Cholesterol controversy: cutoff point of low-density lipoprotein cholesterol level in Guidelines by Japan Atherosclerosis Society

In 2007, the Japan Atherosclerosis Society published the Guidelines for prevention of atherosclerotic cardiovascular diseases. However, the guidelines have several flaws with regard to the cutoff level of serum low-density lipoprotein cholesterol (LDL-C). First, LDL-C level is used instead of serum total cholesterol (TC) level in the guidelines. In this case, they must show at least some basic data on the relationship between LDL-C level and mortality or morbidity from coronary heart disease (CHD). Second, it was recommended that the LDL-C level be below 140 mg/dL or 3.6 mmol/L (corresponding to a TC level of 220 mg/dL or 5.7 mmol/L, respectively). These levels are unreasonable considering that the TC levels of 240-260 mg/dL are optimal in terms of all-cause mortality for the Japanese population. Third, although there are big differences in mortality and morbidity from CHD between sexes, they discussed the matter without considering these differences. Last but not least, the conflict of interest of the editors of the guidelines has never been disclosed. The Japanese population has a lower CHD mortality and incidence than populations from other industrialized countries despite an increase in serum TC level in the former. In populations with a markedly lower coronary mortality or morbidity such as the Japanese population, it is still important to determine the optimal cutoff level of LDL-C to prevent the development of CHD and other atherosclerotic diseases.     

Relation of cigarette smoking to 25-year mortality in middle-aged men with low baseline serum cholesterol: the Chicago Heart Association Detection Project in Industry

It has been suggested that smoking does not influence risk of cardiovascular diseases in populations with low serum cholesterol levels. To determine whether cigarette smoking is an independent risk factor among men with low levels of serum cholesterol, data on 25-year coronary, cardiovascular, and all-cause mortality for 8,816 middle-aged men screened between 1967 and 1973 by the Chicago Heart Association Detection Project in Industry were examined. With Cox multivariate proportional hazards regression, relative risks of coronary heart disease and cardiovascular disease mortality associated with smoking for the two subcohorts with favorable levels of serum total cholesterol, that is, less than 180 and 180-199 mg/dl, were of the same magnitude as those for men with elevated serum cholesterol, that is, 200-239 and 240 mg/dl. In the two lower strata of cholesterol, the absolute risk and absolute excess risk of mortality for current smokers at baseline were substantially higher compared with men who never smoked, with all-cause death rates of 423.0 and 428.0 per 1,000 and absolute excess rates of 209.8 and 225.7 per 1,000. These translate to estimated shorter life expectancies of 5.3 and 5.7 years, respectively. Adverse effects of smoking on risk of coronary, cardiovascular, and all-cause mortality prevail for men with lower as well as higher serum cholesterol levels.     

Will lowering population levels of serum cholesterol affect total mortality? Expectations from the Honolulu Heart Program.

Major campaigns now underway to reduce the serum cholesterol levels of entire national populations have not given serious consideration to the high rates of noncardiovascular disease and death associated with low cholesterol levels (less than 190 mg/dl). To explore this problem, the relationships between serum cholesterol levels, measured in 1965-1968 in 7478 Japanese American men in Hawaii, and subsequent total and cause-specific mortality through 1985, were analyzed by multivariate Cox regression to control for potential confounders. Total mortality rates for 1648 deaths showed a U-shaped curve by baseline cholesterol level, with significant inverse trends (p less than 0.03) for deaths due to hemorrhagic stroke, all cancer, benign liver disease, chronic obstructive lung disease and "unknown cause". Only the inverse trends for cancer and benign liver disease showed flattening when 227 deaths in the first 5 years of follow-up were deleted from the analysis. Simulation models using three different strategies of cholesterol reduction in this cohort revealed that none of these approaches had any substantial impact on predicted total mortality over 15 years. However, the population-based approach might theoretically increase mortality for 60% of the cohort with baseline cholesterol levels less than 225 mg/dl.     

Serum lipid levels in an Iranian population of children and adolescents: Tehran lipid and glucose study

Data from 3148 participants aged 3–19years (1447 males and 1701 females) in the cross-sectional phase of Tehran lipid and glucose study (February 1999–May 2000) were used to determine serum lipid levels [total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] after 12–14 hours overnight fast. The values were analyzed by sex and age. Mean serum TC concentration was 170 mg/dl. TC was significantly greater in females than males (173 vs. 167 mg/dl, p < 0.05). The 90th and 95th percentiles for serum TC were 211 and 227 mg/dl, respectively. There was a significant decrease in mean TC in males during puberty. Thirty-one percent of population had TC values between 170 and 199 mg/dl and 16% had values of 200 mg/dl or greater. The mean TGs values were 103 for males and 108 mg/dl for females [non-significant (NS)]. The prevalence of high-risk values of TGs increased with age in males, reaching a peak at 17–19years. The mean HDL-C level was 45 mg/dl. Mean HDL-C was highest at 7–10years of age and decreased thereafter. The mean LDL-C was 102 in males and 107 mg/dl in females (NS). Twenty-two percent had LDL-C values between 110 and 129 mg/dl and 17% had values 130 mg/dl or greater. The results showed higher levels of TC, LDL-C and TGs and lower HDL-C in Tehranian children and adolescents than other studies. To design comprehensive public health programs to reduce serum lipid levels among Iranian children and adolescents, underlying factors for the high prevalence of dyslipoproteinemia should be sought.     

Community-based evaluation survey of immunizations in Burkina Faso.

A cluster sample survey was conducted in January 1989 in 3 provinces of Burkina Faso to evaluate an immunization programme (based on two contacts, providing inactivated poliomyelitis vaccine plus DPT) that had been launched in 1982-84. The objectives were to estimate neonatal tetanus (NNT) mortality and poliomyelitis prevalence in the study area. The target population (using the same sample of households comprised 2107 live infants born during the preceding year for the NNT survey, and 17,154 children aged 0-9 years for the poliomyelitis survey. The NNT mortality rate was 3.3 per 1000 live births, and the poliomyelitis prevalence rate was 2.8 per 1000 children aged 5-9 years. Dates of onset of poliomyelitis cases among children aged 0-9 years and the numbers of children at risk during the 10-year recall period, reconstituted with demographic indicators taken from standardized life-tables, were used to calculate the incidence rates of poliomyelitis. These rates could be compared in the 5-year period preceding the survey, and showed a decreasing trend consistent with routine surveillance data.     

Comparison of the entropy technique with two other techniques for detecting disease clustering using data from children with high blood lead levels

The entropy technique was compared with two other case-control techniques for detecting disease clustering using data on blood lead levels of children who were patients at the King/Drew Medical Center in South-Central Los Angeles in 1991 to 1994. The other two methods are the nearest neighbor technique (NNT) and Moran's IPOP technique, a variation of Moran's I test, in which rates are adjusted for population size. Four different blood lead levels (15 microg/dl, 20 microg/dl, 30 microg/dl, 35 microg/dl) were used as cutoff levels to designate cases. Persons with blood lead levels greater than or equal to the cutoff level were designated as cases. The authors found significant clustering for all four cutoff levels using the entropy method, and for the first three cutoff levels using the NNT. They found significant clustering with Moran's IPOP for some scales for two of the cutoff levels. While performance of the entropy technique and the NNT were independent of scale, that of Moran's IPOP was highly scale-dependent.     

A comparative study of serum proteins, lipids, calcium and inorganic phosphorus between Japanese and Dutch university students.

The levels of serum proteins, lipids and minerals in Japanese and Dutch students measured by biochemical methods were compared and their correlation with the nutritional status were investigated. The mean values of serum total proteins (TP), albumin (Alb), globulin (Glb) and albumin/globulin (A/G) ratio in the Japanese students (7.8±0.5, 4.7±0.3 and 3.2±0.4g/dl, and 1.5±0.2, respectively) were similar to those of the Dutch students (7.8±0.5, 4.7±0.3 and 3.0±0.3g/dl, and 1.6±0.2, respectively). However, the mean value of TP in males (8.0±0.5g/dl for the Japanese and 8.0±0.4g/dl for the Dutch) was significantly higher than this in females (7.7±0.3g/dl for the Japanese and 7.5±0.5g/dl for the Dutch) in the each group (p<0.01) and the mean value of Alb of male Dutch students (4.9±0.2g/dl) was higher than that in females (4.5±0.3g/dl, p<0.01). No significant differences were found between the two groups in serum lipid and mineral levels. The serum phospholipid (PL) level in female Dutch students (217±37mg/dl) was significantly higher than that in males (188±25mg/dl, p<0.01), while the serum triglyceride (TG) level in female Japanese students (60±25mg/dl) was significantly lower than that in males (74±33mg/dl, p<0.05), which agreed with the frequency distribution patterns of these lipids. Comparing the two student groups of both countries, there were significant positive correlations between TP and Alb (p<0.001 for both groups), TP and Glb (p<0.001 for both groups) and Alb and A/G ratio (p<0.001 for the Japanese and p<0.01 for the Dutch) in each group. A significant negative correlation between Glb and A/G ratio (p<0.001) was also found in each group. Significant positive correlations were also observed between PL and TG (p<0.01 for the Japanese and p<0.05 for the Dutch), PL and total cholesterol (TC) (p<0.001 for each group) and TG and TC (p<0.01 for the Dutch). The serum PL and TC increased significantly with the serum TP in the Japanese students (p<0.01 for PL and TP, p<0.05 for TG and TP) but not in the Dutch students. The authors concluded that serum protein, lipid and mineral profiles between the two groups did not differ much in spite of their different eating patterns.     

What Unfavorable Factors Are Associated with Low Serum Total Cholesterol in a Japanese Population?

An inverse association between blood cholesterol level and excess mortality in low cholesterol level subjects has been reported, but there has been no reasonable explanation widely accepted. To evaluate the associations between unfavorable factors and low blood cholesterol in non-Western populations, we performed a cross-sectional study in a rural Japanese population. A self-administered questionnaire concerning health characteristics and a nutritional survey, using a continuous 48-hour dietary record, was conducted on 461 males and 571 females aged 20-79 years old. The serum total cholesterol (TC) of less than 160 mg/dl was defined as low cholesterol, which accounted for 18% of the subjects. The multivariate odds ratio of having low cholesterol adjusted for age and selected variables were 0.70 (95% Cl: 0.52-0.94) for 1 SD increment of Key's lipid factor, 0.71 (0.51-0.97) for 1SD increment of vitamin A intake, 2.23 (1.01-4.91) for heavy drinking, 2.80 (1.21-6.46) for being underweight and 2.59 (1.01-6.61) for blood transfusion in males, and 1.04 (1.00-1.08) for 10 cigarette-year increase in smoking in females. Even when further adjusted for body mass index, these associations were still significant except for those who were underweight and had undergone blood transfusion in males. These findings may partly explain the excess mortality of the Japanese males with low serum TC.     

上海市大气污染对中风死亡的影响

[目的]研究大气污染物与中风总死亡及两种不同类型中风死亡间的关联,确定大气污染环境中风死亡易感人群。[方法]收集上海市2003—2008年大气污染及中风死亡数据,采用时间分层-病例交叉设计方法分析两者间相关关系。[结果]所研究大气污染物与不同类型中风死亡均存在相关关系,当暴露于大气中的二氧化硫(SO2)与二氧化氮(NO2)时,心脏病患者的缺血性中风死亡风险提高。当SO2与NO2两种污染物每增加10μg/m3时,导致心脏病患者死于缺血性中风的比值比(95%可信区间)分别为1.057(1.010~1.107)与1.076(1.023~1.131),高于在同等条件下非心脏病患者所面临的缺血性中风死亡风险。本研究并未发现高血压与糖尿病存在类似的修饰效应。[结论]大气污染物能够增加人群中风死亡风险,心脏病患者更易诱发中风。     

Strategy for primary prevention of coronary heart disease based on results of health check-up]

To investigate one of the strategies for effective primary prevention of coronary heart disease (CHD) in employees, the future morbidity of CHD was predicted from the results of an annual health check-up. The decrease in morbidity by measures against coronary risk factors was estimated with simulations. By a CHD risk prediction algorithm based on the Framingham Study, the 10-yr incidence of CHD was predicted in 6,444 male employees of a manufacturing company according to the results of a health check-up in 1998: age, total cholesterol (TC), HDL-cholesterol (HDL-C), blood pressure (BP), diabetes mellitus, and smoking habit. The decrease in CHD incidence obtained by a decrease in TC, increase in HDL-C, decrease in BP, control of diabetes mellitus, or quitting the smoking habit was estimated with simulations by means of the algorithm. The mean +/- SD in 6,444 employees was 45 +/- 11 yr for age; 121 +/- 16 and 79 +/- 10 mmHg for systolic and diastolic BP, respectively; 193 +/- 34, 53 +/- 13, and 98 +/- 18 mg/dl for TC, HDL-C, and fasting blood sugar, respectively; 4.80 +/- 0.58% for HbA1c; and 44% for the frequency of the smoking habit. Among 6,444 males, 455 (7.1%) were predicted to suffer from CHD for 10 yr ahead. If TC was decreased to less than 200 mg/dl in all 2,614 males (N) with TC > or = 200 mg/dl, the decrease (D) in the predicted number of employees with CHD was 64; namely, a reduction of TC to less than 200 mg/dl in 41 males (N/D) with TC > or = 200 mg/dl was estimated to decrease the number of CHD patients by one. Similarly, the D and N/D were 38 and 35 for reduction in BP to less than 140/90 mmHg; 20 and 17 for control of diabetes mellitus; and 90 and 32 for quitting the smoking habit, respectively. A measure against diabetes mellitus was the most effective in respect of N/D, but the predicted total reduction was small (D = 20). On the other hand, a measure against the smoking habit was estimated to have a relatively small N/D as well as the largest D. In 5,386 employees with at least one of the risk factors of TC > or = 200 mg/dl, HDL-C < 45 mg/dl, BP > or = 130/85 mmHg, diabetes mellitus, and the smoking habit, the normalization of all risk factors was estimated to decrease by 230 CHD patients (D = 230, N/D = 23). These results suggest that the strategy for effective primary prevention of CHD in employees of a company should include at first, quitting the smoking habit supported by total prohibition of smoking within company facilities, followed by measures against hyperlipidemia, hypertension and diabetes mellitus.     

Effects of short-term aerobic conditioning and high cholesterol feeding on plasma total and lipoprotein cholesterol levels in sedentary young men

The plasma total cholesterol (TC) and lipoprotein cholesterol concentrations of sedentary young men (n = 23) were determined during 4 wk of controlled feeding and 6 wk of supervised aerobic conditioning. Subjects were assigned to dietary treatments of 400 mg cholesterol per day (M) or 1400 mg cholesterol per day (H); both diets had a P/S ratio of about 0.6. Dietary groups M and H were subdivided into exercise (MX and HX) and sedentary (MS and HS) groups. Compared to the sedentary groups, MX and HX exhibited significant (p less than 0.01) improvements in cardiorespiratory fitness. After 2 and 4 wk of high cholesterol feeding, group HS exhibited significant (p less than 0.05) elevations in TC (+30 +/- 7 and +32 +/- 9 mg/dl) with nonsignificant increases in very low-density lipoprotein cholesterol and low-density lipoprotein cholesterol. Group HX exhibited consistent weekly increases in high-density lipoprotein cholesterol (HDL-C) (from 46 +/- 3 mg/dl, the base level, to 53 +/- 4 mg/dl at wk 4) with aerobic conditioning. By combining exercise and sedentary group data at each level of dietary cholesterol it was shown that TC and HDL-C levels significantly (p less than 0.05) increased by the 4th wk of high cholesterol feeding. The TC/HDL-C ratio significantly (p less than 0.05) increased for the sedentary subjects as compared to all the exercising subjects by wk 4 of controlled feeding.     

Serum lipid levels in an Iranian adults population: Tehran Lipid and Glucose Study

Data from 6246 participants aged 20–64 years (2339 males and 3907 females) in the cross-sectional phase of Tehran Lipid and Glucose Study (February 1999–May 2000) were used to determine distribution of serum lipid levels after 12–14 hour overnight fast. Mean total cholesterol (TC) concentration was 210 mg/dl. TC was significantly greater in females than males, 213 and 206 mg/dl, respectively (p < 0.0001). Thirty-one percent of population had TC values between 200 and 239 and 24% had values of 240 mg/dl or greater. Mean low-density lipoprotein cholesterol (LDL-C) was 129 and 135 mg/dl in males and females, respectively (p < 0.0001). Twenty-seven percent had LDL-C values between 130 and 159 and 23% had values 160 mg/dl or greater. The mean triglycerides (TGs) values were 190 and 162 mg/dl for males and females, respectively (p < 0.0001). The mean high-density lipoprotein cholesterol (HDL-C) was 39 in males and 45 mg/dl in females (p < 0.0001). The results showed higher levels of TC, LDL-C and TGs and slightly lower HDL-C in Tehranian adults than other studies in the industrialized countries.     

天津市居民的血脂水平及影响因素

本文报道了随机抽查的５４６０名天津市市区普通居民的血脂水平。结果发现，居民的血清总胆固醇（ＴＣ）、甘油二酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ）和ＨＤＬ／ＴＣ比值在各年龄组分别波动在１４２～１９６ｍｇ／ｄｌ、７９～１３ｌｍｇ／ｄｌ、４８～５５ｍｇ／ｄｌ和０．２８４１～０．３８３４之间。ＴＣ、ＴＧ随年龄增长而上升，ＨＤＬ／ＴＣ比值随年龄增长而下降，ＨＤＬ与年龄无关。女性ＨＤＬ显著高于男性；老年组的ＴＣ、ＴＧ为女性显著高于男性，而中年组，男性高于女性。血脂水平与体量指数（ＢＭＩ）、运动及文化程度有关。ＢＭＩ越大，则ＴＣ、ＴＧ越高，而ＨＤＬ、ＨＤＬ／ＴＣ比值越低；运动越多，ＴＣ、ＴＧ越低，而ＨＤＬ／ＴＣ比值越大；男性文化程度与ＨＤＬ／ＴＣ比值成反比。     

A socio-medical study of adult diseases related to life style--comparison of foreigners living in Japan and Japanese

The purpose of this study was to investigate the relationship between life style factors and adult diseases among three ethnic groups, Chinese living in Japan, Koreans living in Japan and Japanese. The mortalities of major cancers and other adult diseases of Chinese and Koreans in Japan were compared with those of Japanese by calculating Standardized Mortality Ratios (SMR) of the two groups using death rates in the Japanese population as the standard. Life style data on smoking, drinking and dietary habits of the three groups were collected by self-administered questionnaire surveys, and age-adjusted proportions were calculated with the truncated world population as the standard. The results are summarized as follows: 1. The mortality rates for liver cancer, lung cancer, diabetes mellitus, heart disease, hypertensive disease, cerebrovascular disease and liver cirrhosis for Koreans of both sexes in Japan were significantly higher than those for Japanese, but the mortality rates of stomach cancer, pancreatic cancer and breast cancer for Korean females were lower than those for Japanese females. 2. The mortality rates for heart disease, diabetes mellitus, hypertensive disease, liver cirrhosis, rectum cancer, liver cancer, lung cancer (females), breast cancer (females) and cerebrovascular disease (females) for Chinese in Japan were higher than those for Japanese, but the rates for stomach cancer, pancreatic cancer (both sexes), uterus cancer (females) and cerebrovascular disease (males) were lower than those for Japanese. 3.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hemostatic variables in Japanese and Caucasian men. Plasma fibrinogen, factor VIIc, factor VIIIc, and von Willebrand factor and their relations to cardiovascular disease risk factors

Mortality rates of coronary heart disease are much lower and hemorrhagic stroke rates are higher in Japanese than in Caucasians. To investigate whether population differences in plasma concentrations of coagulation factors are consistent with these mortality differences, the authors examined, in 1987, a total of 136 men aged 34-55 years in four different samples: rural Japanese living in Akita, Japan; urban Japanese living in Osaka, Japan; and Japanese Americans and Caucasian Americans living in Minneapolis-St. Paul, Minnesota. The mean plasma fibrinogen level in Caucasians was 290 mg/dl, which was significantly higher than that in each of the Japanese samples (223-250 mg/dl; test for difference: p less than 0.001). The mean coagulation activities of factor VII and factor VIII (factor VIIc and factor VIIIc) were higher in Caucasian and Japanese Americans than in rural and urban Japanese (p less than 0.01 for factor VIIc and p = 0.03 for factor VIIIc). von Willebrand factor did not differ significantly across the populations. The relations of these coagulation factors with other cardiovascular risk factors (age, body mass index (weight (kg)/height (m)2), blood pressure, serum total cholesterol, serum triglyceride, cigarette smoking, and alcohol intake) were also examined. Mean plasma fibrinogen was consistently higher in current smokers than in nonsmokers within each sample. Factor VIIc and factor VIIIc levels were positively associated with serum total cholesterol and serum triglyceride. No consistent associations were seen between von Willebrand factor and cardiovascular risk factors. After the authors controlled for these covariates, mean fibrinogen and factor VIIc levels remained significantly different, but factor VIIIc levels did not. Different levels of coagulation factors across these samples are probably attributable to differences in environmental factors, especially diet, as well as genetic differences between Caucasians and Japanese. Furthermore, the differences in plasma fibrinogen and factor VIIc levels may explain part of the difference in mortality from cardiovascular disease across these populations.     

A randomized controlled trial of dietary fiber intake on serum lipids

OBJECTIVE: Clinical trials have indicated that water-soluble fiber from oats reduces serum cholesterol among hypercholesterolemic patients on a low-fat diet. We examined the effect of dietary fiber intake on serum lipids among persons without hypercholesterolemia. DESIGN: Randomized controlled trial. SETTING AND SUBJECTS: We recruited 110 participants who were aged 30-65 years and had a serum cholesterol level < 240 mg/dl from community. INTERVENTION: Study participants were randomly assigned to receive 8 g per day of water-soluble fiber from oat bran or a control intervention. RESULTS: At baseline, the mean levels of serum cholesterol and other measured variables were comparable between the high-fiber and control groups. Over the 3-month intervention, mean changes (95% confidence interval (CI)) in total, HDL-, and LDL-cholesterol were -2.42 mg/dl (-8.90 to 4.05 mg/dl; P = 0.46), -0.24 mg/dl (-2.19 to 1.71 mg/dl; P = 0.81), and -1.96 mg/dl (-7.32 to 3.40 mg/dl; P = 0.47) in the fiber group and -0.02 mg/dl (-5.29 to 5.26 mg/dl; P = 0.99), 1.42 mg/dl (-0.74 to 3.59 mg/dl; P = 0.19), and -0.64 mg/dl (-5.30 to 4.03 mg/dl; P = 0.79) in the control group, respectively. The net changes (95% confidence interval) in total, HDL-, and LDL-cholesterol were -2.40 mg/dl (-10.6 to 5.81 mg/dl; P = 0.56), -1.66 mg/dl (-4.55 to 1.22 mg/dl; P = 0.26) and -1.33 mg/dl (-8.33 to 5.68 mg/dl; P = 0.71), respectively. CONCLUSIONS: Our study does not support the hypothesis that water-soluble fiber intake from oat bran reduces total and LDL-cholesterol in study participants with a normal serum cholesterol level.     

Longitudinal study of the association between ABO phenotype and total serum cholesterol level in a Japanese cohort.

The relationship between ABO blood phenotype and total serum cholesterol (TC) level was examined in a Japanese population to determine whether an elevated TC level is associated with phenotype A, as has been demonstrated in many West European populations. Such studies in nonwhite populations are scarce, and findings generally failed to demonstrate the relationship. Inconsistent results from cross-sectional studies of various racial groups with widely varying ages raised an age effect as a possible explanatory factor. It was also suggested that the ABO-TC association may not be apparent in populations with low fat intake or low mean cholesterol level. These hypotheses are addressed by examining long-term TC data collected serially from the unexposed controls of the atomic bomb survivors in Hiroshima and Nagasaki who were participants of the Adult Health Study program at the Atomic Bomb Casualty Commission-Radiation Effects Research Foundation between 1958 and 1986. The statistical method of growth curve analysis, through the mixed effect model of Laird and Ware [1982], was used to model age-dependent changes in cholesterol levels within individuals. The effects of the ABO polymorphism in modifying the resultant growth curve are examined. We demonstrate that TC levels are elevated on average by about 4 mg/dl in phenotype A compared to non-A in the Japanese (P < 0.00001), and that this relationship is maintained from early to late adulthood, independent of sex, body mass index, cohort status, or city of residence. Thus, phenotype A individuals may be more predisposed to cardiovascular disease through one of its major risk factors. This is the first study of the ABO-cholesterol association in the Japanese, and the first based on a cohort with longitudinally collected TC data.     

Distributions of total cholesterol, triglycerides, and high-density lipoprotein cholesterol in Israeli Jewish children of different geographic-ethnic origins, ages 9-17 years

To determine age and ethnic patterns of blood lipid levels in childhood and adolescence and to extend previous adult and late adolescent Israeli data to prepubertal ages, the levels of plasma total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were determined among 1,153 schoolchildren in the area of Petah-Tikva. Half of the children were born to immigrants from Yemen. Among boys, TC levels progressively decreased as age increased from 10-11 to 14-15 years (159 to 142 mg/dl). The age-specific TC and HDL-C means among boys are compatible with an initial swift fall with age, followed by a rise restricted to TC during puberty. Among girls, progressively lower means through ages 12-13 and increasingly higher ones for older age groups are also compatible with puberty-determined changes, previously observed in American cohorts. The differences in TC were only partly accounted for by lower HDL-C means at higher ages (52 mg/dl in the youngest and 45 mg/dl in the oldest age group, respectively, among boys, compared with 53 mg/dl for girls at both ages 9 and 16-17). TG levels in boys, but not in girls, showed age differences paralleling those found for HDL-C, but in an inverse direction. TC means were lower as age increased only among female offspring of European-born Jews (159 to 148 mg/dl, ages 9-12 compared with ages 13-17), a phenomenon that requires further study. Overall, TC and HDL-C were clearly higher among girls than boys beginning at ages 12-13, with little or no sex differences in TG. The sex differences in TC, contrary to previous studies, were not fully accounted for by HDL-C sex differences. The ethnic variability paralleled previous findings in Israeli adults and adolescents, showing low TC levels among male offspring of Yemenite and other Asian-born fathers. The ethnic differences among girls were small. No specific pattern of age-related lipid changes was found in the group of Yemenite origin, who represented offspring of parents with notoriously low levels of coronary heart disease incidence.     

Factorial experiment to determine influence of fish protein and fish oil on serum and liver lipids in rabbits.

Rabbits were fed purified diets consisting of casein (CA), fish protein (FP), and soy protein (SP) combined with MaxEpa oil (ME) or corn oil (CN) to determine the effects of dietary protein and lipid sources on serum total, lipoprotein, and hepatic lipid levels. Dietary proteins and lipids exerted significant (p < 0.05) separate effects on serum total cholesterol (TC) (p < 0.005), very-low-density lipoprotein cholesterol (VLDL-C) (p < 0.001), and high-density lipoprotein cholesterol (HDL-C) (p < 0.001), whereas only dietary proteins significantly affected low-density lipoprotein cholesterol (LDL-C) (p < 0.001) and the LDL-C/HDL-C ratio (p < 0.05). Hence, FP induced serum TC (233 mg/dl), VLDL-C (22 mg/dl), and LDL-C (151 mg/dl) intermediary to hypercholesterolemic CA (TC, 319 mg/dl; VLDL-C, 57 mg/dl; LDL-C, 204 mg/dl) and cholesterol-lowering SP (TC, 129 mg/dl; VLDL-C 19 mg/dl; LDL-C, 84 mg/dl). The twofold rise in HDL-C on feeding FP (35 mg/dl), compared with CA (20 mg/dl) and SP (16 mg/dl), resulted in a drop in LDL-C/HDL-C to a level similar to that of SP groups. The cholesterol-lowering action of ME (188 mg/dl), in contrast to CN (266 mg/dl), was reflected mainly in VLDL (ME, 15 mg/dl; CN, 50 mg/dl) but also in HDL (ME, 16 mg/dl; CN, 31 mg/dl) fractions. Compared with CN, the significant (p < 0.05) ME-induced rise in serum and VLDL triglycerides was accompanied by a significant (p < 0.001) drop in lipoprotein lipase activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alcohol intake and the pattern of trauma in young adults and working aged people admitted after trauma

AIMS: To investigate the relationship of different patterns of alcohol intake to various types of trauma. METHODS: We examined the associations of alcohol consumption in a series of 385 consecutive trauma admissions (278 men, 107 women, age range 16-49 years). Patients underwent clinical examinations, structured interviews on the amount and pattern of alcohol intake, and measurements of blood alcohol concentration (BAC). RESULTS: On admission, 51% of the patients had alcohol in their blood. Binge drinking was the predominant (78%) drinking pattern of alcohol intake. Assaults, falls and biking accidents were the most frequent causes of trauma. Dependent alcohol drinking and binge drinking were found to be significantly more common among patients with head trauma than in those with other types of trauma (77% vs 59%, OR=2.38; 95% CI 1.50 to 3.77). The OR for sustaining head injury increased sharply with increasing BAC: 1-99 mg/dl (1.24; 95% CI 0.55-2.01), 100-149 mg/dl 1.64; 95% CI 0.71-3.77), 150-199 mg/dl (3.20; 95% CI 1.57-6.53) and >199 mg/dl (9.23; 95% CI 4.79-17.79). CONCLUSIONS: Binge drinking is a major risk factor for head trauma among trauma patients. Assaults, falls and biking accidents are the commonest causes for such injuries. The relative risk for head injury markedly increases with increasing blood alcohol levels. Alcohol control measures should feature in policies aiming at the prevention of trauma-related morbidity and mortality.