Serum cholesterol, diet, and the decline in coronary heart disease mortality

There has been a recent and dramatic decline in coronary heart disease death rates in the United States. The possible contribution of secular trends in serum cholesterol to this decline was examined by comparison of data from five epidemiologic studies: the Framingham Study, the Tecumseh Study, the Health Examination Survey, the Health and Nutrition Examination Survey, and the Lipid Research Clinics Program Prevalence Study. It appears that in the 1960s there was a modest decline in serum cholesterol levels (approximately 5 mg/dl in middle-aged adults). Although it is impossible to exclude methodologic variation as the main explanation for the observed trends, the contribution of dietary changes to this decline was also examined, by comparison of data from the Diet-Heart Study and the Lipid Research Clinics study. The decline in serum cholesterol was found to be consistent with the observed changes in dietary fat intake in the 1960s. When the potential impact of the decline in cholesterol levels on coronary heart disease death rates was assessed by use of a Framingham multivariate logistic risk function, it was found that a decline in cholesterol of 5 mg/dl would predict a 4.3% decline in 6-year coronary heart disease death rates in middle-aged men.     

Contesting lifestyle risk and gendering coronary candidacy: lay epidemiology of heart disease in Finland in the 1970s

This study addresses two issues currently under critical discussion in the epidemiology of cardiovascular diseases (CVD), the relative neglect of women and the individualised nature of key risk factors. It focuses on the North Karelia project (NKP), a community programme aimed at coronary heart disease (CHD) prevention in a predominantly rural Finnish region in the early 1970s, that is, during a period when the epidemiological understanding of CVD still was relatively new and actively promoted. Adopting the notions of lay epidemiology and coronary candidacy, culturally mediated explanatory models lay people use to assess who is likely to develop heart disease and why, the study shows that locals targeted by the project critically engaged with both of these bias. Based on the rich materials resulting from project activities the study shows, first, how many locals subsumed the individualised and lifestyle‐based approach to CHD prevention promoted by NKP under a more general framework emphasising the health effects of ongoing structural changes in the area, and second, how women constructed themselves as viable coronary candidates. The case supports the position in the current discussions on lay expertise that wants to integrate lay experiences more firmly into epidemiological studies and public health.     

The effects of acculturation on healthy lifestyle characteristics among Hispanic fourth-grade children in Texas public schools, 2004-2005

BACKGROUND: Childhood obesity is a national epidemic that disproportionately affects Hispanic children. Evidence suggests that increased acculturation among this population adversely affects diet and other healthy lifestyle characteristics, leading to higher rates of overweight and obesity. Healthy lifestyle characteristics must be understood in order to prevent or decrease overweight and obesity among Hispanic children. METHODS: Using the School Physical Activity and Nutrition (SPAN) study, we examined cross‐sectional data on healthy lifestyle characteristics collected in Texas public schools from Hispanic fourth‐grade children in 2004–2005. We calculated adjusted odds ratios and associated confidence intervals using multivariate logistic regression analyses to analyze the association between acculturation and healthy lifestyle characteristics among Spanish‐speaking Hispanic children compared to English‐speaking Hispanic children. RESULTS: Spanish‐speaking Hispanic boys consumed more milk and fruit than English‐speaking Hispanic boys (milk: adjusted odds ratio [AOR]: 1.7, p = .02; fruit: AOR: 2.5, p = .0001). The likelihood that Spanish‐speaking Hispanic boys and girls did not know that there is a relationship between overweight and health problems were 2 times greater (boys: AOR: 1.7, p = .03; girls: AOR: 2.2, p = .006) than their English‐speaking Hispanic counterparts. Likelihood of weight loss attempts was greater among Spanish‐speaking Hispanic boys than English‐speaking Hispanic boys (AOR: 1.9, p = .04). CONCLUSIONS: Results are mixed. Lower levels of acculturation appear to be associated with both positive and negative healthy lifestyle characteristics, depending on sex. These findings have important implications for school health policies and programs and should be distributed to school administrators.     

'Think differently and be prepared to demonstrate trust': findings from public hearings, England, on supporting lay people in public health roles

Professional support processes are critical for the establishment and maintenance of community health worker programmes. This paper reports on three public hearings held in England, UK, that were conducted as part of a national study into approaches to develop and support lay people in public health roles. Individuals with relevant theoretical or practical expertise, including lay activists, presented evidence in public as expert witnesses. Formal presentations, questions and plenary discussions were recorded and later analysed as qualitative data. This paper presents the results and critically examines emergent issues relating to the sustainability of lay health worker programmes. Consideration is given to the diversity of contemporary practice in England. Barriers seen to affect sustainability included organizational culture and onerous bureaucratic processes. Major themes emerging from the expert evidence included recruitment and training strategies, financial support and the need for a robust infrastructure. The expert hearings, in creating a public space for deliberation, opened up discussion on the levels and type of programme support required to foster lay health worker programmes. The paper concludes that professional support needs to be accompanied by a reorientation of public services to support lay engagement in programme delivery.     

Contextualising lifestyles: how socially contrasting places in Fife,Scotland influence lay understandings of lifestyle and health behaviours in relation to coronary heart disease

Coronary heart disease (CHD) is a significant public health issue showing persistent geographical health inequalities. However, little attention has focussed on lay perspectives of how contrasting social contexts influence lifestyles and health behaviour in relation to CHD. The aim of this qualitative study is to explore lay perspectives of lifestyle and behaviour in socioeconomically contrasting places, with women and men who had survived a heart attack in Fife, Scotland. This study contributes to knowledge on CHD health inequalities and health promotion, particularly cardiac rehabilitation, emphasising the importance of situating experiences and understandings of health, geographically.     

Effects of hostility and lifestyle on coronary heart disease among middle-aged urban Japanese.

OBJECTIVE: To explore the association between multi-dimensional aspects of hostility and coronary heart disease among middle-aged urban Japanese. SUBJECTS AND METHODS: We conducted a case-control study. Cases were consecutive patients with acute coronary syndrome admitted to a hospital in Japan. Fifty-three patients (45 men and 8 women) aged 35 to 65 were enrolled. For each case, two sex and age (+/-2 years) matched controls were recruited from among participants in a health check-up program at a health promotion center located in the same area as the hospital. Two questionnaires, both with four components, were used to measure hostility and coping with anger: the one was for anger, hostility, physical aggression and verbal aggression, and the other for aggression, social inhibition, guilt, and controlled affect. RESULTS: The scores of all components from two questionnaires were higher for cases than controls, but the differences were not significant. Multivariate analysis showed that anger, fat intake, alcohol consumption and house size were significantly associated with the etiology of acute coronary syndrome. CONCLUSION: Anger, lifestyle, and socioeconomic status play important roles for the etiology of coronary heart disease in middle-aged urban Japanese.     

生活方式和膳食因素与高尿酸血症关系的病例对照研究

目的探讨生活方式及膳食因素中存在的高尿酸血症的危险因素。方法采用病例对照研究,采用logistic回归模型筛选高尿酸发病的危险因素。结果豆类、鱼虾类、奶类、汤类、坚果类这5大类是高尿酸发病的危险因素,饮酒史OR=3.972,甜食OR=2.011,维生素C OR=0.657、饮茶OR=0.409,这4个因素与高尿酸血症的发生有关系。其中饮茶、补充维生素C与高尿酸的发病成负相关。结论减少饮酒,少食海鲜类和豆类富含嘌吟的食物,补充维生素C,多饮茶可以预防或者减少高尿酸血症的发生。     

安徽省公安和疾病控制系统有关人员艾滋病知识态度调查报告

目的了解安徽省公安和疾病控制系统有关人员艾滋病知识、态度和行为(KAP)水平。方法采用标准问卷对参加“全省公安监管场所艾滋病病毒抗体筛查培训班”的学员进行自填式问卷调查。结果收到有效问卷154份,能全部正确回答所有20个知识问题的共有42人,占28.4%;能正确回答80%及以上问题的共有119人,占80.4%;疾控人员正确应答率明显高于公安人员(P<0.001)。调查对象对3条传播途径的了解顺序为:性传播>血液传播>母婴传播(χ2=80.72,P<0.001)。艾滋病知识知晓率同职业有关,同人口学指标在去除工作系统混杂后都无统计学关联。对于5个态度问题,能全部给出有利于艾滋病防治答案的共有89人,占60.1%;能给出80%及以上有利答案的共有118人,占79.7%;疾控人员正确应答率明显高于公安人员(P<0.001)。多因素分析表明,态度同职业有关;在疾控系统内,态度同艾滋病知识有关(P=0.026)。结论公安系统有关人员中,还有不少人艾滋病知识水平不高,甚至存在一些错误概念,少数人持有不利于艾滋病防治的态度;疾控系统人员虽然比公安系统人员具有较高的艾滋病知识和有利态度,但作为从事艾滋病防治工作的业务人员来说,仍然需要进一步提高。     

The impact of public cholesterol screening on diet, general well-being, and physician referral.

Public cholesterol screenings have become common. To evaluate the public health impact of such events, we conducted a public cholesterol screening and, three months later, invited participants between the ages of 18 and 72 to return for follow-up. More than 77% (N = 143) returned. We collected information on diet and general well-being at baseline and follow-up, and we obtained information on further medical evaluation of the initial cholesterol value at follow-up. Diet improved regardless of baseline cholesterol level (overall diet score 2.10 baseline, 1.75 follow-up, P less than .001). There were no adverse psychosocial ("labeling") effects in persons told of elevated cholesterol levels. About one-third of individuals referred to their physicians for elevated cholesterol values discussed the cholesterol issue with their physicians, as did a similar proportion of those told of a desirable cholesterol level. Total cholesterol decreased from 218.5 to 211.6 mg/dL (P = 0.18, 95% CI for the change, -18.5 to +4.7 mg/dL). Public cholesterol screening did not appear to have any adverse effects and may lead to beneficial changes in diet in persons screened.     

Mediterranean diet adherence in the Mediterranean healthy eating,aging and lifestyle (MEAL) study cohort

A decline in adherence to the Mediterranean dietary pattern has been observed over the last years. The aim of this study was to assess the level of adherence to the Mediterranean diet and possible determinants in the Mediterranean healthy Eating, Aging and Lifestyle (MEAL) study cohort. Demographic and dietary data of 1937 individuals were collected in 2014–2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and the MEDI-LITE score were used to assess adherence to the Mediterranean diet. The score well characterised consumption of major food groups, micro- and macro-nutrients. The cohort had a general good adherence, but only a minority was highly adherent. High adherence was directly associated with education, non-smoking and physical activity and inversely with high occupational status. In conclusions, Mediterranean diet is still followed in Sicily; however, nutrition education campaigns should promote healthy traditional dietary patterns in certain groups of individuals.     

Unscrambling the research: Eggs, serum cholesterol and coronary heart disease

The role of dietary cholesterol in raising plasma cholesterol levels has been debated over the past 25 years. Consequently, eggs, as a food high in dietary cholesterol, have been targeted as a food to limit when advising patients on a diet to lower serum cholesterol levels. The aim of the present review was to evaluate the literature to address the effects of dietary cholesterol from eggs on serum cholesterol levels and risk of coronary heart disease. An increase in dietary cholesterol from eggs by 100 mg daily, equivalent to half a medium egg or three to four eggs a week, results in an increase of approximately 0.05 mmol/L in LDL cholesterol. Adding 100 mg of cholesterol per day (equivalent to three to four eggs a week) to a high saturated fat diet caused an increase in LDL cholesterol of 0.061 ± 0.006 mmol/L, whereas adding the same quantity of cholesterol to a low saturated fat diet caused an increase in LDL cholesterol of only 0.036 ± 0.004 mmol/L (P = 0.03). Despite the small increase in LDL‐cholesterol levels with increasing egg intake, most epidemiological studies have shown little or no association between egg intake and risk of coronary heart disease. However, the impact of dietary cholesterol for people with type 2 diabetes has been poorly studied. In conclusion, in a healthy Western population, there is insufficient evidence to excessively restrict egg intake as part of a healthy diet. Eggs should be considered in a similar way as other protein‐rich foods and selected as part of a varied diet that is low in saturated fat and contains a variety of cardio‐protective foods such as fish, wholegrains, fruits, vegetables, legumes and nuts.     

Relationships among diet, physical activity and other lifestyle factors and debilitating diseases in the elderly

Diet and physical activity are two major lifestyle factors that play a role in the prevention or management of debilitating conditions affecting older people. Both under- and overnutrition predispose to diseases. Low sodium and high potassium intakes, as well as the consumption of fruits and vegetables are associated with a reduction of hypertension and diseases arising from hypertension such as stroke and dementia. Dietary patterns (consumption of quantity and types of fats, cholesterol, vegetable oils, fish) are important in the prevention of coronary heart disease. Calcium and vitamin D intakes are important factors in the development of osteoporosis, while various dietary factors have been linked to the development of cancer. Physical activity is important in the prevention of functional decline and increased survival, reduced incidence of falls and fractures, and has various cardiovascular health benefits. Apart from prevention of diseases, exercise also has an important role in improving function in some chronic diseases such as heart failure or chronic obstructive pulmonary disease. Both diet and exercise interact, so that public health recommendations often take the form of lifestyle modification advice in the prevention of disease and disability.     

饮食服务职业人群高血压、冠心病与膳食因素调查

为了解饮食服务行业炊管人群高血压、冠心病及膳食因素,为更好地在特殊职业人群中开展高血压、冠心病综合预防措施提供可靠依据。于2002年5月我们对临沂市直部分20-59岁特殊职业人群进行了抽样调查。1 对象与方法1.1调查对象 2002年5月,在临沂市直饮食服务行业(宾馆、招等所、食堂)从事饮食服务行业炊管人员及其机关工作人员(对照组)共740人进行了高血压、冠心病调查,饮食服务炊管人员368名,平均看年龄34岁,机关工作人员372名,平均年龄33岁。     

Dietary habits, lifestyle and cardiovascular risk factors in a clinically healthy Italian population: the 'Florence' diet is not Mediterranean

OBJECTIVE: To evaluate dietary habits and lifestyle of Italian subjects, to provide current data on adequacy of the nutritional guidelines and recommendations especially in relation to primary prevention of cardiovascular diseases and to assess the influence of dietary habits on lipid profile and homocysteine levels. DESIGN: Cross-sectional. SETTING: Population-based study. SUBJECTS: A sample of 520 clinically healthy subjects (211 males, 309 females) with a mean age of 46 y, living in Florence area, Italy. INTERVENTIONS: Dietary pattern was assessed by trained dietitians through a semiquantitative food questionnaire. Fasting blood samples were drawn for assessment of lipid profile, homocysteine and circulating vitamins. RESULTS: Contribution from total fats was over 30% in about 70% of subjects and intake of saturated fatty acids (SFA) was above the recommended values in at least 40% of the study population. Furthermore, almost the whole (99.6%) population reported low intake of polyunsaturated fatty acids (PUFA). High levels of total cholesterol were present in over 40% of the study population, whereas abnormal values of LDL-cholesterol were observed in about 30%. High levels of homocysteine were found in 11.7% of the study population. An extremely high percentage of subjects reported low intake of vitamins, especially with regard to folic acid (89%), vitamin B(6) (70.1%) and vitamin E (99.6%). In a multiple linear regression model, circulating levels of vitamin B(12) and folic acid, and intake of alcohol and vitamin C resulted in being independently associated with homocysteine plasma levels. CONCLUSIONS: In a typical Mediterranean country, general outlines of Mediterranean diet are not completely followed, especially concerning total fats, SFA, PUFA and vitamins' intake. SPONSORSHIP: Ministero della Salute (Italy) - 'Progetto per la Salute e la Prevenzione di Malattia' 2001-2003.