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D Kromhout

Publications and source records attributed to D Kromhout.

At least 181 records · Page 10Linked to original sources
PubMed1994

Apolipoprotein e4 allele and cognitive decline in elderly men.

OBJECTIVES: To determine whether polymorphism of apolipoprotein E--notably, the e4 allele--predicts cognitive deterioration in the general population. DESIGN: Population based cohort investigated in 1990 and in 1993. SETTING: Zutphen, the Netherlands. SUBJECTS: Representative cohort of 538 Dutch men aged 70-89 at baseline. MAIN OUTCOME MEASURES: Cognitive function assessed by mini mental state examination, change in cognitive function and incidence of impaired cognitive function at three years. RESULTS: The baseline prevalence of impaired cognitive function (mini mental state examination score < or = 25) was higher among carriers of the e4 allele compared with men without the allele (41.0% (55) v 31.1% (122) P = 0.03), and this result was still valid after adjustment for age, occupation, smoking, alcohol use, and cardiovascular diseases. The decline in cognitive function at three years was largest in men homozygous for e4 (-2.4 points), intermediate in those heterozygous for e4 (-0.7 points), and lowest in men without e4 (-0.1 points), and it was independent of other risk factors (P = 0.02). The risk of developing impaired cognitive function during follow up was significantly increased in allele carriers compared with non-carriers (27.6% (16/58) v 15.5% (32/207)). The adjusted odds ratio was 2.87 (95% confidence interval 1.29 to 6.42). Twenty two per cent of the risk of developing impaired cognitive function in this population may be attributable to the e4 allele. CONCLUSIONS: The apolipoprotein e4 allele predisposes to cognitive decline in a general population of elderly men.

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PubMed1994

Diet and physical activity as determinants of hyperinsulinemia: the Zutphen Elderly Study.

The relation of dietary factors and physical activity to hyperinsulinemia was examined in 389 men aged 70-89 years who participated in the Zutphen Elderly Study in 1990. Information about the usual diet was obtained using a cross-check dietary history, and habitual physical activity was assessed using a validated questionnaire. Known and newly diagnosed diabetic patients were excluded from this study, since serum insulin and C-peptide levels are indicators of insulin resistance and hyperinsulinemia in non-diabetics only. Insulin levels during the oral glucose tolerance test were lowest in men with the highest physical activity. This inverse association was independent of age, body mass index, the ratio of subscapular to triceps skinfold thickness, cigarette smoking, and energy intake (p < 0.001). In addition, insulin levels were inversely associated with the intake of dietary fiber and polyunsaturated fatty acids, which could not be accounted for by variables such as energy intake, body mass index, physical activity, prescribed diets, or the presence of coronary heart disease. In contrast, insulin levels increased with the increasing intake of saturated fatty acids and alcohol. The fasting C-peptide level was independently associated with the intake of total fat, saturated and monounsaturated fatty acids, and alcohol, whereas an inverse relation with the intake of total carbohydrates and dietary fiber was seen. Besides overweight, physical activity and dietary factors such as the intake of fatty acids, fiber, carbohydrates, and alcohol, were independently associated with hyperinsulinemia and insulin resistance. Therefore, these behavioral factors may partly determine the occurrence of non-insulin-dependent diabetes mellitus and coronary heart disease and play a role in the prevention of these disorders.

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PubMed1994

Trends in blood pressure and the prevalence and treatment of hypertension in young adults in The Netherlands, 1974-1986.

To investigate trends in blood pressure and the prevalence and treatment of hypertension in the Netherlands between 1974 and 1986, data from two screening projects on cardiovascular risk factors were used. Between 1974 and 1980 about 30,000 men and women aged 37-43 were screened. Between 1981-1986 about 80,000 men aged 33-37 were examined. An increase in average systolic blood pressure by 2 mmHg in men in the period 1974-1980 was followed by an insignificant change during the period 1981-1986. Average diastolic blood pressure increased by 4 mmHg between 1974 and 1980 but decreased by the same amount between 1981 and 1986. The prevalence of hypertension in 40-year-old men increased from 12.7% in 1974 to 17.8% in 1980. The prevalence of hypertension in 35-year-old men did not change between 1981 and 1986 and amounted to 9.6%. Treatment of 40-year-old hypertensive men increased from 8% in 1974 to 21% in 1980 and from 9% in 1981 to 13% in 1986 among 35-year-old men. Average systolic blood pressure did not change in 40-year-old women between 1974-1980 but average diastolic blood pressure increased by 2 mmHg during that period. The percentage of hypertensive women was 8.5% and did not change between 1974 and 1980. Also, the percentage of treated hypertensive women did not change and amounted to 28%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Serum total cholesterol and systolic blood pressure as risk factors for mortality from ischemic heart disease among elderly men and women.

Serum total cholesterol (TC) and systolic blood pressure (SBP) were investigated as risk factors for mortality from ischemic heart disease among 272 elderly men and women during 17 years of follow-up. For men, TC was not significantly associated with mortality from ischemic heart disease. Among women, a significant positive association was found (p-trend = 0.03 when adjusted for age, body mass index, SBP, alcohol consumption, smoking, and the prevalence of myocardial infarction, angina pectoris and diabetes mellitus). Among women a significant positive association was also observed for SBP after adjustment for all potential confounders (p-trend = 0.05). Among men, the adjusted association with SBP was not statistically significant. The results suggest that TC and SBP are stronger independent risk factors for mortality from ischemic heart disease among elderly women than among elderly men. These differences between genders may be due to selective mortality among middle-aged men and physiological changes in women during menopause.

Age Factors↗
PubMed1994

Dietary risk factors for clinically diagnosed gallstones in middle-aged men. A 25-year follow-up study (the Zutphen Study).

In a long-term follow-up study of middle-aged men, the relation between the intake of energy, nutrients, and foods and the 25-year incidence of clinically diagnosed gallstones was studied. Information on the presence of gallstones was obtained by self-report and verified through medical records after death. Of 860 men, 54 developed symptomatic gallstones, yielding an incidence rate of 3.1/1000 person-years. The present study provides a comprehensive picture of dietary risk factors for clinically diagnosed gallstones based on a long-term follow-up. Calcium intake was inversely associated with gallstone incidence in the univariate and multivariate Cox proportional hazards analyses (hazard ratio (HR) upper tertile: 0.3; 95% CI: 0.1 to 0.7). A positive association with sugars (monosaccharides and disaccharides) appeared after the introduction of age, body mass index, calcium intake, and the intake of energy from nutrients other than sugars into the model (HR upper tertile: 2.3; 95% CI: 1.0 to 4.8). Calcium may alter the composition of bile by preventing the reabsorption of secondary bile acids in the colon, whereas sugars may influence bile composition through lipoprotein metabolism.

Adult↗
PubMed1994

Dietary flavonoids and cancer risk in the Zutphen Elderly Study.

Flavonoids are polyphenolic antioxidants naturally present in vegetable foods. Some flavonoids, such as quercetin, inhibit carcinogenesis in rodents, but their effect in humans is unknown. We measured the flavonoids quercetin, kaempferol, myricetin, apigenin, and luteolin in foods and assessed flavonoid intake in 1985 by dietary history in 738 men aged 65-84 years without a history of cancer, who were then followed for five years. Mean flavonoid intake was 25.9 mg/day. The major sources of flavonoid intake were tea at 61% and vegetables and fruits (mainly onions, kale, endive, and apples) at 38%. Between 1985 and 1990, 75 men developed cancer (all sites) and 34 men died from cancer. Flavonoid intake in 1985 was not associated with incidence of all-cause cancer (p for trend = 0.54) or with mortality from all-cause cancer (p for trend = 0.51). Flavonoid intake was also not associated with risk of cancers of the alimentary and respiratory tract (p for trend = 0.92). Adjustment for age, body mass index, smoking, physical activity, and vitamin C, vitamin E, beta-carotene, and dietary fiber intake did not change the relative risks. A high intake of flavonoids from vegetables and fruits only was inversely associated with risk of cancer of the alimentary and respiratory tract (relative risk of highest vs. lowest tertile = 0.51, 95% confidence interval 0.25-1.05); these results suggest the presence of other nonvitamin components with anticarcinogenic potential in these foods. We conclude that intake of flavonoids, mainly from tea, apples, and onions, does not predict a reduced risk of all-cause cancer or of cancer of the alimentary and respiratory tract in elderly men. The effect of flavonoids on risk of cancer at specific sites needs further investigation in prospective cohort studies.

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PubMed1994

Changes in major risk factors for cardiovascular diseases over 25 years in the Serbian cohorts of the Seven Countries Study.

The Serbian cohorts of the Seven Countries Study were examined four times during a 25-year period. Large changes were observed in average serum cholesterol, blood pressure and the prevalence of smoking in these ageing cohorts. Comparison of men of the same age strata e.g. men aged 50-59 examined at baseline and after 10 years of follow-up and of men aged 65-69 examined after 10 and 25 years of follow-up showed that serum cholesterol increased by about 45% in Zrenjanin, 35% in Velika Krsna and 15% in Belgrade over the last 25 years. Systolic blood pressure increased by 9% in Zrenjanin and 7% in Velika Krsna. No significant increase in systolic blood pressure was observed in Belgrade. There was no major secular trend in smoking and the changes observed during 25 years were mainly due to ageing. No major change was observed in body mass index. The increases in serum cholesterol and blood pressure observed in the Serbian cohorts during the last 25 years are compatible with the increase in cardiovascular disease mortality observed in Yugoslavian men aged 30-69 during the period 1970-1984.

Adult↗
PubMed1994

Total and HDL-cholesterol in The Netherlands: 1987-1992. Levels and changes over time in relation to age, gender and educational level.

BACKGROUND: To gain insight into the prevalence of and trends in plasma cholesterol levels in the general population of the Netherlands, a monitoring project was carried out from 1987 to 1992. METHODS: Each year a random sample of men and women aged 20-59 years in three towns in the Netherlands was invited to participate in the study. The overall response rate was 50% for men and 57% for women and a total of almost 42,000 men and women participated. Total (TC) and high density lipoprotein cholesterol (HDL-C) was measured and the non-HDL-C/HDL-C ratio was computed. Data were age-standardized to the Dutch population distribution aged 20-59 years. RESULTS: The prevalence of hypercholesterolaemia (TC > or = 6.5 mmol/l) in men ranged from 5% in the youngest (20-29 years) to 29% in the oldest age group (50-59 years), and from 4% to 38% in women. Low HDL-C levels (< or = 0.9 mmol/l) in men ranged from 15% in the youngest to 26% in the oldest age group, and in women from 4% in the youngest to 7% in the oldest age group. The lipid profile of those with a higher educational level was more favourable than that of the less educated. From 1987 to 1992, in men, TC decreased by 0.12 mmol/l, HDL-C decreased by 0.07 mmol/l and the non-HDL-C/HDL-C ratio increased by 0.22. In women no statistically significant changes were observed. Changes over time did not differ according to age and educational level. CONCLUSION: The prevalence of hypercholesterolaemia is still high in the Netherlands. During the period 1987-1992 the lipid profile worsened in men and remained stable in women.

Adult↗
PubMed1994

Differences in the association between alcohol consumption and blood pressure by age, gender, and smoking.

The positive association between alcohol consumption and blood pressure is well known. Little is known, however, about effect modification by age, gender, and smoking on the alcohol-blood pressure association. We used data of a cross-sectional study conducted in the Netherlands to investigate the association between alcohol consumption and blood pressure. Between 1987 and 1990, we examined about 30,000 men and women age 20-59 years. After adjustment for age, body mass index, and smoking, we found that in men systolic and diastolic blood pressure increased by 0.9 and 0.6 mmHg per daily drink, respectively. In women, systolic and diastolic blood pressure were 2 and 1 mmHg higher in those who consumed 2 or more glasses per day compared with nondrinkers, respectively. We observed a stronger association between alcohol and blood pressure in older men compared with younger men and in male and female smokers compared with nonsmokers. These data show that gender, age, and smoking all are important effect modifiers of the alcohol-blood pressure relation.

Adult↗
PubMed1994

Hyperinsulinemia, risk factors, and coronary heart disease. The Zutphen Elderly Study.

We investigated the association between fasting insulin concentration--an indicator of insulin resistance in nondiabetic individuals--cardiovascular risk factors, and coronary heart disease in a study of 390 men in the town of Zutphen. In 1990, an extensive examination was carried out on the participating men (aged 70 to 89 years). Fasting insulin levels were determined and a number of other risk factors measured. Known and newly diagnosed diabetics were excluded from the data analyses. Fasting insulin concentration was significantly associated with levels of glucose, triglycerides, uric acid, serum albumin, creatinine, and fibrinogen as well as resting heart rate. Inverse associations with high-density lipoprotein cholesterol and factor VII activity were observed. These results were independent of confounding factors such as age, body mass index, ratio of subscapular to triceps skinfold thicknesses, cigarette smoking, physical activity, and alcohol consumption. Men with a fasting insulin level higher than 80 pmol/L (highest quartile of the distribution) had a significantly higher prevalence of coronary heart disease and especially of myocardial infarction. This result was independent of potential confounding variables as well as of possible intermediates (total and high-density lipoprotein cholesterol, hypertension, serum triglycerides, fasting glucose, and other risk factors related to fasting insulin) (odds ratio, 2.2; 95% confidence interval, 1.2-4.0). No association between fasting insulin level and hypertension or blood pressure was observed. These results show that fasting insulin is an important indicator of coronary heart disease in elderly men. Clotting factors, resting heart rate, uric acid, serum albumin, and creatinine may also play a role in this metabolic syndrome.

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PubMed1994

Association between QT interval and coronary heart disease in middle-aged and elderly men. The Zutphen Study.

BACKGROUND: Heart-rate-adjusted QT-interval (QTc) is prognostic of sudden death in myocardial infarction patients. So far, population studies have yielded conflicting results on the predictive value of QTc for coronary heart disease morbidity and mortality. Therefore, we investigated this in a longitudinal study of middle-aged and elderly men. METHODS AND RESULTS: From 1960 to 1985, 877 middle-aged men were followed and repeatedly examined in the Zutphen Study. In 1985 the remaining cohort was extended to 835 elderly men from the same birth cohort and followed until 1990. Men with prolonged QTc (420 ms1/2 or more) had a higher risk of myocardial infarction and coronary heart disease death relative to men with QTc less than 385 ms1/2. Age-adjusted coronary heart disease mortality rate ratios were 4.3 (95% confidence interval, 1.3 to 13.8) in middle-aged men and 3.3 (95% confidence interval, 1.0 to 11.6) in elderly men. These associations could not be attributed to prevalent heart disease and were independent of other cardiovascular risk factors. CONCLUSIONS: These results indicate that within the normal range of QTc in the general population, men with long QTc are at higher risk for coronary heart disease. Because QTc is easily determined, it may provide a valuable contribution to risk stratification.

Age Factors↗
PubMed1994

Fish consumption and risk of stroke. The Zutphen Study.

BACKGROUND AND PURPOSE: A low-to-moderate average daily fish consumption has been reported to convey protection against coronary heart disease incidence and mortality. Currently there is no information about its effect on stroke risk. METHODS: In 1960, 1965, and 1970 cross-check dietary histories were obtained in 552 men aged 50 to 69 years in 1970 in the town of Zutphen, The Netherlands. The association between fish consumption and stroke incidence in the period 1970 to 1985 was assessed by Cox proportional hazards models. Adjustments were made for confounding by age, systolic blood pressure, cigarette smoking, serum total cholesterol, energy intake, alcohol consumption, and prescribed diet. RESULTS: The mean fish consumption in 1970 was 17.9 g/d. Men who consumed more than 20 g of fish per day in 1970 had a reduced risk of stroke compared with those who consumed less fish. The hazard ratio (HR) amounted to 0.49 (95% confidence interval [CI], 0.24 to 0.99), and did not change after adjustment for potential confounders. Fewer strokes occurred among the 301 men who always reported fish consumption between 1960 and 1970 than among the men who changed fish consumption habits between 1960 and 1970 or did not consume fish at all (HR, 0.63; 95% CI, 0.34 to 1.16). CONCLUSIONS: These results suggest that consumption of at least one portion of fish per week may be associated with a reduced stroke incidence.

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PubMed1994

Trends in smoking prevalence from 1974 to 1986 in young adults in The Netherlands.

Data of two screening projects for cardiovascular risk factors were used to analyse trends in smoking behaviour in the Netherlands between 1974 and 1986. In 1974-1980 about 30,000 men and women aged 37-43 years and in 1981-1986 about 80,000 men aged 33-37 years in five different towns were screened. Among men, smoking prevalence decreased significantly during the study period in three of the five towns and remained more or less constant in the other two. The decrease was stronger in 1974-1980 (ca. 2 percentage points per year) than in 1981-1986 (ca. 1 percentage point per year). Among women, smoking prevalence decreased at different rates in three of the towns and increased considerably in one town in the period 1974-1980. The smoking prevalence in 37-43 year old Dutch men and women amounted to 58-66% and 48-57% respectively in 1980. In 1986, the smoking prevalence was 48-58% in 33-37 year old men. Comparison with data from other countries showed that smoking prevalence among both men and women in the mid eighties was still high in the Netherlands.

Adult↗
PubMed1994

Occupational exposures estimated by a population specific job exposure matrix and 25 year incidence rate of chronic nonspecific lung disease (CNSLD): the Zutphen Study.

The influence of occupational exposures on total mortality and respiratory mortality and morbidity was examined, employing a population specific Job Exposure Matrix (JEM). Moreover, the relationship between time-related variables of exposure to dust and chronic nonspecific lung disease (CNSLD) incidence was analysed, using time since first exposure and duration of exposure. Occupational exposures in the Zutphen cohort were assessed by application of a JEM, arbitrarily considering jobs as exposed when at least 10% of men who had held the job of interest reported an exposure to one or more from a list of 27 chemical agents. None of the exposures was related to mortality due to CNSLD, although results were influenced by the healthy-worker effect and low mortality rates. Exposure to wood dust and a high probability of exposure to dust were associated with total mortality. Exposures to dust and solvents were statistically significantly related to CNSLD incidence. An exposure-response relationship was found for the probability of exposure to dust with CNSLD incidence. Time-related estimates of exposure to dust based on work history were negatively related to CNSLD incidence. The results suggest the presence of a healthy-worker effect, in a general population study, resulting in an underestimation of the relationship between occupational exposures and respiratory diseases based on the evidence published so far. The use of the full work history to determine exposure to dust leads to stronger relationships with CNSLD incidence, compared to conventional analyses using exposure at the start of follow-up.

Age Factors↗
PubMed1994

Regional fat distribution as risk factor for clinically diagnosed gallstones in middle-aged men: a 25-year follow-up study (the Zutphen Study).

Obesity is considered to be an important risk factor for the formation of gallstones. The relationship is well established for women but not for men. In a long-term follow-up study of middle-aged men the relationship between various markers of obesity and the incidence of clinically diagnosed gallstones during 25 years of follow-up was studied. Information on the presence of gallstones was obtained by self-report and verified through medical records after death. Of the 860 men who were between 40 and 59 years old at the start of the study, 54 developed gallstones, yielding an incidence rate of 3.1/1000 person-years. Cox proportional hazard models were used to examine the associations between the risk factors and newly diagnosed gallstones. Univariate analysis revealed that the subscapular-to-triceps skinfold thickness ratio (STR) yields a significant positive association (HR upper quartile: 2.5, 95% CI: 1.1-5.7). Subscapular skinfold thickness had a borderline significant, positive association, which became significant after exclusion of subjects who developed symptomatic gallstones within the first 3 years of follow-up (HR upper quartile: 2.5, 95% CI: 1.0-6.2). The multivariate model revealed that the association of STR with clinically diagnosed gallstones was independent of Body Mass Index. Our results indicate that regional fat distribution, as measured by the subscapular-to-triceps skinfold thickness ratio, may play an important role in the formation of gallstones in men, as was previously found for women in other studies.

Adipose Tissue↗
PubMed1993

Self-rated health, mortality, and chronic diseases in elderly men. The Zutphen Study, 1985-1990.

The value of self-rated health in predicting mortality and the incidence of chronic diseases was studied in a cohort of 783 elderly Dutch men in the Zutphen Study. In 1985, 48% of the men felt "healthy," while 12% felt "moderately healthy" or "not healthy." As of 1990, 23% of the 783 men had died. Survival analysis showed that self-rated health was highly predictive of subsequent 5-year mortality from all causes (p < 0.001). When adjusted for the presence of major chronic diseases, age, medication use, smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, serum cholesterol, education, marital status, and family history of chronic diseases, the relative risk for "moderately healthy" or "not healthy" men compared with "healthy" men was 2.7 (95% confidence interval (CI) 1.8-4.3). Analysis of cause-specific mortality revealed that self-rated health was associated with cardiovascular mortality (crude relative risk (RR) = 2.7), but this finding resulted mainly from confounding by baseline prevalence of cardiovascular diseases (adjusted RR = 1.9, 95% CI 0.9-3.8). However, self-rated health was an independent risk factor for cancer mortality (adjusted RR = 4.2, 95% CI 1.9-9.4) and mortality due to other causes (adjusted RR = 3.0, 95% CI 1.2-7.8). Self-rated health did not independently predict the incidence of chronic diseases. This suggests that self-rated health especially affects fatality from chronic diseases rather than their onset, and this issue should be pursued further.

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