in four primary health care areas: Girona 1, Girona 4, Salt and Camprodon and in one primary health care center in the province of Girona. Body mas index (BMI) was calcuted by dividing weight in kilograms bye height in meters squared. Obesity was defined as grades II and III of Garrow's index (BMI >= 30 kg/m2) and overweight as degree I (25 kg/m2 >= BMI < 30 kg/m2). Because the sample was not randomized, the prevalences were adequately weighted. The comparison between prevalences in two different primary health care areas for each sex (in the same Garrow's index and age group) was carried out using a parametric test of differences in proportions (Student's t-test). A hierarchical logistic regression was used to compare prevalences in the same grade Garrow's index, controlling for age and sex.

RESULTS

The prevalence of obesity was estimated as 15.6% in men aged from 20-74 years (from 14.0% in Girona 1 to 22.4% in Camprodon) and 17.5% for women (15.6% in Girona 1, 22.7% in Camprodon). The weighted mean was 16.7%. The prevalence of overweight was 44% in men and 33% in women and the weighted mean was 37.8%. The prevalence of obesity was graduated with statistically significant differences between Girona 1, Salt, Girona 4, Camprodon and Sils.

CONCLUSIONS

The estimates of the prevalences of obesity and overweight obtained in this study were closer to those of other studies in similar populations than previously believed. Indeed, the prevalences may be similar to those of the European Union and, in some age groups, to those of the United States.

Validation of self-reported smoking status by simultaneous measurement of carbon monoxide and salivary thiocyanate

OBJECTIVE

The objective of this study was to determine the validity of tobacco questionnaires when using as gold standard either a single biomarker or a combination of two biomarkers.

METHODS

The methods were self-reported smoking compared with salivary thiocyanate and expired carbon monoxide in a 1996, population-based, Swiss survey of 552 men and 565 women.

RESULTS

Sensitivity of self-reported smoking relative to salivary thiocynate or carbon monoxide alone was low (38.2% for salivary thiocyanate > or = 100 mg/L, 56.4% for salivary thiocyanate > or = 150 mg/L and 62.6% for carbon monoxide > or = 9 ppm). When defining true positive smokers as people with high concentration of both salivary thiocyanate and carbon monoxide, overall, sensitivity was 88.6% and specificity was 87.2%. In women, sensitivity increased from 85 to 89% when removing subjects exposed to passive smoking. When excluding heavy smokers, sensitivity decreased to 63% in men and to 71% in women. Older women had tendency to misreport smoking.

CONCLUSIONS

This comparison of questionnaire data with the simultaneous measurement of salivary thiocyanate and expired carbon monoxide indicates that valid responses can be obtained for self-reported, current smoking in population-based surveys. However, the validity of questionnaires can be underestimated if the gold standard (of exposure to tobacco smoke) is either high levels of carbon monoxide or high levels of salivary thiocyanate.