Cross-sectional and longitudinal relationships between alcohol consumption and lipids, blood pressure and body weight indices

OBJECTIVE: Serum lipids, blood pressure and body mass may mediate the U-shaped relationship of alcohol consumption with type 2 diabetes mellitus and coronary heart disease. This study examines the cross-sectional and long-term longitudinal relationships of (changes in) alcohol consumption with (changes in) serum lipids, blood pressure and body mass indices. METHOD: In this prospective, observational cohort study, two measurements of alcohol consumption, serum total and high-density lipoprotein cholesterol, triglycerides, blood pressure, body weight, the thickness of four skinfolds and waist circumference were performed 4 years apart in healthy volunteers (143 men and 174 women, 32 years old at the first measurement). Alcohol consumption from beer, wine and distilled spirits was assessed using an extensive dietary history interview. Linear regression analyses were performed to study the cross-sectional relationships between the amount of alcohol consumed at the age of 32 years and the levels of the lipids, blood pressure and body weight indices, and to study the longitudinal relationships between the changes in the amount of alcohol consumed over the 4 years of follow-up and the concurrent changes in the lipids, blood pressure and body weight indices. Nonlinearity was investigated for the cross-sectional relationships. RESULTS: A 10-g/day difference in alcohol consumption was positively related with a 0.05 mmol/L (1.9 mg/dl) difference in high-density lipoprotein cholesterol in both cross-sectional (p = .004), and longitudinal (p < .0001) analyses. This relationship did not differ for men and women or for the consumption of beer, wine or distilled spirits. Relationships with changes in total cholesterol, triglycerides, systolic, diastolic, and pulse pressure, body weight and the sum of four skinfolds were not significant. A borderline significant inverse longitudinal relationship was found with waist circumference. The other lifestyle behaviors (tobacco smoking, physical activity and dietary habits) were major confounders of most cross-sectional relationships between alcohol and serum lipids, blood pressure and body mass indices. The longitudinal relationships, however, were not confounded by changes in the other lifestyle behaviors. A significant nonlinear relationship was found for systolic blood pressure, in which drinkers of about 30 g/day had the lowest values. CONCLUSIONS: Moderate alcohol consumption and moderate long-term changes in alcohol consumption are positively related with the levels and changes in high-density lipoprotein cholesterol in healthy adult men and women. A moderate inverse association between alcohol and waist circumference may be expected. No relationships were found with triglycerides, blood pressure, body weight and the sum of the thickness of four skinfolds. Other lifestyle behaviors confound the cross-sectional, but not the longitudinal, relationships between alcohol consumption and serum lipids, blood pressure and body mass indices. Gender and type of beverage do not modify the relationships between alcohol consumption and these indices.     

Blood pressure in a random sample of the New Zealand population.

Blood pressures were measured as part of a health check in a randomly selected sample of the New Zealand population. One thousand, four hundred and ten men and 1605 women over 15 years were studied. Measurements were made by trained observers using the Hawksley Random Zero instrument. Systolic and diastolic pressures increased with age in men and women. There were 29% of men and 24% of women over the age of 45 with pressures over 160/95 mmHg of whom 24% of men and 33% of women were on treatment for hypertension. Of all subjects 9% of men and 12% of women were on treatment for hypertension. Systolic and diastolic pressures correlated significantly with body mass index, waist/hip ratio and skinfold measurements in men and women. The most significant correlation was with the body mass index. No regional or urban/rural differences were seen in systolic or diastolic pressures. A history of hypertension in the fathers of respondents related to blood pressures in the highest tertile of diastolic blood pressures in males, and systolic pressure of females. The association was not seen between mothers of respondents in respect of diastolic pressure.     

Trends in cardiovascular risk factors in Auckland, 1982 to 1987

This paper examines trends in Auckland over a five year period (1982-87) in the major cardiovascular risk factors: serum total cholesterol, blood pressure and cigarette smoking; trends in body mass index are also presented. The data came from two independent random samples of European people aged 40-64 years chosen from the central Auckland electoral rolls in 1982 (915 men and 476 women) and 1986-88 (503 men and 359 women); response rates were over 80% in both surveys. In the five year period self reported smoking declined by 22% in men and 10% in women; the decline was particularly marked in upper socioeconomic men and women aged 55-64 years. There were no consistent changes in either blood pressure or body mass index levels. Serum cholesterol levels, after adjustment for the change in laboratory methods, declined by approximately 1% in both men and women. Cardiovascular risk factor levels remain high in Auckland; comprehensive population based prevention programmes, such as Heartbeat (New Zealand), are urgently required in New Zealand.     

Serum lipids, body mass, and exercise levels in Auckland, 1982

The level of coronary heart disease risk factors was examined in a random sample of 1598 people aged 35 to 64 years in Auckland during 1982. Data on serum total cholesterol and high density lipoprotein cholesterol, height, weight, body mass index and exercise patterns, are reported. The mean serum cholesterol was 5.71 mmol/l in men and 5.81 mmol/l in women with 22% and 24% of men and women respectively having a serum cholesterol of 6.5 mmol/l or more. Total cholesterol levels were lower than in previous New Zealand studies at all ages and in both sexes. Approximately 54% of men and 48% of women in the sample were overweight or obese and only 37% of men and 30% of women reported taking regular exercise each week. These data indicate that there is considerable potential for the primary prevention of coronary heart disease in New Zealand.     

Cardiovascular risk factors levels of Pacific people in a New Zealand multicultural workforce

AIMS: To compare cardiovascular risk factors among the major Pacific Island communities participating in a New Zealand multicultural workforce survey. METHOD: There were 650 employed Pacific Island participants (Samoan 357, Cook Islands 177, Tongan 71, Niuean 45), aged 40-65 years, who were interviewed in a work-based, cross-sectional survey. During an oral glucose tolerance test, blood samples were collected for determination of blood glucose and serum lipids. Participants provided information on smoking and leisure time physical activity. Blood pressure, weight and height were measured and body mass index calculated. Ten-year risk of cardiovascular disease was calculated using equations from the Framingham study. RESULTS: Among men, their ten-year risk of a cardiovascular event was similar for the four communities compared (range 11.5% to 13.2%). However, individual risk factors did vary between the ethnic groups with Cook Island men having significantly higher total cholesterol, blood pressure and urinary microalbumin than other Pacific Island ethnic groups, while Tongan men were more likely to smoke and had lower HDL levels than other groups. Among women, Samoan and Cook Island participants had significantly higher ten-year cardiovascular risk scores (5.7%) than Niuean (4.4%) and Tongan (3.7%), due primarily to elevated total cholesterol levels. CONCLUSION: Cardiovascular risk factor levels vary between Pacific Islands communities in New Zealand. Targeted interventions to specific Pacific communities may be more beneficial than the current homogeneous prevention strategy applied to all communities.     

Heart disease and diabetes risk factors in Pacific Islands communities and associations with measures of body fat.

AIMS: To describe the prevalence of obesity and other coronary heart disease and Type 2 diabetes risk factors by age and ethnic group in Pacific Island communities and to determine the associations between these risk factors and body mass index. METHODS: Cross-sectional data from commuity-based intervention projects were combined to provide anthropometric, blood sample and blood pressure data on 1,175 Pacific Islands people (467 men, 708 women) aged 20 years and over from church communities in South, Central and West Auckland. Self-reported data on diabetes status and leisure-time physical activity were also collected. RESULTS: Based on an ethnic-specific mass index (BMI) cut-off (> 32 kg/m2), 45% of men and 66% of women were obese. The age-standardised prevalence of known diabetes was 12%. Men and women aged 40-60 years had the highest risk factor levels and were the most sedentary. Tongans had higher risk factor levels than Samoans. In men, BMI and waist circumference were associated (p<0.05), in the direction of greater disease risk, with blood pressure and concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and blood glucose. In women, these associations were similar but less consistent. CONCLUSIONS: While these data are not representative for all Pacific people living in New Zealand, they do show an extremely high prevalence of obesity and significant associations between obesity and other cardiovascular risk factors. These communities warrant a very high priority as part of public health efforts to address New Zealand's growing obesity epidemic.     

Declining levels of total serum cholesterol in adult New Zealanders

AIM: To measure the average serum concentration of total cholesterol and high density lipoprotein cholesterol in a representative sample of New Zealanders. METHODS: Serum total and high density lipoprotein cholesterol levels were measured in a representative sample of 1,412 men and 1,741 :women aged 15 years or older who participated in the National Nutrition Survey (1997) of New Zealanders. RESULTS: The average serum total cholesterol concentration in men was the same as in women (5.7 mmol/L); however, younger women (44 years and under) tended to have lower levels and older women (55 years and over) higher levels of total cholesterol than men. Women in all age groups had higher average levels of high density lipoprotein cholesterol (1.4 mmol/L) than men (1.2 mmol/L). Ethnic differences were apparent with Maori men having significantly higher average levels of total cholesterol than their New Zealand European counterparts. CONCLUSIONS: Mean serum total cholesterol concentration in women has declined by 0.3 mmol/L from 6.0 mmol/L (p<0.05) since the previous representative survey of New Zealanders (Life in New Zealand Survey, 1989), but by only 0.1 mmol/L in men, despite a similar reduction amongst men and women in the proportion of dietary energy derived from total and saturated fat. It is possible that weight gain in men and women during the last nine years is having a differential effect on serum cholesterol concentrations.     

Ethnic and gender differences in the use of coronary artery revascularisation procedures in New Zealand

AIMS: To examine ethnic and gender variations in the use of coronary artery revascularisation procedures in New Zealand and to determine whether the introduction of priority scores affected intervention trends. METHODS: Analysis of the National Minimum Database for coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) intervention rates for New Zealand Pacific, Maori and other men and women aged 40 years and over during the decade 1990-1999. RESULTS: Coronary artery revascularisation rates were lower in women than in men in all ethnic groups and in Pacific and Maori men compared with other New Zealand men. Compared to all men, the mean age-standardised CABG and PTCA intervention rate ratios in all women were 0.34 and 0.36. Compared to other New Zealand men, the mean age-standardised CABG and PTCA intervention rate ratios were 0.64 and 0.25 in Pacific and 0.40 and 0.29 in Maori men respectively. Compared to other New Zealand women, the rate ratios for CABG and PTCA were 0.73 and 0.21 in Pacific and 0.74 and 0.43 in Maori women respectively. Introducing priority scores was neither associated with reduced cardiac procedures nor significantly reduced variation in procedures across all ethnic groups. CONCLUSIONS: Although Pacific and Maori peoples had higher rates of coronary artery disease morbidity and mortality, revascularisation rates were lower in both groups. Strategies beyond the use of priority scores are needed to address ethnic and gender disparities in coronary artery revascularisation procedures in New Zealand.     

Cadmium in blood and urine among smokers and non-smokers with high cadmium intake via food

In New Zealand a species of oyster (Ostrea lutaria) consumed widely contains on an average 5 micrograms Cd/g wet weight. In this study we have investigated the cadmium intake, and blood and urinary cadmium levels in a group of 78 people with a known high oyster consumption. A second group of 17 non-smoking men and women who did not eat oysters were used as a control group. Each subject was interviewed and information on smoking habits, diet, medical and occupational history was obtained. The results show that in spite of a very high intake of cadmium via oysters the concentration of the toxic metal in whole blood and urine was not elevated greatly in proportion to the intake. It is clearly demonstrated that cigarette smoking had a more pronounced and significant effect on whole blood cadmium levels than the intake of cadmium via oysters.     

Methodology of the 1997 New Zealand National Nutrition Survey

AIMS: To describe the development and use of the methodologies in the 1997 New Zealand National Nutrition Survey (NNS97). METHODS: NNS97 was a voluntary cross-sectional population survey conducted over a twelve month period on 4,636 non-institutionalized urban and rural New Zealand residents aged fifteen years and older. Survey data were collected in the participants' home and included: a self-administered qualitative food frequency questionnaire, including questions on food preparation habits; a three-pass 24-hour diet recall; interviewer-administered questions on diet supplement use, barriers to dietary change and participant perception of household food security; physical measurements including weight, height, three circumferences, two skinfolds and elbow breadth; blood pressure; and a blood sample to determine cholesterol and iron status. RESULTS: New methodologies developed for NNS97 included a computer based interview system, probability analyses for estimating prevalence of inadequate intake of selected nutrients, determination of iron status by both dietary and biochemical assessment, assessments of dietary supplement use and food security. A full range of quality control procedures at each stage of the data collection were also initiated. CONCLUSION: NNS97 has improved on previous New Zealand national nutrition survey methodologies, particularly with direct data capture and rigorous quality control procedures used in the collection of survey data.     

Deaths from lung cancer and ischaemic heart disease due to passive smoking in New Zealand

Passive smoking is increasingly recognised as a public health hazard. Among New Zealanders who have never smoked, the prevalence of exposure to spousal smoking has been estimated to be 12.7% for men and 16.1% for women. The prevalence of exposure to passive smoking in the workplace has been estimated to be 33.6% and 23.4% for never smoking men and women respectively. The pooled risk estimates from epidemiological studies of the health effects of passive smoking were used to estimate the numbers of deaths from lung cancer and ischaemic heart disease attributable to passive smoking in New Zealand in 1985. The pooled relative risk estimates for lung cancer mortality were 1.3 (95% confidence interval (CI): 1.1-1.5) in both men and women exposed to passive smoking at home, and 2.2 (CI 1.4-3.0) in both men and women exposed to passive smoking at work. Using these relative risk estimates, it was calculated that 30 lung cancer deaths (range: 11-41) were attributable to involuntary smoking in New Zealand in 1985. From pooled relative risk estimates of ischaemic heart disease death of 1.3 (CI 1.1-1.6) and 1.2 (CI 1.1-1.4) for exposure to spousal smoking in men and women respectively, it was estimated that a further 91 ischaemic heart disease deaths (range: 39-177) were due to passive smoking at home. The number of ischaemic heart disease deaths due to passive smoking in the workplace was even higher, at 152 (range: 62-224), assuming relative risks of 2.3 (CI 1.4-3.4) and 1.9 (CI 1.4-2.5) for men and women respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

Trends in coronary heart disease mortality in New Zealand and Sweden. Why the difference?

Coronary heart disease mortality has shown a downward trend in New Zealand during the 1970s as in most western countries. In contrast, Sweden, which has a similar health care system to New Zealand, has shown a continuing increase in coronary mortality for males during the same period. Medical and surgical management of ischaemic heart disease in Sweden is very similar to that found in New Zealand and possibly more intensive in some respects. Hypertension detection and control measures have been successfully applied in Sweden as in New Zealand and a similar reduction in cigarette smoking has occurred in both countries. However, whereas significant beneficial changes have occurred in the New Zealand diet during the past two decades, dietary change, although actively promoted, has not occurred in Sweden for various reasons. The lack of dietary change in Sweden has been coupled with a probable reduction in habitual physical activity in the adult population. Diet appears to be a principal determinant of coronary disease incidence, and population dietary change an important prerequisite for effective primary prevention. In the absence of dietary change, the effect of primary and secondary preventive measures may be limited. The reasons that appropriate dietary recommendations have not been successful in Sweden can be examined and are instructive for effective prevention in all countries.     

Cardiovascular mortality in New Zealand and Australia 1968-1983: how can the diverging trends be explained?

Cardiovascular diseases are responsible for almost 50% of all deaths in New Zealand and Australia. In 1968 death rates were higher in Australia than in New Zealand for all causes of death, all cardiovascular disease, coronary heart disease and cerebrovascular disease. Over the period 1968-1983 death rates declined in both countries but at a significantly greater rate in Australia. By 1983 death rates for all categories were higher in New Zealand than Australia. The decline in cardiovascular disease accounted for approximately 90% and 70% of the decline in all causes of death in New Zealand and Australia respectively. Life expectancy has increased more rapidly for Australian middle aged men and women. From the limited cardiovascular morbidity and risk factor data available, it is not possible to identify the reasons for the differential rates of improvements in the two countries. Both nations require comprehensive and complementary studies which monitor changes in health practices such as diet, smoking and exercise, as well as surveys that allow differences in the patterns of medical and surgical practices to be determined.     

Blood cholesterol levels of 32-year-old alcohol consumers are better than of nonconsumers

Blood cholesterol levels are expected to be important factors in the causal pathway between alcohol consumption and CHD. The relation between alcohol consumption and blood cholesterol levels is investigated in 130 men and 145 women aged 32.4 years old (+/-1.0), from the Amsterdam Growth and Health Longitudinal Study. When controlled for gender, cholesterol levels at age 13.1 years, and lifestyle at adult age (smoking, physical activity, dietary habits), no significant differences were found for total cholesterol (TC) levels between alcohol consumers and nonconsumers. Serum high-density lipoprotein (HDL) cholesterol levels were 0.12 mmol/l higher in subjects consuming >/=100 grams of alcohol per week than in nonconsumers (p < 0.05). Regression coefficients of subjects consuming 10 to 50, or 50 to 100 g alcohol per week did not differ statistically from those of nonconsumers. The positive relation between alcohol consumption and serum HDL was modified by smoking (found in nonsmokers, but not in smokers). No differences between beer, wine, and spirits were found for their relation with serum HDL. In conclusion, 32.4-year-old nonsmoking subjects who consumed >/=100 g of alcohol per week had improved HDL levels compared with nonconsumers, whereas the protective effect of drinking smaller amounts of alcohol did not reach statistical significance.     

Recurrence and survival after potentially curative surgery for colorectal cancer.

AIMS: To measure long-term outcomes in an unselected consecutive series of patients undergoing potentially curative surgery for colorectal cancer at Dunedin Hospital and identify risk factors for disease recurrence and mortality. METHOD: A retrospective study of 241 patients operated on between January 1990 and December 1992, and followed up to January 1996. RESULTS: Overall five-year actuarial survival was 55 percent, and 66, 56 and 43 percent respectively for Dukes' stage A, B and C disease. Factors associated with increased overall mortality were advanced Dukes' stage, perioperative blood transfusion and smoking, whereas factors associated with disease recurrence were advanced Dukes' stage, large tumour size and presentation with obstruction. CONCLUSIONS: Mortality following potentially curative surgery for colorectal cancer in Dunedin has not changed significantly since the previous study 15 years earlier and is similar to more recently published data from other New Zealand centres.     

Cadmium levels in the urine of female farmers in nonpolluted areas in Japan

About 1200 urine samples were collected, mostly in winter seasons in 1982-1984, from adult women in 7 nonpolluted areas in widely separated parts of Japan, and analyses for cadmium (Cd-U) were conducted in a single laboratory. The geometric mean (GM) by decades of age groups of Cd-U, after adjustment for a specific gravity of urine of 1.016, increased from 0.88 microgram/l in the twenties to reach a maximum of 1.78 micrograms/l in the fifties followed by gradual decrease to 1.31 micrograms/l in the eighties. The effect of smoking (about 8 cigarettes/d as a mean) was absent. Analyses of additional 125 urine samples from men revealed that Cd-U in men was not higher than that in women. When classified geographically, Cd-U was higher in the area on the coast of the Sea of Japan, as suspected in preceding studies on blood cadmium levels and dietary cadmium intakes. The Cd-U levels observed in the present study are similar to the values in previous publications on the Japanese and are apparently higher than the counterpart values from Europe, the United States, and New Zealand.     

Valuing quality of life: results for New Zealand health professionals

AIMS: To illustrate the means by which health state preferences, which are required in the calculation of QALYs, may be generated. To elicit health state values from a sample of New Zealand health professionals, and to compare these with those evident from a sample of health professionals and of the general population overseas. METHODS: This research employed a questionnaire (EQ-5D) developed by the EuroQol group which elicits preferences for health states described in terms of three levels within each of five dimensions of health-related quality of life. This questionnaire was administered to groups of students enrolled in a postgraduate Diploma of Public Health course in Auckland (1993-1995), Wellington and Dunedin (1993-1998), and Christchurch (1993-1997). RESULTS: The health state preferences for the New Zealand sample are similar to those evident for samples of health professionals in Sweden and, to a lesser extent, those evident from a sample of the English general public. CONCLUSIONS: The EQ-5D represents a means of readily eliciting health state preferences in the form required to facilitate cost utility analysis. Further research is required in New Zealand to generate a "tariff of health state preferences from the general public across all health states and to explore hypotheses specific to New Zealand, including the possibility that there may be significant differences between Maori and non-Maori with regards to health state preferences.     

Intercensal trends in cigarette smoking in New Zealand 1: age, sex and ethnic status

The 1981 New Zealand census has shown that since 1976 the proportion of cigarette smokers has fallen from 40% to 35% in men and from 32% to 29% in women. In men, there has been a reduction in smoking in every age group, but in women smoking has increased in those aged 20-24 and 70-74 years. More girls aged 15-19 years are smokers than boys. Maori rates of smoking are much higher than other ethnic groups but since 1976 there has been a considerable reduction in the proportion of Maori men and women who smoke. The important exception is that smoking by Maori women aged 20-24 years has increased to very high levels (70%). Almost half the men and a third of the women who smoke consume 20 or more cigarettes a day. The average number of cigarettes smoked per day has fallen since the 1976 census to 18 for men and 14 for women. From 1976 to 1981, the prevalence of smoking in New Zealand has shown a considerable reduction in non-Maori and Maori men and women of most ages, except for younger women.     

Blood lipid levels in New Zealand

OBJECTIVES: the study aimed to determine age and gender specific levels of lipids and lipoproteins in New Zealanders. Participants were randomly selected from 20 general electoral roles, and from a sample of 15-18 year olds. METHODS: plasma cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured in 2941 men and women aged 15-99 years. RESULTS: mean (SD) plasma cholesterol was 6.0 (1.3) mmol/L in men and 6.1 (1.3) mmol/L in women. There was a marked variation in total cholesterol and calculated LDL cholesterol with age, and the pattern was different in men and women. There was also a considerable regional variation; levels tending to increase from north to south. Overall mean cholesterol levels adjusted for age and geographical distribution were 5.8 and 6.0 mmol/L for men and women respectively. CONCLUSION: the fact that approximately a third of the adult population in New Zealand under 65 years have cholesterol levels greater than 6.5 mmol/L indicates the need for effective diet and lifestyle changes to reduce the high rates of CHD.     

Diet, serum cholesterol and the prevention of coronary heart disease in New Zealand

A combination of the population strategy and the high risk strategy has been recommended for the prevention and control of coronary heart disease in New Zealand. In this paper, using data from a variety of sources, we estimate the potential relative benefits of these two strategies to reduce the contribution of diet and high blood cholesterol to coronary heart disease mortality in New Zealand. It is estimated that diet is responsible, at a minimum for between 22% (1600 deaths) and 39% (2800 deaths) of the coronary heart disease mortality in New Zealand each year. Achievement of the suggested short term dietary goals for the New Zealand population would have at least the same benefit as the identification and successful treatment of all people in the top 10% of the serum cholesterol distribution. This indicates that the population strategy should have higher priority in efforts to prevent and control coronary heart disease. Decisions concerning the level at which elevated blood cholesterol levels are treated pharmacologically will have important logistic and cost implications; national guidelines are required for the management of people with high blood cholesterol levels.