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D Kromhout

Publications and source records attributed to D Kromhout.

At least 37 records · Page 2Linked to original sources
PubMed2002

Evolution of all-causes and cardiovascular mortality in the age-group 75-84 years in Europe during the period 1970-1996; a comparison with worldwide changes.

BACKGROUND: In spite of the increase in longevity in the past century, studies of mortality patterns in elderly populations are scarce. We investigated cardiovascular and all-cause mortality patterns in age-group 75-84 years in Europe in the period 1970-1996. Methods Mortality data for the age-group 75-84 years were obtained from WHO and standardized according to the old European population standard. Tables were produced showing mortality rates per country around the year 1995 and trends were calculated over the period 1970-1996 using linear regression analysis. Results In both men and women aged 75-84 all-cause and cardiovascular mortality rates were higher in Central and Eastern Europe compared with Western Europe. For the last 3 available years, all-cause mortality rates differed by a factor 2/2.5 (men, women) when comparing the country with the highest with that of the lowest rate. For total cardiovascular mortality this factor was about 4/5 (men, women). During the period 1970-1996, all-cause and total cardiovascular mortality rates declined in most European countries. The decline in all causes of mortality was almost exclusively due to a decline in total cardiovascular disease mortality, especially stroke. Increases in total cardiovascular mortality were observed in some central European countries and Greece. CONCLUSION: Major changes, mainly a decline, occurred in all-cause and cardiovascular mortality in subjects aged 75-84 in Europe. Therefore a passive attitude to health problems in the elderly is not warranted.

Aged↗
PubMed2002

Predicting cardiovascular risk in the elderly in different European countries.

AIMS: The objective of this study was to develop risk functions for coronary heart disease and cardiovascular disease mortality for elderly men in different European countries. METHODS AND RESULTS: The FINE Study is a prospective follow-up study of 2170 elderly men aged 65-84 years in Finland, Italy and The Netherlands. During 10 years of follow-up 289 men died from coronary heart disease and 545 men from cardiovascular disease. Risk functions were estimated using logistic regression analysis, in order to take competing causes of death into account. The results of the present study show that total cholesterol and smoking were the most important predictors of coronary heart disease mortality, and HDL cholesterol, systolic blood pressure and smoking of cardiovascular disease mortality. Left ventricular hypertrophy, being subject to coronary heart disease or cardiovascular disease in Finland and The Netherlands and use of antihypertensive medication in Italy, were also important predictors. For estimating the absolute risk of coronary heart disease and cardiovascular disease mortality in the elderly it is necessary to take into account the European country in which they live. CONCLUSION: Total and HDL cholesterol, systolic blood pressure and smoking remain important predictors of coronary heart disease and/or cardiovascular disease mortality in elderly men, but also left ventricular hypertrophy, being subject to coronary heart disease, use of antihypertensive medication and country are predictive of coronary heart disease and cardiovascular disease risk.

Aged↗
PubMed2001

Lifestyle factors and plasma homocysteine concentrations in a general population sample.

The authors cross-sectionally investigated the extent to which coffee, tea, and alcohol consumption, physical activity, and smoking were associated with nonfasting total plasma homocysteine concentrations in a random sample of 3,025 Dutch adults aged 20--65 years from a population-based cohort examined in 1993--1996 (n = 19,066). The lifestyle factors most strongly associated with plasma total homocysteine level were smoking (positive), alcohol drinking (negative), and coffee consumption (positive). The smoking effect was most prominent in women, and the alcohol effect was most pronounced in men. Data indicated that independently of other lifestyle factors, age, and intake of folate and B vitamin supplements, a change in lifestyle could result in a 0.1- to 1.7-micromol/liter change in plasma total homocysteine level. The authors conclude that lifestyle changes could result in a public-health-relevant change in plasma total homocysteine concentrations.

Adult↗
PubMed2001

Chronic obstructive pulmonary disease and intake of catechins, flavonols, and flavones: the MORGEN Study.

Flavonoids have been suggested to protect against chronic lung disease. We studied intake of catechins, flavonols, and flavones in relation to pulmonary function and COPD symptoms in 13,651 adults from three Dutch cities examined from 1994 to 1997. Dietary intake was estimated using a food frequency questionnaire, and flavonoid intake was calculated using specific food composition tables. Pulmonary function (FEV1) was determined by spirometry and COPD symptoms by questionnaire. Associations were presented for the fifth versus the first quintile of intake (Q5-Q1), adjusted for age, height (for FEV1 only), sex, smoking, BMI, and energy intake. Smoking was strongly associated with COPD, independent of dietary effects. Average catechin, flavonol, and flavone intake was 58 mg/d (SD = 46) with tea and apples as main sources. Total catechin, flavonol, and flavone intake was positively associated with FEV1 (beta(Q5-Q1) = 44 ml, 95% CI = 18-69) and inversely associated with chronic cough (OR(Q5-Q1) = 0.80, 95% CI = 0.66-0.97) and breathlessness (OR(Q5-Q1) = 0.74, 95% CI = 0.58- 0.94), but not chronic phlegm. Catechin intake was independently associated with FEV1 (beta(Q5-Q1) = 130 ml, 95% CI = 101-159) and all three COPD symptoms (OR(Q5-Q1) = 0.60-0.72, p < 0.001). Flavonol and flavone intake was independently associated with chronic cough only. Solid fruit, but not tea, intake was beneficially associated with COPD. Our results suggest a beneficial effect of a high intake of catechins and solid fruits against COPD.

Adult↗
PubMed2001

Cohort analysis of fruit and vegetable consumption and lung cancer mortality in European men.

Our aim was to examine the relationship between fruit and vegetable consumption and lung cancer mortality in a cohort of European males. Around 1970, dietary intake of Finnish, Italian and Dutch middle-aged men was assessed using a cross-check dietary history. Complete baseline information was available for 3,108 men, of whom 1,578 were baseline smokers. We used Cox proportional hazard analyses to calculate risk estimates for the consumption in country-specific tertiles on lung cancer in smokers. During 25 years of follow-up, 149 lung cancer deaths occurred in the smokers. Fruit consumption was inversely associated with lung cancer mortality among smokers; compared with the lowest, adjusted RRs for the intermediate and highest tertiles were 0.56 (0.37-0.84) and 0.69 (0.46-1.02), p-trend 0.05. Only in the Dutch cohort was this association statistically significant [adjusted relative risks (RRs) 1.00, 0.33 (0.16-0.70) and 0.35 (0.16-0.74), p-trend 0.004]. In Finland lung cancer risk was lower with higher fruit intake but not significantly, whereas in Italy no association was observed. Stratifying on cigarette smoking intensity (non, light and heavy) revealed an inverse association in the heavy smokers only [adjusted RRs (95% confidence intervals [CI]) 1; 0.47 (0.26-0.84); 0.40 (0.20-0.78)). Vegetable consumption was not related to lung cancer risk in smokers. However, analyses stratified on cigarette smoking intensity gave some indication for a lower lung cancer risk with higher intake. In conclusion, in this prospective analysis among European smoking men, fruit intake was inversely related to lung cancer mortality. This association was confined to heavy cigarette smokers.

Adult↗
PubMed2001

Dietary catechins and epithelial cancer incidence: the Zutphen elderly study.

The flavonoids, a group of more than 4,000 polyphenolic antioxidants, are potential cancer preventive components of fruits and vegetables. Catechins, one of the 6 major groups of flavonoids, are present in high concentrations in tea as well. Our objective was to evaluate the association between intake of catechins and incidence of epithelial cancers with data from the Zutphen Elderly Study, a prospective cohort study among 728 men aged 65-84 years in 1985. The average catechin intake at baseline was 72 mg/day (range, 0-355 mg/day). After 10 years of follow-up, 96 incident epithelial cancers were recorded, including 42 cases of lung cancer. After multivariate adjustment, catechin intake was not associated with epithelial cancer (risk ratio [RR] from lowest to highest tertile: 1.00, 0.75, 0.94; p for trend: 0.82), or lung cancer (RR from lowest to highest tertile: 1.00, 0.72, 0.92; p for trend: 0.80). Catechins not from tea were borderline significantly inversely associated with lung cancer incidence (RR and 95% confidence interval [CI] for a 7.5-mg increase in intake: 0.66, 0.42-1.05), whereas catechins from tea were not. Catechins from apple, the major source of non-tea catechins, were also related to lung cancer incidence (RR and 95% CI for a 7.5-mg catechin increase: 0.67, 0.38-1.17). Because tea, the major catechin source in this population, was not associated with cancer risk, it seems unlikely that catechins are responsible for the observed inverse trend between non-tea catechins and lung cancer incidence. However, differences in bioavailability of the various catechins may play a role; effects on individual cancer sites cannot be excluded and merit further investigation.

Aged↗
PubMed2001

Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study.

BACKGROUND: Evidence on the relation between trans fatty acid intake and coronary heart disease is limited. We investigated this relation in a Dutch population with a fairly high trans fatty acid intake, including trans fatty acids from partly hydrogenated fish oils. METHODS: We prospectively studied 667 men of the Zutphen Elderly Study aged 64-84 years and free of coronary heart disease at baseline. We used dietary surveys to establish the participants' food consumption patterns. Information on risk factors and diet was obtained in 1985, 1990, and 1995. After 10 years of follow-up from 1985-95, there were 98 cases of fatal or non-fatal coronary heart disease. FINDINGS: Between 1985 and 1995, average trans fatty acid intake decreased from 4.3% to 1.9% of energy. After adjustment for age, body mass index, smoking, and dietary covariates, trans fatty acid intake at baseline was positively associated with the 10-year risk of coronary heart disease. The relative risk for a difference of 2% of energy in trans fatty acid intake at baseline was 1.28 (95% CI 1.01-1.61). INTERPRETATION: A high intake of trans fatty acids (all types of isomers) contributes to the risk of coronary heart disease. The substantial decrease in trans fatty acid intake, mainly due to industrial lowering of trans contents in Dutch edible fats, could therefore have had a large public-health impact.

Aged↗
PubMed2001

Smoking cessation and quality of life: the effect of amount of smoking and time since quitting.

BACKGROUND: Knowledge of the impact of smoking cessation on health-related quality of life may be important in encouraging smokers to quit. We determined whether the difference in quality of life between ex- and current smokers is influenced by amount of smoking or time since quitting. METHODS: Data were collected within a cross-sectional study among a random sample of the general population in The Netherlands. Health-related quality of life was measured with the RAND-36 questionnaire (adapted from SF-36). Smoking behavior was assessed with a self-administered questionnaire. Adjusted differences in quality of life scores between ex- and current smokers were tested with multivariate analysis of variance, among 9,660 men and women aged 20-59 years, without history of tobacco-related chronic diseases. RESULTS: Ex-smokers reported significantly higher quality of life scores than current smokers. This was more pronounced for mental health, especially for role functioning limitations due to emotional problems (difference 6.5 points; P < 0.0001), than for physical health dimensions. Differences were generally larger between ex- and current heavy smokers than between ex- and current light or moderate smokers (P trend <0.05 when ex-smokers had quit <5 or > or =10 years ago). No significant trend was observed with time since quitting. CONCLUSIONS: Generally, the higher the amount of smoking, the higher were quality of life differences between ex- and current smokers.

Adult↗
PubMed2001

Parental history of myocardial infarction: lipid traits, gene polymorphisms and lifestyle.

To investigate the relationship between parental history of myocardial infarction (MI), lipid traits and gene polymorphisms involved in lipid metabolism, we examined Dutch men and women, who were selected from a large population-based study. Subjects whose father (n=112), mother (n=115) or both parents (n=115) suffered from a premature MI presented with significantly higher apolipoprotein B (apo B) levels than subjects without a parental history (n=114). Genetic analyses revealed that the apo E4 isoform and the D9N mutation of lipoprotein lipase (LPL) were more frequent among subjects with a parental history (P< or =0.05). A similar trend was found for the LPL N291S mutation. In contrast, the LPL S447X mutation and polymorphisms at the cholesteryl ester transfer protein (TaqIB) and apo CIII (SstI) loci proved to be noninformative. Body mass index and lifestyle could not explain differences in apo B levels between parental history groups. In contrast, the apo E polymorphism and the LPL D9N mutation accounted for some, but not all, of the higher apo B levels in subjects with a parental history. Therefore, other genetic or lifestyle-related factors must be responsible for the increased levels of apo B in individuals with a family history of myocardial infarction.

Adult↗
PubMed2001

The homocysteine distribution: (mis)judging the burden.

The nonfasting plasma total homocysteine (P-tHcy) concentration was measured in a random sample of 3025 Dutch adults aged 20-65 years (main study). The positively skewed distribution had a geometric mean of 13.9 micromol/L in men and 12.6 micromol/L in women. Blood of the main study was not cooled or centrifuged immediately after drawing. A stability study (n = 26) indicated that this could have resulted in a small (0.4 micromol/L) overestimation of the means. A comparative study (n = 88), and a reproduction of these results in an entirely different population (n = 213), showed a systematic difference in P-tHcy concentration of -2.4 micromol/L between our laboratory (Nijmegen, the Netherlands) and that in Bergen, Norway. With the information of the additional studies we provided precise and valid data of the Dutch P-tHcy distribution, from which we conclude the status in the Netherlands is worse than in other European countries. Furthermore, we showed that comparison of P-tHcy data is complicated unless the interlaboratory differences are known. @ 2001 Elsevier Science Inc.

Adult↗
PubMed2001

Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly).

Older males are known to carry, more likely than younger people, one or more chronic diseases with an expected impact on mortality. This study was aimed at identifying the relationship of prevalent chronic diseases in elderly populations of different countries with all-cause mortality. Men aged 65-84 from defined areas were enrolled in Finland (N=716), the Netherlands (N=887) and Italy (N=682). They were survivors of cohorts studied for 25 years within the Seven Countries Study. Major chronic diseases were diagnosed at entry. Ten-year follow-up for mortality was completed. Entry prevalence of selected chronic diseases was higher in Finland (56%) than in Italy (51%) and the Netherlands (44%). Ten-year age-adjusted death rates from all causes were higher in Finland (565 per 1000) and lower in the Netherlands (478 per 1000) and Italy (445 per 1000). The absolute risk of death related to chronic disease was high in the three countries, but was higher in Finland than in the Netherlands and Italy. The most lethal condition was stroke, with 10-year death rates of 806 per 1000 in Finland and 707 and 729 per 1000 in the Netherlands and Italy, respectively. The relative risk of all-cause mortality for a set of seven chronic diseases (coronary heart disease, heart failure, claudicatio intermittens, cerebrovascular accidents, diabetes, COPD and cancer) adjusted by age, other diseases and cohort was less than two for each condition, except cerebrovascular accidents in the Netherlands (RR 2.20). In general, relative risk was higher in Finland, intermediate in the Netherlands and lower in Italy, where only cerebrovascular accidents, intermittent claudication, diabetes and the presence of any chronic condition had a significant relative risk. About one third of men had one chronic disease, and between 10% and 15% had two diseases. The coexistence of any two or three chronic conditions was associated with a relative risk of 2 or more in Finland and the Netherlands and less than 2 in Italy. In these elderly men prevalent morbidity and comorbidity was relatively common and it explained a large proportion of excess in all-cause mortality in 10 years of follow-up.

Aged↗
PubMed2001

Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study.

This analysis aims at describing all-cause mortality and their determinants in 16 cohorts of middle-aged men of eight nations. A total of 12,763 men aged 40-59 years were enrolled in the late 1950s and early 1960s in 16 cohorts located in the USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan. The highest death rates were found in Slavonia-Croatia, due to high rates of infectious diseases and violence (death rate of 610 per 1000), and in East Finland due to high rates from coronary heart disease (death rate of 597 per 1000). The lowest death rates were found in a highly educated group in Belgrade, Serbia (death rate 295 per 1000) and in Crete, Greece (death rate 314 per 1000). The ecological analysis showed no significant relationship between mean risk factor levels and all-cause death rates except for the direct association with systolic blood pressure during the first 15 years follow-up. Individual multivariate analysis on eight national pools showed that age, systolic blood pressure, and smoking habits are direct, significant, and universal long-term predictors of all-cause mortality. Serum cholesterol, physical activity and body mass index were so only in some areas. Multivariate coefficients were similar across nations. Pooled hazards ratios were 1.55 for a difference of 5 years of age (CI: 1.51-1.59); 1.23 for 10 cigarettes smoked per day (CI: 1.20-1.26); 0.91 for one unit (based on three grades) of physical activity score (CI: 0.87-0.95); 1.04 for 1 mmol/l of serum cholesterol (CI: 1.02-1.07); and 0.93 for three units of body mass index (CI: 0.91-0.96). In conclusion some cardiovascular risk factors predict long-term risk of all-cause mortality in different cultures.

Adult↗
PubMed2001

Catechin intake and associated dietary and lifestyle factors in a representative sample of Dutch men and women.

OBJECTIVE: To study the intake of catechins in the Dutch population and to assess the relation between catechin intake and other dietary factors. Catechins, dietary components that belong to the flavonoid family, potentially protect against chronic diseases such as cancer and cardiovascular diseases. Catechins are the major components of tea, but they are present in many other plant foods as well. DESIGN: Data were used from a nationwide dietary survey carried out in 1998 among a representative sample of 6200 Dutch men and women aged 1-97y. Dietary data were collected using a 2 day dietary record method. RESULTS: The average daily catechin intake was 50 mg (s.d. 56 mg/day). Catechin intake increased with age, and the intake was higher in women (60 mg/day) than in men (40 mg/day). Tea was the main catechin source in all age groups, whereas chocolate was second in children, and apples and pears were second in adults and elderly. Catechin intake was lower in smokers than in non-smokers, and increased with socio-economic status. A high intake was associated with a high intake of fiber (r = 0.20), vitamin C (r = 0.17) and beta-carotene (r = 0.10). CONCLUSIONS: Catechins are quantitatively important bioactive components of the daily diet, which should be taken into account when studying the relation between diet and chronic diseases. Catechin intake is only moderately associated with the intake of other nutrients, but much stronger with certain health behaviours such as smoking.

Adolescent↗
PubMed2001

Physical activity and dietary fiber determine population body fat levels: the Seven Countries Study.

BACKGROUND: A global epidemic of obesity is developing. Current prevalence rates are about 20-25% in American adults and 15-20% in Europeans. OBJECTIVE: We investigated the association between population levels of physical activity, dietary fat, dietary fiber and indicators of body fat. DESIGN: Cross-cultural study of 16 cohorts of, in total, 12 763 middle-aged men in seven countries. These men were examined between 1958 and 1964. MEASUREMENTS: Height, weight and subscapular skinfold thickness were measured. Information about job-related physical activity and diet was gathered by questionnaire. RESULTS: The population average body mass index (weight/height) varied between 21.8 and 26.0 kg/m2 and the population average subscapular skinfold thickness between 8.4 and 23.7 mm. The population average physical activity index and dietary fiber intake were both strongly inversely related to population average subscapular skinfold thickness and explained together 90% of the variance in subscapular skinfold thickness. Similar but less strong results were obtained for average population body mass index. CONCLUSION: At the population level job-related physical activity and dietary fiber but not dietary fat, are important determinants of subscapular skinfold thickness.

Adipose Tissue↗
PubMed2001

Diet and chronic obstructive pulmonary disease: independent beneficial effects of fruits, whole grains, and alcohol (the MORGEN study).

BACKGROUND: In recent years antioxidants, foods rich in antioxidants (e.g. fruits, vegetables) and fish have been suggested to protect against chronic obstructive pulmonary disease (COPD). There are also indications for a protective effect of whole grain intake and of consuming moderate amounts of alcohol. It is, however, not clear whether the effects of the different dietary factors on COPD are independent of each other and if so, whether their effects are additive. OBJECTIVE: To gain more insight into the potential protective effect of diet on COPD, we studied fruit, vegetable, fish, alcohol and whole grain consumption simultaneously in relation to pulmonary function and COPD symptoms. METHODS: Analysed were cross-sectional data collected in 13 651 men and women aged 20-59 years participating between 1994 and 1997 in the MORGEN study (monitoring project on risk factors and health in The Netherlands). Regression models were adjusted for age, gender, height (for pulmonary function only), smoking, BMI and energy intake. RESULTS: Fruit and whole grain intake showed independent beneficial associations with COPD (P-trend < 0.001). Furthermore, in subjects with low alcohol consumption (1-30 g/day) the forced expiratory volume in 1 s (FEV1) was higher and the prevalence of COPD symptoms lower than in non-drinkers (P < 0.001). The effects of a favourable intake of fruits (> 180 g/day), whole grains (> 45 g/day) and alcohol (1-30 g/day) were largely additive. In the 2998 subjects with a favourable intake of the three foods, the FEV1 was 139 mL higher and the prevalence of COPD symptoms lower (odds ratio (OR) = 0.44) than in subjects (n = 1406) with unfavourable intakes of fruits, whole grains and alcohol (P < 0.001). A similar effect was observed in those who had never smoked. Fish and vegetable intake did not show independent beneficial associations with COPD. CONCLUSIONS: Our results suggest independent beneficial effects of fruits, whole grains and alcohol on COPD that are largely additive and cannot be explained by smoking habits.

Adult↗
PubMed2001

Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations; the FINE study. Finland, Italy, Netherlands, Elderly.

BACKGROUND: This study aims to examine cardiovascular risk factors in relation to all-cause mortality in elderly populations of different European countries. METHODS: Men aged 65--84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; n=716), in the Netherlands (the town of Zutphen; n=887), and in Italy (the rural areas of Crevalcore and Montegiorgio; n=682). Ten-year all-cause mortality was studied in relation to measurements taken at entry: age, systolic blood pressure, HDL- and non-HDL-cholesterol, body mass index, heart rate and smoking habits. Univariate and multivariate analyses were performed with all-cause mortality as the end-point. RESULTS: Ten-year death rates from all causes were higher in Finland (574 per 1000), lower in the Netherlands (475 per 1000), and Italy (466 per 1000). Age, heart rate and smoking in all three countries were independently associated with 10-year all-cause mortality. Non-HDL-cholesterol was not related with all-cause mortality. The observed associations between HDL-cholesterol, systolic blood pressure, body mass index and all-cause mortality were dependent on the in- or exclusions of early death. CONCLUSION: In these elderly men only age, smoking habits and heart rate were consistently associated with all-cause mortality.

Age Factors↗