Roles of Vitamins E and C on Neurodegenerative Diseases and Cognitive Performance

Demographic changes, together with improvements in nutrition, general health, and life expectancy, will greatly change the social and economic structures of most industrialized and developing countries in the next 50 years. Extended life expectancy has increased the number of chronic illnesses and disabilities, including cognitive impairments. Inflammatory processes and vascular dysfunctions appear to play important roles in the pathogenesis of age-associated pathologies including Alzheimer's and Parkinson's disease. A large body of evidence shows that both vitamins E and C are important for the central nervous system and that a decrease in their concentrations causes structural and functional damage to the cells. Several studies reveal a link between diets rich in fruits and vegetables containing generous amounts of vitamins E and C and lower incidence of certain chronic diseases.     

Introduction. Symposium: Obesity in developing countries: biological and ecological factors

Over the past decade there has been an increasing concern about the impact of chronic, noncommunicable diseases on the health of developing world populations. Traditionally, major causes of illness and death in developing countries have been linked to infectious diseases and undernutrition, and these are still major public health problems in several regions of the world. But recent projections indicate that in 20 y noncommunicable diseases will account for over 60% of the disease burden and mortality in the developing world. Obesity is recognized as an underlying risk factor for many of these chronic conditions. As in developed societies, the risk for obesity in developing countries is also strongly influenced by diet and lifestyle, which are changing dramatically as a result of the economic and nutrition transition. This symposium discusses key aspects of the phenomenon of obesity in the developing world and provides some specific examples from countries facing increasing prevalence of that condition.     

2013年中国居民吸烟对归因死亡和期望寿命的影响

目的 分析2013年我国吸烟的归因死亡和对期望寿命的影响。方法 利用2013年死因监测数据和慢性病及其危险因素监测数据,针对不同疾病特点,将以现在吸烟率作为暴露水平的直接法和以吸烟影响比作为暴露水平的间接法相结合,计算吸烟导致不同疾病死亡的人群归因分值,从而估计吸烟对于死亡和期望寿命的影响。结果 2013年中国人群由于吸烟导致约159.33万人死亡,占总死亡人数的17.38%,其中男性吸烟导致的死亡占比（23.66%）远远高于女性（8.30%）,城市人群吸烟导致的死亡占比（17.24%）略低于农村人群（17.51%）,东部地区人群吸烟导致的死亡占比最低（16.81%）,西部地区最高（17.91%）。2013年中国人群吸烟导致死亡人数在前三位的疾病是肺癌、COPD和缺血性心脏病,吸烟导致死亡归因分值最大的前三位疾病是肺癌、COPD和鼻咽癌。2013年中国人群吸烟导致期望寿命损失2.04岁,其中最高的为西部地区男性,共损失3.05岁。结论 吸烟仍是我国重要的公共卫生问题,针对重点地区人群开展控烟工作,可以降低吸烟相关疾病的死亡,有效地提高我国人群健康水平。     

The Link Between Childhood Undernutrition and Risk of Chronic Diseases in Adulthood: A Case Study of Brazil

Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with under-nourished children. This review summarizes data from Brazil - a developing country undergoing the nutrition transition - suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include longterm effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment.     

Changing health in China: re-evaluating the epidemiological transition model

This paper reviews the changing health situation in China, which has shown remarkable improvement in the 50 years since the founding of the People's Republic of China (PRC) in 1949. At first sight this improving health situation follows the classical epidemiological transition model. Just three decades ago health in China was characterised by high rates of infectious disease and early mortality (diseases of poverty) in a mainly peasant society. More recently infectious disease rates have decreased, with corresponding and extended morbidity and mortality associated with an aging population in a rapidly urbanising society. This process has given rise to new health problems, including chronic and degenerative diseases (diseases of affluence). Nonetheless, while there is some validity in the application of the epidemiological transition concept, further analysis demonstrates that China faces a new epidemiological phase, characterised by increasing life expectancy and diseases of affluence coupled with the emergence and re-emergence of infectious diseases. We demonstrate that China's state policy plays a major role in defining the parameters of health in a Chinese context. We conclude that, today, China is faced with a new set of health issues, including the impact of smoking, hypertension, the health effects of environmental pollution and the rise of HIV/AIDS; however, state policy remains vital to the health of China's vast population. The challenge for policy is to maintain health reform whilst tackling the problems associated with rapid urbanisation, widening social and spatial inequalities and the emergence of HIV/AIDS and other infectious diseases.     

Forecasting chronic disease risks in developing countries

Declining fertility and infant mortality has caused the population in many developing countries to age. Population ageing can produce a rapid shift in the predominant public health problems from infant mortality and infectious diseases to chronic disease mortality at later ages. Designing public health strategies to deal with the health consequences of population ageing in developing countries is difficult both because of a remaining burden of infectious diseases and because of changes in life style associated with economic development that may raise chronic disease risks. Because there are few longitudinal studies of chronic disease risks in developing countries, we investigate the use of a planning and forecasting model, which combines data from multiple sources, in six developing countries.     

1990—2010 年疾病谱变化对上海市居民期望寿命增长的影响

目的］ 比较上海市1990—2010 年不同时期人群期望寿命变化趋势,探讨疾病谱变化对期望寿命的影响,确定疾病干预的优先领域。 ［方法］ 利用1990—2010 年上海市居民死亡登记系统的死亡数据和上海市公安系统的人口数据,应用简略寿命表法、期望寿命分解法、死因分解法,比较年龄和不同死因对期望寿命的影响。 ［结果］1990—2010 年上海市男性和女性期望寿命分别增加了6.91 岁和6.94 岁,年均增寿均达0.35 岁。65 岁以上老年人口对期望寿命增长的贡献最大,男女分别占增寿总量的52.97%和51.44%。呼吸系统疾病、循环系统疾病和肿瘤死亡率的降低是期望寿命增加的主要原因,他们对男女性期望寿命的贡献分别为2.13 岁和1.98 岁、1.42 岁和1.89 岁、1.35 岁和0.67岁。 ［结论］ 上海市现阶段,居民的死亡大部分是疾病造成,提高人群期望寿命,重点是关注中老年人健康状况。近20年慢性病死亡率虽大幅下降,但仍是上海市主要死因,建立健全慢病防治体系,提高慢性病防治效果,是进一步提高上海市人口健康水平,增加上海市居民期望寿命的有效途径。     

Change in life expectancy in connection with three large groups of causes of death in Medellín, Colombia, between 1989-1991 and 1994-1996]

OBJECTIVES: To examine changes in life expectancy in Medellin, Colombia, between 1989-1991 y 1994-1996, in connection with four large groups of causes of death commonly employed in studies on the burden of disease: group 1, communicable diseases, perinatal and maternal health problems, and nutritional deficits; group 2, non-communicable diseases; group 3, wounds; group 4, ill-defined causes. The latter were excluded from the analysis because of their ambiguity. METHODS: The calculations were made according to the method described by J. H. Pollard in 1986, with the aid of Microsoft Excel, by using the recommended formulas. The computations were double checked with EPIDAT (version 3.0, unofficial). RESULTS: Between 1989-1991 y 1994-1996, a total gain of 1.93 years in life expectancy was seen in Medellin, with a rise from 62.13 to 64.06 years. The gain was greater in men than in women (2.42 vs. 1.09 years, respectively). The increase noted among females was greatest in the extreme age groups (girls 1 to 4 and women over 54 years of age); in men, it was highest in the middle years (between the ages of 25 and 44). In both sexes, the greatest percentage loss in life expectancy was seen in persons 15 to 19 years of age (23% in men and 4% in women, roughly). In the group comprising communicable diseases, perinatal and maternal health problems, and nutritional deficits, a loss in life expectancy was seen in men (0.04 years), whereas in the group of non-communicable diseases there was a gain in life expectancy in both sexes (0.60 years among men and 0.55 years among women). The greater gain in life expectancy among men was linked to a reduction in mortality from wounds (1.98 years). CONCLUSIONS: If one compares the results obtained in Medellin at the end of the study period with life expectancy at birth in Colombia in 1995, which was 70 years, it is obvious that life expectancy in Medellin is still lagging behind, even though it has risen progressively over the years. This is in keeping with the epidemiological transition the city has experienced, which has been linked with a rise in mortality from degenerative and cardiovascular diseases, chronic respiratory ailments, and diabetes, as well as from diseases resulting from human activity. Nevertheless, this epidemiological transition has been slow in Medellin when compared to Colombia as a whole due to high rates of death from infectious and parasitic diseases, which are more characteristic of the transition in its earlier stages. Despite the fact that mortality from wounds has decreased in Medellin, particularly among young males, it may be worthwhile to reassess the effectiveness of interventions undertaken in recent years to promote peaceful coexistence and tolerance in the community.     

Ageing, lifestyle modifications, and cardiovascular disease in developing countries

Developing countries face the double menace of still prevalent infectious diseases and increasing cardiovascular disease (CVD) with epidemic proportions in the near future, linked to demographic changes (expansion and ageing), and to urbanisation and lifestyle modifications. It is estimated that the elderly population will increase globally (over 80% during the next 25 years), with a large share of this rise in the developing world because of expanding populations. Increasing longevity prolongs the time exposure to risk factors, resulting in a greater probability of CVD. As a paradox, increased longevity due to improved social and economical conditions associated with lifestyle changes in the direction of a rich diet and sedentary habits in the last century, is one of the main contributors to the incremental trend in CVD. The variable increase rate of CVD in different nations may reflect different stages of "epidemiological transition" and it is probable that the relatively slow changes seen in developing populations through the epidemiological transition may occur at an accelerated pace in individuals migrating from nations in need to affluent societies (i.e. Hispanics to the USA, Africans to Europe). Because of restrained economic conditions in the developing world, the greatest gains in controlling the CVD epidemic lies in its prevention. Healthy foods should be widely available and affordable, and healthy dietary practices such as increased consumption of fresh fruits and vegetables, reduced consumption of saturated fat, salt, and simple sugars, may be promoted in all populations. Specific strategies for smoking and overweight control may be regulation of marketed tobacco and unhealthy fast food and promotion of an active lifestyle. Greater longevity and economic progress are accompanied by an increasing burden of CVD and other chronic diseases with an important decrease in quality of life, which should question the benefit of these additional years without quality.     

Lack of improvement of life expectancy at advanced ages in The Netherlands

BACKGROUND: Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. METHODS: We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970-1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74-1980/84) and the 1980s (1980/84-1990/94) were estimated with a decomposition technique developed by Arriaga. RESULTS: Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85-89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. CONCLUSIONS: Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation.     

辽宁省城乡居民30年间出生期望寿命差异分析

目的 分析30年间辽宁省城乡居民出生期望寿命的变化及主要疾病死亡率对期望寿命年代差异的影响.方法 应用简略寿命表法、期望寿命差异的年龄分解和死因分解法分析辽宁省城乡居民1973-1975年和2004-2005年的死亡数据,以死亡率变化对出生期望寿命年代差异的贡献值及百分比为分析指标.结果 30年间辽宁省城市、农村居民期望寿命分别增加了4.68岁和4.91岁,女性增幅显著大于男性.0～4岁和55～74岁组人群死亡率下降对城乡居民期望寿命增加的贡献比例最大,男性为76.27%和82.81%,女性为58.76%和62.13%.呼吸系统疾病和传染病是对期望寿命年代差异贡献最大的两类疾病;呼吸系统疾病死亡率下降对不同人群期望寿命增加的贡献比例为62.20%(城市女性)～85.39%(农村男性),传染病的贡献比为16.70%(城市女性)～36.26%(农村男性).城乡居民心脏病死亡率、农村居民脑血管病和恶性肿瘤死亡率的增加对期望寿命年代差异的贡献率为负值.结论 呼吸系统疾病和传染病是影响30年间辽宁省城乡居民期望寿命差异的主要疾病,提高慢性非传染性疾病的防治水平是进一步提高居民期望寿命的关键.

Abstract：

Objective To analyze the impact of mortality by age and causes of death on life expectancy at birth among residents of Liaoning province.Methods The study included mortality data of urban and rural residents in two periods (1973-1975 and 2004-2005).Both Abridged Life Table and Arriaga method were used to calculate and to decompose life expectancy changes by age and causes of death.Results From 1975-2005,the life expectancy increased by 4.68 years in urban residents and 4.91 for rural residents with a higher increment among females than males.Most part of the increase (76.27% and 82.81% for urban and rural male,58.76% and 62.13% for urban and rural female) in life expectancy within the last 30 years could be explained by the decrease of mortality in the populations at age 0-4 and 55-74.Diseases related to respiratory system and infectious disease were contributing the most to the gap in life expectancy between the two periods.Mortality of heart disease was a negative contributor to the changes in life expectancy among both rural and urban residents while the mortalities of cerebro-vascular diseases and malignant tumors were the negative contributors for rural residents.Conclusion The increase of life expectancy in the last 30 years was mainly resulted from the decrease of mortality on both respiratory and infectious diseases.Control of chronic diseases is the key point to increase the life expectancy among the residents of Liaoning province.     

Strong bones in later life: luxury or necessity? The view from Tunisia: need for an inclusive approach.

Demographic, epidemiological, and socioeconomic factors are the primary reasons behind the varied priorities of many developing countries in detecting and preventing osteoporosis. The problem of detecting and preventing the disease does not assume the same urgency, because of the prevailing epidemiological situation in Tunisia and other developing countries. However, there are no precise data on the incidence of osteoporosis and its progression; thus, the means of detection are considered inadequate. Some of the socioeconomic factors in the control of the disease include the following: high rate of illiteracy; excessive focus of the health system on curative care and insufficient attention to early detection and prevention of the disease; and inadequate and inefficient health insurance systems. The increase in life expectancy and the aging of the population make it necessary for health officials to focus their attention on osteoporosis. Attention must be drawn to the importance of nutrition at the very beginning of life, during gestation, wherein deficiencies at this period lead to numerous diseases in adult life. Ensuring that people have strong bones throughout their life spans is a need that can be addressed through the development of an integrated strategy suited to the epidemiological situation of each country.     

Nutrition transition in west Sumatra, Indonesia

Indonesia, like many developing countries, is experiencing a rapid urbanisation characterised by double burden of disease in which non communicable diseases become more prevalent while infectious diseases remain undefeated. This report describes the nutrition transition which occurred to Indonesia after economic transformation in 1966, based on information gathered from published reports. The major sources of information used in this paper were: a) a series of Indonesian National Socio-Economic Surveys (SUSENAS) conducted regularly by Central Bureau of Statistics (which provided a coherent picture of the nutrition transition in Indonesia) and b) data collected from two relatively smaller surveys conducted in West Sumatra (which demonstrated the changes in food and nutrient intakes over the period 1983-1999). It was found that while Indonesia had a rapid economic growth since 1970s, major dietary changes included an increase in expenditure for meat, eggs, milk and prepared food, and a fall in expenditure in cereal products. Nutrient proportions had changed from carbohydrate to fat and protein but the proportions remained close to the ideal ratio. There was also a dramatic shift in causes of death from infectious to chronic diseases. It is concluded that the nutrition transition in Indonesia is similar to patterns in other developing countries. Although fat consumption increased slightly, there is movement to maintain the traditional diet.     

The double burden of communicable and non-communicable diseases in developing countries

Now, at the dawn of the third millennium, non-communicable diseases are sweeping the entire globe. There is an increasing trend in developing countries, where the demographic and socio-economic transition imposes more constraints on dealing with the double burden of infectious and non-infectious diseases in a poor environment, characterized by ill-health systems. It is predicted that, by 2020, non-communicable diseases will cause seven out of every ten deaths in developing countries. Among non-communicable diseases, special attention is devoted to cardiovascular disease, diabetes, cancer and chronic pulmonary disease. The burden of these conditions affects countries worldwide but with a growing trend in developing countries. Preventative strategies must take into account the growing trend of risk factors correlated to these diseases. In parallel, despite the success of vaccination programmes for polio and some childhood diseases, other diseases like AIDS, tuberculosis, malaria and dengue are still out of control in many regions of the globe. This paper is a brief review of recent literature dealing with communicable and non-communicable diseases in developing countries. It gives a global view of the main diseases and their impact on populations living in low- and middle-income nations.     

Cohort studies around the world: methodologies, research questions and integration to address the emerging global epidemic of chronic diseases

With ageing populations, increased economic prosperity and the ensuing lifestyle changes, there has been a dramatic increase in the burden of chronic non-communicable diseases in countries of the developing world. The distribution of risk factors for chronic diseases among populations in developing countries has traditionally been very different from that in their Western counterparts, thus resulting in considerable variation in disease distribution in these settings. However, with the increase in globalization along with rapid advancements in technology, many developing countries are now faced with the challenge of a dual disease burden, battling existing communicable infectious diseases as well as the emerging epidemic of non-communicable chronic diseases. This paper highlights the need for multiple cohort studies on chronic diseases around the world, and explores some of the challenges in establishing and maintaining these studies in resource-constrained settings.     

Evolutionary, historical and political economic perspectives on health and disease

The origin and rise of social inequalities that are a feature of the post-Neolithic society play a major role in the pattern of disease in prehistoric and contemporary populations. We use the concept of epidemiological transition to understand changing ecological relationships between humans, pathogens and other disease insults. With the Paleolithic period as a baseline, we begin with ecological and social relationships that minimized the impact of infectious disease. Paleolithic populations would have retained many of the pathogens that they shared with their primate ancestors and would have been exposed to zoonoses that they picked up as they adapted to a foraging existence. The sparse mobile populations would have precluded the existence of endemic infectious disease. About 10,000 years ago, the shift to an agricultural subsistence economy created the first epidemiological transition, marked by the emergence of infections, a pattern that has continued to the present. Beginning about a century ago, some populations have undergone a second epidemiological transition in which public health measures, improved nutrition and medicine resulted in declines in infectious disease and a rise in non-infectious, chronic and degenerative diseases. Human populations are entering the third epidemiological transition in which there is a reemergence of infectious diseases previously thought to be under control, and the emergence of novel diseases. Many of the emerging and reemerging pathogens are antibiotic resistant and some are multi-antibiotic resistant. Inequality continues to widen within and between societies, accelerating the spread of emerging and reemerging diseases.     

2015-2020年四类重点慢性病对济南市户籍人口期望寿命的影响分析

目的 分析2015-2020年恶性肿瘤、心脑血管疾病、慢性呼吸系统疾病和糖尿病（四类重点慢性病）对济南市户籍人口期望寿命增长的影响。方法 利用济南市2015-2020年死因监测资料和人口数据,应用简略寿命表和Arriaga分解法,分析2015-2020年四类重点慢性病及其具体病种的死亡率对期望寿命增长的贡献,不同性别、不同年龄段死亡率对期望寿命增长的贡献。结果 2015-2020年济南市户籍人口期望寿命增长了1.59岁。四类重点慢性病死亡率下降贡献了1.25岁,贡献比例为78.62%,男性期望寿命增长了1.66岁,四类重点慢性病死亡率下降贡献了1.18岁;女性期望寿命增长了1.52岁,四类重点慢性病死亡率下降贡献了1.35岁。恶性肿瘤、心脑血管疾病、慢性呼吸系统疾病和糖尿病的死亡水平下降对期望寿命的贡献分别为0.42、0.62、0.20和0.01岁。胃癌死亡率下降对期望寿命的贡献大于肺癌,高血压性心脏病死亡率增加导致了负贡献,哮喘和糖尿病对期望寿命的贡献微乎其微。结论 2015-2020年济南市户籍人口期望寿命增长主要由四类重点慢性病死亡率下降贡献。肺癌、糖尿病、高血压性心脏病等对期望寿命贡献较小,甚至为负贡献,应重点关注。     

Nutrition-related disease and death in Zhejiang Province?

In Zhejiang province economic development and changes in nutrition appear to have increased both life expectancy and nutrition-related chronic disease morbidity. Life expectancy is longer in urban populations than in rural and in both urban and rural females. From 1997 to 2002 urban females had an average life expectancy of 81.4 years. In 2002 the estimated incidence of ischaemic heart disease was higher in rural males and females whereas diabetes mellitus was higher in urban males and females. From 1990 to 2002 lung cancer had large increases in all groups, cancers of the oesophagus and stomach increased in rural males and females, and cancer of the large intestine increased 40 per cent in urban males. In 2002 deaths from cerebrovascular disease were much higher in rural males and females. Apart from differences in lifestyle factors between urban and rural, access to medical resources may also be relevant to the differences within the province in chronic disease rates and in life expectancy.     

Women's health status in Poland in the transition to a market economy

Since 1989 Poland has been experiencing large-scale social and economic changes as a result of the reforms associated with the transition to a market economy. This study uses a 1996 Health Survey of over 20,000 women to examine the impact of the new socio-economic situation and of women's multiple roles on their health at the early stage of transition. We investigated the importance of selected economic, socio-demographic and cultural determinants in explaining differences in women's health status in Poland, focusing on education level, (un)employment, living conditions, marital status, smoking and life style. There are health inequalities between men and women in Poland based on life expectancy, chronic diseases and health self-assessment. Some of these, especially the large differences between life expectancy at working ages, may be attributed to the difficult socio-economic situation. The multivariate analysis of women's self-assessed health and morbidity from selected chronic diseases indicated substantial inequalities in health. Together with the behavioural and cultural risk factors recognized by medicine, such as obesity, lack of physical exercise and smoking, the paper shows the crucial role of economic factors in influencing Polish women's health. Women whose financial position is poor are more likely to assess their health as less than good, to suffer from respiratory and circulatory systems' diseases and report neurotic problems. Other factors, strongly connected with the transition process in Poland, which contribute to health problems are lack of employment and low educational level, particularly for younger women. Women's marital and parental status are also important predictors of some categories of health problems; however, their influence varies for women of different ages. Our survey also supports the thesis that loneliness in old age, defined on the basis of living in a one-person household, may be negatively correlated with health status.