Recent Changes In Lifestyle Research Articles

Cardiovascular disease and risk factors in three Alaskan Eskimo populations: the Alaska-Siberia project

Objectives. To determine the prevalence of CVD and to identify and characterize associated risk factors in three distinct Eskimo populations.Study Design. Cross-sectional.Methods. A slightly modified Strong Heart Study protocol was followed to examine 454 participants, aged 25–91, from four villages.Results. Overall, 6% of the participants under 55 years of age and 26% of those ≥ 55 years of age showed evidence of CHD by ECG, or in patient records. The prevalence of “definite coronary heart disease” (CHD) in women with glucose intolerance (GI) was 21.0%, compared to 2.4% in those with normal glucose tolerance (NGT). Men had comparable values of 26.7% and 6.3%. In addition, comparable values for “possible CHD” were 29.7% vs 6.0% for women and 21.4% vs 8.0% for men. GI was associated with relatively higher prevalences of CHD in women than in men (prevalence ratio = 8.5 vs 4.3). CHD was significantly related to age, glucose intolerance and insulin. Hypertension and obesity were significantly associated with CHD only in some ethnic groups. The prevalence of current smokers was 56%.Conclusions. Recent changes in lifestyle and diet of Alaskan Eskimos, leading to obesity, hypertension, insulin resistance and DM, contribute to an increased risk for cardiovascular disease. (Int J Circumpolar Health 2005; 64(4):365–386)

Cancer and non-cancer epidemiological study in the high background radiation area of Yangjiang, China

The major objective of this study is to examine cancer mortality risk associated with low-level radiation exposure occurring in the high background radiation area (HBRA) in Yangjiang of Guangdong Province, China. The average annual effective doses received by the inhabitants from natural sources of external and internal exposures in HBRA are estimated to be 2.10 and 4.27 mSv, respectively, and the corresponding doses in the control area (CA) to be 0.77 and 1.65 mSv. We analyzed the mortality of non-cancer diseases as well in order to shed light on the comparability of the HBRA and the CA. We examined mortality for cancer and non-cancer diseases during the period 1979–1998. The prospective mortality study followed 125,079 subjects during the period 1979–1998, accumulated 1,992,940 person-years (PYs) at risk, and ascertained 12,444 deaths, including 1202 cancer deaths. The mortality of all cancer showed no difference between the HBRA and the CA [relative risk (RR)=1.00; 95% confidence interval (CI), 0.89 to 1.14]. When cancer deaths were limited to persons with pathological diagnosis, the RR changed only slightly (RR=0.99; 95% CI, 0.78 to1.26). The RR was not evidently modified by sex or age or follow-up period (1979–1986, 1987–1998). In site-specific cancer mortality analysis, only cancer of the esophagus showed a statistically significant excess in the HBRA (RR=2.61; 95% CI, 1.11 to 7.66). However, the observed excess mortality of esophageal cancer did not show a monotonic increase with external radiation dose or cumulative lifetime dose. The RR comparing non-cancer mortality in the HBRA with that in the CA was 1.06 (95% CI, 1.01 to 1.10), which was a statistically significant increase. However, the excess was limited to those aged under 50 and the latter half of the observation period (the period 1987–1998), suggesting that the excess mortality may be due to recent changes in lifestyles of the younger generations. In the cause-specific analysis of non-cancer deaths, disease of the digestive organs showed a statistically significant increase. This appears to be mainly due to liver diseases. In conclusion, the present study showed no increase of cancer mortality in the HBRA. However, it is difficult for the present study to support or deny the possibility that the radiation-related cancer risk associated with chronic exposure to low-dose radiation may be different from the risk associated with high dose ranges or high dose-rate exposure. The observed increase of non-cancer mortality in the present study is unlikely to be attributable to radiation exposure.

Breast Cancer Incidence in the City and Province of Palermo in 1999‐2002: A Breast Cancer Registry Report

The aim of this study was to assess the incidence of breast cancer in women from the city and province of Palermo (Sicily) in 1999, 2000, 2001, and 2002, using a population-based cancer registry approach. In recent years, a sharp increase of breast cancer incidence has been observed worldwide. Overall, direct age-standardized incidence rates (SIR) were 81.0 per 100,000 person-years, higher in Palermo City (89.4) than in Palermo Province (70.4). Results reported here show a highly significant difference in breast cancer incidence in different areas of Sicily, particularly in the youngest age groups; and a profound difference between the metropolitan area of Palermo and the surrounding areas. The evidence of the different breast cancer incidence in Palermo City and in the other small municipalities of Palermo Province suggests a different cancer risk pattern that seems to be related to recent changes in lifestyle and diet.

Breast cancer registry in Palermo and its Province: incidence in 1999.

The incidence of breast cancer in the city of Palermo and its Province was investigated. The cancer rate was higher in the city of Palermo (100.8/100,000/year), a great southern urban area, than in the 81 municipalities of the Province (79.2/100,000/year). Rates were also compared with those in other geographic areas of Italy, showing a smaller than expected negative north-south gradient in incidence, especially in the young age group, as shown by the cumulative risk observed in the 0-54-year-old group. These findings confirm the role of recent life style changes in the cancer risk distribution.

日本人の内頚動脈病変とその診断・治療

Recent changes in lifestyle have caused an increase in extracranial internal carotid artery (ICA) lesions in Japan. The prevalence of severe ICA atherosclerosis with>50% stenosis in the Suita City was 4.4% (7.9% in men and 1.3% in women), being almost equal to that reported in developed western countries. Several clini-cal studies also indicated that atherothrombotic brain infarction particularly due to extracranial ICA lesions has rapidly been increasing in frequency in Japan. The ICA lesions have strong relationships to cardiovascu-lar risk factors and coronary heart diseases.Carotid ultrasonography is a rapid, noninvasive and accurate way to examine ICA lesions. Diffusion MRI studies will provide new knowledge how ICA lesions produce infarcts particularly in borderzone areas.The efficacy of carotid endarterectomy (CEA) in the management of severe ICA stenosis was established in US, Canada, and Europe, but not in Japan. Carotid artery stenting remains a matter of investigations. Clini-cal evidence on the effectiveness and limitations of such surgical interventions and medicla management with antithrombotic agents and HMG-CoA blockers should be collected for Japanese patients with ICA lesions.

Association among 5-year changes in weight, physical activity, and cardiovascular disease risk factors in Mexican Americans.

Recent changes in lifestyle have led to a global epidemic of obesity. To determine the associations of these changes with cardiovascular disease (CVD) risk, the authors correlated changes in CVD risk factors with changes in weight and physical activity in a population-based sample of 539 Mexican Americans in the San Antonio Heart Study in 1992-1999 who were examined twice approximately 5 years apart. Average weight change during that interval was 2.7 kg. While change in physical activity (expressed as percent change) was associated modestly only with change in low density lipoprotein cholesterol median diameter (p = 0.017), weight change was strongly and positively associated with unfavorable changes in lipid and lipoprotein traits, insulin levels, and blood pressure, explaining 2-10% of the variation in the risk factor changes during the interval. The unfavorable associations with weight gain tended to be more pronounced in lean compared with obese individuals and in men compared with women. However, the associations were significant for most CVD risk factors in all groups. In Mexican Americans, a population at high risk for obesity, weight change was positively correlated with metabolic variables associated with risk of CVD. Therefore, increasing adiposity in this population may tend to slow, or even reverse, the decline in CVD morbidity and mortality.

Low dietary fiber and high protein intakes associated with newly diagnosed diabetes in a remote aboriginal community

The high prevalence of diabetes mellitus in North American aboriginal populations may be due to recent changes in lifestyle, including the adoption of a high-fat, low-fiber diet. To determine whether fat or fiber intakes were associated with new cases of diabetes, we studied 72% (728/1018) of residents aged > 9 y from a remote aboriginal community in northern Ontario using the 75-g oral-glucose-tolerance test and 24-h dietary recall. The mean fat intake of this population (36% of energy) was typical for North America, but fiber intake (1.2 g/MJ) was very low. Logistic-regression analysis, adjusted for age, sex, and body mass index, showed that a 1-SD increase in fiber intake reduced the risk of having diabetes by 39% (P = 0.026) whereas the same increase in protein intake increased the risk by 38% (P = 0.027). There was no significant effect of energy, fat, starch, or simple sugars. These data support Trowell's original dietary-fiber hypothesis that "... dietary fiber depleted starchy foods are conducive to the development of diabetes mellitus in susceptible human genotypes."

Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: the Suita study.

Because extracranial carotid atherosclerotic lesions have been considered rare, no reports have been published on the prevalence and distribution of these lesions in a general Japanese population. However, recent changes in lifestyle are thought to have caused an increase in these lesions. The aim of this study was to use high-resolution ultrasonography to examine the prevalence of asymptomatic extracranial carotid artery lesions and its relation to cardiovascular risk factors in an urban Japanese population. The subjects were 814 men and 880 women aged 50 to 79 years randomly sampled from the residents of Suita, a city located in the second largest urban area of Japan. Asymptomatic carotid lesions were detected and evaluated by a single physician with high-resolution B-mode ultrasonography. We found significant sex differences in the prevalence of atherosclerotic lesions in the extracranial carotid artery; 4.4% of all the subjects, 7.9% of the men, and 1.3% of the women had atherosclerosis accompanied by stenosis of >50%. A strong association between these lesions and the results of a 75-g oral glucose tolerance test was found in both sexes. Multiple regression analysis of carotid atherosclerosis showed significant relationships with age, systolic blood pressure, fasting blood glucose, pack-years of smoking, total serum cholesterol, and HDL cholesterol in men (P<.05) and significant relationships with age, systolic blood pressure, pack-years of smoking, and total serum cholesterol in women (P<.05). Our data showed that cardiovascular risk factors were strongly related to carotid atherosclerosis and that the proportion of severe carotid atherosclerosis with >50% stenosis was not low and was almost equal to that reported in developed western countries.

Non‐insulin‐dependent Diabetes Mellitus (NIDDM) in Korea

The prevalence of diabetes mellitus in Korea has increased tremendously during the past several decades. In addition to the explosive increase of diabetes mellitus, the clinical characteristics of diabetes mellitus in Korea seems to be quite different from those of Western countries. Most patients with non-insulin-dependent diabetes mellitus (NIDDM) are non-obese and many of them lose weight significantly during the course of developing diabetes. The pathogenic mechanism(s) underlying this phenotype is still unclear. A subgroup of patients known as slow onset IDDM exists, but this could not explain the majority of non-obese NIDDM in Korea. In order to examine whether insulin resistance/hyperinsulinaemia is important in the development of NIDDM we conducted the following studies. Fasting plasma glucose and insulin concentration were measured in subjects with normal glucose tolerance, impaired glucose tolerance and diabetes mellitus. The peak plasma insulin level was much lower than that of Pima Indians or Caucasians. We also found that the insulin sensitivity index measured by euglycemic hyperinsulinaemic clamp in the first degree relatives of Korean NIDDM patients was not lower than that in a control group. This data suggests that insulin resistance, or hyperinsulinaemia, does not play a major role in the development of NIDDM in Korea. Taken together with the rarity of obese NIDDM in Korea, it maybe suggested that the insulin secretory capacity of Korean people being smaller than Western people they cannot compensate for the insulin resistance imposed by recent changes in life style.

Cancer in the Gizan Province of Saudi Arabia: An Eleven Year Study

The occurrence of histologically diagnosed primary malignant tumors in Saudi and Yemeni patients in Gizan Province over the 11 years from 1982 to 1992 was analyzed. During the study period, 1398 malignancies of known primary site were seen in males and 972 in females. In common with other parts of Saudi Arabia, the overall incidence of malignant disease was low by Western standards with lymphoreticular malignancies relatively common and tumors of lung, bowel, breast and the female genital system relatively uncommon. Some malignancies are more common in Gizan Province as compared to elsewhere in Saudi Arabia. Oral cancer was the most common malignancy in females and the most common overall, probably due to widespread use of oral tobacco preparations. Liver cancer was the most common malignancy in males, reflecting the endemic nature of hepatitis B in the area. The incidence of bladder cancer, and particularly of squamous carcinoma of the bladder, was also more, probably due to the high incidence of schistosomiasis in the area. No significant trends in incidence of specific malignancies were noted over the 11-year study period, even though the period has been marked by dramatic and unprecedented changes in lifestyle and public health.

Progression of carotid atherosclerosis in Japanese patients with coronary artery disease.

Along with the recent changes in lifestyle in Japan, the incidence of coronary artery disease has increased while the incidence of stroke appears to be decreasing. We investigated the relation between the progression of carotid atherosclerosis and the severity of coronary artery disease in the Japanese population. The 2-year change in extracranial carotid atherosclerosis in 50 Japanese patients who underwent coronary angiography was evaluated using carotid echotomography. To quantify the extent of carotid atherosclerosis, the maximal thickness measurements of all plaques were summed for an individual plaque score, except for new plaques found on reexamination. Carotid disease progression was evaluated by the sum of plaque score change and the thickness of the new plaque found on reexamination. The plaque score changed by -3.2 to 10.1 mm (mean +/- SD, 1.06 +/- 2.42 mm). The extent of coronary atherosclerosis (p less than 0.02) and serum total cholesterol level (p less than 0.01) were different between the progressing (n = 17) and the nonprogressing (n = 30) groups of carotid atherosclerosis when the progressing group included the patients with a delta plaque score of greater than or equal to 1.0 mm. Neither age, serum triglyceride level, serum high-density lipoprotein cholesterol level, pack-years of smoking, percentage of smokers, percentage of hypertensive patients, nor percentage of diabetic patients was different between the two groups. Carotid disease progression was significantly higher in patients with three-vessel coronary disease than in patients without significant coronary artery disease (p less than 0.005). There was a significant positive linear correlation between carotid disease progression and Gensini's coronary artery disease score (R = 0.411, p less than 0.005). Our data showed that severe coronary artery disease and a high serum total cholesterol level were strong predictors for carotid disease progression in Japanese patients with high rates of coronary artery disease.

Análisis Edad-Período-Cohorte de la Mortalidad Por Cardiopatía Isquémica en España 1965–1985

With the objective of studying the temporal evolution of ischaemic cardiopathy (IC), or coronary heart disease mortality, in Spain, we carried out a cohort analysis with conventional graphic techniques and modern statistical methods. This permits better understanding and quantification of the age-period-cohort effects and identification of the potential factors operating upon them. To this end, loglineal (Poisson regression) models were constructed of the IC mortality rates for both sexes, using the GLIM package, in which the regression coefficients are the natural Relative Risk (RR) logarithms of the various age groups (35-74 years), period of death (1970-1985) and birth cohort (1985-1960) with respect to the reference group mortality, controlled by the effect of other groups. In respect of the results, the maximum RR value corresponds to decrease year 1975, and falls progressively to 1985, though at all times remaining above the 1970 value. The effect of 1985, though less than 1980, does not present significant differences from the latter. Nevertheless, no clear cohort effect was found. As a probable explanation for the pattern observed, this would suggest recent changes in life style and in medical attention. There is a discussion of the consistency of the models selected with the graphical results and with present knowledge of the natural history of IC and with the evolution of its determining factors, together with validation of the models. In summary, the IC mortality patterns observed show an increase up to the mid-seventies, and stabilization from that date onwards, in all age and sex groups, which is consistent with an age-period effect.