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D Kromhout

Publications and source records attributed to D Kromhout.

At least 73 records · Page 4Linked to original sources
PubMed2000

Saturated fat, vitamin C and smoking predict long-term population all-cause mortality rates in the Seven Countries Study.

BACKGROUND: The Seven Countries Study has shown that population mortality rates for various chronic diseases are related to diet and smoking. This paper addresses the associations between diet, smoking and 25-year all-cause mortality. METHODS: Baseline surveys were carried out between 1958 and 1964 on 12,763 middle-aged men constituting 16 cohorts in seven countries. In 1987/88 equivalent food composites representing the average food intake of each cohort at baseline were collected and chemically analysed in one central laboratory. During 25 years of follow-up 5973 men died and age-adjusted population mortality rates were calculated for each cohort. RESULTS: Multivariate linear regression analyses showed that the population intake of saturated fat and the prevalence of smoking were positively associated with population all-cause mortality rates. Population vitamin C intake was inversely associated with all-cause mortality. It was calculated that a reduction in saturated fat intake of 5% of energy, a 20 mg/d increase in vitamin C and a 10% decrease in the prevalence of smokers may decrease the 25-year all-cause population mortality rate by 12.4% (95% CI: 5.6, 19.4%) at an average population all-cause mortality rate of 45%. CONCLUSION: At the population level saturated fat, vitamin C and cigarette smoking are important determinants of all-cause mortality.

Adult↗
PubMed2000

A case-control study of plasma antioxidant (pro-)vitamins in relation to respiratory symptoms in non-smokers.

The aim of this study was to investigate the relations between plasma levels of antioxidants, beta-carotene and alpha-tocopherol, and chronic respiratory symptoms in Dutch adults who never smoked or were long-term former smokers. Cases (who reported one or more respiratory symptoms) and controls were selected from a population-based cross-sectional study. Plasma concentrations of antioxidants were determined in 491 cases and 496 controls. ORs for the presence of chronic respiratory symptoms were estimated for quintiles of plasma antioxidant concentration after adjustment for age, gender, and body mass index. The OR of respiratory symptoms in all but the highest quintile of plasma beta-carotene decreased and were slightly below one. We saw no meaningful relation with plasma alpha-tocopherol.

Adult↗
PubMed2000

Total but not high-density lipoprotein cholesterol is consistently associated with coronary heart disease mortality in elderly men in Finland, Italy, and The Netherlands.

We studied the relation between serum total and high-density lipoprotein (HDL) cholesterol and 10-year coronary heart disease mortality in elderly men in different European countries. The Finland, Italy and the Netherlands Elderly (FINE) Study is a prospective follow-up study in 2,132 elderly men ages 65-84 years in Finland, the Netherlands, and Italy. We estimated relative risks using Cox proportional hazard analysis with time-dependent covariates. Total cholesterol was positively related to coronary heart disease mortality in all three countries. The combined relative risk for the total population of the FINE Study was 1.17 (95% confidence interval = 1.06-1.29) for each 1.00 mmol/liter increase in total cholesterol. HDL cholesterol was inversely related to coronary heart disease mortality in Finland, but not in the Netherlands and Italy. In Italy we noted an interaction among HDL cholesterol, body mass index, and alcohol intake, with an inverse association for HDL cholesterol in lean men who drank <40 gm of alcohol daily and a positive association for HDL cholesterol among overweight men who drank > or =40 gm of alcohol per day. Serum total cholesterol remains an important predictor of coronary heart disease mortality in elderly men in different European countries. The effect of HDL cholesterol differed among the three countries.

Aged↗
PubMed2000

Coronary heart disease incidence in northern and southern European populations: a reanalysis of the seven countries study for a European coronary risk chart.

OBJECTIVE: A systematic reanalysis of 10 year coronary heart disease incidence data from the northern and the southern European cohorts of the seven countries study, to contribute indirectly to the production of a European coronary risk chart. DESIGN AND SETTING: Men aged 40-59 years at entry were studied in three northern European cohorts based in Finland and Netherlands (n = 2213); and in 10 southern European cohorts based in Italy, former Yugoslavia, and Greece (n = 5897). Multiple logistic models for the prediction of coronary deaths, coronary incidence (hard criteria), and coronary incidence (any criterion) were solved for the two geographical groups and their pool. Risk factors fed into the models were age, systolic blood pressure, serum total cholesterol, and cigarette smoking. RESULTS: 10 year coronary heart disease mortality and incidence were higher in northern than in southern Europe, with ratios around 2.65. Ratios among the three coronary heart disease manifestations were identical in the two cultural groupings. Coefficients of the multiple logistic models were similar and not significantly different between the two groupings. When applying the coefficients back to the same or the opposite population, the relative risk was large and similar in the different cultures. Relative risk was larger for more severe coronary heart disease manifestations. The absolute risk was overestimated when applying the northern European model to southern European populations and vice versa, with ratios of about 1.5 and 0.5, respectively. Coronary risk charts created to reproduce the shape of those incorporated in recent European guidelines confirmed the excess of absolute risk in the northern compared with the southern European cohorts, all else being equal. CONCLUSIONS: In theory, a more appropriate European coronary risk chart could be produced by adopting coefficients to correct for different background incidence rates in different cultures. Other coefficients could appropriately be used to transform mortality risk into incidence risk.

Adult↗
PubMed2000

Arginine intake and risk of coronary heart disease mortality in elderly men.

From experimental studies, the hypothesis is derived that the amino acid arginine, the precursor of NO, could restore the impaired endothelial function and increased platelet activation observed in atherosclerosis. We investigated whether dietary intake of arginine is associated with reduced coronary heart disease risk in elderly persons. The study population consisted of 806 men aged 64 to 84 years at baseline who participated in the Zutphen Elderly Study, a population-based cohort followed up for 10 years. Information about habitual food consumption was collected by use of the cross-check dietary history method. Ninety (11.2%) of the 806 men died from coronary heart disease. Mean+/-SD baseline arginine intake was 4. 35+/-1.07 g/d. Meat was the main source of arginine intake (37.1%), followed by bread (13.1%) and milk and milk products (12.1%). Arginine intake was not associated with coronary heart disease mortality. After adjustment for age, the relative risk (RR) for the medium tertile of arginine intake was 0.72 (95% CI 0.44 to 1.18), and the RR for the highest tertile was 0.71 (95% CI 0.43 to 1.19, P: for trend=0.19) compared with the lowest tertile of arginine intake. After additional adjustment for history of coronary heart disease and diabetes mellitus, energy intake, body mass index, smoking habit, physical activity, and other relevant dietary and biological risk factors, the RR was 1.86 (95% CI 1.06 to 3.27) for the medium intake and 1.56 (95% CI 0.83 to 2.93) for the highest intake (P: for trend=0.17). These results do not support the hypothesis that dietary arginine intake lowers the risk of coronary heart disease mortality.

Aged↗
PubMed1999

Baseline and previous physical activity in relation to mortality in elderly men: the Zutphen Elderly Study.

Understanding the effect of changes in physical activity on mortality risk may help researchers clarify intervention strategies. This study investigated associations of physical activity at baseline and 5 years previously with all-cause mortality risk in a cohort of 472 elderly Dutch men. Relative risks were estimated for relations between mortality in 1990-1995 and physical activity levels in 1990 and 1985. Adjustments were made for baseline age, chronic diseases, functional status, and lifestyle factors. In contrast to previous levels of physical activity (adjusted p-trend = 0.39), baseline total time spent in physical activity was inversely associated with mortality risk (p-trend = 0.004; for the most active tertile vs. the least active, relative risk = 0.44; 95% confidence interval: 0.25, 0.80). No consistent associations were observed after fractionating total physical activity into activities of differing intensity or into four different types of activity. Relative to maintaining a physically active lifestyle (i.e., walking or bicycling for 20 minutes at least three times per week) in both survey years, a gradient of increasing risk was observed from adopting an active lifestyle to becoming sedentary to remaining sedentary (p-trend = 0.004). Recent levels of physical activity were more important for mortality risk among elderly men than activity 5 years previously. Becoming or remaining sedentary was significantly associated with increased mortality risk in comparison with remaining physically active.

Activities of Daily Living↗
PubMed1999

Chocolate as a source of tea flavonoids.

The antioxidant catechin content of chocolate is four times that of tea. Chocolate contributed 20% of the catechin intake in a representative sample of the Dutch population, and tea contributes 55%. Epidemiological assessments of health effects of tea should include other foods that are sources of catechins.

Cacao↗
PubMed1999

Cigarette smoking and mortality risk: twenty-five-year follow-up of the Seven Countries Study.

BACKGROUND: Although most observations in the Seven Countries Study suggest that cigarette smoking is harmful for health, universality of this conclusion remains controversial. SUBJECTS AND METHODS: Cohort-specific and pooled smoking habits at baseline (1957-1964) in 12 763 men aged 40 through 59 years living in Europe, the United States, and Japan in relation to 25-year mortality follow-up. Pooled hazard ratios for smokers vs never smokers were calculated by the Cox proportional hazards model, adjusting for baseline country of residence, age, body mass index, serum cholesterol, systolic blood pressure, and clinical cardiovascular disease. RESULTS: Adjusted hazard ratios for all-causes death in smokers compared with never smokers were 1.3 (95% confidence interval, 1.2-1.4) for smokers of less than 10 cigarettes per day and 1.8 (95% confidence interval, 1.7-1.9) for smokers of 10 cigarettes per day or more. Hazard ratios were elevated for death due to coronary heart disease, all stroke, other arterial disease, lung cancer, other cancer, chronic obstructive pulmonary disease, and other disease in smokers compared with never smokers. Within country, a few instances in which never smokers had a higher cause-specific death rate than smokers of 10 cigarettes per day or more were attributable to random variation associated with low prevalence of never smokers and multiple comparisons. CONCLUSIONS: These findings confirm the association of cigarette smoking with elevated risk of mortality from all causes, several cardiovascular diseases, cancer, and chronic obstructive pulmonary disease. Risk associated with cigarette smoking is independent of culture.

Accidents↗
PubMed1999

Dietary fiber and plant foods in relation to colorectal cancer mortality: the Seven Countries Study.

Many observational studies have found that higher consumption of vegetables, and to a lesser extent of fruits, was associated with lower risk of colorectal cancer. In particular, fiber or foods high in fiber have received attention in the potential prevention of colorectal cancer. We performed an ecological analysis with data of the Seven Countries Study, to investigate whether intake of fiber and plant foods contributes to cross-cultural differences in 25-year colorectal-cancer mortality in men. In the Seven Countries Study, around 1960 12,763 men aged 40 to 59 were enrolled in 16 cohorts in 7 countries. Baseline dietary information was gathered in small random samples per cohort, and nutrient intakes were based on chemical analyses of the average diets per cohort. Crude and energy-adjusted mortality-rate ratios were calculated for a change of 10% of the mean intake of fiber and plant foods, i.e., total plant foods, fruits, vegetables, potatoes, grains, and related sub-groups. Fiber intake was inversely associated with colorectal-cancer mortality with an energy-adjusted rate ratio of 0.89 (95% confidence interval 0.80-0.97). An increase of 10 gram of daily intake of fiber was associated with a 33% lower 25-year colorectal-cancer mortality risk. Intakes of vitamin B6 [0.84 (0.71-0.99)] and alpha-tocopherol [0.94 (0.89-0.99)] were also inversely associated with risk. Consumption of plant foods and related sub-groups was not related to colorectal cancer. It appears that fiber intake best indicates the part of plant food consumption, including whole grains, that is relevant for lowering colorectal cancer risk.

Adult↗
PubMed1999

Primordial prevention of cardiovascular disease risk in The Netherlands.

Developments about cardiovascular disease (CVD) risk factors in The Netherlands since the 1970s are described in relation to health policy. The prevalence of hypercholesterolemia, hypertension, and obesity changed little in the 1970s and 1980s. In recent years, however, the prevalence of hypercholesterolemia tended to decrease and that of obesity to increase. The prevalence of hypertension remained stable but the percentage of treated hypertensives declined since 1987. Between 1958 and 1993 the percentage of male smokers decreased from 90% to about 40%. In women the percentage of smokers decreased from about 40% in 1975 to about 30% in 1993. Between 1987 and 1992 the intake of saturated fat decreased from 16.5 to 14.1% of energy. But during that period the intake of vegetables also decreased from 144 to 128 g/day and that of fruits from 125 to 114 g/day. Recent surveys show that up to age 65, approximately 25% of the Dutch population is physically inactive. This percentage increases sharply after age 65. Health policy for primordial prevention of CVD in The Netherlands is aimed at reduction of smoking prevalence, improvement of dietary habits, and promotion of physical activity.

Cardiovascular Diseases↗
PubMed1999

Fatty acids, antioxidants, and coronary heart disease from an epidemiological perspective.

Oxidized low density lipoproteins (LDL) play a major role in the development of atherosclerosis. Saturated fatty acids, especially fatty acids with 12-16 carbon atoms, are the most important determinants of the LDL cholesterol level. The LDL lipoprotein fraction can be oxidized by, e.g., smoking. Oxidative damage of LDL lipoproteins can be prevented by nutritive, e.g., vitamin E, and nonnutritive antioxidants, e.g., flavonoids. It can therefore be hypothesized that fatty acids and antioxidants are important determinants of coronary heart disease (CHD). There is a large body of evidence from prospective studies that LDL cholesterol-lowering is associated with a lower CHD risk. The evidence for a protective effect of antioxidants on CHD risk is much weaker and is most promising for vitamin E and flavonoids. The Seven Countries Study showed that at the population level saturated fat, cigarette smoking, and flavonoids are important determinants of long-term CHD mortality. These results suggest that a diet low in saturated fat and rich in antioxidants in combination with no smoking is associated with low CHD risk.

Antioxidants↗
PubMed1999

How to select a frail elderly population? A comparison of three working definitions.

Aim of this study was to compare three different working definitions for selecting a frail elderly population. Frailty was defined as inactivity combined with (1) low energy intake (n = 29), (2) weight loss (n = 26), or (3) low body mass index (n = 26). In the Zutphen Elderly Study (n = 450; age 69-89 years) differences in health, functioning, and diet in 1990 and functional decline and mortality in the following 3 years between "frail" and "nonfrail" participants, according to the working definitions, were studied using logistic regression analysis. Differences according to the inactivity/weight loss criterium were more pronounced than according to the other two criteria. Inactivity/weight loss was associated with lower subjective health and performance and more diseases and disabilities in 1990. Three-year relative risks of mortality (odds ratio [OR]: 4.1, 1.8-9.4) and functional decline (OR: 5.2, 1.04-25.8 for disabilities, OR: 3.7, 0.8-16.2 for performance) were higher as well. Inactivity in combination with weight loss seems a practicable working definition for selecting a frail elderly population.

Activities of Daily Living↗
PubMed1999

Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group.

In the Seven Countries Study, associations between the intake of food-groups and 25-year mortality from coronary heart disease (CHD, defined as sudden coronary death or fatal myocardial infarction) were investigated. Baseline surveys were carried out between 1958 and 1964. A number of individual characteristics were measured in 12,763 middle-aged men belonging to 16 cohorts in seven countries (USA, Finland, The Netherlands, Italy, former Yugoslavia, Greece and Japan). Dietary information was collected in sub-samples using the weighed record method. Vital status of all participants was verified at regular intervals during 25 years of follow-up and the underlying cause of death was adjudicated. Eighteen different food-groups and combinations were considered for comparison among cohorts. Large differences in food-group consumption were seen, with high consumption of dairy products in Northern Europe, meat in the USA, vegetables, legumes, fish, and wine in Southern Europe, and cereals, soy products, and fish in Japan. Population death rates from CHD showed large differences, ranging from 268 per 1000 in East Finland to 25 per 1000 in Crete, Greece. Animal food-groups were directly correlated, and vegetable food-groups (except potatoes) as well as fish and alcohol were inversely correlated with CHD mortality. Univariate analysis showed significant positive correlation coefficients for butter (R = 0.887), meat (R = 0.645), pastries (R = 0.752), and milk (R = 0.600) consumption, and significant negative correlation coefficients for legumes (R = -0.822), oils (R = -0.571), and alcohol (R = -0.609) consumption. Combined vegetable foods (excluding alcohol) were inversely correlated (R = -0.519), whereas combined animal foods (excluding fish) were directly correlated (R = 0.798) with CHD death rates. Multivariate stepwise analysis selected butter, lard + margarine and meat as significant predictors and produced an R2 of 0.922. These findings were confirmed by factor analysis. These cross-cultural analyses are consistent with the hypothesis that dietary patterns are important determinants of differences in population CHD death rates, and confirm the opposite effects on apparent risk of animal and vegetable foods.

Coronary Disease↗
PubMed1999

Physical activity modulates the effect of a lipoprotein lipase mutation (D9N) on plasma lipids and lipoproteins.

We investigated interactions between a mutation (D9N) in the lipoprotein lipase (LPL) gene and physical activity, as well as other lifestyle factors, on lipid traits in a population-based sample of Dutch men and women (n = 379). We used questionnaire information to classify physical activity, alcohol consumption, and smoking habits, while overweight was defined as a body mass index (BMI) > 25 kg/m2. Non-fasting blood samples were used for the determination of lipid traits and the D9N genotype. Fifteen subjects (4%) carried the mutation. They presented with higher levels of total cholesterol, apolipoprotein (apo) B and triglycerides compared to non-carriers. While no interactions with overweight, alcohol consumption, and smoking were found, a strong interaction between the D9N mutation and physical activity became apparent. Physically inactive D9N carriers (n = 5) had considerably higher total cholesterol (+2 mmol/l, p < or = 0.0001) and apo B levels (+63 mg/dl, p < or = 0.0001) compared to non-carriers of this mutation, whereas their high-density lipoprotein (HDL)-cholesterol concentrations were lower (-0.22 mmol/l, p < 0.05). This was not the case for physically active D9N carriers (n = 10). In conclusion, a common variant of the LPL gene (D9N) adversely affects plasma lipid and lipoprotein profiles. However, the unfavorable consequences may be counteracted by physical activity.

Adult↗
PubMed1999

Parenteral nutrition following intensive cytotoxic therapy: an exploratory study on the need for parenteral nutrition after various treatment approaches for haematological malignancies.

Patients receiving intensive cytotoxic therapy are traditionally supported with parenteral nutrition (PN), although it is unclear whether all patients benefit from PN. This study aimed to identify regimen-associated differences in PN requirements, to reveal discrepancies between the number of PN indications and the frequency with which PN was actually given, and to describe characteristics of patients who met nutritional goals without PN. PN indications were defined as: (1) severe malnutrition at admission; (2) a prolonged period (7-10 days) of minimal oral intake; or (3) clinical weight loss >10%. PN was found to be needed in only 35% of consolidation courses, compared with 80% during remission induction and 55% during BMT. Significant differences were also seen between BMT protocols: PN was required in only 37% of autologous BMT recipients conditioned without total body irradiation (for lymphoma) vs 92% of recipients of a mismatched graft. A high body mass index was the only significant characteristic of patients who could do without PN. In conclusion, PN is not required for all patients undergoing intensive cytotoxic therapy. Screening of nutritional status at the start of therapy and monitoring oral intake following cytotoxic treatment may allow more appropriate identification of patients requiring PN.

Adult↗
PubMed1999

Plasma concentrations of the antioxidants beta-carotene and alpha-tocopherol in relation to lung function.

OBJECTIVE: To study the association between plasma antioxidants (beta-carotene and alpha-tocopherol) and lung function in Dutch adults aged 20-59 y. DESIGN: Cross-sectional. SETTING: Population-based study. SUBJECTS: A random sample (n=367) was drawn from all participants (men and women) aged 20-59 y with reproducible lung function measurements in 1995. INTERVENTION: Completion of general questionnaire and physical examination. MAIN OUTCOME MEASUREMENTS: Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and plasma levels of beta-carotene and alpha-tocopherol. RESULTS: SUBJECTS with a high plasma beta-carotene level (90th percentile, that is 0.57 micromol/L) tended to have a higher FEV1 (73 ml, s.e.m. 60 ml; P=0.22) and a higher FVC (147 ml, s.e.m. 76 ml; P=0.05) than subjects with a low plasma beta-carotene level (10th percentile, that is 0.11 micromol/L) after adjustment for age, height, gender, smoking status, pack-years of smoking and alcohol consumption. There was no difference in lung function between subjects with high and low plasma alpha-tocopherol concentrations. CONCLUSIONS: The results suggest that subjects with a high plasma beta-carotene tended to have a higher FVC than subjects with a low plasma beta-carotene concentration which was borderline statistically significant. The difference for FEV1 between high and low levels of plasma beta-carotene tended to be in the same positive direction as that of FVC but did not reach the pre-set statistical significance level. There is no relation between plasma alpha-tocopherol and lung function. SPONSORSHIP: Ministry of Public Health, Welfare and Sports of the Netherlands and the National Institute of Public Health and the Environment.

Adult↗
PubMed1999

Changes in and factors related to loneliness in older men. The Zutphen Elderly Study.

AIM: To investigate (i) whether loneliness increases in old age, and if so, whether it relates to ageing itself, to time trends or to cohort effects and (ii) the relationship between changes in institutionalization, partner status and health and loneliness. METHODS: 939 men born between 1900 and 1920 completed the De Jong-Gierveld Loneliness Scale, and answered questions about their partner status, health and institutionalization in 1985, 1990 and 1995. RESULTS: For the oldest group (born between 1900 and 1910) loneliness scores increased, but not for the younger groups. The increase in loneliness was attributable to ageing. No birth cohort or time effects were found. Loneliness was related to changes in institutionalization, partner status and subjective health but not to limitations in activities of daily living or cognitive function. CONCLUSIONS: the increased loneliness experienced by very old men is influenced by loss of a partner, moving into a care home or not feeling healthy.

Aged↗