Dietary patterns and cardiovascular disease in Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS)

Background and aimsEmpirically-derived dietary patterns have been shown to have both positive and adverse associations with cardiovascular disease (CVD). Yet, such associations remain unclear in the Greek population. The aim of this study was to investigate the association between empirically-derived dietary patterns and the presence of CVD and CVD-related medical conditions in a nationally representative sample of Greek adults.Methods and resultsAdult participants (≥20 years old) of the Hellenic National Nutrition and Health Survey (HNNHS) were included (N = 3552; 41.2% men; 43.7 years, SD: 18.1). Dietary patterns were derived by principal component analysis using 24-h recall data. The presence of dyslipidemia (elevated cholesterol and/or triglycerides), hypertension, coronary heart disease, and total CVD, was defined according to the International Clinical Diagnosis (ICD)-10 codes. Odds ratios of CVD outcomes were estimated across dietary patterns using multivariable logistic regression analysis. Three dietary patterns -Traditional (proxy Mediterranean), Western, and Prudent-were identified explaining 16.5% of the total variance in consumption. Logistic regression analysis, adjusted for age, sex, total caloric intake, sociodemographic characteristics, and other CVD risk factors, showed an inverse association between the Traditional dietary pattern and CVD presence (OR: 0.53; 95% CI: 0.30–0.95), and a positive association between the Western pattern and dyslipidemia (1.52; 1.02–2.26). No association was found between the Prudent pattern and CVD outcomes.ConclusionThe variability of food intake combinations in the Greek population seem to be associated with the presence of CVD and CVD related conditions. Such findings are imperative for national monitoring and informed priority setting.     

Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999-2004

OBJECTIVES: Peripheral arterial disease (PAD) is associated with significant cardiovascular morbidity and mortality. The study objectives were to examine the prevalence of PAD and associated risk factors. DESIGN: A cross-sectional nationally representative health examination survey. SETTING: The National Health and Nutrition Examination Survey 1999-2004. PARTICIPANTS: Data from 3,947 men and women aged 60 and older who received a lower extremity examination. MEASUREMENTS: The main outcome was PAD, defined as an ankle-brachial blood pressure index of less than 0.9 in either leg. RESULTS: In older U.S. adults, PAD prevalence was 12.2% (95% confidence interval (CI) = 10.9-13.5%). PAD prevalence increased with age. PAD prevalence was 7.0% (95% CI = 5.6-8.4%) for those aged 60 to 69, 12.5% (95% CI = 10.4-14.6%), and 23.2% (95% CI = 19.8-26.7%) for those aged 70 to 79 and 80 and older. Age-adjusted estimates show that non-Hispanic black men and women and Mexican-American women had a higher prevalence of PAD than non-Hispanic white men and women (19.2%, 95% CI = 13.7-24.6%; 19.3%, 95% CI = 13.3-25.2%; and 15.6%, 95% CI = 12.7-18.6%, respectively). The results of the fully adjusted model show that current smoking (OR = 5.48, 95% CI = 3.60-8.35), previous smoking (OR = 1.94, 95% CI = 1.39-2.69), diabetes mellitus (OR = 1.81, 95% CI = 1.12-2.91), low kidney function (OR = 2.69, 95% CI = 1.58-4.56), mildly decreased kidney function (OR = 1.71, 95% CI = 1.22-2.38), high-sensitivity C-reactive protein greater than 3.0 mg/L (OR = 2.69, 95% CI = 1.24-5.85), treated but not controlled hypertension (OR = 1.95, 95% CI = 1.40-2.72), and untreated hypertension (OR = 1.68, 95% CI = 1.13-2.50) were all significantly associated with prevalent PAD. CONCLUSION: PAD prevalence increases with age and is associated with treatable risk factors for cardiovascular disease.     

Relationship between Mediterranean Diet Score and atherothrombotic risk: Findings from the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994

Background

Mediterranean diet has been promoted as the preferred dietary model for cardiovascular disease prevention in the United States.

Objective

We sought to evaluate the degree to which the Mediterranean diet is associated with reduced levels of atherothrombotic biomarkers in a population-based sample in the U.S.

Design

Data from 13,197 adults between the ages of 18 and 90 were collected and atherothrombotic risk factors assessed as part of the NHANES III, 1988–1994. Adherence to the Mediterranean diet was evaluated using food frequency questionnaires, supplemented by the 24-h dietary recall data, to develop Mediterranean Diet Scores (MedDietScore) that were analyzed in tertiles. The cross-sectional relationship of MedDietScore to atherothrombotic factors were analyzed using multiple variable regression analysis adjusted for complex sampling design using SUDAAN.

Results

The components of the Mediterranean diet and the dietary pattern's associations with atherothrombotic risk factors differed by age and gender. For men <45 years of age as MedDietScore increased: total cholesterol/HDL cholesterol (TC/HDL) ratio (p = 0.0390), serum insulin (p = 0.0414), and white blood cell (WBC) (p = 0.0246) decreased. For men ≥45 years as MedDietScore increased: TC/HDL ratio (p = 0.0008), Hemoglobin A1c (HgbA1c) (p = 0.0001), HOMA index (p = 0.0486), C-reactive protein (p = 0.0034), fibrinogen (p = 0.0028) decreased and HDL cholesterol (HDL-c) levels (p < 0.0001) increased. For pre-menopausal women, as MedDietScore increased: TC/HDL ratio (p < 0.0001), non-HDL cholesterol (p = 0.0012), apolipoprotein B (p = 0.0112), HgbA1c (p = 0.0001), decreased and HDL-c levels (p < 0.0001) increased. For post-menopausal women, as MedDietScore increased: TC/HDL ratio (p = 0.0005), Triglycerides (p < 0.0001), serum insulin (p = 0.0062), HOMA index (p = 0.0063) and Homocysteine (Hcy) (0.0046) levels decreased and HDL-c levels (p = 0.0005) increased.

Conclusions

Mediterranean diet appears to be associated with selective measures of cardioprotective lipid profiles, glucose metabolism, and inflammation and coagulation levels.     

Nutrition-related cardiovascular risk factors in older people: results from the Third National Health and Nutrition Examination Survey

SETTING: In view of the recognized potential benefits of nutritional therapy in older persons, Congress is evaluating the coverage of nutritional services for Medicare beneficiaries. OBJECTIVE: To estimate the number of older persons in the US who have one or more cardiovascular risk factors (hypertension, increased low density lipoprotein (LDL) cholesterol, and diabetes mellitus), for which nutritional therapy is recommended. DESIGN: Cross-sectional analysis of adults, aged > or = 65, participating in the Third National Health and Nutrition Examination Survey (NHANES III). MAIN OUTCOMES: The authors estimated the proportion of adults, aged > or = 65, with diabetes mellitus, increased LDL cholesterol, and/or hypertension. Efforts were made to assess whether obesity status, gender, race, and/or socioeconomic factors were associated with the prevalence of any or all three conditions. RESULTS: Approximately 86% (20 million persons) in the US, aged > or = 65, have at least one of the index conditions. Whereas a higher body mass index (BMI) increased the likelihood of having any or all three conditions, 81% of persons of average body weight (BMI <25 kg/m2) had at least one condition. After adjusting for age, gender, BMI, marital status, and poverty index, blacks were more likely than whites to have any one condition (odds ratio (OR) = 3.0, P < .01) or all three conditions (OR = 2.3, P = .05). CONCLUSIONS: Almost 90% of Americans aged > or = 65 have one or more nutrition-related cardiovascular risk factors. Improved nutritional interventions may be valuable especially for blacks, who have a higher prevalence of conditions requiring nutritional therapy.     

Airway obstruction in never smokers: results from the Third National Health and Nutrition Examination Survey

Purpose

Chronic obstructive pulmonary disease (COPD) is usually described as a disease of cigarette smoking. COPD is rarely considered in persons with no smoking history except in the context of another exposure. Accordingly, the disease has not been well characterized in these “never smokers.”

Methods

We evaluated airway obstruction (defined as forced expiratory volume in 1 second/forced vital capacity <0.70) in US adults aged 30 to 80 years interviewed in the Third National Health and Nutrition Examination Survey with valid spirometry who had never smoked. Previously described risk factors were examined for their association with obstruction in bivariate and multivariate analyses.

Results

Never smokers represented 42% of the Third National Health and Nutrition Examination Survey population aged 30 to 80 years, with obstruction prevalence of 91 per 1000. Never smokers accounted for 4.56 million cases of obstruction, or 23% of the total burden. Among these obstructed never smokers, 19% reported a prior diagnosis of asthma alone, and 12.5% reported COPD (alone or with asthma), leaving 68.5% with no prior respiratory diagnosis. After adjustment for other factors, higher rates of obstruction were significantly associated with increasing age, male sex, lower body mass index, and a history of allergies.

Conclusions

Never smokers represent a significant proportion of airway obstruction in US adults. Only one fifth of obstruction in this group is explained by asthma. COPD may explain much of the remainder, although known risk factors were not explanatory in this dataset. Recommendations that lung health screening programs be limited to smokers should be reconsidered.     

A risk score assessment tool for peripheral arterial disease in women: From the National Health and Nutrition Examination Survey

Background

Peripheral arterial disease (PAD) carries a significant morbidity and mortality. Women are more commonly affected with this condition and are mostly asymptomatic, and undertreated. The objective of the study was to develop and validate a simple risk score to identify women with PAD.

Hypothesis

Identifying those at early stage of the disease could help reduce the risk of complications.

Methods

Using data from the National Health and Nutrition Examination Survey 1999‐2004, we identified women who had data on ankle brachial index. The cohort was divided into development (70%) and validation (30%) groups. Using variables that are self‐reported or measured without laboratory data, we developed a multivariable logistic regression to predict PAD, which was evaluated in the validation cohort.

Results

A total of 150.6 million women were included. A diagnosis of PAD was reported in 13.7%. Age, body mass index, hypertension, diabetes mellitus, smoking, non‐oral contraceptive pill usage, and parity were all independently associated with PAD. The C‐statistics was 0.74, with good calibration. The model showed good stability in the validation cohort (C‐statistics 0.73).

Conclusion

This parsimonious risk model is a valid tool for risk prediction of PAD in women, and could be easily applied in routine clinical practice.     

The prevalence and risk factors associated with isolated untreated systolic hypertension in Korea: the Korean National Health and Nutrition Survey 2001

Although isolated systolic hypertension (ISH) increases the risk of coronary heart disease and stroke, more than any other hypertension subtype, the prevalence and risk factors associated with ISH in the Korean population are not known. The 2001 Korean National Health and Nutrition Survey was a cross-sectional and nationally representative survey conducted in 2001. The prevalence of ISH by age and body mass index (BMI) was examined in 6601 Korean adults over 20 years of age. After adjusting for age, 4.32+/-0.32% of Korean adults had ISH, 5.28+/-0.37% had isolated diastolic hypertension and 5.82+/-0.36% had systolic/diastolic hypertension. The overall prevalence of ISH was found to increase directly with advancing age and increasing BMI. Although the ISH was found to be more common in men overall (4.81+/-0.50% in men, 4.12+/-0.37% in women), it was more common in women over 70 years of age. Independent variables associated with risk for ISH included advanced age, BMI, triglyceride (TG) levels, monthly income and alcohol intake. However, gender, fasting blood glucose, total cholesterol and high-density lipoprotein cholesterol levels, residential area, education level and smoking were found not to be significantly associated with ISH risk. The findings of the present study demonstrate that the prevalence of untreated ISH in Korea was lower than in Western countries. Age, BMI, TG levels, monthly income and alcohol intake were associated with ISH.     

Association between metabolic syndrome and estimated glomerular filtration rate in older Koreans based on data from the third Korean National Health and Nutrition Examination Survey

Aim: To examine the association between metabolic syndrome (MetS) and renal function in older Koreans. Methods: A total of 1270 people aged 60 years and older who participated in the third Korean National Health and Nutrition Examination Survey were included in this study. Results: After adjusting for confounding factors, central obesity, high‐density lipoprotein cholesterol and fasting glucose were significantly associated with decreased renal function in men. In women, however, each component of MetS with the exception of fasting glucose was not associated with renal function. The odds ratios for MetS were 2.548 in men and 1.454 in women after adjustment for confounding variables; both were statistically significant. The odds ratio of decreased renal function increased as the number of components of MetS increased. Conclusion: The results of this study suggest that MetS may be an independent risk factor for decreased renal function in older population as well.     

Association between low pulmonary function and metabolic risk factors in Korean adults: the Korean National Health and Nutrition Survey

Impaired lung function is a risk factor for cardiovascular events and mortality. In addition, lung function impairment is also associated with insulin resistance and type 2 diabetes mellitus. It is well known that a common mechanism, such as insulin resistance and obesity, underlies metabolic syndrome. Our aim was to evaluate the association between impaired lung function and metabolic risk factors using data from a nationwide survey of chronic obstructive pulmonary disease prevalence in Korea and the Korean National Health and Nutrition Survey in 2001. The study population included 4001 subjects (aged ≥18 years) who underwent spirometry at least twice. We analyzed the association of low pulmonary function with metabolic syndrome components using multiple linear regression and also analyzed the association of metabolic syndrome with restrictive lung disease and obstructive lung disease using multiple logistic regression adjusted for waist to height ratio, sex, age, smoking, and the other covariates. Waist girth, systolic blood pressure, and triglyceride were associated with forced vital capacity (FVC); and only triglyceride was so with forced expiratory volume in 1 second (FEV₁), but not with FEV₁/FVC ratio. The odds ratio of metabolic syndrome for restrictive lung disease (FVC <80%, FEV₁/FVC >0.7) was 1.40 (95% confidence interval, 1.01-1.98), and that for obstructive lung disease (FEV₁/FVC <0.7) was 0.93 (95% confidence interval, 0.67-1.28) after adjustment for covariates. These results indicate that low pulmonary function in the general population is associated with clustering of metabolic syndrome risk factors and, furthermore, that restrictive lung disease is also related to metabolic syndrome.     

The metabolic syndrome and mortality from cardiovascular disease and all-causes: findings from the National Health and Nutrition Examination Survey II Mortality Study

The prospective associations between the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP/ATP III) expert panel and mortality from cardiovascular disease and all-causes has not been extensively examined. Using data from the National Health and Nutrition Examination Survey II Mortality Study (1976-1992), the author examined the association between the metabolic syndrome and mortality from all-causes and cardiovascular disease among 2431 US adults aged 30-75 years. The NCEP/ATP III criteria were modified to substitute body mass index >/=25 kg/m(2) for waist circumference for women and >/=30 kg/m(2) for men. After multiple-adjustment, the hazard ratios for participants with the metabolic syndrome were 1.37 (95% confidence interval (CI): 1.02, 1.85) for mortality from cardiovascular disease, 1.29 (95% CI: 0.92, 1.82) for mortality from coronary heart disease, 1.68 (95% CI: 0.86, 3.27) for mortality from stroke, 1.23 (95% CI: 0.95, 1.59) for mortality from diseases of the circulatory system, and 1.15 (95% CI: 0.92, 1.45) for all-cause mortality compared with participants without the syndrome. The association between the number of metabolic syndrome criteria and mortality from cardiovascular disease was near linear (P = 0.007). Three criteria of the syndrome-excess weight, hypertriglyceridemia, and low high-density lipoprotein cholesterol concentration-were not independently associated with any of the outcomes. Additional prospective studies are needed to examine the association between the metabolic syndrome and the incidence of cardiovascular disease and mortality from cardiovascular disease and all-causes.     

老年人误吸危险因素与风险评估的研究进展

误吸是老年人最常见的临床问题之一,具有发生率高、危害大、诊断困难等特点。该文从老年人误吸的危险因素及风险评估两方面进行综述,旨在为老年人误吸的早期识别、科学评估、及时干预提供参考。     

High attributable risk of elevated C-reactive protein level to conventional coronary heart disease risk factors: the Third National Health and Nutrition Examination Survey

BACKGROUND: C-reactive protein (CRP), a marker of systemic inflammation, is predictive of coronary heart disease (CHD) events. However, the extent to which high CRP levels (>3 mg/L) may be attributable to high cholesterol levels and other CHD risk factors has not been well defined. METHODS: The prevalence of high CRP levels in the third National Health and Nutrition Examination Survey (n = 15 341) was studied using CHD risk-factor cut points designated as abnormal (total cholesterol values, >or=240 mg/dL [>or=6.22 mmol/L]; fasting blood glucose levels, >or=126 mg/dL [>or=6.99 mmol/L]; blood pressure, >or=140/90 mm Hg; body mass index [BMI], >or=30 kg/m(2); high-density lipoprotein cholesterol values, <40 mg/dL [<1.04 mmol/L] for men and <50 mg/dL [<1.30 mmol/L] for women; triglyceride levels, >or=200 mg/dL [>or=2.26 mmol/L]; current smoking status) or borderline (total cholesterol values, 200-239 mg/dL [5.18-6.19 mmol/L]; fasting blood glucose levels, 100-125 mg/dL [5.55-6.94 mmol/L]; blood pressure, 120-139/80-89 mm Hg; BMI, 25.0-29.9 kg/m(2), and triglyceride values 150-199 mg/dL [1.70-2.25 mmol/L], former smoking status), or normal. RESULTS: Weighted multiple logistic regression analysis demonstrated that high CRP level was significantly more common with obesity (odds ratio [OR], 3.78; 95% confidence interval [CI], 3.28-4.35]), overweight (OR, 1.88; 95% CI, 1.62-2.18), and diabetes (OR, 1.91; 95% CI, 1.54-2.38) and that high CRP level was rare in the absence of any borderline or abnormal CHD risk factor in men (4.4%) and women (10.3%). Overall, the risk of elevated CRP level attributable to the presence of any abnormal or borderline CHD risk factor was 78% in men and 67% women. CONCLUSIONS: These data suggest that elevated CRP levels in the general population are in large measure attributable to traditional CHD risk factors. Moreover, CRP level elevation is rare in the absence of borderline or abnormal risk factors. As such, CRP measurements may have limited clinical utility as a screening tool beyond other known CHD risk factors.     

Distribution of C-reactive protein and its relation to risk factors and coronary heart disease risk estimation in the National Health and Nutrition Examination Survey (NHANES) III

The authors examined the distribution of, and risk factors associated with, the inflammatory marker C-reactive protein (CRP) among a large sample of non-institutionalized American adults aged 30–74 years of age, and its relation to estimated 10-year coronary heart disease risk. The population studied comprised 4472 men and 5212 women aged 30–74 years, without coronary heart disease, who had CRP measurements in the Third National Health and Nutrition Examination Survey (NHANES III). The 10-year risk of coronary heart disease was estimated from Framingham risk factor algorithms among those with CRP levels of ≤ 0.21 mg/dL, >0.21–<0.5mg/dL, 0.5–<1.0 mg/dL, and ≥1.0 mg/dL. Mean (SD) levels of CRP were 0.41 (0.64) mg/dL in men and 0.55 (0.91) mg/dL in women. Levels of at least 1 mg/dL were measured in 6.4% of men and 12.9% of women. CRP levels were highest among non-Hispanic black men and Mexican-American women. According to multiple logistic regression analysis, cigarette smoking and increased age, body mass index, and systolic blood pressure in men, and body mass index and diabetes in women, were strongly associated with a greater likelihood of CRP levels of ≥1.0 mg/dL (p<0.001). Among persons with CRP levels of ≥0.21 mg/dL, >0.21-<0.5 mg/dL, 0.5-<1.0 mg/dL and ≥1.0 mg/dL, the 10-year estimated risk of coronary heart disease were 13.4%, 17.6%, 19.6%, and 21.1% among men, respectively, and 2.7%, 3.6%, 4.1% and 4.3% among women, respectively (both p <0.001 across CRP categories); higher risks across CRP groups were also found among ethnic/gender subgroups. CRP remained a significant predictor of coronary heart disease risk in unadjusted and age-adjusted analyses.Conclusion. Elevation of CRP is associated with several major coronary heart disease risk factors and with unadjusted and age-adjusted projections of 10-year coronary heart disease risk in both men and women.     

Prevalence and risk factors of hypertension for the middle-aged population in China — results from the China Health and Retirement Longitudinal Study (CHARLS)

Background: The prevalence of hypertension in middle-aged people is increasing. However, few studies have examined the risk factors of hypertension among the middle-aged population. The aim of this study is to present the prevalence of hypertension and its risk factors for the middle-aged population in China.

Methods: The data were from the third-wave national survey (2015) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 7,178 respondents aged 45–59 years were included in this study. Hypertension was defined as SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or currently taking antihypertensive medicines. Multivariate logistic regression analyses were used to identify the risk factors of hypertension.

Results: The prevalence of hypertension was 29.12% (95%CI = 28.07–30.17). Hypertension was more prevalent among men than women (31.63% vs. 27.03%). Older age, higher BMI, chronic diseases, and poor health status were independently associated with hypertension in both genders (p < 0.05). Among women, college education (OR = 0.302, 95%CI = 0.152–0.598), marriage or cohabitation (OR = 0.756, 95%CI = 0.584–0.98), and drinking more than once a month (OR = 0.645, 95% = 0.498–0.836) led to a decreased likelihood of hypertension. Individuals with larger waist circumference were more likely to have hypertension (OR = 1.57, 95%CI = 1.294–1.906).

Conclusion: Our results indicate that hypertension is highly prevalent in the middle-aged population in China. Men are more likely to have hypertension than women. Older age, higher BMI, chronic diseases and poor self-rated health are risk factors for hypertension in both genders. Large waist circumference, singleness, low educational level, and non-drinking are risk factors of hypertension among women but not among men.