Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

METHODS

For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

FINDINGS

For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

INTERPRETATION

Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes.

FUNDING

British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

Measured vs self-reported overweight/obesity in the Italian adult population: CUORE Project 2018-19

Background

In monitoring population health and the effectiveness of public health strategies, the body mass index (BMI) is often assessed within national surveys from self-reported height and weight rather than measured values. Using data collected within a recent health examination survey (HES), the discrepancies between self-reported and measured values were assessed, and correction models were estimated and implemented on national interview survey data.

Methods

Within the CUORE Project, the Italian National Institute of Health conducted the HES 2018-2019 measuring height and weight as well as collecting data on self-reported values in random samples of general population aged 35-74 years residing in ten (of 20) Italian regions distributed in the North, Centre and South: 1033 men and 1061 women.

Results

Self-reported and measured data comparison showed greater differences in mean values of height than weight and in women than in men (height +2 cm in men and +3.2 in women; weight -0.7 kg and -1.4 kg, respectively) and a corresponding underestimation of BMI (-0.7 kg/m2 and -1.4 kg/m2, respectively). Differences were stable across age groups and educational levels, except for height discrepancy, which was greatest in women aged 65-74 years. Self-reported vs measured prevalence were: normal weight 39.7%-33.3% in men and 54.8%-44.7% in women, overweight 45.8%-46.1% and 26.0%-29.2%, obesity 13.8%-20.1% and 15.7%-23.9%. Linear regression models adjusted by sex and age classes were assessed for height and weight (R2 > =0.92) and implemented to estimate adjusted BMI and normal weight/overweight/obesity prevalence on the national multi-purpose interview survey data collected by the Italian National Institute of Statistics.

Conclusions

To provide more accurate prevalence of normal weight, overweight and obesity, self-reported values could be adjusted using correction models developed on the basis of the relationship between self-reported and measured height and weight values.

Key messages

• Discrepancies between self-reported and measured values of height and weoght were found.

• Self-reported values could be adjusted using correction models developed on the basis of the relationship between self-reported and measured height and weight values.

The CUORE project cardiovascular risk assessment in primary care: the ongoing experience in Italy

Background

Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO).

Aim

To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population.

Methods

Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples.

Results

Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR < 3%); 9.9% of M, 0.4% of W were at high risk (CR ≥ 20%); 26% of M, 16% of W were current smokers; 13% of M, 10% of W were diabetic; 33% of hypertensive M, 35% of hypertensive W were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14% of M, 7% of W). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (0.2-0.7 mmHg), total cholesterol by 4.1 mg/dl (3.0-5.2 mg/dl), smokers prevalence by 3.1% (2.3%-4.0%); HDL-cholesterol increased in W by 0.3 mg/dl (0.1-0.5 mg/dl).

Conclusions

Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process.

Key messages

The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.

Raised blood pressure in Italy: results of the CUORE Project-health examination survey 2018-2019

Background

The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends a 25% relative reduction in the prevalence of raised blood pressure (RBP) by 2025. Prevalence of RBP and mean blood pressure in the Italian general adult population measured in the 2018 CUORE Project-Health Examination Survey are presented to investigate if Italy can reach this target.

Methods

Within the health examination survey conducted in 2018-2019, representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women) were examined in 8 Italian Regions from the Northern, Central and Southern Italy. Blood pressure was measured by automated oscillometric device using standardized procedures and methods; mean level of two measurements are here considered. RBP is defined as systolic and/or diastolic blood pressure equal or greater than 140/90 mmHg or being under specific drug treatment. The survey is funded by the Italian Ministry of Health-CCM.

Results

Preliminary analysis shows that prevalence of RBP is 43% (95% C.I. 40-47) in men and 32% (29-36) in women. Prevalence of persons with raised blood pressure and not receiving pharmacological treatment is 19% (15-22) in men and 9% (5-12) in women. In men and women prevalence of raised blood pressure is significantly higher in the Southern Regions. Mean value of systolic blood pressure is 131 mmHg (130-132) in men and 122 mmHg (121-123) in women. Mean value of diastolic blood pressure is 77 mmHg (76-78) in men and 73 mmHg (72-74) in women.

Conclusions

Preliminary data underline that RBP is commonly observed in the Italian adult population. However, in comparison to data measured within the CUORE Project 10 years earlier, prevalence of RBP and mean blood pressure are declining, facilitating the meeting of WHO-NCDs target.

Key messages

Raised blood pressure is commonly observed in the Italian general adult population. If confirmed, in the last ten years prevalence of raised blood pressure and mean blood pressure are declining in the Italian general adult population.

Body mass index and obesity in Italy: results of CUORE Project-Health Examination Survey 2018-2019

Background

The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target.

Methods

Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI<30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. A standardized questionnaire was used to collect data on educational level that was used as a proxy of socio-economic status. The survey is funded by the Italian Ministry of Health-CCM.

Results

In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions.

Conclusions

Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level.

Key messages

Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.

Sodium intake in Italy from 2008 to 2019: results of the CUORE Project-Health Examination Surveys

Background

The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan 2014-2019, in collaboration with the Interdisciplinary Working group for Salt Reduction in Italy. To estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project.

Methods

Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from representative random samples of residents in all Italian Regions. A new survey was conducted in 2018-2019 involving random samples of residents in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the first seven regions examined in the 2018-2019 survey and the age range of 35-74 years.

Results

Within the 2008-2012 survey, mean level of sodium chloride per day in 642 men and 627 women were 10.6 g (10.3-11.0 g) and 8.0 g (7.7-8.3 g) respectively, whereas in the 2018-2019 survey the corresponding mean levels in 673 men and 709 women were 9.3 g (95% C.I.: 9.1-9.6 g) and 7.1 g (6.9-7.3 g), respectively. A sodium chloride intake level lower than the WHO recommended target of 5g/day (or 85 mmol/day) was detected in 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012 vs 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019.

Conclusions

These preliminary data show that the average habitual sodium intake in Italy is still higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of the WHO-NCD target.

Key messages

Habitual salt intake in the Italian general adult population is still higher than the recommended by the WHO. If confirmed, in the last ten years a reduction of habitual salt intake in Italian general adult population seems to be occurred.

WHO Action Network on Measuring Health Literacy: the Italian pilot for the Survey 2019 Title

Background

Health Literacy-HL is an important determinant to improve and maintain health and quality of life during life course. HL implies people’s knowledge, motivation, competencies to access, understand, appraise, apply information to make judgements and decisions in everyday life concerning healthcare, disease prevention, health promotion. Thanks to Ministry of Health funds, Italy joined the WHO Action Network on Measuring Population and Organizational Health Literacy-M-POHL for collecting comparable data on HL in order to measure and promote citizens’ HL among MS.

Objective: The HLS-EU-Q16 questionnaire was administered to a sample of adult population during the Health Examination Survey-HES of the CUORE Project started in 2018, to verify and evaluate the feasibility of the HL survey.

Methods

One hundred people aged 35-74 years, resident in Reggio Calabria (South of Italy), were interviewed (face-to-face) following consecutive access to the HES. According to the HLS-EU-Q16 sum score, three levels of HL were defined: inadequate, problematic, and sufficient. HL mean score and standard deviation-SD were elaborated together with prevalence of the three HL levels. Socio-demographics conditions, lifestyles, risk factors were measured during the HES.

Results

HL mean score of 98 completed questionnaires (47 men, 51 women) was 13.0 (SD = 3.5), with no sex difference; prevalence of persons with inadequate HL was 11.2%, problematic 26.5%, sufficient 62.3%. Sufficient HL level presents the highest prevalence (72%) of high educational level. Smoking habit decreases as HL level increases.

Conclusions

The HLS-EU-Q16 questionnaire represents a standardised tool applicable in the general population. Preliminary results from the Italian pilot of the HLS-EU-Q16 suggest that the survey is feasible within the HES of the CUORE Project, with the opportunity to link HL data with HES measured data. More than one third of interviewed adult population have inadequate/problematic HL.

Monitoring of obesity in the Italian adult population: preliminary results of 1998-2018 trend

Background

Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project.

Methods

Mean of BMI and prevalence of obesity (BMI > =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee.

Results

In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively.

Conclusions

Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025.

Key messages

Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.

Preventive actions for the gradual reduction of excessive salt intake and its monitoring in Italy

Issue

The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI).

Description of the problem

According to the “Gaining Health” Programme, agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. The reduction of excessive salt intake is one of the main objective of the NPP 2014-2019 pursued by the Regions through initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators. The Italian Institute of Health conducts national surveys to estimate habitual salt intake in the general adult population by collecting 24h urine. Baseline assessment was in 2008-2012 from random samples of persons aged 35-79 years, resident in all 20 Regions. A new survey is ongoing (2018-2019) involving persons aged 35-74 years, resident in 10 Regions. Surveys are funded by the MoH-CCM; urinary sodium excretion is effected by a central lab at Federico II University of Naples, subjected to strict quality controls.

Results

The baseline survey showed a mean sodium excretion of 10.6 g/24h (95% confidence interval 10.5-10.8) in 1963 men and 8.2g/24h (8.1-8.4) in 1894 women. Results of the ongoing survey are expected in the coming months.

Lessons

In Italy preventive actions of salt reduction supported by the MoH have been implemented. Estimation of salt intake in diet by 24h/urine is included. Results of baseline and on-going surveys will allow to estimate the possibility of meeting the WHO salt reduction target by 2025.

Key messages

In Italy inter-sectors preventive actions of salt reduction are implemented. Results of the baseline and on-going surveys will allow to estimate in Italy the possibility of meeting the WHO salt reduction target by 2025.

Excess dietary sodium and inadequate potassium intake in Italy: results of the MINISAL study

OBJECTIVE

As excess sodium and inadequate potassium intake are causally related to hypertension and cardiovascular disease, the MINISAL-GIRCSI Program aimed to provide reliable estimates of dietary sodium and potassium intake in representative samples of the Italian population.

DESIGN AND METHODS

Random samples of adult population were collected from 12 Italian regions, including 1168 men and 1112 women aged 35-79 yrs. Electrolyte intake was estimated from 24 hour urine collections and creatinine was measured to estimate the accuracy of the collection. Anthropometric indices were measured with standardised procedures.

RESULTS

The average sodium excretion was 189 mmol (or 10.9 g of salt/day) among men and 147 mmol (or 8.5 g) among women (range 27-472 and 36-471 mmol, respectively). Ninety-seven % of men and 87% of women had a consumption higher than the WHO recommended target of 5g/day. The 24 h average potassium excretion was 63 and 55 mmol, respectively (range 17-171 and 20-126 mmol), 96% of men and 99% of women having an intake lower than 100 mmol/day (European and American guideline recommendation). The mean sodium/potassium ratio was 3.1 and 2.8 respectively, i.e. over threefold greater than the desirable level of 0.85. The highest sodium intake was observed in Southern regions. Sodium and potassium excretion were both progressively higher the higher the BMI (p < 0.0001).

CONCLUSIONS

These MINISAL preliminary results indicate that in all the Italian regions thus far surveyed dietary sodium intake was largely higher and potassium intake lower than the recommended intakes. They also highlight the critical association between overweight and excess salt intake.

Infection rate and spontaneous seroreversion of anti-hepatitis C virus during the natural course of hepatitis C virus infection in the general population

BACKGROUND

Hepatitis C virus (HCV) infection is common worldwide but there are different prevalence rates in different countries. Data on the incidence of HCV in the general population are scarce. Spontaneous viral clearance occurs in 10-25% of infected individuals after acute infection yet controversy exists regarding the frequency of spontaneous clearance during the natural course of HCV infection in the general population.

AIMS

Anti-HCV prevalence, HCV infection rate, and the kinetics of anti-HCV were studied in a cross section of the general population of central Italy.

STUDY POPULATION AND METHODS

Anti-HCV prevalence (EIA-3 Ortho, RIBA-3 Ortho Chiron) was estimated in 3884 randomly selected individuals. Infection rate and antibody kinetics were estimated in 2032 participants for whom a second blood sample was taken after a median follow up of seven years. HCV-RNA determination by polymerase chain reaction was performed on follow up sera.

RESULTS

The overall confirmed anti-HCV prevalence was 2.4%. Two participants seroconverted for anti-HCV, giving an overall infection rate of 1.4 cases per 10 000 person years (95% confidence interval 0.2-5.2 per 10 000 person years). Of the 36 individuals confirmed as anti-HCV positive at enrollment, seven (19.4%) showed complete seroreversion. Seven (87%) of the eight individuals with indeterminate results at enrollment were serologically non-reactive at the end of follow up. Of the 25 participants confirmed to be anti-HCV positive at both enrollment and follow up, 23 (92.0%) with stable serological profiles tested positive for HCV-RNA at the end of follow up.

CONCLUSIONS

There is still a permanent risk, although low, of HCV spread in the general population in an area of low level endemicity. In this setting, a wide spectrum of modifications of viral and antibody patterns can be observed in HCV infected patients.

Heart rate as a predictor of mortality: the MATISS project

OBJECTIVES

This study sought to verify the independent role of heart rate in the prediction of all-cause, cardiovascular, and noncardiovascular mortality in a low-risk male population.

METHODS

In an Italian population-based observational study, heart rate was measured in 2533 men, aged 40 to 69 years, between 1984 and 1993. Data on cardiovascular risk factors were collected according to standardized procedures. Vital status was updated to December 1997.

RESULTS

Of 2533 men followed up (representing 24,457 person-years), 393 men died. Age-adjusted death rates for 5 heart rate levels showed increasing trends. The adjusted hazard rate ratios for each heart rate increment were 1.52 (95% confidence interval [CI] = 1.29, 1.78) for all-cause mortality, 1.63 (95% CI = 1.26, 2.10) for cardiovascular mortality, and 1.47 (95% CI = 1.19, 1.80) for noncardiovascular mortality. Relative risks between extreme levels were more than 2-fold for all endpoints considered.

CONCLUSIONS

Heart rate is an independent predictor of cardiovascular, noncardiovascular, and total mortality in this Italian middle-aged male population.

[Cardiovascular risk factors in women in menopause]

BACKGROUND

During menopause, women are more exposed to cardiovascular risk factors, some of them can be easily modified by primary and secondary prevention. This paper describes some demographic indicators and cardiovascular risk factors among Italian women.

METHODS

This study describes the Italian women's cardiovascular risk, using the data collected and updated at the end of the 1990s, within the Cardiovascular Epidemiological Observatory, an Italian Collaborative Project of the Istituto Superiore di Sanità and the Italian Association of Cardiologists.

RESULTS

Women aged 60 years and over represent 13% of the population; regional differences on mean values of cardiovascular risk factors are evident. Hypertension, hypercholesterolemia, diabetes and obesity are prevalent particularly in Southern Italy and among the social classes in the lowest education level.

CONCLUSIONS

The data confirm the importance of the main objectives stated by the National Health Plan 1998-2000: promotion of healthier dietary habits, of physical activity, and reduction of smoking habits. This requires specific action to improve women's health condition, to provide for their special needs and to create awareness among women about the importance of preventive action also during the aging process.

Hand-grip strength predicts incident disability in non-disabled older men

OBJECTIVES

To verify if hand-grip performance in older men is a predictor of disability.

DESIGN

Population-based prospective study.

SETTING

A sample from the Italian rural cohorts of the FINE study (Finland, Italy, Netherlands Elderly), representative of the general population of elderly men surveyed in 1991 and 1995.

PARTICIPANTS

140 men aged 71-91 years who reported no disability in performing activities of daily living (ADLs), instrumental activity of daily living (IADLs) and mobility activities at baseline examination and provided information on their functional status at follow-up 4 years later.

MEASUREMENTS

Disability was defined as needing help in performing ADLs, IADLs and mobility. Hand-grip strength was evaluated at baseline by a mechanical dynamometer.

RESULTS

After adjusting for potential confounding variables, a lower concentration of high-density lipoprotein cholesterol was the only factor predicting disability in men aged 76 years or younger and only reduced hand-grip strength predicted incident disability in men 77 years or older.

CONCLUSION

Poor hand strength as measured by hand-grip is a predictor of disability in older people. The hand-grip test is an easy and inexpensive screening tool to identify elderly people at risk of disability.

Change in cardiovascular risk factors during a 10-year community intervention program

The study describes changes in cardiovascular risk factors during 10 years of a community intervention program conducted in a rural area in Central Italy. Two areas were involved, one for treatment and one for reference. In 1983-84, 739 men and 859 women in the treatment area and 942 men and 1045 women in the control area, aged 20-69 years, were screened; total and HDL cholesterol, systolic and diastolic blood pressure, fasting blood glucose, smoking habit, weight and height were measured. Between 1983 and 1993 several intervention activities based on community medicine were carried out in the treatment area. They were based on interaction with the local socio-sanitary institutions and school system in order to influence individual persons, small groups and entire community. Major effort was addressed to mass health education, nutrition education, antismoking-propaganda and detection and treatment of hypertension, diabetes and hyperlipidemia.

Does the Clock Drawing Test predict cognitive decline in older persons independent of the Mini-Mental State Examination? The FINE Study Group. Finland, Italy, The Netherlands Elderly

OBJECTIVE

To evaluate the value of the Clock Drawing Test (CDT) in predicting cognitive deterioration over a 4-year period, independent of baseline cognitive status evaluated by the Mini-Mental State Examination (MMSE).

DESIGN

A preplanned analysis of data collected during the second (1991) and the third (1995) follow-up of the Italian rural cohorts of the FINE Study (Finland, Italy, the Netherlands Elderly).

SUBJECTS

Of the 427 men (mean age 77.6 +/- 4.1 years; range 72-90 years) interviewed in 1991, 264 survived and were reinterviewed in 1995. The study population included 247 persons who were interviewed and received a complete cognitive evaluation in both 1991 and in 1995.

MEASUREMENTS

Cognitive assessment in 1991 included the MMSE, the Dementia Rating Scale (DRS), and the CDT. The CDT was classified as normal or pathological, based on previously established criteria. The MMSE and the DRS were repeated in 1995.

RESULTS

Independent of age and baseline MMSE, score, subjects with pathological CDT compared with normal CDT had lower MMSE scores at follow-up (P < .01). These results were also confirmed by evaluating cognitive decline through its impact on change over time in daily life autonomy, as measured by the DRS (P < .01). Among persons scoring more than 21 on the MMSE, compared with persons with a normal CDT, those with pathological CDT performance were 5.4 (95% CI: 2.1-14.2) and 5.5 (95% CI: 1.6-19.6) times more likely to have a MMSE score below 21 and 18, respectively, 4 years later, independent of age and baseline MMSE score.

CONCLUSIONS

Findings suggest that the CDT identifies older persons at high risk of cognitive decline and adds prognostic information that supplements the standard MMSE test.

[Prevalence of some cardiovascular risk factors in a sample of the aged population]

The distribution of some cardiovascular risk factors in a cohort of elderly population is reported. The study population consisted of 427 males aged 71-91, examined in 1991 and belonging to the Italian rural section of the Seven Countries Study on Cardiovascular Diseases. Systolic blood pressure shows an increasing trend with age, with mean levels greater than 160 mmHg in each quinquennium, while the prevalence of hypertension ranges between 60 and 75%. Other risk factors considered such as serum cholesterol, triglycerides, weight, height and smoking habit show decreasing levels with ageing. This trend is clear also for fasting glucose from the age group 76-80.