Dietary cardiovascular risk factors and serum cholesterol in an Old Order Mennonite community.

OBJECTIVES: Dietary and coronary heart disease risk factors in Old Order Mennonite men and women were examined. METHODS: A food frequency questionnaire was mailed to 250 Mennonites who had participated in a previous study of coronary heart disease risk factors. RESULTS: Mennonites consumed a diet high in total fat, saturated fats, and cholesterol. Men had lower average serum cholesterol levels (174 mg/dL) than women (191 mg/dL). CONCLUSIONS: The Mennonites' diet was similar to that of the overall US population in saturated fat percentage and higher in cholesterol. Serum cholesterol levels, adiposity, and blood pressure were lower than expected among Mennonite men, perhaps because of their higher levels of physical activity.     

Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat

In general, vegetarians have lower serum lipids and blood pressures than omnivores have. We tested the blood pressure and serum lipid lowering effects of two fat-modified diets differing primarily in their source of protein. Twenty-six men were randomized in an incomplete block design to two of three diets: a high-fat diet, a fat-modified lactoovovegetarian diet (LOV) and a diet in which 60% of plant protein in the LOV was replaced with lean meat (LM). Compared with the high-fat diet both prudent diets significantly lowered blood pressure, serum total cholesterol (TC), and LDL cholesterol but significantly increased serum triglycerides. The LOV diet had a significantly greater cholesterol-lowering effect than did the LM diet (10% vs 5% decrease) but blood pressure reductions were similar. The partial substitution of lean meat for plant protein in a fat-modified diet did not negate the overall cardiovascular-risk lowering of the lactoovovegetarian diet.     

Disparities in screening for and awareness of high blood cholesterol--United States, 1999-2002

High blood cholesterol is a major modifiable risk factor for atherosclerotic cardiovascular disease. Two national health objectives for 2010 are to reduce to 17% the proportion of adults with high total blood cholesterol levels and to increase to 80% the proportion of adults who had their blood cholesterol checked during the preceding 5 years. In addition, an overall national health objective is to eliminate racial/ethnic and other disparities in all health outcomes. During 1960-1994, total blood cholesterol levels among the overall U.S. population declined; however, levels have changed little since then, despite increases in cholesterol screening and awareness. To assess racial/ethnic and other disparities among persons who were screened for high blood cholesterol during the preceding 5 years and among persons who were aware of their high blood cholesterol, CDC analyzed data from the 1999-2000 and 2001-2002 National Health and Nutrition Examination Surveys (NHANES). This report summarizes the results of that analysis, which indicated that Mexican Americans, blacks, and younger adults were less likely to be screened for high blood cholesterol, and persons in those populations who had high cholesterol were less likely to be aware of their condition. Efforts are needed to encourage persons, especially among these populations, to seek screening and gain awareness of high blood cholesterol.     

Dietary fiber sources lower blood cholesterol in C57BL/6 mice.

Five sources of dietary fiber were compared for their effect on blood and liver cholesterol. The effects of soybean fiber, rice bran (full fat), oat bran, barley bran and mixed bran on total blood cholesterol concentrations and liver cholesterol concentrations were measured in beef-fed C57BL/6 male mice. Each diet contained cooked beef, beef tallow, corn starch and 7% dietary fiber from one of the five fiber sources. A control group consumed a fiber-free diet. Dietary cholesterol was provided by the beef and beef tallow only. The experimental diets were fed for 3 wk; blood and liver were collected when the mice were 18 wk old. The liver cholesterol concentration in the rice bran-fed group was the lowest of the six diet groups and was significantly different than concentrations in the oat bran-fed group and the barley bran-fed group (P less than 0.05). The oat bran, mixed bran, and barley bran did not significantly lower blood cholesterol in the mice. Both the soybean fiber and rice bran diet groups had significantly lower total blood cholesterol than did the fiber-free controls (P less than 0.05). The soybean fiber group also had significantly lower blood cholesterol than the mixed-bran group.     

Effect of a cooperative extension nutrition and exercise program for older adults on nutrition knowledge,dietary intake,anthropometric measurements,and serum lipids

The purpose of this study was to assess the impact of a nutrition and fitness program for older adults on their nutritional status. Twenty-four adult volunteers between the ages of 60 and 88 participated in a nutrition and exercise program. Pre- and post-program data were collected on nutrition knowledge, dietary intake using a 24-hour recall procedure, anthropometric values, serum lipids, and exercise patterns. After initial data collection, the subjects participated in a 12-week nutrition program. Nutrition knowledge scores increased significantly, with an average increase of 12%. Total dietary intake of fat did not significantly change following the program. However, there was a significant change in the type of fat consumed: saturated fat intake decreased and polyunsaturated fat intake increased. Percent of calories from carbohydrate, protein and fat averaged 51%, 19% and 30%, respectively. Body weight significantly decreased; however, there was not a significant decrease in % bodyfat, % overfat and pounds overweight. Both systolic and diastolic blood pressures significantly decreased, as did total cholesterol, LDL cholesterol and triglycerides. HDL cholesterol and % HDL cholesterol significantly increased. The number of days per week exercised, time exercised, and exercise intensity also significantly increased.     

Effects of voluntary running exercise on blood pressure and renin-angiotensin system in spontaneously hypertensive rats and normotensive Wistar-Kyoto rats

The effect of a voluntary running exercise on blood pressure and renin-angiotensin system (RAS) was studied in male spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY). SHR and WKY were assigned to either voluntary running exercise or sedentary control groups at 5 wk of age. The systolic blood pressure in the exercised group for both strains of rats was significantly lower than in the sedentary control group. The plasma renin activity (PRA) and plasma renin concentration (PRC) were significantly lower in voluntary running exercised SHR than in sedentary SHR, whereas the same exercise did not result in a lower PRA and PRC in WKY. These results suggested that the blood pressure lowering effect of voluntary running exercise is related to the suppression of RAS in SHR.     

Ischemic heart disease risk factors in middle-aged Seventh-day Adventist men and their neighbors

Seventh-day Adventists in California have much lower mortality from ischemic heart disease than do other Californians, but the risk factors have not been well documented previously for a representative sample. This study, conducted in 1982, chose a random sample of 160 Californian non-Hispanic white middle-aged Adventist men, 160 of their similar-aged male neighbors, and documented traditional ischemic heart disease risk factors. Results show major dietary differences between the two groups as expected, this being reflected in significant differences in consumption of total fat, saturated fat, dietary cholesterol, and crude fiber. Questionnaire data suggested that the Adventists also exercised 50% more, rarely smoked, but had identical Framingham Type A/B scores. There were no differences in obesity or blood pressure levels, but serum total cholesterol was significantly lower in the Adventists (190.1 vs. 203.5 mg/dl, p less than 0.001), as was low density lipoprotein cholesterol (125 vs. 134.0 mg/dl, p less than 0.03) and high density lipoprotein (HDL) cholesterol (42.3 vs. 46.0 mg/dl, p less than 0.005). Consequently, the ratio of total cholesterol/HDL cholesterol was virtually identical between the two groups. Possible explanations for some of these findings are discussed.     

Patient adherence in an individualized rehabilitation programme: a clinical follow-up

AIMS: This investigation aims to describe patients with longstanding pain who did not complete their participation and/or participated infrequently in physiotherapy (PT) treatment based on their own activity and responsibility, and in addition to understand the phenomenon of adherence from a behavioural theoretical perspective. METHODS: The phenomenon compliance/adherence was studied in relation to health locus of control (HLC) factors and health belief (HB) variables. Outcome measures were based on a questionnaire answered by all patients before the beginning of treatment. Definitions of adherence were completed treatment period and exercise frequency respectively. Patients completing treatment were compared with those who did not. Exercise frequencies of those completing treatment were also studied. RESULTS: Those who did not complete treatment reported higher pain intensity, higher Oswestry score, and worse general health than those completing treatment. Results also showed that those who exercised once a week or less often valued the significance of healthcare treatment less, perceived higher pain intensity, presented a higher Oswestry score, worse general health, more pain locations, lower expectations, were younger and almost solely women, than those who exercised more often. CONCLUSIONS: Individuals exercising irregularly were above all women. This fact needs further investigation. Individuals' belief in treatment effects is of significance to adherence. Adherence is a comprehensive concept and depending on how we look at it we find different populations.     

Longitudinal study of risk factors for coronary heart disease across the menopausal transition

The patterns of change in blood lipids, diastolic blood pressure, body mass index, smoking and drinking behaviors, and exercise were examined in an ongoing longitudinal study from 1991 to 1995 of 150 middle-aged Melbourne, Australia, women as they passed through menopause. Changes in risk factors over time were examined with reference to time of the final menstrual period (FMP). Random effects models were fitted with adjustments for repeated measures and other covariates, including age. There were overall net increases between 3 years before and the 3 years after menopause of 0.25 mmol/liter for low density lipoprotein cholesterol, 0.05 mmol/liter for high density lipoprotein cholesterol (HDL cholesterol), 0.34 mmol/liter for triglycerides, 0.12 kg/m2 for body mass index, and 0.48 mmHg for diastolic pressure. The proportion of drinkers decreased by 13%, that of smokers increased by 17%, and that of women who exercised at least once a week increased by 6%. The only change dependent on the FMP was a significant decrease in HDL cholesterol (counterbalanced by a similar rise in HDL cholesterol in the year before the FMP), and the rate of decrease was maximal around 9 months after menses ceased, with an instantaneous estimate of slope of 0.55 mmol/liter per year.     

The influence of a wide range of absorbed cholesterol on plasma cholesterol levels in man

The influence of absorbed dietary cholesterol on plasma cholesterol concentration was studied in two populations, one Seventh Day Adventist (SDA) vegetarian and one nonvegetarian, representing a broad range of plasma cholesterol values and dietary cholesterol intakes. As a group, the SDA vegetarians had significantly lower levels of plasma cholesterol and triglycerides than did the nonvegetarians. This hypolipidemic pattern in the SDA vegetarians was apparently closely related to dietary habits, sinceanother group of SDA who were nonvegetarian had significantly higher plasma cholesterol and triglyceride levels than their vegetarian counterparts. Both the dietary intake of cholesterol and the percentage absorption of cholesterol were lower in vegetarians than in nonvegetarians. The mass of cholesterol absorbed increased linearly with the mass of cholesterol ingested in all groups, but no relationship could be demonstrated between absorbed cholesterol and plasma cholesterol concentration.     

Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population : Jichi Medical School Cohort Study.

The distribution of serum C-reactive protein (CRP) levels and their association with age, sex, and atherosclerotic risk factors were studied in a large Japanese population between 1992 and 1995. The subjects consisted of 2,275 males and 3,832 females aged 30 years and over. CRP was measured by nephelometry. The distribution of CRP was highly skewed toward a lower level than that of previous studies and seemed to be a combination of two separate distribution curves. The increase in CRP with age was statistically significant, and males had higher CRP levels than did females. Males who were current smokers had higher CRP levels than did nonsmokers. Age, systolic blood pressure, diastolic blood pressure, triglycerides, fibrinogen, and body mass index were all positively associated with CRP in both sexes, while total cholesterol and blood glucose were positively related in females only. High density lipoprotein cholesterol was inversely related in both sexes. Multiple logistic regression analysis showed that sex, age, systolic pressure, high density lipoprotein cholesterol, triglycerides, fibrinogen, and body mass index were significant independent variables. In conclusion, the distribution of CRP among the Japanese was quite different from that among Westerners, although CRP levels correlated with other atherosclerotic risk factors, similar to those in Westerners.     

A long-term nutrition intervention experience: lipid responses and dietary adherence patterns in the Multiple Risk Factor Intervention Trial

Nutrition counselors in the Multiple Risk Factor Intervention Trial (MRFIT) were able to help middle-aged men who were at high risk for coronary heart disease change their dietary habits, maintain those changes over time, and decrease their serum cholesterol levels. Most of a 7.5% mean serum cholesterol reduction achieved after 6 years of nutrition intervention occurred during the first year of the trial and was thereafter sustained. Total cholesterol and low-density lipoprotein cholesterol fraction decreases indicated improvement in terms of coronary heart disease risk. The food record rating, a numerical, semi-objective adherence technique that assesses a 3-day food record with respect to lipid-lowering potential, was used throughout the trial to measure adherence to recommended food patterns. Participants with lower food record rating scores, which indicate better adherence, demonstrated greater reductions in serum total cholesterol, plasma total cholesterol, and low-density lipoprotein fraction cholesterol determinations on a group basis. Subjective evaluations of the suitability of home and working environments, evidence of deviation from the MRFIT food patterns, and overall nutrition program motivation also showed that as ratings in each category became more favorable, lower food record rating scores and greater blood lipid reductions were consistently observed. The subgroup of participants who were non-smokers and not hypertensive demonstrated greater lipid responses and better dietary adherence. Continued smoking and antihypertensive medications appeared to adversely influence dietary adherence and/or lipid reductions. The MRFIT experience, however, demonstrated for the first time that dietary changes and blood lipid reductions can be achieved after the initial intervention effect, despite a continued emphasis on high blood pressure management and smoking cessation.     

The effects of diet and exercise training on growth,body composition and blood lipid levels in rats

Adult male Sprague-Dawley rats were fed ad libitum either a high-fat diet or a low-fat diet. Half of the animals from each dietary group were submitted to an exercise regimen consisting of 2 hour swimming bouts, on alternate days for either 4 (Phase I) or 10 (Phase II) weeks. Body weight and food intake were measured weekly, and serum cholesterol levels as well as body composition were determined at the end of the treatment. High-fat diet fed animals ate significantly more food (Phase I 14%, Phase II 15%) weighed more (Phase I 9.5%, Phase II 18.2%) and had more body fat (Phase I 5.1%, Phase II 9.7%) than the low-fat fed controls. Total serum cholesterol (total-C) was greater in high-fat diet animals (Phase I 9 mg/dl, Phase II 30 mg/dl) due to higher levels of cholesterol in all lipoprotein fractions. Exercised animals in both diet groups weighed less (Phase I 13%, Phase II 20%) and had significantly lower levels of body fat (Phase I 4.5%, Phase II 8.2%) than their sedentary counterparts, yet food intake was similar in the two groups. Total-C was less in the exercised animals due to less circulating low density lipoprotein cholesterol (LDL-C) (Phase I 24 mg/dl, Phase II 41 mg/dl) and very low density lipoprotein cholesterol (VLDL-C) (Phase II 4 mg/dl, Phase II 21 mg/dl). Rats exercised for 10 weeks had significantly greater high density lipoprotein cholesterol (HDL-C) (14 mg/dl) than did their sedentary counterparts. The increased HDL-C/total-C ratio observed in both phases was due to the reduction of total-C associated with exercise. Treatments in Phase II had a greater effect on the variables studied than in Phase I, suggesting that time is an important consideration for diet and exercise studies. These results indicate that diet and exercise have independent effects on growth, body composition and serum cholesterol.     

Effect of exercise on tissue lipids and serum lipoproteins of rats fed two levels of fat.

Adult rats were fed a low fat (4%) or a high fat (40%) diet, and groups of other rats selected for good running were fed these two diets and were treadmill exercised 5 days a week for 6 weeks. The serum triglycerides were significantly lower in exercised rats fed the low fat diet, but not in those fed the high fat diet, as compared with corresponding controls. The liver lipids were vastly elevated in sedentary rats fed the high fat diet as compared with those fed the low fat diet. An interesting effect of exercise was reflected by the near normal liver lipid levels in rats fed the high fat diet and exercised. However, in these animals, the muscle concentration of cholesterol was significantly higher than that in all other groups. The very low density lipoproteins tended to be lower while the low density lipoproteins tended to be greater in exercised as compared with sedentary rats. It was suggested that the decline in very low density lipoproteins was due to decreased synthesis resulting from adaptive changes in the exercised animal. It was further postulated that the increase in low density lipoproteins was possibly due to increased synthesis necessitated by the need to enhance the catabolism and excretion of cholesterol in exercised animals.     

Health status of users of hormone replacement therapy by hysterectomy status in Western Australia

STUDY OBJECTIVES: To compare the demographic, behavioural, and biological correlates of use of hormone replacement therapy (HRT) in women with an intact uterus and women who have undergone hysterectomy. DESIGN: Cross sectional analysis of data from the Busselton Health Study and the 1994 Healthway-National Heart Foundation Risk Factor Survey. SETTING: Busselton and Perth, Western Australia, 1994. PARTICIPANTS: 2540 women aged 35-79 years. MAIN OUTCOME MEASURES: Demographic, behavioural, and biological correlates of use of HRT by hysterectomy status. RESULTS: In women with an intact uterus, after adjustment for age and place of residence, current use of HRT was significantly associated with having a professional level of occupation, ever use of alcohol, having a history of smoking, and a lower body mass index. Current users of HRT had significantly lower levels of total cholesterol and higher levels of triglycerides than non-users. In women who had undergone hysterectomy, the only non-biological characteristic associated with use of HRT was having a history of smoking. Current users of HRT had lower levels of systolic blood pressure, lower levels of LDL cholesterol, higher levels of HDL cholesterol, and higher levels of triglycerides. The association between use of HRT and participation in exercise, level of systolic blood pressure, level of HDL cholesterol, and total/HDL cholesterol ratio varied significantly by hysterectomy status. After adjustment for age and place of residence, the mean levels of systolic and diastolic blood pressure, body mass index, waist/hip ratio, LDL cholesterol, and total/HDL cholesterol ratio were highest in women who had undergone hysterectomy and were not using HRT. CONCLUSIONS: Demographic/behavioural and biological correlates of use of HRT varied depending on hysterectomy status. Demographic and behavioural characteristics were more important as selection factors for use of HRT in women with an intact uterus than in women who had undergone hysterectomy. Women who had undergone hysterectomy and were not using HRT had a significantly worse profile for CHD than did women with an intact uterus. These results indicate that any bias in estimates of the protective effect of HRT on risk of CHD in observational studies is likely to depend on the prevalence of hysterectomy within the study population. Hysterectomy status needs to be taken into account in any studies that investigate the effect of HRT on risk of CHD.     

Cholesterol screening in a community health promotion program: epidemiologic results from a biracial population.

The prevalence and interrelationship of high blood cholesterol levels with other cardiovascular disease risk factors were studied in a biracial suburb of New York City. Participants in community-based screenings to determine blood cholesterol levels have been predominantly white women in older age groups, highly educated and nonsmokers. To reach a more representative segment of a local population and promote healthy lifestyle behaviors, cholesterol screenings were conducted within an ongoing health promotion program in Mount Vernon, NY. Plasma cholesterol levels were determined for 5,011 participants, including 2,308 whites and 1,778 blacks. Of the men, 29 percent had high cholesterol levels; among women, it was 27 percent. Of the men with high levels, half had levels greater than 200 milligrams per deciliter, as did 55 percent of the women. After statistical adjustments were made for age and other risk factors for high blood cholesterol, mean cholesterol levels were higher for whites than blacks. The level for white men was 204 milligrams per deciliter; for women, 212. For black men, the level was 199 milligrams per deciliter; for women, 208, P < .10. Hispanic men had levels of 199, P < .10. The levels for Hispanic women (203 milligrams per deciliter) were significantly lower than that of white women. Among whites who smoked more than 1 pack of cigarettes per day, mean cholesterol levels were 11 milligrams per deciliter higher than for those who never smoked or were light smokers (0, 1-20 cigarettes per day, P < .10). There were too few who smoked more than 1 pack to test this association adequately among blacks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Do beans and oat bran add to the effectiveness of a low-fat diet?

The effects of consuming an increased amount of soluble fibre as oat bran or beans were examined in 40 free-living hypercholesterolaemic men and women. The subjects were initially established on a low-fat background diet (29% of energy from fat) and then 55 g low-fibre oat bran, 55 g high-fibre oat bran or 80 g mixed cooked beans were added to their diet in random order for 6 week periods. Body weight and overall composition of the diet did not change. Plasma cholesterol and low-density lipoprotein cholesterol (LDL-C) were unchanged. High-density lipoprotein cholesterol (HDL-C) was significantly higher on all three intervention diets than on the lower fibre run-in diet. Supplementation of a moderately low-fat diet with palatable quantities of oat bran or beans without changing the overall fat intake does not appear to significantly lower cholesterol but may have a benefit by increasing HDL-C and reducing the ratio of LDL-C to HDL-C.     

Injury prevalence and associated costs among participants of an employee fitness program

The prevalence, cost, and type of injury among participants of an employee fitness program and nonexercising co-workers were studied over a 2-year period from 1984 to 1985. The purpose of the study was to determine whether participants of an employee fitness program (n = 2,871) experienced a greater risk of injury and resultant higher costs than nonparticipants (n = 3,233). Overall, there were no significant differences in the rate or cost of injuries among the various participation levels (from 0 to 3 or more times per week). However, the data indicated that individuals who occasionally participated in the fitness program experienced a greater, but nonsignificant, risk of injury (6.3 per 100 persons who exercised less than 1 session per week, and 7.7 per 100 persons who exercised 1-2 sessions per week) than nonparticipants (5.7 per 100 persons). Injury prevalence was lower among individuals who exercised 3 or more sessions per week (5.4 per 100 persons) as was the resultant per capita cost of injuries ($32 vs $42 for nonparticipants). We conclude the impact of exercise at an onsite health and fitness facility on overall injury rates and costs among employees is negligible.     

Serum cholesterol and cancer mortality in the Seven Countries Study

In the Seven Countries Study, carried out in Finland, Greece, Italy, Japan, The Netherlands, the United States, and Yugoslavia, among 11,325 "healthy" men aged 40-59 years in 15 years, there were 594 cancer deaths. Among 477 cancer deaths five years after cholesterol measurement, there was a significant excess of lung cancer deaths in the bottom 20% of the cholesterol distributions in the populations. Age, blood pressure, smoking habits, occupation, and relative body weight did not help explain this. A U-shaped relationship between cancer and cholesterol was not seen in any population. Trend analysis with various cutting points indicated increasing risk of lung cancer death at cholesterol levels under 170 mg/dl. The 45 men dead from cancer in the first two years had lower cholesterol levels than their compatriots who died from cancer later but they did not differ in relative weight or fatness. In contrast to relationships for individuals within populations, the highest cancer death rates were in northern Europe, where the general level of cholesterol was also highest. Other characteristics of the populations--age, relative weight, smoking habits, blood pressure, physical activity, and vitamin A and ascorbic acid in the diet--did not help in the attempt to understand the regional differences in cancer mortality. There is no evidence that any of the observed cancer-serum cholesterol relationships among or within the populations involve an effect of serum cholesterol concentration on oncogenesis or cancer mortality but the possibility of such an effect cannot be denied.