An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men

Bobák, Martin; Hw, Hense; Kark, Jeremy D.; Kuch, Bernhard; Vojtíšek, Petr; Sinnreich, Ronit; Gostomzyk, J. G.; Bui, Mai H.; Eckardstein, Arnold von; Junker, Ralf; Fobker, Manfred; Schulte, Helmut; Assmann, Gerd; Marmot, Michael

doi:10.1093/ije/28.3.437

Cited by 44 publications

(22 citation statements)

References 34 publications

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“…Third, our study does not seek to explain the whole geographic variation in coronary mortality, since it is also due to non-dietary factors, particularly genetic, biological, such as homocysteinaemia and blood coagulability (Stampfer & Rimm, 1999;Bobak et al, 1999), or behavioural, such as Dietary patterns and Spanish children F Rodríguez-Artalejo et al physical activity during child-and adulthood (Byers et al, 1998). Lastly, our results are of practical relevance.…”

Section: Discussionmentioning

confidence: 87%

Dietary patterns among children aged 6–7 y in four Spanish cities with widely differing cardiovascular mortality

et al. 2002

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Objective: Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6 -7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. Design and setting: Cross-sectional anthropometric and dietary survey in four cities in Spain. Subjects: A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. Outcome measures: Body mass index (BMI), overweight (BMI > 17.6 kg=m 2 ), obesity (BMI > 20.1 kg=m 2 ) and intake of food and nutrients. Results: Children in the four cities showed a high prevalence of overweight (range across cities, 28.9 -34.5%) and obesity (8.5 -15.7%). They also had a moderately hypercaloric diet (range, 2078 -2218 kcal=day), marked by an excessive intake of lipids (45.0 -47.3% kcal), particularly saturated fats (16.6 -16.9% kcal), proteins (17.0 -17.3% kcal), sugars (20.0 -21.9% kcal) and cholesterol (161.6 -182.9 mg=1000 kcal=day), and a low intake of complex carbohydrates (17.5 -18.1% kcal) and fibre (19.6 -19.9 g=day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg=m 2 ; P ¼ 0.0001) and ponderal index (0.58 kg=m 3 ; P ¼ 0.0001) and a higher intake of energy (104 kcal=day; P ¼ 0.007), cholesterol (16.00 mg=1000 kcal=day; P ¼ 0.0001) and sodium (321 mg=day; P ¼ 0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. Conclusions: Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences.

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Section: Discussionmentioning

confidence: 87%

Dietary patterns among children aged 6–7 y in four Spanish cities with widely differing cardiovascular mortality

et al. 2002

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“…The three selected accession countries from central Europe also appear to have mean intakes well below the WHO recommended 400 g person 21 day 21 . There is evidence from former Socialist economies that low intake of fruits and vegetables is not only widespread but is responsible for a significant proportion of the health gap, contributing to the high mortality from non-communicable diseases 32,33 . The effect of levelling up to the highest consuming group shows that the potential health gain could result in some tens of thousands of deaths saved each year under the age of 65 years.…”

Section: Discussionmentioning

confidence: 99%

The potential contribution of increased vegetable and fruit consumption to health gain in the European Union

Joffe

Robertson

2001

Public Health Nutr.

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Background: The risk of many important diseases can be reduced by consuming a diet rich in vegetables and fruit. For this reason the World Health Organization (WHO) recommends a daily intake of more than 400 g person 21 . The pattern of both the supply and intake of vegetables and fruit and the potential health gain achieved by increasing intake in the European Union (EU) and three accession countries are presented in this paper. Methods: Patterns of supply and dietary intake were assessed using (1) FAO food balance sheets, which allow comparison between the levels of supply in countries but do not reflect actual intake; and (2) survey data reflecting dietary intake. Using WHO mortality data for coronary heart and cerebrovascular disease and major cancers up to age 65 years, the number of preventable deaths is estimated, assuming vegetable and fruit consumption were levelled up to that of the highest consuming group, and assuming relative risks of 0.5, 0.7 or 0.9. Results: Vegetable and fruit consumption varies considerably between EU Member States. The populations of about half (seven) of the EU Member States have a mean daily intake of less than 275 g. Using the best current estimates of relative risk, over 26,000 deaths before the age of 65 years would be prevented annually in the EU if intake was levelled up to the highest consumption levels (and about double this number of deaths before the age of 75 years). Conclusion: Increasing the intake of vegetables and fruit is feasible and could result in considerable improvements in public health within the EU. Priority should be given to developing methods that demonstrate the burden of disease caused by too low intakes of vegetables and fruit. This would enable the appropriate social, cultural and economic policies to be developed within the EU.

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“…The subjects of this analysis were participants of the German sample of a trinational population-based study [9]. Age-stratified random samples of men and women aged 45–65 years were drawn from the population of Augsburg (Germany).…”

Section: Methodsmentioning

confidence: 99%

Determinants of Short-Period Heart Rate Variability in the General Population

et al. 2001

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Decreased heart rate variability (HRV) is associated with a worse prognosis in a variety of diseases and disorders. We evaluated the determinants of short-period HRV in a random sample of 149 middle-aged men and 137 women from the general population. Spectral analysis was used to compute low-frequency (LF), high-frequency (HF) and total-frequency power. HRV showed a strong inverse association with age and heart rate in both sexes with a more pronounced effect of heart rate on HRV in women. Age and heart rate-adjusted LF was significantly higher in men and HF higher in women. Significant negative correlations of BMI, triglycerides, insulin and positive correlations of HDL cholesterol with LF and total power occurred only in men. In multivariate analyses, heart rate and age persisted as prominent independent predictors of HRV. In addition, BMI was strongly negatively associated with LF in men but not in women. We conclude that the more pronounced vagal influence in cardiac regulation in middle-aged women and the gender-different influence of heart rate and metabolic factors on HRV may help to explain the lower susceptibility of women for cardiac arrhythmias.

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An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men

Cited by 44 publications

References 34 publications

Dietary patterns among children aged 6–7 y in four Spanish cities with widely differing cardiovascular mortality

Dietary patterns among children aged 6–7 y in four Spanish cities with widely differing cardiovascular mortality

The potential contribution of increased vegetable and fruit consumption to health gain in the European Union

Determinants of Short-Period Heart Rate Variability in the General Population

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