The effect of participatory community-based diabetes cares on the control of diabetes and its risk factors in western suburb of Yasouj, Iran

This study aimed to investigate whether a community-based participatory diabetes care program could efficiently improve diabetic care and reduce its risk factors. To induce a participatory approach, a local group was established in partnership with academics, local leaders, health providers and public representatives. The group conducted community needs assessment and priority setting process. Diabetes was identified as the first priority health problem in this area. A total of 2569 30- to 65-year-old residents were screened for diabetes and 405 of them took part in a 13-week nutrition education and physical exercise intervention. Out of 1336 high-risk individuals, 17% had fasting blood sugar (FBS) ≥126 mg/dl and 13.5% with FBS between 110 and 125 mg/dl. Percentages of participants with triglycerides (TG) ≥150 mg/dl and cholesterol ≥200 mg/dl were 33.8% and 23.5%, respectively. After completion of the intervention, the mean FBS, HbA1C, TG and cholesterol were decreased significantly. Although systolic and diastolic blood pressure and body mass index were decreased too, the differences were not statistically significant. The mean physical activity increased and consumption of fried foods and saturated oil decreased significantly. The results suggest that participatory community-based care could be a feasible model for control of diabetes and its risk factors.     

Pattern of coronary artery disease risk factors in population younger than 55 years and above 55 years: a population study of 31999 healthy individuals

More than eighty percent of patients with coronary heart diseases (CHD) have conventional risk factors. Prevalence of well known risk factors seems to show a different pattern in younger patients and individual above 55 years. To evaluate the pattern of conventional CHD risk factors in healthy individuals in two different age groups. A large scale population based survey of 31999 individuals from ten medical centers was designed. Screening of risk factors was performed upon these protocols: taking medical history, physical examination and blood tests of complete blood cell counts, fasting blood sugar, lipid profile, urinalysis and creatinine. Prevalence of the risk factors in healthy people aged above 55 years were: 8.1% for systolic blood pressure (SBP)>140 mmHg, 3.8% for diastolic blood pressure (DBP)>90 mmHg, 13.9% for fasting blood glucose (FBS)≥126 Mg/dl, 36.9% for total cholesterol>200 Mg/dl, 19.2% for triglyceride (TG)>200 Mg/dl, 67.8% for HDL-c<40 Mg/dl, 27.2% for LDL-c>130 Mg/dl, 4.72 for TC/HDL-c ratio, 2.88 for LDL-c/HDL/c ratio and 4.24 for TG/HDL-c ratio. Prevalence of risk factors in individuals younger than 55 years were: 1.7% for SBP>140 mmHg, 1.2% for DBP>90 mmHg, 5.2% for FBS≥126 Mg/dl, 31.3% for TC>200 Mg/dl, 21.5% for TG>200 Mg/dl, 69.4% for HDL-c<40 Mg/dl, 23.2% for LDL-c>130 Mg/dl, 4.7 for TC/HDL-c ratio, 2.83 for LDL-c/HDL-c ratio and 4.43 for TG/HDL-c ratio. In univariate model of analysis: prevalence of the risk factors were significantly higher in age above 55 years than in people younger than 55 years except for hypertriglyceridemia and HDL-c<40 Mg/dl. In a multivariate model of logistic regression, pattern of following CHD risk factors remained to demonstrate a statistically significance difference between two age groups: FBS≥126 Mg/dl P=0.006, TG>200 Mg/dl P= 0.002, HDL-c<40 Mg/dl P= 0.019, education status P=0.001, sex P=0.012, and SBP>140 mmHg P=0.001. Pattern of such a CHD risk factors of FBS≥126 Mg/dl, TG>200 Mg/dl, HDL-c<40 Mg/dl, education status, sex and SBP>140 mmHg demonstrated a statistically significant difference in the age above 55 years to the healthy people younger than 55 years. These results cab be implicated to set up prediction models for stratifying individuals at higher risk of CHD.     

Distribution and cardiovascular risk correlates of serum triglycerides in young Japanese adults

To examine the distribution and cardiovascular risk correlates of serum triglycerides, a cross-sectional population study based on annual health examinations at the workplace was performed in 2199 young Japanese adults aged 23 to 37 years. Triglyceride levels showed significant sex (male > female) differences, and the percentages of those with high triglycerides (> or = 150 mg/dl) were 9.4% for males and 0.8% for females. In terms of conjoint trait of dyslipidemia, 86.1% of males displayed normal levels of both triglycerides (< 150 mg/dl) and high-density lipoprotein (HDL) cholesterol (> or = 40 mg/dl), while 98.7% of females had normal values. Age- and sex-specific triglyceride levels above the 75th percentile (equivalent to 82-116 mg/dl for males and 56-63 mg/dl for females) increased the risk (odds ratio (OR)) for having obesity, hypertension, and hyperuricemia by 2.9 (95% confidence interval (CI)=2.0-4.3),1.7 (CI=1.1-2.9), and 3.0 (CI=1.6-5.9), respectively. The respective ORs for triglyceride levels above the 75th percentile and HDL cholesterol below the 25th percentile (equivalent to 45-49 mg/dl for males and 58-63 mg/dl for females), compared with triglyceride levels the 75th percentile or less and HDL cholesterol levels the 25th percentile or more, were 8.7 (CI=5.8-12.9), 2.2 (CI=1.5-3.3), and 6.0 (CI=3.2-11.5). Our results suggest a threshold effect of triglyceride levels considered as normal on enhanced cardiovascular risk in young Japanese adults, especially in those with low HDL cholesterol levels.     

Postprandial plasma triglyceride and cholesterol responses to a low-fat meal.

Postprandial plasma cholesterol and triglyceride (TG) levels were measured after the consumption of a relatively low-fat (35% of calories) diet in 41 subjects. Plasma cholesterol levels did not change appreciably during the postprandial state. In 34 subjects a biphasic plasma TG response curve was noted, with an initial peak occurring 1 to 3 hr after feeding and a secondary TG peak 4 to 7 hr after the meal. The primary peak was greater than 90%, accounted for by chylomicrons, whereas the secondary peak represented very low-density lipoproteins (greater than 82%). Furthermore, the heights of the primary and secondary peaks were closely correlated to the fasting TG level (r = 0.61 and 0.72, respectively) indicating that the fasting TG concentration is an important determinant of the postprandial TG response. Because low-fat (high-carbohydrate) diets are known to raise fasting TG levels in patients who do not have fasting hyperchylomicronemia, and because relatively few patients have chylomicrons in the fasting state, these data suggest that such diets may lead to day long increases in plasma TG levels in the majority of subjects.     

Composition of fatty acids in plasma and erythrocytes and eicosanoids level in patients with metabolic syndrome

Background

The elevated postprandial triacylglycerol (TG) concentration is associated with elevated coronary artery disease. Oral fatty tolerant test (OFTT) is less performed in the health. This study was to evaluate the effect of sex and body mass index (BMI) on postprandial TG concentration of the low fat meal in healthy young persons. This study included 112 healthy college students (18.8+/-1.6y). Their body height and weight were measured for body mass index (BMI). According to BMI, 27 subjects were in the under-weight subgroup, 60 in the normal weight subgroup and 25 in the over-weight subgroup. After overnight fasting low fat OFTT (27 g fat, 600 kcal) was performed and the plasma TG and glucose concentrations were measured before and at 2, 4 and 6 hour after a fat meal. The area under the curve (AUC) of TG was calculated.

Results

The fasting TG levels were similar and the fasting TG levels gradually increased as BMI increased in both sexes. The postprandial TG levels at 2 and 4 h decreased in female, but did not significant change in male. In female, the TG curves of 3 BMI subgroups showed saddle type, but in male the TG curve of the over-weight subgroup had a peak at 2 h, on the other hand the TG curve of under- weight subgroup had a dip at 2 h.

Conclusions

Gender and BMI are important influencing factors for TG metabolism after fat meal in the youth. The young male persons with over-BMI have abnormal TG metabolism.     

Chlamydia screening among sexually active young female enrollees of health plans--United States, 1999-2001

Chlamydia trachomatis infection is the most commonly reported sexually transmitted disease (STD) in the United States, with the highest rates among adolescent females and young women. Approximately 5%-14% of routinely screened females aged 16-20 years and 3%-12% of women aged 20-24 years are infected with chlamydia. Because up to 70% of chlamydial infections in women are asymptomatic, routine screening and treatment of infected persons is essential to prevent pelvic inflammatory disease, infertility, ectopic pregnancy, and perinatal infections. Since the 1990s, CDC, the U.S. Preventive Services Task Force, and several clinical organizations have recommended routine screening for chlamydial infection for all sexually active women aged <26 years and for pregnant women of all ages. To evaluate rates of chlamydia screening among sexually active young females, CDC analyzed 1999-2001 data from the Health Plan Employer Data and Information Set (HEDIS) reported by commercial and Medicaid health insurance plans. This report summarizes the results of that analysis, which determined that screening rates were low despite slight increases in screening covered both by commercial and Medicaid plans during 1999-2001. Increased screening by health-care providers and coverage of screening by health plans will be necessary to reduce substantially the burden of chlamydial infection in the United States.     

甘油三酯和高密度脂蛋白胆固醇比值与胰岛素抵抗的关系

目的分析甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）的浓度比值与胰岛素抵抗的关系,为筛查胰岛素抵抗的高危人群提供依据。方法利用2012年江苏省慢性病及危险因素监测流动人口专题调查资料,采用问卷调查、体格测量、实验室检测等方法收集人口统计学信息、慢性病防治情况、行为危险因素情况及血脂等信息。采用多元线性回归分析指标的影响大小,采用受试者工作特征曲线（ROC）及非条件logistic回归分析指标的筛查价值。结果 TG/HDL-C比值对空腹胰岛素水平具有显著影响（标准化偏回归系数：男性为0.243,女性为0.254,P〈0.01）,对于胰岛素抵抗的ROC曲线下面积：男性为0.73（95%CI：0.69-0.77）,女性为0.63（95%CI：0.58-0.67）。以TG/HDL-C比值男性≥1.12、女性≥0.71作为筛查胰岛素抵抗的适宜切点,比值高于切点人群的胰岛素抵抗患病率是比值低于切点人群的2.43倍,患病风险是低于切点人群的2.7倍（95%CI：2.1-3.5）。结论 TG/HDL-C比值与空腹胰岛素水平密切相关,对于在成年非糖尿病人群中筛查胰岛素抵抗具有一定价值。     

Indirect estimation of Chlamydia screening coverage using public health surveillance data

Although routine screening of all sexually active adolescent females for Chlamydia trachomatis infection is recommended at least annually in the United States, no national or state-specific population-based estimates of chlamydia screening coverage are known to exist. Conclusions regarding screening coverage have often been based on surveys of health care provider or facility screening practices, but such surveys do not consider persons who do not seek care at these facilities or who seek care at more than one facility. The authors developed a method to estimate the proportion of sexually active females aged 15-19 years screened for chlamydia in 45 states and the District of Columbia by using national data on chlamydia positivity, estimates of sexual activity from the National Survey of Family Growth, and chlamydial infections reported to the Centers for Disease Control and Prevention. Because of uncertainty regarding these values and related assumptions, credibility intervals were calculated by using a Monte Carlo model. When this model was used, the median state-specific proportion of sexually active females aged 15-19 years screened in 2000 was 60% (90% credibility interval: 55, 66). These results and this method should be evaluated for their utility in guiding implementation of national and state chlamydia control programs.     

Evaluation of qualitative and quantitative tests for proteinuria and glucosuria as screening tests for cadmium-induced renal tubular dysfunction

To evaluate the screening tests for cadmium-induced renal tubular dysfunction, qualitative and quantitative tests for urinary protein and glucose have been done in 146 urine samples obtained from subjects who had lived in the cadmium-polluted Jinzu River basin in Toyama Prefecture, Japan. The subjects consisted of 66 men and 80 women aged 55 to 71 years with beta 2-microglobulinuria exceeding 1,000 micrograms/g creatinine. The results obtained from this study were as follows; 1) The positive reaction (above 1+) for protein by the dipstick method was seen in 19.7% of men and 20.0% of women, and for glucose using Tes-tape in 48.5% of men and 33.8% of women. 2) The geometric means of protein and glucose concentrations in urine were 16.4 mg/dl and 12.7 mg/dl in men, and 14.2 mg/dl and 6.8 mg/dl in women, respectively. 3) The criteria of the primary screening in the health survey system for the residents in cadmium-contaminated areas conducted by the Japan Environment Agency were a proteinuria level exceeding 10 mg/dl and a glucosuria above (+/-) with Tes-tape. Nearly all subjects with urinary beta 2-microglobulin exceeding 30 mg/g creatinine were screened by these criteria in both sexes, whereas only 52.9% of men and 30.0% of women who had urinary beta 2-microglobulin between 10 to 30 mg/g creatinine could be screened in this manner. These results indicate that semiquantitative tests are insufficient as initial tests for screening cadmium-induced renal tubular dysfunction.     

Precision of a dry-chemistry method of lipid screening

OBJECTIVES: The purpose of this study was to compare total capillary cholesterol values acquired using the Reflotron with a venous sample taken simultaneously, to determine if the Reflotron meets the guidelines of the National Cholesterol Education Program (NCEP) for accuracy. STUDY DESIGN: An announcement and a registration form for a cholesterol screening programme were distributed with employee pay slips at a large southern university. Approximately 15 employees were scheduled for each screening date, with walk-ins allowed at the health assessment site as space allowed. Capillary and venous samples were collected from screening participants (n=285). METHODS: Approximately 20 ml of blood was collected from each participant, after fasting for 12 h, using standardized venepuncture techniques in the antecubital vein in the bend of the elbow. In order to overcome technician error, two drops of blood (30 microl) were collected immediately from the previously drawn venous sample by drawing blood into the capillary tube from the opening in the top of the venous tube before centrifuging the venous sample, rather than 'sticking' the finger. RESULTS: A Kolmogorov-Smirnov (KS) test of normality was calculated for total capillary cholesterol (KS=1.27, P=0.79) and total venous cholesterol (KS=0.99, P=0.28), which revealed insufficient evidence that the distributions were not normal. Participants' total capillary cholesterol values averaged 213.27 mg/dl [standard deviation (SD)=44.66 mg/dl)] when analysed on the Reflotron, and slightly higher (228.86 mg/dl, SD=40.50 mg/dl) for venepuncture. A paired t-test for variance between groups revealed significant differences in total capillary and total venous cholesterol values (t=-41.93, P<0.0001). A mean centered coefficient of variation was performed, revealing a 3.3% error rate, i.e. greater than the 3% allowable by the NCEP III guidelines. The mean percent bias was -7.28% (SD=3.10%) and the absolute mean percent bias was 7.46% (SD=2.64%). The percentage of participants with total cholesterol misclassified was 16.85%. Concomitantly, Spearman correlation coefficients were high (r2=0.94, P=0.01). CONCLUSIONS: Although the Reflotron met most of the NCEP III guidelines for accuracy, the portable analyser provided clinically relevant underestimations of total cholesterol values, especially for the lower and upper values. Consequently, lipid values obtained using the Reflotron may be useful for screening, but the Reflotron should not be used as a diagnostic and management tool.     

Relation of serum total antioxidant status with metabolic risk factors in Korean adults

The purpose of the present study was to examine the relation of total antioxidant status (TAS) to metabolic risk factors in Korean adults. Anthropometric measures, blood pressure, serum lipids and fasting glucose were determined in 406 men and women. TAS was measured by using commercially available Randox kit. Serum TAS was significantly positively correlated with body weight (p=0.004), body mass index (BMI) (p=0.033), waist circumference (p=0.017), total cholesterol (p=0.038) and triglyceride (TG) (p<0.001). The mean TAS of hypertriglyceridemic subjects (TG ≥150 mg/dl) was significantly higher than that of subjects whose TG was lower than 150 mg/dl (p=0.001). When central obesity, TG, high density lipoprotein cholesterol, fasting glucose and blood pressure were considered as metabolic risk factors, TAS was shown to be elevated with increased number of metabolic risk factors (p=0.004). The positive association between TAS and a number of metabolic risk factors suggests that increased TAS may not always indicate one''s healthier condition. In order to help understand TAS as a marker of total antioxidant capacity in humans with various metabolic conditions, it is needed to clarify the factors affecting TAS in relation to changes in metabolic risk factors.     

Postprandial lipemia in hypertension

OBJECTIVE: Many studies have shown that patients with coronary artery disease have an exaggerated rise and a delayed fall of plasma triglyceride (TG) concentration postprandially. We examined whether patients with essential hypertension have the same response to a fatty meal. METHODS: A fatty meal (350g per 2 m(2) body surface with 83.5% fat) was given to 25 patients with essential hypertension (H) and to 25 normotensives (N). The two groups were matched for age, body mass index, lipid profile, basal glucose and insulin concentrations, and an index of homeostasis model of insulin resistance (HOMA-IR). A quantitative insulin sensitivity check index (QUICKI) was calculated. Blood samples were taken at 0, 4, 6, and 8 hours after the fatty meal. Lipid variables were measured in all samples. Blood glucose and insulin levels were measured in the fasting state. RESULTS: Total and high density lipoprotein cholesterol, apolipoprotein A1 and B, lipoprotein (a), HOMA-IR and QUICKI did not differ significantly over time between the groups. The plasma TG concentration (mg/dL) increased significantly after fat loading in H (from 118 +/- 31 to 284 +/- 137 at 4 hours, 327 +/- 93 at 6 hours and 285 +/- 71 at 8 hours) compared to N group (from 105 +/- 29 to 150 +/- 38 at 4 hours, 148 +/- 40 at 6 hours and 115 +/- 34 at 8 hours), p = 0.001, p < 0.001 and p < 0.001, respectively. CONCLUSION: This study suggests that patients with hypertension have an exaggerated response and delayed clearance of plasma TG concentration after fat loading.     

Fasting and postprandial plasma concentrations of acylation-stimulation protein (ASP) in lean and obese Pima Indians compared to Caucasians.

OBJECTIVE: ASP stimulates the clearance of free fatty acids (FFA) from the circulation and the synthesis of triglycerides (TG) in adipose tissue. We tested whether fasting and post-prandial plasma ASP concentrations are increased in Pima Indians, a population with a very high prevalence of obesity, but a remarkably low prevalence of dyslipidemia. RESEARCH METHODS AND PROCEDURES: Plasma concentrations of ASP, TG, FFA, total cholesterol (CHOL), and insulin (INS) were measured in 15 Pima Indians (P) and 15 Caucasians (C) closely matched for age, sex, and body weight [7 lean and 8 obese subjects, body mass index (BMI) cut-off 30 kg/m2], before and for 4 hours after a standard mixed meal (20% of daily caloric requirements, 41% carbohydrate, 44% fat, 15% protein). RESULTS: Fasting ASP was positively related to percent body fat (dual energy X-ray absorptiometry; r=0.49, p<0.01) and to TG and FFA, independently of percent body fat (partial r = 0.42 and 0.46, respectively, both p<0.05). There were no differences in fasting TG, FFA, CHOL, INS, or ASP between lean C and lean P. In contrast, obese P had lower TG, lower CHOL, higher INS and, on average, 27% lower ASP compared to obese C. The ethnic difference in ASP remained after adjustment for TG, FFA, and percent body fat. ASP decreased in response to the meal in all four groups with no differences between groups. There was a significant inverse correlation between preprandial ASP and the change in FFA 60 minutes after the meal (r=-0.56, p<0.001). DISCUSSION: Pima Indians do not have higher plasma ASP concentrations than Caucasians. Whether other alterations in the ASP-pathway, such as increased sensitivity of adipocytes to ASP, contribute to the high prevalence of obesity and low prevalence of dyslipidemia in Pima Indians, remains to be elucidated.     

Validity of urinary glucose test for diabetes screening in workplace regular medical checkups]

It has been acknowledged that urinary glucose level varies depending on the time after meal which may hence affect validity of urinary glucose test as a screening test for diabetes. However, sample collection time has not been standardized for urinary glucose test in workplace regular medical checkups. In this study, we investigated the effect of timing of urine sampling on results of urinary glucose screening tests, and using data obtained from the 75 g oral glucose tolerance tests (OGTT) evaluated the validity of urinary glucose test in workplace medical checkups. Also, we made a survey among industrial physicians about the timing of sample collection. Between 1991 and 1996, 455 males and 116 females who participated in a 2-day health examination including the OGTT in a hospital in Chiba were used as study subjects. These did not include an additional 22 subjects who had already been diagnosed as having diabetes but received the OGTT. The examinees observed a strict fast after supper the previous evening and urine and blood samples were collected before and 2 hours after glucose intake for the OGTT. Diagnosis of diabetes was made following the criteria of WHO (1985) and screening test results were defined positive when urinary glucose level was equal to or more than 40 mg/dl. Sensitivity and specificity were calculated for diabetes and impaired glucose tolerance separately for male and female. Industrial physicians who participated in a lecture course for qualification were surveyed about the timing of urine sample collection for urinary glucose test in workplace regular medical checkups. For the urine samples collected 2 hours after glucose intake, sensitivity was very high (male 84%, female 100%), in addition to a relatively high specificity (male 71%, female 92%). However the samples collected before glucose intake showed extremely poor sensitivity (male 11%, female 0%). Similar results were obtained when screening was made for impaired glucose tolerance and both diabetes and impaired glucose tolerance combined. The survey among the industrial physician revealed that in the majority (58%) of workplace medical checkups, the urine sample had been collected when examinees were fasting. The largest reason for this was that the urinary glucose test was performed together with upper gastro-intestinal examination or measurement of serum triglyceride both of which require fasting of examinees. The results of the present study showed that urinary glucose tests have been frequently performed at a timing that produces low validity. The procedures of workplace regular medical checkups should be evaluated with the concept of Evidence Based Medicine. The standard of the timing of urine sample collection for urinary glucose test should be carefully examined.     

A preliminary study of hyperlipidemia in Bangkok school children

As a preliminary study, we determined the serum lipid profiles among primary school children from four Bangkok schools and identified the risk factors and their association with child lipid profiles. We conducted a cross-sectional study using fasting blood samples and food frequency questionnaires. Overall, there were 40% that had hypercholesterolemia with total cholesterol (TC) at > or = 200 mg/dl and high low density lipoprotein cholesterol (LDL-C) at > or = 130 mg/dl. Overall, 5.4% had high triglyceride (TG) levels at > or = 150 mg/dl. There was no association between lipid profiles and age, gender or nutritional status, except that higher TG levels were found among obese children than others (p < 0.001). The most popular high fat foods were fried chicken, sausages and cakes, in order of preference. Results from this study indicate that Bangkok public primary school children are facing a problem with hyperlipidemia. Build up discipline in healthy eating habits, healthy food choices and physical exercise should pave the way to healthy Thai kids and growing adults with better quality of life.     

Application of three-dimensional body scanner: observation of prevalence of metabolic syndrome

BACKGROUND AND AIMS: This retrospective cross-sectional study correlates blood pressure, blood glucose, lipid and uric acid levels with anthropometric measurements. METHODS: A total of 3975 visitors to the Department of Health Management were randomly selected to participate in this cross-sectional study. Whole body three-dimensional (3-D) laser scans were used to obtain anthropometric measurements. A health index (HI) was also designed based on anthropometric parameters. Subjects were defined as having metabolic syndrome when three of the following criteria were met: obesity (BMI of at least 30 kg/m(2); or a WHR of over 0.9 for males and 0.85 for females); triglyceride of at least 150 mg/dl; high-density lipoprotein (HDL)-cholesterol below 35 mg/dl for males and 39 mg/dl for females; fasting sugar levels of at least 110 mg/dl and hypertension. RESULTS: Of 3975 subjects, 341 (8.6%) met the criteria for diabetes mellitus (DM); of these, 32.8% were diagnosed with hypertension. This proportion exceeded 18% of the subjects had normal glucose levels. Of the 3975 subjects, 658 (16.6%) met the criteria for metabolic syndrome. Proportionally, more male subjects than female subjects were diagnosed with metabolic syndrome (18.5% vs 14.7%). Of these, central obesity, elevated triglyceride and low HDL-cholesterol were the main factors in men, while fasting glucose, hypertension and central obesity were the main factors in women. This investigation found that larger proportions of subjects with impaired glucose tolerance (41.1%) and DM (64.2%) than of subjects with normal glucose subjects, suffered from metabolic syndrome (9.5%). CONCLUSIONS: 3-D body scanning is useful in correlating pertinent factors with metabolic syndrome, these factors include central obesity, hyperglycemia, dyslipidemia, hyperuricemia and hypertension.     

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.     

A critical evaluation of high density lipoprotein cholesterol as an index of coronary artery disease risk in Malaysians

Fasting serum specimens from (a) 217 male and 46 female patients with coronary artery disease (CAD), aged 35-75 years, who had undergone angioplasty (PTCA) / coronary artery bypass graft (CABG), and (b) 160 apparently healthy controls (106 males, 54 females, aged 30-75 years), were assessed for serum lipid profile. Both sex and ethnicity significantly influenced the levels of serum high density lipoprotein cholesterol (HDLC); in the controls, females had higher HDLC levels than males (46.7 mg/dl vs 38.5 mg/dl, p<0.00l), while the Indian males possessed significantly lower HDLC values than the male Malay or Chinese. HDLC, triglycerides (TG) and the atherogenic index- LDLC/HDLC ratio were significantly different between the CAD patients and the healthy controls, while total cholesterol (TC) and LDLC did not seem to be of diagnostic value. Serum HDLC was lower in the CAD patients compared to the healthy controls in both sexes (p<0.001), either expressed as HDLC per se or as % HDLC. This observation combined with the odds ratio (OR) values of 0.24 and 0.28 for HDLC and % HDLC respectively in males, firmly establishes HDL as a protective factor of CAD in Malaysians. Significance testing for the X2 values associated with the OR values for the various lipid indices, together with the findings on the receiver-operating characteristices (ROC) curves, i.e. plots of sensitivity vs 1-specificity, indicated that HDLC, % HDLC and TQ were equally efficient as a means of risk assessment to CAD in Malaysians.     

Outcome and cost of a statewide diabetes screening and awareness initiative in New York.

From 1997 through 1999, a total of 365 diabetes screening and awareness events targeting high-risk populations were held throughout New York State. These events were planned and implemented by community-based coalitions that received funding from the state's Diabetes Control Program. The American Diabetes Association's diabetes risk questionnaire was administered, and those individuals identified as high risk received a capillary blood glucose test. Screened individuals with glucose readings above the cut-off value (140 mg/dl or 110 mg/dl if fasting) were referred to a physician for diagnostic testing. A total of 32,954 individuals took the questionnaire, 27,237 received the blood test, and 1,564 were referred to a physician. Among those who were successfully tracked (n = 1,113), 354 were newly diagnosed with diabetes mellitus. Seventy-two percent of participants screened were aged 45 years and older, and 67% had a body mass index of 25 or higher. Only 15% were members of ethnic minorities, and uninsured individuals were also underrepresented at 10%. The entire initiative, including planning, promotion, and administration, required 5,428 person-hours of staff time and a total cost of approximately 262,000 dollars. Fifty-seven percent of the total cost was derived from in-kind support of the coalitions. The cost of detecting each new case was 741 dollars.     

Some behavioural changes observed among fasting subjects, their nutritional habits and energy expenditure in Ramadan

This study was conducted in five provinces and food consumption, physical activity types and duration for 3 consecutive days were recorded in the questionnaire together with some general characteristics of 750 (320 males, 430 females) adults who were on fast during Ramadan at time of interview. One hundred and eighty-seven subjects had some type of health problems, among whom 60.4% were using drugs, and 31.6% were on diets; however, during Ramadan 9.7 and 18.8% of the subjects dropped taking drugs and did not regularly keep on diets, respectively. During the fasting time, from dawn to sunset, 34.3% of the subjects developed some behavioural disturbances, such as feeling tired and being unwilling to work. Although the meal consumed at dawn consisted of foods that were usually eaten at breakfast, the meal consumed at sunset consisted of a great variety of foods. Calcium intake was the most insufficiently consumed nutrient. It was observed that the daily energy intakes were less than the expenditures both in males and females. Further research should be done on the effects of fasting in health and disease.