Mahmoud Zureik, Pierre Ducimetiere, Jean-Michel Warnet, Genevieve Orssaud
Abstract
Objective - To assess the association of proportions of fatty acids in cholesterol esters with the risk of premature death from cancer in middle aged men.
Design - Prospective cohort study.
Setting - Paris, France.
Subjects - 3,277 working men aged 36-52 in 1981-5.
Main outcome measures - Cancer mortality during an average of 9-3 years of follow up. Results - 59 men died of cancer during follow up. The age adjusted relative risks for men in the highest thirds of the distribution of the proportions of linoleic, palmitoleic, and oleic acid in cholesterol esters as compared with those in the corresponding lowest thirds were 0.16 (95% confidence interval 0.05 to 0.51), 3.39 (1.63 to 7.05), and 4.22 (1.95 to 9.12), respectively. Adjustment for and stratification by smoking, alcohol consumption, serum cholesterol concentration, and body mass index did not alter the results. At the time of examination subjects with cancer had a lower intake of polyunsaturated fats, assessed by 24 hour recall, than those without cancer (13.2 v 17.4 g/day, P less than 0.01) .
Conclusions - Monounsaturated and polyunsaturated fatty acids of cholesterol esters are strong biological markers that predict premature death from cancer in French men. Consistently, intake of polyunsaturated fats did not seem to increase the risk of death from cancer. The association of biological markers of dietary fat intake with incidence of and mortality from cancer should be investigated prospectively in other populations.
Institut National de la Sante et de la Recherche Medicale (INSERM) Unit 258 Hopital Broussais 75014-Paris France Mahmoud Zureik research fellow Pierre Ducimetiere director of researchLaboratoire de la Direction de l'Action Sociale de l'Enfance et de la Sante Centre Medico-Social 75013-Paris France Jean-Michel Warnet professor of toxicology Genevieve Orssaud director
Correspondence to: Dr Zureik.
Gary K Dowse, Hassam Gareeboo, K George M M Alberti, Paul Zimmet, Jaakko Tuomilehto, Anil Purran, Djamil Fareed, Pierrot Chitson, Veronica R Collins, Farojdeo Hemraj for the Mauritius Non-communicable Disease Study Group
Abstract
Objective - To study changes in the prevalence of risk factors for cardiovascular disease after a five year population-wide intervention programme promoting a healthy lifestyle in a developing country.
Design - Cross sectional cluster surveys in 1987 and 1992. Methodology included a two hour 75 g oral glucose tolerance test, measurement of body mass index, waist:hip ratio, basal lipid concentrations, and blood pressure; and a lifestyle questionnaire.
Setting - Mauritius, in the Indian Ocean.
Subjects - All adults aged 25-74 years residing in geographically defined clusters.
Main outcome measures - Age standardised prevalence of categorical disease and risk factor conditions and mean levels and frequency distributions of continuous variables.
Results - Response rates were 86.2% (5080/5892) in 1987 and 89.5% (5162/5770) in 1992. Significant decreases were found in the prevalence of hypertension (15.0% to 12.1% in men and 12.4% to 10.9% in women); cigarette smoking (58.2% to 47.2% and 6.9% to 3.7% respectively); and heavy alcohol consumption (38.2% to 14.4% and 2.6% to 0.6% respectively). Moderate leisure physical activity increased from 16.9% to 22.1% in men and from 1.3% to 2.7% in women. Mean population serum total cholesterol concentration fell appreciably from 5.5 mmol/l to 4.7 mmol/l (P less than 0.001). The prevalence of overweight or obesity increased, and the rates of glucose intolerance changed little. The population frequency distributions of blood pressure, serum lipid concentration, and a composite risk factor score shifted advantageously.
Conclusions - Lifestyle intervention projects can be implemented and have positive effects in developing countries. A pronounced improvement in the population lipid profile in Mauritius was probably related to a change in the saturated fat content of a widely used cooking oil.
International Diabetes Institute Melbourne Australia Gary K Dowse senior epidemiologist Paul Zimmet director Veronica R Collins epidemiologistMinistry of Health Port Louis Mauritius Hassam Gareeboo project manager Anil Purran chief medical officer Pierrot Chitson operations manager Farojdeo Hemraj principal biochemist
Human Diabetes and Metabolism Research Centre University of Newcastle upon Tyne Newcastle upon Tyne K George M M Alberti professor
Department of Epidemiology and Health Promotion National Public Health Institute Helsinki Finland Jaakko Tuomilehto professor
World Health Organisation Port Louis Mauritius Djamil Fareed WHO representative
Correspondence to: Dr G K Dowse, Geraldton Public Health Unit, PO Box 68, Geraldton, WA 6530, Australia
Charlotte Cox, Jim Mann, Wayne Sutherland, Madeleine Ball
Abstract
Objective - To determine the extent to which plasma lipid concentrations of individuals are consistently sensitive to changes in saturated fats; to examine whether groups that consistently have large or small responses can be defined; and to identify factors which predict response of lipids to dietary change.
Design - A double crossover design in which two diets (S, providing 21% energy from saturated fat, and P, providing 10%) were followed for periods of six weeks in the sequence SPSP or PSPS.
Setting - 67 free living subjects, total cholesterol 5.5-7.9mmol/l.
Main outcome measures - Relation of cholesterol responses to repeated dietary changes and of potential predictors and cholesterol response.
Results - Similar average changes in cholesterol mask a wide range of individual responses. Response was not related to compliance. In all participants the change in cholesterol observed when the nature of dietary fat was changed on the two crossovers was correlated (r=0.31, P=0.01); the degree of correlation between the two sets of responses was greater in the 46 consistent responders than in the 21 variable responders (r=0.71 v r=0.21). Mean differences in cholesterol between diet S and diet P during the two crossovers were 1.16 (SD 0.35) mmol/l and 0.95 (0.26) mmol/l for consistent hyperresponders and 0.18 (0.26) mmol/I and 0.18 (0.25) mmol/l for consistent minimal responders. In consistent responders, changes in total cholesterol in response to increasing saturated fats correlated with baseline cholesteryl ester transfer activity (r=0.32, P=0.03); total cholesterol (r=0.37, P=0.01); triglycerides (r=0.30, P=0.04); and apolipoprotein B (r=0.54, P=0.01).
Conclusions - There is a degree of consistency in cholesterol response to instructions to change dietary fat which is not explained by dietary compliance, and there are groups of consistent hyperresponders and minimal responders within a population of hypercholesterolaemic individuals. Several factors predicting response have been identified. These results have relevance to dietary approaches aimed at reducing the lipoprotein mediated risk of coronary heart disease.
Departments of Human Nutrition and Medicine University of Otago PO Box 56 Dunedin New Zealand Charlotte Cox lecturer in human nutrition Jim Mann professor in human nutrition and medicine Wayne Sutherland research fellow Madeleine Ball senior lecturer in human nutrition
Correspondence to: Professor Mann.
Jane E Ferrie, Martin J Shipley, M G Marmot, Stephen Stansfeld, George Davey Smith
Abstract
Objective - To assess the effect of anticipating job change or non-employment on self reported health status in a group of middle aged male and female white collar civil servants.
Design - Longitudinal cohort study (Whitehall II study). Questionnaire data on self reported health status and health behaviour were obtained at initial screening and four years later, during the period when employees of the department facing privatisation were anticipating job change or job loss.
Setting - London based office staff in 20 civil service departments.
Subjects - 666 members of one department threatened with easy privatisation were compared with members of the 19 other departments.
Main outcome measures - Self reported health status measures and health related behaviours, before and during anticipation of privatisation.
Results - In comparison to the remainder of the cohort, the profile of health related behaviours of cohort members who faced privatisation was more favourable, both before and during anticipation of privatisation. There were no significant differences in the changes in health behaviours between cohort members moving into a period of job insecurity and the remainder of the cohort. Self reported health status, however, tended to deteriorate among employees anticipating privatisation when compared with that of the rest of the cohort.
Conclusions - The application of a longitudinal design, allowing the same individuals to be followed from job security into anticipation, provides more robust evidence than has previously been available that anticipation of job loss affects health even before employment status has changed.
Department of Epidemiology and Public Health University College London Medical School London WC1E 6BT Jane E Ferrie research fellow Martin J Shipley senior lecturer in medical statistics M G Marmot professor Stephen Stansfeld seniorlecturer in social and community psychiatryDepartment of Social Medicine University of Bristol Bristol BS8 2PR George Davey Smith professor of clinical epidemiology
Correspondence to: Ms Ferrie.
Hillary Klonoff-Cohen, Sharon L Edelstein
Abstract
Objective - To determine whether infants who died of the sudden infant death syndrome routinely shared their parents' bed more commonly than control infants.
Design - Case-control study.
Setting - Southern California.
Subjects- 200 white, African-American, Latin American, and Asian infants who died and 200 living controls, matched by birth hospital, date of birth, sex, and race.
Main outcome measures - Routine bedding (for example, crib, cradle), day and night time sleeping arrangement (for example, alone or sharing a bed); for cases only, sleeping arrangement at death. Differences in bed sharing practices among races.
Results - Of the infants who died of the syndrome, 45 (22.4%) were sharing a bed. Daytime bed sharing was more common in African-American (P less than 0.001) and Latin American families (P less than 0.001) than in white families. The overall adjusted odds ratio for the syndrome and routine bed sharing in the daytime was 1.38 (95% confidence interval 0.59 to 3.22) and for night was 1.21 (0.59 to 2.48). These odds ratios were adjusted for routine sleep position, passive smoking, breast feeding, intercom use, infant birth weight, medical conditions at birth, and maternal age and education. There was no interaction between bed sharing and passive smoking or alcohol use by either parent.
Conclusions - Although there was a significant difference between bed sharing among African-American and Latin American parents compared with white parents, there was no significant relation between routine bed sharing and the sudden infant death syndrome.
Department of Family and Preventive Medicine Division of Epidemiology University of California San Diego La Jolla CA 92037-0607 United States Hillary Klonoff-Cohen assistant professorGeorge Washington Biostatistical Center George Washington University Rockville MD 28052 Sharon L Edelstein senior scientist
Correspondence to: Dr Klonoff-Cohen.
Christopher Dowrick, Iain Buchan
Abstract
Objectives - To assess the extent to which the outcome of depression among primary care attenders may be affected by medical diagnosis or by feedback of questionnaire results in unrecognised cases.
Design - Prospective 12 month study including a randomised controlled trial of the effects of disclosure, with data on depression status and clinical management collected by questionnaire and interview.
Setting - Two group practices in north Liverpool.
Subjects - 1099/1444 (76%) consecutive adult attenders completed the Beck depression inventory, of whom 179 with scores of at least 14 were followed up.
Interventions - Disclosure of a random 45% (52/116) of depression scores to general practitioners for subjects whose depression was undetected.
Main outcome measures - Depression status estimated by depression score at start of study and at six and 12 months, with subsample validation against ICD-10 criteria.
Results - Questionnaire response rates were 76% (136/179) at six months and 68% (122/179) at 12 months and were higher for women than men. The median depression score was 19 (interquartile range 15 to 22) initially, decreasing to 16 (11 to 23) at 12 months. The median depression score decreased significantly (two sided test, P=0.019) in subjects whose depression was unrecognised at the index consultation but increased in those whose depression had been detected by their general practitioners. Disclosure of cases of unrecognised depression to general practitioners had no effect on outcome. Intention to treat was associated with a worse prognosis, although only a minority of subjects received adequate treatment.
Conclusions - Disclosure of undetected depression did not improve prognosis. A diagnosis of depression in general practice should be considered simply as a marker of its severity.
Department of Primary Care University of Liverpool Liverpool L69 3BX Christopher Dowrick senior lecturerDepartment of Medicine University of Liverpool Iain Buchan honorary lecturer in clinical mathematics and computing
Correspondence to: Dr Dowrick.