Evaluation of the Haemoglobin Colour Scale and comparison with the HemoCue haemoglobin assay

OBJECTIVE: To evaluate the Haemoglobin Colour Scale developed by WHO for estimating haemoglobin concentration and to compare the results obtained using it and the HemoCue assay with those determined using a reference method, the Technicon H3 analyser. METHODS: The Colour Scale and HemoCue assay were used to test 408 blood samples. Subsequently, Bland-Altman plots were determined and the proximity of the test results to those obtained using the reference method was determined. FINDINGS: The mean difference between the Haemoglobin Colour Scale and the reference method was 0.19 g/dl (95% confidence interval: 3.50 g/dl below to 3.11 g/dl above); the corresponding value for the HemoCue assay was 0.50 g/dl (1.16 g/dl below to 0.16 g/dl above). Only 46.08% of the results obtained by means of the Colour Scale were within 1.0 g/dl of the reference method, whereas 95.34% of the HemoCue results fell within this limit; 22.79% of the Colour Scale results but none of the HemoCue results lay more than 2.0 g/dl from the reference method. CONCLUSION: The Haemoglobin Colour Scale test is too inaccurate for general use, particularly if devices such as the HemoCue are available.     

Prevalence of Iron-deficiency Anaemia among University Students in Noakhali Region,Bangladesh

Iron-deficiency anaemia (IDA) is a common health problem in rural women and young children of Bangladesh. The university students usually take food from residential halls, and the food value of their diets is not always balanced. This cross-sectional study was conducted to estimate the prevalence of iron-deficiency anaemia among the university students of Noakhali region, Bangladesh. Haemoglobin level of 300 randomly-selected students was measured calorimetrically, using Sahli''s haemoglobinometer during October to December 2011. Statistical analysis was done by using SPSS software for Windows (version 16) (SPSS Inc., Chicago, IL, USA). In the study, 55.3% students were found anaemic, of whom 36.7% were male, and 63.3% were female. Students aged 20-22 years were more anaemic (43.4%) than other age-groups. Majority (51.3%) of male students showed their haemoglobin level in the range of 13-15 g/dL, followed by 26.0% and 21.3% with 10-12 g/dL and 16-18 g/dL respectively. Although 50.5% anaemic and 51.1% non-anaemic female students showed normal BMI—lower percentage than anaemic (60.7%) and non-anaemic (71.9%) male students, the underweight students were found more anaemic than the overweight and obese subjects. Regular breakfast-taking habit showed significant (p=0.035, 95% CI 0.5-1.0) influence on IDA compared to non-regular breakfast takers. Consumption of meat, fish, poultry, eggs, or peanut butter regularly; junk food; multivitamins; and iron/iron-rich food showed insignificant (p=0.097, 95% CI 0.5-1.1; p=0.053, 95% CI 1.1-2.3; p=0.148, 95% CI 0.6-1.2; and p=0.487, 95% CI 0.7-1.4 respectively) role in provoking IDA. In the case of non-anaemic subjects, all of the above parameters were significant, except the junk food consumption (p=0.342, 95% CI 0.5-1.2). Our study revealed that majority of university students, especially female, were anaemic that might be aggravated by food habit and lack of awareness. The results suggest that anaemia can be prevented by providing proper knowledge on the healthful diet, improved lifestyle, and harmful effect of anaemia to the students.Key words: Iron-deficiency anaemia, Prevalence, University students, Bangladesh     

Association between Maternal Anaemia and Postpartum Depression in an Urban Sample of Pregnant Women in Iran

The aim of this prospective study was to determine the relationship between anaemia during pregnancy and postpartum depression. Two hundred eighty-one non-anaemic mothers with singleton and low-risk pregnancy and no history of antidepressant-use were studied. Demographic and reproductive data at week 20 were obtained. Mothers were followed up and haemoglobin (Hb) was checked at delivery. Iranian version of Edinburgh Postpartum Depression Scale (EPDS) was completed 4-6 weeks after delivery. Mean age of the mothers was 26.6±4 years. The prevalence of postpartum depression according to EPDS was 5.5%. Binary logistic regression analysis showed that Hb <11 g/dL at delivery would increase the chance of postpartum depression (OR 4.64; 95% CI 1.33-16.08). The results show that diagnosis and treatment of physiologic factors, especially anaemia, would reduce the risk of postpartum depression.Key words: Anaemia, Edinburgh Postpartum Depression Scale, Haemoglobin, Postpartum depression, Iran     

Changes in haemoglobin levels according to changes in body mass index and smoking habits, a 20-year follow-up of a male cohort

Haemoglobin level declines with increasing age in cross sectional studies. Little is known about the longitudinal changes of haemoglobin. Because both high or low haemoglobin levels increase mortality and morbidity we examined how changes in lifestyle factors like body mass index (BMI) and smoking habits influence cohort changes in haemoglobin level. In all, 4159 men aged 20–49 years at baseline were examined in 1974 and 1994–1995 in a longitudinal, population-based study from the municipality of Tromsø, Northern Norway. Mean haemoglobin was 148 g/l. There was no difference in mean haemoglobin after 20 years in any strata of age. Mean BMI increased 2.1 kg/m². The prevalence of smokers decreased 20.1 percentage points. In a multiple regression analysis increase in BMI was associated with increased haemoglobin change. Smoking cessation lowered mean haemoglobin 1.6 g/l compared to never smokers. Haemoglobin increased 0.8 g/l in smoking quitters whose BMI increased >2.5 kg/m² compared to a decrease of 6.7 g/l in weight reducers. There was a positive dose–response relationship between changes in cigarettes smoked per day and change in haemoglobin among consistent smokers. In conclusion, in contrast to cross sectional studies, mean haemoglobin did not change during 20 years ageing of relatively young men. This could be explained by higher BMI and less smoking. The increase in BMI affected haemoglobin change to such an extent that the reduction in haemoglobin due to smoking cessation was counteracted. Prospective studies are needed to address the health implications.     

Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren

OBJECTIVE: We aimed to assess the health impact of a national control programme targeting schistosomiasis and intestinal nematodes in Uganda, which has provided population-based anthelmintic chemotherapy since 2003. METHODS: We conducted longitudinal surveys on infection status, haemoglobin concentration and clinical morbidity in 1871 randomly selected schoolchildren from 37 schools in eight districts across Uganda at three time points - before chemotherapy and after one year and two years of annual mass chemotherapy. FINDINGS: Mass treatment with praziquantel and albendazole led to a significant decrease in the intensity of Schistosoma mansoni - 70% (95% confidence interval (CI): 66-73%) after one year and 82% (95% CI: 80-85%) after two years of treatment. Intensity of hookworm infection also decreased (75% and 93%; unadjusted). There was a significant increase in haemoglobin concentration after one (0.135 g/dL (95% CI: 0.126-0.144)) and two years (0.303 g/dL (95% CI: 0.293-0.312)) of treatment, and a significant decrease in signs of early clinical morbidity. The impact of intervention on S. mansoni prevalence and intensity was similar to that predicted by mathematical models of the impact of chemotherapy on human schistosomiasis. Improvements in haemoglobin concentration were greatest among children who were anaemic or harbouring heavy S. mansoni infection at baseline. CONCLUSION: Anthelmintic treatment delivered as part of a national helminth control programme can decrease infection and morbidity among schoolchildren and improve haemoglobin concentration.     

A randomized placebo-controlled trial of iron supplementation in breastfed young infants initiated on complementary feeding: effect on haematological status

To combat iron deficiency manifesting around six months of age, iron-fortified complementary feeding has been recommended. In developing countries, in view of the poor bioavailability of iron from predominantly cereal-based diets and the high cost of fortification, medicinal iron supplementation is an alternative intervention. This double-blind randomized placebo-controlled trial was conducted from April 1999 to March 2000 in the Out-patient Department of a tertiary hospital in New Delhi, India, to evaluate the haematological effects of medicinal iron supplementation to breastfed young infants initiated on complementary feeding. One hundred healthy non-low birth-weight, predominantly breastfed infants aged 4-6 months were randomized into two groups to receive either iron (2 mg/kg/day) (IS group; n=49) or placebo drops (P group; n=51) beginning with the initiation of home-based non-fortified complementary feeding. Haematological parameters and anthropometry of mothers and infants were measured at baseline and repeated for infants after four and eight weeks of recruitment. Seventy-one subjects (35 in the IS group and the 36 in P group) came for the first follow-up, and of these, 43 (19 in the IS group and 24 in the P group) reported for the second visit. The adjusted (for maternal and baseline infant ferritin) serum ferritin levels were significantly higher in the IS group at both the follow-ups (p=0.006). The adjusted (for maternal ferritin and baseline infant ferritin) change in haemoglobin was significantly higher only at the second follow-up (0.7 g/dL; 95% confidence interval [CI] 0.3-1.0 g/dL). The adjusted rise in haemoglobin was higher in initially anaemic infants (at second follow-up by 1 g/dL; 95% CI 0.5-1.6 g/dL). Medicinal iron supplementation, at the time of initiating complementary feeding, to breastfed young infants resulted in an elevation of serum ferritin and haemoglobin. The response was higher in initially anaemic infants. From a programmatic perspective, evidence needs to be generated on the relative merits of selective (anaemic) versus general supplementation and daily versus weekly supplementation.     

Associations between mild-to-moderate anaemia in pregnancy and helminth, malaria and HIV infection in Entebbe, Uganda

It is suggested that helminths, particularly hookworm and schistosomiasis, may be important causes of anaemia in pregnancy. We assessed the associations between mild-to-moderate anaemia (haemoglobin >8.0 g/dl and <11.2 g/dl) and helminths, malaria and HIV among 2507 otherwise healthy pregnant women at enrolment to a trial of deworming in pregnancy in Entebbe, Uganda. The prevalence of anaemia was 39.7%. The prevalence of hookworm was 44.5%, Mansonella perstans 21.3%, Schistosoma mansoni 18.3%, Strongyloides 12.3%, Trichuris 9.1%, Ascaris 2.3%, asymptomatic Plasmodium falciparum parasitaemia 10.9% and HIV 11.9%. Anaemia showed little association with the presence of any helminth, but showed a strong association with malaria (adjusted odds ratio (AOR) 3.22, 95% CI 2.43-4.26) and HIV (AOR 2.46, 95% CI 1.90-3.19). There was a weak association between anaemia and increasing hookworm infection intensity. Thus, although highly prevalent, helminths showed little association with mild-to-moderate anaemia in this population, but HIV and malaria both showed a strong association. This result may relate to relatively good nutrition and low helminth infection intensity. These findings are pertinent to estimating the disease burden of helminths and other infections in pregnancy. [Clinical Trial No. ISRCTN32849447].     

Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999

BACKGROUND: Few studies have examined factors related to the time required for children's blood lead levels (BLLs) > or = 10 microg/dL to decline to < 10 microg/dL. OBJECTIVES: We used routinely collected surveillance data to determine the length of time and risk factors associated with reducing elevated BLLs in children below the level of concern of 10 microg/dL. METHODS: From the North Carolina and Vermont state surveillance databases, we identified a retrospective cohort of 996 children < 6 years of age whose first two blood lead tests produced levels > or = 10 microg/dL during 1996-1999. Data were stratified into five categories of qualifying BLLs and analyzed using Cox regression. Survival curves were used to describe the time until BLLs declined below the level of concern. We compared three different analytic methods to account for children lost to follow-up. RESULTS: On average, it required slightly more than 1 year (382 days) for a child's BLL to decline to < 10 microg/dL, with the highest BLLs taking even longer. The BLLs of black children [hazard ratio (HR) = 0.84; 95% confidence interval (CI), 0.71-0.99], males (HR(male) = 0.83; 95% CI, 0.71-0.98), and children from rural areas (HR(rural) = 0.83; 95% CI, 0.70-0.97) took longer to fall below 10 microg/dL than those of other children, after controlling for qualifying BLL and other covariates. Sensitivity analysis demonstrated that including censored children estimated a longer time for BLL reduction than when using linear interpolation or when excluding censored children. CONCLUSION: Children with high confirmatory BLLs, black children, males, and children from rural areas may need additional attention during case management to expedite their BLL reduction time to < 10 microg/dL. Analytic methods that do not account for loss to follow-up may underestimate the time it takes for BLLs to fall below the recommended target level.     

Severe anaemia in pregnancy: a problem of primigravidae in rural Zaire.

Haemoglobin levels were measured in 2950 pregnant women attending antenatal clinics in Kimpese, Bas Zaire. 72% were suffering from moderate anaemia (haemoglobin (Hb) 7-11 g/dl) and 3.7% from severe anaemia (Hb less than 7 g/dl) at their first visit, before receiving any haematinics or anti-malarial prophylaxis. Haemoglobin levels rose with both increasing parity (P less than 0.001) and age. Multiple regression analysis revealed that parity was significant but age was not. The fall in haemoglobin early in the second trimester was greatest in primigravidae and diminished with successive pregnancies until the fourth. One in 6 primigravidae approached labour with a haemoglobin level less than 7.7 g/dl. Thick blood smears were examined from 379 women who presented in the first and second trimester. 70% of primigravidae had malaria parasitaemia, compared with 13% of multigravidae (P less than 0.001). Early malaria prophylaxis in the first 2 pregnancies is an important primary health care objective if the contribution of malaria to the significant fall in haemoglobin in the second trimester is to be averted.     

Can hospital transfusion committees change transfusion practice?

Blood and blood products are commonly over-used in hospital practice. We investigated whether the introduction of a red-cell transfusion trigger (haemoglobin <8 g dL(-1)) influenced transfusion practice in surgery. Coronary artery bypass grafts (CABGs, n=400), total hip replacements (n=107), colectomies (n=85) and transurethral prostatectomies (TURPs, n=158) were reviewed over two periods of six months, before and after the introduction of the policy by the local hospital transfusion committee. After introduction of the policy, the proportion of patients transfused fell from 57% to 45% with CABGs (P=0.02) and from 52% to 26% with hip replacements (P=0.006); for colectomies and TURPs there was no change. Hospital stay did not increase in any of the groups. In the second period, haemoglobin concentration on discharge was lower after total hip replacement, by a mean (95% CI) of 0.7 (0.3-1.2) g dL(-1) (P=0.002) and after colectomy, by a mean of 0.6 (0.1-1.1) g dL(-1) (P=0.03). Although other factors cannot be excluded, we suggest that the reductions in red-cell transfusion were in large part attributable to the new transfusion policy.     

Diagnosing anaemia in pregnancy in rural clinics: assessing the potential of the Haemoglobin Colour Scale

Anaemia in pregnancy is a common and severe problem in many developing countries. Because of lack of resources and staff motivation, screening for anaemia is often solely by clinical examination of the conjunctiva or is not carried out at all. A new colour scale for the estimation of haemoglobin concentration has been developed by WHO. The present study compares the results obtained using the new colour scale on 729 women visiting rural antenatal clinics in Malawi with those obtained by HemoCue haemoglobinometer and electronic Coulter Counter and with the assessment of anaemia by clinical examination of the conjunctiva. Sensitivity using the colour scale was consistently better than for conjunctival inspection alone and interobserver agreement and agreement with Coulter Counter measurements was good. The Haemoglobin Colour Scale is simple to use, well accepted, cheap and gives immediate results. It shows considerable potential for use in screening for anaemia in antenatal clinics in settings where resources are limited.     

Factors associated with haemoglobin concentration among Timor-Leste children aged 6-59 months

The study was conducted to assess the prevalence of and factors associated with haemoglobin (Hb) concentrations among children aged 6-59 months in Timor-Leste. The 2003 Demographic and Health Survey was a multi-stage cluster survey of 4,320 households from four different geographic regions in Timor-Leste. In total, 4,514 children aged 6-59 months were included in the analysis. The prevalence of anaemia (Hb concentration <11.0g/dL) was 38.2% (638/1,668) for children aged 6-23 months and 22.6% (644/2,846) for older children (p<0.001). Girls had a higher mean Hb concentration than boys (11.9g/dL vs 11.7g/ dL, p<0.006) and children who had diarrhoea in the previous two weeks had a lower Hb concentration than children without diarrhoea (11.5g/dL vs 11.9g/dL, p<0.001). Children from the richest and middle-class households had a lower average Hb concentration than those from the poorest households (11.8g/ dL, 11.7g/dL vs 12.0g/dL, p<0.001). Children of mothers with some secondary or more education had a lower mean Hb concentration than children of mothers with completed primary, some primary and no education (11.7 g/dL vs 11.9 g/dL, 11.8 g/dL, and 11.9 g/dL, p=0.002). Children from severely-anaemic mothers had a lower mean Hb concentration than children from moderately-, mild and not anaemic mothers (10.5 g/dL vs 11.1 g/dL, 11.6 g/dL, 12.0 g/dL, p<0.001). After backward stepwise hierarchical multiple regression, wasting, male sex, recent diarrhoea, household wealth index (richest and middle-class), maternal educational status (some secondary or more and some primary), and maternal anaemic status were significantly associated with a lower Hb concentration in children and increased age of child and duration of breastfeeding (6 months) with a higher Hb concentration. Anaemia-prevention programmes among children in Timor-Leste should focus on those children aged less than two years, children with recent diarrhoea, wasted children, high socioeconomic status, and anaemic mothers.     

Haemoglobin colour scale for anaemia diagnosis where there is no laboratory: a systematic review

BACKGROUND: Anaemia is a major public health problem, in poor countries most of the cases are diagnosed clinically. This is inaccurate and the haemoglobin colour scale (HCS) has been developed as an inexpensive, simple alternative for assessing anaemia. Laboratory and community studies have assessed its diagnostic accuracy, but controversy over its validity and usefulness remains. We carried out a systematic review to identify and summarize studies, explain heterogeneity, and make recommendations for future research. METHODS: We searched electronic databases (MEDLINE, EMBASE, CINAHL, and Science Citation Index), checked documents and references, and contacted experts. We included all the studies comparing HCS diagnostic accuracy with a reference standard. Both reviewers independently screened titles and abstracts, assessed studies for inclusion, appraised quality, and extracted data. RESULTS: We included 14 studies, mostly from sub-Saharan Africa. Studies had heterogeneous populations, health care settings, anaemia prevalence, and findings. HCS sensitivity for detecting anaemia was high in most of the studies (75-97%); specificity was generally lower (41-98%). Sensitivity and specificity were higher for laboratory-based studies compared with more pragmatic 'real-life' studies, and the 'study setting' appeared to explain some of the heterogeneity. Five studies compared the HCS with clinical diagnosis; sensitivity was higher for the HCS in four studies, but specificity was often higher with clinical diagnosis. A few studies evaluated the HCS in situations where there was no laboratory. CONCLUSIONS: The HCS may improve anaemia diagnosis where there is no laboratory, but there is a need for policy-relevant diagnostic research which is pragmatic, implementation-focused and assesses clinical outcomes. This requires a different approach and research skill-mix from efficacy studies.     

Serum selenium and serum lipids in US adults

BACKGROUND: Selenium, an essential micronutrient, has received considerable attention for its antioxidant properties. In addition, selenium may affect several cardiometabolic risk factors, such as glucose homeostasis and lipid concentrations. However, the effects of selenium intake on the lipid profile in selenium-replete populations, such as the United States, are largely unknown. OBJECTIVE: We examined the relation of serum selenium concentrations with serum lipids in a representative sample of US adults. DESIGN: This was a cross-sectional analysis of 5452 men and women aged >/= 20 y participating in the third National Health and Nutrition Examination survey. Serum selenium was measured by atomic absorption spectrometry. RESULTS: The multivariable adjusted differences in total cholesterol, LDL cholesterol, HDL cholesterol, apolipoprotein B (apo B), and apolipoprotein A-I (apo A-I) comparing the highest with the lowest quartile of serum selenium were 16.6 mg/dL (95% CI: 11.6, 21.4 mg/dL), 10.9 mg/dL (95% CI: 6.4, 15.4 mg/dL), 3.2 mg/dL (95% CI: 1.6, 5.0 mg/dL), 8.9 mg/dL (95% CI: 5.6, 12.2 mg/dL), and 6.9 mg/dL (95% CI: 1.7, 12.1 mg/dL), respectively. Participants in the highest quartile of serum selenium had 10% higher concentrations of triacylglycerols than did participants in the lowest quartile (ratio of triacylglycerol concentrations: 1.10; 95% CI: 1.05, 1.17). The difference in the ratios of LDL cholesterol to HDL cholesterol and apo B to apo A-I that compared the highest with the lowest selenium quartiles were 0.11 (95% CI: -0.02, 0.25) and 0.03 (95% CI: 0.00, 0.06), respectively. CONCLUSION: Elevated serum selenium was associated with elevated serum concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triacylglycerols, apo B, and apo A-I among US adults, a selenium-replete population. Experimental studies are needed to determine cause and effect relations and the potential mechanisms underlying these associations.     

Almonds Have a Neutral Effect on Serum Lipid Profiles: A Meta-Analysis of Randomized Trials

Almond consumption may be associated with improvements in serum lipid profiles. The aim was to evaluate the influence of almonds on lipid parameters to help define the role of almonds as a lipid modulator. MEDLINE, EMBASE, Cochrane CENTRAL, and the Natural Medicines Comprehensive Database were searched through July 2008, with no language restrictions, for randomized controlled trials of almonds in human patients that reported efficacy data on at least one of the following endpoints: total, low-density lipoprotein (LDL), or high-density lipoprotein (HDL) cholesterol, triglycerides, or the LDL:HDL ratio. A manual search of references from primary or review articles was performed to identify additional relevant trials. Five randomized, controlled trials (totaling 142 participants) met all inclusion criteria. Upon meta-analysis, almond consumption ranging from 25 to 168 g/day significantly lowered total cholesterol [weighted mean difference -6.95 mg/dL (95% confidence interval [CI] −13.12 to −0.772) (−0.18 mmol/L [95% CI −0.34 to −0.02])] and showed a strong trend toward reducing LDL cholesterol [weighted mean difference -5.79 mg/dL (95% CI -11.2 to 0.00) (-0.15 mmol/L [95% CI -0.29 to 0.00])]. No significant effect on HDL cholesterol, triglycerides, or LDL:HDL ratio was found. No statistical heterogeneity was observed for any analysis (I²=0% for all). Review of funnel plots and the Egger's weighted regression statistic P values suggested a low likelihood of publication bias in all analyses (P>0.25 for all). Almond consumption may decrease total cholesterol and does not significantly affect LDL or HDL cholesterol, triglycerides, or the LDL:HDL ratio. The current body of randomized trials does not support the ingestion of almonds solely for their lipid modifying effects. Both the lipid modulating effects and the safety/tolerability of almonds should be further investigated through the conduction of larger randomized, double-blinded trials of longer duration. Such studies might focus specifically on whether the efficacy of almonds as a lipid modulator varies by dose or comorbidity.     

Cholesterol-lowering benefits of oat-containing cereal in Hispanic americans

This randomized, controlled trial of cholesterol lowering by an oat bran cereal containing beta glucan vs a corn cereal without soluble fiber in Hispanic Americans was conducted for 11 weeks. One-hundred fifty-two men and women, ages 30 to 70 years, with baseline low-density lipoprotein cholesterol (LDL-C) levels between 120 and 190 mg/dL and triglycerides <400 mg/dL were included. After eating a National Cholesterol Education Program Step 1 diet for 5 weeks, subjects were randomly assigned to the corn or the oat cereal for the next 6 weeks. The daily dose of beta glucan was 3 g. Consumption of oat cereal was associated with a reduction in plasma levels of both total cholesterol (-10.9+/-21.6 mg/dL; -4.5%) and LDL-C (-9.4+/-20.3 mg/dL; -5.3%). Consumption of corn cereal did not affect either total cholesterol (+1.2+/-18.3 mg/dL; 1.1%) or LDL-C (+1.2+/-17.5 mg/dL; 2.2%). Differences between the effects of the two cereals on total cholesterol and LDL-C were significant, P =.0003 and P =.0007, respectively.     

Lifestyle and the development of dyslipidemia: a 4-year follow-up study of middle-aged Japanese Male Office Workers

To examine the lifestyle factors related to the development of dyslipidemia [low-density lipoprotein (LDL) cholesterol ≥ 150 mg/dL, high-density lipoprotein (HDL) cholesterol < 40 mg/dL, or triglyceride ≥ 250 mg/dL], 979 dyslipidemia-free Japanese male office workers aged 35 to 54 years were followed up for four years. The numbers of new incidence cases during the follow-up period were 216 for high LDL cholesterol level, 109 for low HDL cholesterol level, and 78 for high triglyceride level. From the Cox proportional hazards model, adjusted hazard ratios (HRs) for the incidence of high LDL cholesterol level were 0.62 [95% confidence interval (CI): 0.47-0.82] for consuming alcohol every day, 1.39 (95% CI: 1.10-1.77) for 5-kg/m² increase in body mass index (BMI), 1.45 (95% CI: 1.10-1.91) for snacking between meals every day, and 1.64 (95% CI: 1.18-2.30) for not eating vegetables every day. As for the incidence of low HDL cholesterol level, adjusted HRs for current cigarette smoking, consuming alcohol every day, and 5-kg/m² increase in BMI were 1.74 (95% CI: 1.17-2.59), 0.61 (95% CI: 0.41-0.89), and 1.79 (95% CI: 1.29-2.46), respectively. Adjusted HRs for the incidence of high triglyceride level were 1.73 (95% CI: 1.07-2.77) for current cigarette smoking, 1.74 (95% CI: 1.10-2.77) for 5-kg/m² increase in BMI, and 0.50 (95% CI: 0.27-0.90) for working 10 h per day or more. These results suggest that an increase in BMI, current cigarette smoking, and snacking between meals every day is closely associated with an increased risk of atherogenic lipid profiles. On the other hand, alcohol consumption and eating vegetables every day may have an anti-atherogenic effect on serum lipid profiles.     

Gender differences in blood lead and hemoglobin levels in Andean adults with chronic lead exposure

A field study of the prevalence of lead (Pb) intoxication was conducted in 158 adults (67 men and 91 women) living at 2,500-2,800 meters in Ecuadorian Andean villages with high Pb contamination from local small-scale Pb-glazing cottage industries. Venous blood samples showed mean blood lead (PbB) levels of 34.5 microg/dL (SD 22.2) for men and 27.0 microg/dL (SD 18.4) for women; this difference was significant (t-test, p = 0.022; Mann-Whitney U, p = 0.044). An ANOVA showed no significant main effect for gender (F = 0.118, p = 0.782) or age (F = 2.479, p = 0.117), and no significant gender-by-age interaction (F = 0.273, p = 0.602). In the Pb-glazing study group, 39% of the men had PbB levels > or = 40 microg/dL, while 41% of the women had PbB levels > or = 30 microg/dL (the WHO health-based biological limits). A reference group of 39 adults (24 men and 15 women) had a mean PbB level of 5.9 microg/dL (SD 2.8; range: 1.8-16.8), significantly different from that of the 158 subjects in the study group (t-test, p < 0.0001). The difference in mean PbB levels of men (6.8 microg/dL) and women (4.7 microg/dL) in the reference group was significant (t-test, p = 0.026; Mann-Whitney U, p = 0.019). The mean altitude-corrected hemoglobin levels in the study group were lower than normal, 11.3 g/dL for men and 10.9 g/dL for women.