Cadmium may be a risk factor for osteoporosis

OBJECTIVES: The primary study aim was to examine the possible role of cadmium as a risk factor for osteoporosis by determining the bone mineral density (BMD) in workers previously exposed to cadmium. A second objective was to validate the BMD data obtained with a movable instrument. METHODS: 43 workers who were exposed to cadmium for < or = 5 years before 1978 were studied. Cadmium in blood (B-Cd) and urine (U- Cd) were used as dose estimates. The BMD was assessed in the forearm, the spine, and the hip (neck and trochanter) with a dual energy x ray absorptiometry (DXA) instrument. Age and sex matched reference populations were used to compute Z scores, commonly used to assess osteoporosis. RESULTS: The mean forearm Z score was -0.60 (95% confidence interval (95% CI) -1.08 to -0.12) in the group exposed to cadmium. The mean Z score for the spine was -0.47 (95% CI -0.92 to - 0.03), for the hip neck -0.40 (95% CI -0.75 to -0.05), and for the hip trochanter -0.22 (95% CI -0.52 to -0.07). The decrease in forearm BMD was correlated with age (p = 0.002) and B-Cd (p = 0.040). No such correlations were found for the other sites. Workers with tubular proteinuria had a lower forearm BMD (p = 0.029) and a lower Z score (p = 0.072) than workers without tubular proteinuria. CONCLUSIONS: There was a suggested dose-effect relation between cadmium dose and bone mineral density. Furthermore, there was a dose-response relation between cadmium dose and osteoporosis. Cadmium may be a risk factor for the development of osteoporosis at lower doses than previously anticipated.

 

     

Dietary intake as a cardiovascular risk factor in Costa Rican adolescents.

PURPOSE: To evaluate Costa Rican adolescents' dietary intake as a cardiovascular disease (CVD) risk factor. METHODS: Dietary intake was determined using 3-day food records; nutrient content of fast foods prepared in school cafeteria was calculated by the weighted records. RESULTS: Around 30% of adolescents exceed the American Heart Association dietary recommendation for total fat and saturated fat. About 50% reported a cholesterol intake higher than 100 mg/1000 kcal. On average, 45% of adolescents do not meet the dietary fiber recommendation of 10 g/1000 kcal, the 66% of the recommended daily allowance for vitamins E and B(6), or around 25% for folic acid. A higher proportion of urban adolescents do not satisfy the established dietary recommendation to prevent CVD. CONCLUSIONS: To avoid further increases in the Costa Rican CVD mortality rate, it is necessary to develop primary prevention programs, oriented to modify adolescent's nutrition habits. Schools have the potential to carry out such programs, as at least 60% of all adolescents in Costa Rica are enrolled in high schools.     

Exposure to mosquito coil smoke may be a risk factor for lung cancer in Taiwan

Background

About 50% of lung cancer deaths in Taiwan are not related to cigarette smoking. Environmental exposure may play a role in lung cancer risk. Taiwanese households frequently burn mosquito coil at home to repel mosquitoes. The aim of this hospital-based case-control study was to determine whether exposure to mosquito coil smoke is a risk for lung cancer.

Methods

Questionnaires were administered to 147 primary lung cancer patients and 400 potential controls to ascertain demographic data, occupation, lifestyle data, indoor environmental exposures (including habits of cigarette smoking, cooking methods, incense burning at home, and exposure to mosquito coil smoke ), as well as family history of cancer and detailed medical history.

Results

Mosquito coil smoke exposure was more frequent in lung cancer patients than controls (38.1% vs.17.8%; p<0.01). Risk of lung cancer was significantly higher in frequent burners of mosquito coils (more than 3 times [days] per week) than nonburners (adjusted odds ratio = 3.78; 95% confidence interval: 1.55-6.90). Those who seldom burned mosquito coils (less than 3 times per week) also had a significantly higher risk of lung cancer (adjusted odds ratio = 2.67; 95% confidence interval: 1.60-4.50).

Conclusion

Exposure to mosquito coil smoke may be a risk factor for development of lung cancer.Key words: Air Pollutants, Lung Neoplasms, Mosquito Coil, Smoke     

Environmental magnetic noise may be a health risk.

It has been demonstrated that magnetic fields stronger than those used in magnetic resonance imaging can be mutagenic, even teratogenic to the human genome. Recent experimental data has shown that magnetic fields ranging from the earth's steady magnetic field to the ten thousand gauss used in magnetic resonance imaging (MRI) can enhance oncogenic expression, among a variety of other effects both positive and negative. It is the purpose of this presentation to suggest that fields considerably weaker than the geomagnetic may have deleterious effects on the human genome, in addition to noting that very weak fields may also be physiologic.     

Dietary glycemic index and load in relation to cardiovascular disease risk factors in Cuban American population

Objective To examine whether dietary glycemic index (GI) or glycemic load (GL) had an effect on the cardiovascular disease (CVD) risk factors and whether the effects were dependent on the diabetes status in the Cuban American population.

Design A case–control, single-time-point study.

Methods A total of 324 middle-aged Cuban American adults had completed data on fasting blood lipids, physical activity level and usual dietary intake using a validated food frequency questionnaire. Published GI values were assigned to food items and average dietary GI and GL were calculated per participant.

Results Subjects without type 2 diabetes (T2D) were 3.3 times more likely to be in the recommended, highest high-density lipoprotein-cholesterol category if they were in the second dietary GL tertile as compared with those in the first dietary GL tertile (P = 0.042, 95% confidence interval = 1.94, 10.78).

Conclusions The results of the present study suggest that in this sample of Cuban Americans a high GI or GL diet do not adversely affects blood lipids, especially among subjects without T2D.     

A community-oriented primary care project in a rural population: reducing cardiovascular risk

A controlled community-oriented primary care (COPC) program designed to reduce cardiovascular risk was conducted in two towns in a poor, rural area of New York State that have populations with high levels of cardiovascular mortality. In both towns, house-to-house visits were used to screen for blood pressure, gather information about cardiovascular risk knowledge and behavior, and provide a cardiovascular educational program. Persons with elevated blood pressure were advised to seek follow-up. Additional interventions, carried out in the study town only, included ongoing follow-up for those with elevated blood pressure and their providers, and sliding-fee medical services for those with financial barriers to care. At rescreening 2 years later, residents of the study population had an adjusted systolic blood pressure 3.1 mm Hg lower than those in the control population (95% confidence interval [CI] = 0.9, 5.3). Furthermore, those who were screened at both rounds had an adjusted systolic blood pressure 2.7 mm Hg lower than those who had not previously been screened (95% CI = 0.6, 4.8). Although knowledge of cardiovascular risk factors increased among those who were surveyed in both rounds, there was little demonstrable effect on cardiovascular risk behaviors. Difficulties were encountered in engaging the participation of all medical providers, and less use was made of the sliding-scale program than expected. While it appears feasible to implement the technical methodology of a COPC model in a rural setting, it is crucial to engage the support of the local and medical community.     

Dietary sources of vitamin A, C, E and beta-carotene in a adult Mediterranean population

OBJECTIVE: Estimation of vitamin A, C, E and beta-carotene food sources, as well as its nutritional intake and density in adult Catalonian population. METHODOLOGY: A cross-sectional study was conducted over 2,346 individuals obtained from the sample of Catalonian Survey of Nutritional Status aged 18 to 75 years old to estimate usual dietary intake of vitamins A, C, E and beta-carotene using two 24 hour dietary recalls administered in two periods (june-july and november-december of 1992). Replicated 24 hour Recalls allowed for estimation of usual intake. Calculation of food sources for vitamins encompassed three phases: foods transformation into nutrients, aggregation of foods in categories and sum of nutrients by food categories. RESULTS: Intake of vitamin A (equivalents of retinol of provitamin A and vitamin A), E, C were closely near or higher than RDA. Nutritional density of vitamin C, E and beta-carotene were higher in female group. Nutritional density was positively associated to age for vitamins C, E and beta-carotene. Addition fat was the first source of vitamin E and it reached 33.8% of total vitamin E intake. Vegetables contributed in 17.3 % to the total vitamin C, whereas fruits accounted for 57.9%. Fruits recached 40.6% of the total beta-carotene intake, whereas vegetables accounted for 34.8%. The major contributors of vitamin A were milk and dairy products. CONCLUSIONS: Nutritional intake of vitamin A, C and E are over the RDA parameters suggesting an healthy nutritional status that must be confirmed and ratify by biochemical assessment. Nutritional densities were higher in female gender than in males in vitamins C, E, and beta-carotene possibly due to a higher intake of total lipids in male gender than in females. Nutritional density was positively associated to age in the same group of vitamins, suggesting a higher intake of empty calories in younger group. Fruits and Vegetables accounted for more than 70% of vitamin C and beta-carotene and major contributors were citrics, carrots, tomatoes, spinach, and cauliflower, highlighting their importance in elaboration of dietary guide lines.     

A new paradigm of cardiovascular risk factor modification

Atherosclerotic cardiovascular diseases (CVDs) are the leading cause of death and disability in the United States. While multiple studies have demonstrated that modification of atherosclerotic cardiovascular risk factors (CVRFs) significantly reduces morbidity and mortality rates, clinical control of CVDs and CVRFs remains poor. By 2010, the American Heart Association seeks to reduce coronary heart disease, stroke, and risk by 25%. To meet this goal, clinical practitioners must establish new treatment paradigms for CVDs and CVRFs. This paper discusses one such treatment model--a comprehensive atherosclerosis program run by physician extenders (under physician supervision), which incorporates evidence-based CVD and CVRF interventions to achieve treatment goals.     

Lipoprotein(a) as a cardiovascular risk factor

Lipoprotein a (Lp(a)) is a strongly genetically determined lipoprotein that resembles in density and size a low-density lipoprotein particle (LDL) to which apolipoprotein (a) is bound. There are several isoforms of Lp(a). There is strong evidence that Lp(a) is an independent risk factor for atherosclerosis and cardiovascular disease. Lp(a) is involved in the pathogenesis of atherosclerosis and has prothrombotic properties. Differences in isoform size and lack of standardization have complicated measurement of Lp(a). Currently, reliable determination of Lp(a) is possible with isoform-independent assays. At present the only options to lower Lp(a) levels are nicotinic acid and Lp(a) apheresis. New drugs with Lp(a)-lowering potential are being developed. There is no evidence from trials as yet that reducing Lp(a) levels decreases cardiovascular risk. Currently the clinical value of Lp(a) as a cardiovascular risk factor is limited. Lp(a) measurement could be of value in selected patient populations.     

Blood lead as a cardiovascular risk factor.

Many epidemiologic and experimental animal studies support the hypothesis of there being a causal association between lead exposure and increased blood pressure/cardiovascular disease. This study includes 1,052 men and women from Copenhagen County, Denmark, who were examined in 1976 and 1981; in 1987, only the men were examined. Blood lead fell by approximately 40% for the men during the 11-year period and by approximately 30% for the women during the first 5-year period. There was a univariate association between systolic blood pressure and blood lead for both sexes in 1976, but it disappeared at the following examinations. For women, there was also a significant association with diastolic blood pressure, even after confounders were controlled for at the two examinations. Moreover, the authors found a significant univariate association between changes in blood lead and changes in systolic blood pressure from 1976 to 1987 in the males. All participants taking part in the study in 1976 were followed regarding hospital admissions and deaths throughout a follow-up period lasting for 14 years. There was a significant univariate association with total mortality, coronary heart disease, and cardiovascular disease. However, with regard to coronary heart disease and cardiovascular disease, the associations disappeared when confounders were controlled for. Blood lead was a significant predictor of total mortality after control for relevant confounders. This study supports the hypothesis of there being a weak causal association between blood lead and blood pressure, total mortality, coronary heart disease, and cardiovascular disease. The importance of this association is very modest for the individual, but the population attributable risk may be considerable.     

Dietary cholesterol: from physiology to cardiovascular risk

Dietary cholesterol comes exclusively from animal sources, thus it is naturally present in our diet and tissues. It is an important component of cell membranes and a precursor of bile acids, steroid hormones and vitamin D. Contrary to phytosterols (originated from plants), cholesterol is synthesised in the human body in order to maintain a stable pool when dietary intake is low. Given the necessity for cholesterol, very effective intestinal uptake mechanisms and enterohepatic bile acid and cholesterol reabsorption cycles exist; conversely, phytosterols are poorly absorbed and, indeed, rapidly excreted. Dietary cholesterol content does not significantly influence plasma cholesterol values, which are regulated by different genetic and nutritional factors that influence cholesterol absorption or synthesis. Some subjects are hyper-absorbers and others are hyper-responders, which implies new therapeutic issues. Epidemiological data do not support a link between dietary cholesterol and CVD. Recent biological data concerning the effect of dietary cholesterol on LDL receptor-related protein may explain the complexity of the effect of cholesterol on CVD risk.     

Ceruloplasmin and its clinical relevance as an indactor of cardiovascular risk factor in a school population of Granada

Also known as ferroxidase ceruloplasmin, belongs to the family of inflammation-sensitive proteins, and its main function to transport copper in the blood. Although, in addition to this transport function, at present, there are numerous studies that have attempted to use the determination of serum concentrations as a predictive indicator of cardiovascular risk in patients who are overweight or obese. The results of this study confirm the existence of a significant correlation between serum ceruloplasmin and nutritional status of the subjects, which means that for the population of students assessed, serum levels of this protein are an important predictor the risk of cardiovascular disease.     

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.