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D Kromhout

Publications and source records attributed to D Kromhout.

At least 91 records · Page 5Linked to original sources
PubMed1999

A vitamin E concentrate rich in tocotrienols had no effect on serum lipids, lipoproteins, or platelet function in men with mildly elevated serum lipid concentrations.

BACKGROUND: Tocotrienols, lipid-soluble antioxidants with vitamin E activity, have been reported to lower LDL-cholesterol concentrations and platelet aggregation in men, but results are contradictory. OBJECTIVE: To examine in detail the effects of a vitamin E concentrate rich in tocotrienols on serum lipoproteins and on platelet function in men at risk for cardiovascular disease. DESIGN: In this randomized, double-blind, placebo-controlled parallel trial, 20 men received daily for 6 wk 4 capsules, each containing 35 mg tocotrienols and 20 mg alpha-tocopherol; 20 other men received 4 capsules daily, each providing 20 mg alpha-tocopherol. All men had concentrations of serum total cholesterol between 6.5 and 8.0 mmol/L or lipoprotein(a) concentrations > 150 mg/L. RESULTS: Compliance was confirmed by changes in serum tocopherol and tocotrienol concentrations. Serum LDL cholesterol in the tocotrienol group was 4.80 mmol/L before and 4.79 mmol/L after intervention, and increased from 4.70 to 4.86 mmol/L in the placebo group (95% CI for the difference: -0.54, 0.19 mmol/L; P = 0.333). Also, changes in HDL cholesterol, triacylglycerol, lipoprotein(a), and lipid peroxide concentrations did not differ between the groups. After adjustment for differences in initial values, no effects were found on collagen-induced platelet aggregation velocity, maximum aggregation, or thromboxane B2 formation in citrated whole blood. ATP release, however, was lower in the tocotrienol group. Urinary thromboxane B2 and 11-keto-thromboxane B2 concentrations and coagulation and fibrinolytic measures did not change. CONCLUSION: The tocotrienol supplements used had no marked favorable effects on the serum lipoprotein profile or on platelet function in men with slightly elevated lipid concentrations.

Adenosine Triphosphate↗
PubMed1999

The contribution of chronic conditions and disabilities to poor self-rated health in elderly men.

BACKGROUND: The aim of the study was to investigate the contribution of chronic conditions and disabilities to poor self-rated health from the perspectives of the patient and the population: (a) What is the impact of seven somatic chronic conditions on self-rated health, independent of disabilities? and (b) To what extent can poor self-rated health be attributed to the selected chronic conditions and disabilities? METHODS: Data came from the 1990 (n = 509), 1993 (n = 381), and 1995 (n = 340) surveys of the Zutphen Elderly Study. Odds ratios (OR) and population attributable risks (PAR) were calculated to quantify the contribution of chronic conditions and disabilities to poor self-rated health. RESULTS: From the patient perspective, stroke was most strongly associated with poor self-rated health (OR = 3.5, 95% confidence interval: 1.8-6.9). From the population perspective, 63% of poor self-rated health could be attributed to the selected chronic conditions, with respiratory symptoms (28%), musculoskeletal complaints (24%), and coronary heart disease (13%) making the largest contribution. A total of 73% could be attributed to chronic conditions and disabilities. CONCLUSIONS: In this population of elderly men, stroke resulted in the largest losses in self-rated health in individual patients, whereas the largest contributions to poor self-rated health in the population were made by respiratory symptoms and musculoskeletal complaints.

Aged↗
PubMed1999

Dietary factors and pulmonary function: a cross sectional study in middle aged men from three European countries.

BACKGROUND: Results of epidemiological studies relating individual dietary factors to chronic obstructive pulmonary disease (COPD) are inconsistent. To evaluate the cross sectional association of dietary factors with pulmonary function, data were collected from middle aged men in three European countries. METHODS: The data were collected in the 1960s in Finland (n = 1248), Italy (n = 1386), and the Netherlands (n = 691). Dietary intake was estimated using the cross-check dietary history method. Forced expiratory volume (FEV(0.75) or FEV(1), here called FEV) was measured by spirometry. Associations were adjusted for age, height, smoking, body mass index (BMI), alcohol consumption, and energy intake. RESULTS: FEV was positively associated with intake of vitamin E in Finland, with intake of fruit in Italy, and with intake of beta-carotene in the Netherlands. In all three countries men with intakes of both fruit and vegetables above the median had a higher FEV than those with a low intake of both foods. The difference in FEV ranged from 110 to 169 ml before and from 53 to 118 ml after energy adjustment. Differences in FEV for intake of three antioxidants (vitamins C and E and beta-carotene) above versus below the median ranged from 61 to 181 ml before and from -35 to 58 ml after energy adjustment. Intake of fish was not associated with FEV. CONCLUSIONS: In three European countries a high intake of fruit and vegetables was positively associated with pulmonary function. A high intake of all three antioxidants tended to be positively associated with pulmonary function before, but not after, adjustment for energy intake. Associations of individual antioxidants with pulmonary function were not consistent across countries.

Adult↗
PubMed1999

Consumption of plant foods and stomach cancer mortality in the seven countries study. Is grain consumption a risk factor? Seven Countries Study Research Group.

Plant foods are generally considered to be beneficial for health. A higher consumption of fruits, and to a lesser extent vegetables, is consistently associated with a lower risk of stomach cancer. Results on the association between stomach cancer and grain consumption are less clear. We associated plant food consumption with 25-year stomach cancer mortality at population level in the Seven Countries Study. Around 1960, > 12,000 men aged 40-59 years from 7 countries and 16 cohorts were enrolled. In each cohort, dietary information was collected in small random samples. Crude and adjusted associations were calculated for a change of 10% of mean intake. Results differed for the plant foods studied: an inverse association was observed for fruits (adjusted rate ratio = 0.96, 95% confidence interval = 0.91-0.99), a positive relation for refined grains (adjusted rate ratio = 1.07, 95% confidence interval = 1.03-1.12), and no association for total plant foods, vegetables, whole grains, and potatoes. A high intake of refined grains was correlated with a low consumption of fruits. In conclusion, high intake of refined grains may increase stomach cancer risk. However, because adjustment could only be limited in this study, high intake of refined grains may just reflect the deleterious effect of a diet low in fruits or other characteristics associated with low fruit consumption.

Adult↗
PubMed1999

Serum cholesterol in cross-cultural perspective. The Seven Countries Study.

C.D. de Langen hypothesized already in 1916 that overnutrition by a cholesterol rich diet is associated with hypercholesterolaemia and the occurrence of atherosclerotic complications such as coronary heart disease. It took till the nineteen fifties before the associations between diet, serum cholesterol and coronary heart disease were systematically investigated. Keys started the Seven Countries Study because he was as De Langen interested in the question whether differences in the occurrence of coronary heart disease between populations could be explained by differences in serum cholesterol and diet. The results of the Seven Countries Study showed that serum cholesterol was strongly related to coronary heart disease mortality both at the population and at the individual level. The strength of the association (relative risks) between serum cholesterol and coronary heart disease mortality was similar in different cultures. However, the absolute risks differed substantially. At a serum cholesterol level of 5.2 mmol/l the 25-year coronary heart disease mortality rate was 5 times higher in Northern Europe compared with Mediterranean Southern Europe. At the population level differences in coronary heart disease mortality rates could almost completely be explained by differences in saturated fat (an important determinant of serum cholesterol), flavonoids (strong antioxidants) and cigarette smoking (producer of pro-oxidants). It can be concluded that the relations between diet, serum cholesterol and coronary heart disease are more complex than originally thought. Not only dietary cholesterol but also different fatty acids and antioxidants play a role in the genesis of atherosclerosis.

Antioxidants↗
PubMed1999

The joint impact of family history of myocardial infarction and other risk factors on 12-year coronary heart disease mortality.

We investigated the impact of family history of myocardial infarction on 12-year coronary heart disease mortality. Men and women with a family history had an increased risk for coronary heart disease death, irrespective of other risk factors (RR = 1.58; 95% CI = 1.17-2.13 and RR = 2.12; 95% CI = 1.11-4.05, respectively). Women with a family history seemed to be more susceptible to the detrimental effects of smoking; not to the effects of other risk factors. We found no effect modification by family history in men.

Adult↗
PubMed1998

Physical activity and 10-year mortality from cardiovascular diseases and all causes: The Zutphen Elderly Study.

BACKGROUND: Little is known about physical activity and mortality risk in the elderly. Therefore, we describe the associations between the physical activity pattern of elderly men and the mortality from cardiovascular diseases (CVDs), particularly coronary heart disease (CHD) and stroke, and all causes. METHODS: Self-reported physical activity was assessed with a validated questionnaire for retired men in a population-based sample of 802 Dutch men, aged 64 to 84 years at baseline. Relative risks were estimated for 10-year mortality from CVD (199 deaths), CHD (90), stroke (47), and all causes (373) for tertiles of time spent on physical activity (reference, lowest tertile). Adjustments were made for baseline age, relevant major chronic diseases, cigarette smoking, and alcohol consumption. RESULTS: Mortality risks from CVD and all causes decreased with increasing physical activity (P for trend = .04) with adjusted relative risks of 0.70 (95% confidence interval, 0.48-1.01) and 0.77 (95% confidence interval, 0.59-1.00) in the highest tertile of total physical activity, respectively. Except for CHD, time spent in more intense activities (> or = 4 kcal/kg per hour) was more strongly associated with all mortality outcomes than less intense activities, but no single type of activity was particularly protective. Walking or cycling at least 3 times per week for 20 minutes (our definition of activity based on general health recommendations) was associated with reduced mortality from CVD (adjusted relative risk, 0.69; 95% confidence interval, 0.50-0.88) and all causes (relative risk, 0.71; 95% confidence interval, 0.58-0.88). Additional adjustment for biological cardiovascular risk factors did not affect the strength of any association. CONCLUSION: In a general population of elderly men, physical activity may protect against mortality from CVDs and all causes.

Aged↗
PubMed1998

Lipid profiles reflecting high and low risk for coronary heart disease: contribution of apolipoprotein E polymorphism and lifestyle.

To elucidate the role of modifiable factors and the apolipoprotein E polymorphism in explaining lipid profiles reflecting low, average and high risk for coronary heart disease, we selected subjects from a large population-based study. Subjects with low total cholesterol (TC) (< 15th percentile) and high HDL-cholesterol levels (> 85th percentile) were randomly selected (n = 99) and represent subjects with a low risk lipid profile. Additionally, 95 subjects with total and HDL-cholesterol levels in the 15% around the population-median (median risk lipid profile) and 100 subjects with high TC (> 85th percentile) and low HDL-cholesterol levels (< 15th percentile) (high risk lipid profile) were selected. Compared with E3/3 subjects, the likelihood for a low risk lipid profile was considerably higher (odds ratio 14.3; 2.6-79) in female, but not in male E2-carriers (1.5; 0.3-6.7). Smoking and alcohol consumption were independently associated with a low risk lipid profile in both genders, physical inactivity only in women. The odds ratio for a high risk lipid profile was elevated in male E4-carriers (4.9; 1.1-23) only. In addition to the E4 isoform, smoking and physical inactivity, overweight was the main determinant for a high risk lipid profile (odds ratio 16.8; 3.4-82). Male overweight E4-carriers had a 50 times higher likelihood of a high risk lipid profile than E3/3 men of normal weight. In women, only overweight was independently associated with a high risk lipid profile. Our results suggest that both modifiable factors and the apolipoprotein E polymorphism contribute to a lipid profile, reflecting low, average and high risk for coronary heart disease, but effects may be gender-specific.

Adult↗
PubMed1998

Chlamydia pneumoniae is a risk factor for coronary heart disease in symptom-free elderly men, but Helicobacter pylori and cytomegalovirus are not.

To test the hypothesis that chronic infection with Chlamydia pneumoniae, Helicobacter pylori or cytomegalovirus is associated with coronary heart disease risk in elderly men, a nested case-control study in a cohort investigated in 1985 and 1990 in the town of Zutphen, The Netherlands, was designed. Fifty-four cases with a first diagnosed coronary event between 1985 and 1990, and 108 age-matched control subjects free of coronary heart disease during follow up were included in the study. The overall prevalence of antibodies to cytomegalovirus was 74.7%, to H. pylori 75.9% and to C. pneumoniae 84.0%. A high level of antibodies to C. pneumoniae was associated with an increased coronary heart disease risk (OR = 2.76; 95% CI = 1.31-5.81). This association was stronger in cases developing both myocardial infarction and angina pectoris, than in cases developing only one of these. This association was independent of potential confounders. Antibodies to cytomegalovirus or H. pylori were not associated with coronary heart disease risk. These results support the hypothesis of a role of chronic C. pneumoniae infections in the immunopathogenesis of atherosclerosis.

Aged↗
PubMed1998

The Asn9 variant of lipoprotein lipase is associated with the -93G promoter mutation and an increased risk of coronary artery disease. The Regress Study Group.

Two mutations in the lipoprotein lipase (LPL) gene, a T to G transition at position -93 of the proximal promoter region and an Asp9Asn substitution in exon 2, were examined in 762 Dutch males with angiographically-diagnosed coronary artery disease (CAD) and 296 healthy normolipidemic Dutch males. The two mutations exhibited strong linkage disequilibrium (D' = 0.975). A significantly higher proportion of cases (4.86%) than controls (1.37%) carried the -93G/Asn9 allele (p = 0.008). In the combined sample of cases and controls, adjusted mean plasma total cholesterol (TC) levels were significantly higher in -93G/Asn9 carriers (6.20+/-0.13 mmol/l) than in non-carriers (5.93+/-0.03 mmol/l; p = 0.048), while mean high-density lipoprotein cholesterol (HDL-C) levels were lower in carriers (0.88+/-0.03 mmol/l) than in non-carriers (0.98+/-0.01 mmol/l; p = 0.002). There was a trend towards higher triglyceride (TG) levels in carriers (1.96+/-0.14 mmol/l) compared with non-carriers (1.73+/-0.03 mmol/l) (p = 0.08). Additionally, carrier frequencies in tertiles of TC, HDL-C, TG, and LPL activity, suggested an association of the -93G/Asn9 variant with higher TC and TG levels, and with lower HDL-C and LPL activity levels. Logistic regression revealed a significant odds ratio (OR) for the combined -93G/Asn9 genotype in CAD cases relative to controls (OR: 5.36; 95% CI: 1.57-18.24), with age, body mass index (BMI), smoking, and plasma total- and HDL-cholesterol levels included in the model. In conclusion, we show that the LPL Asp9Asn mutation is in non-random association with a T G substitution at position -93 of the proximal promoter region and that the combined -93G/Asn9 genotype predisposes to decreased HDL-C levels and an increased risk of CAD.

Asparagine↗
PubMed1998

Fruit and fish consumption: a possible explanation for population differences in COPD mortality (The Seven Countries Study).

OBJECTIVE: To investigate whether average intake of antioxidants, fruits, vegetables and fish may help to explain international differences in chronic obstructive pulmonary disease (COPD) mortality. DESIGN: Ecological analysis using information on baseline diet and the 25-year COPD mortality rate in the 16 cohorts of the Seven Countries Study. SETTING: Population-based cohorts. SUBJECTS: Men aged 40-59 years at baseline. METHODS: Dietary information was collected at baseline in small random samples of each cohort. In 1987 the reported foods were bought locally and analysed chemically. After 25 years of follow-up the underlying cause of death of those who died was established centrally. COPD mortality rate ratios were calculated, for a change equivalent to 10% of the overall mean consumption of a dietary factor. RESULTS: We observed independent inverse associations between 25-year COPD mortality and baseline consumption of fruits (rate ratio 0.49; 95% confidence interval 0.36-0.67) and fish (rate ratio, 0.97; 95% confidence interval 0.93-1.00), after adjustment for potential confounders. COPD mortality showed no statistically significant association with intake of antioxidants or vegetables. Fruit and fish consumption together explained about 67% of the variance in the COPD mortality rates of the cohorts. CONCLUSIONS: Fruit and fish consumption may partly explain population differences in COPD mortality. This is in accordance with suggestions for a relationship between fruit and fish consumption and COPD observed in studies in individuals.

Adult↗
PubMed1998

Dietary patterns and cognitive function in elderly men in Finland, Italy and The Netherlands.

OBJECTIVE: To relate dietary patterns to cognitive function in elderly men. DESIGN: Cross-sectional study. SETTING: Population based. SUBJECTS: 1049 men aged 70-91 years around 1990 in five cohorts from the Seven Countries Study: Finland (2 cohorts), the Netherlands (1 cohort), and Italy (2 cohorts). INTERVENTIONS: Food intake was estimated by a cross-check dietary history. Based on the WHO guidelines for the prevention of chronic diseases, a healthy diet indicator was calculated (HDI). A higher HDI indicates a diet more in accordance with the WHO guidelines, and previously we showed that HDI predicted reduced all-cause mortality in our cohorts. Cognitive function was measured using the Mini-Mental State Examination (MMSE), and a score of 23 or lower was used to indicate cognitive impairment. RESULTS: The prevalence of cognitive impairment varied from 14.4% in Zutphen (The Netherlands) to 42.1% in Crevalcore (Italy). There was a tendency towards a lower prevalence of cognitive impairment associated with increased HDI in four out of five cohorts (not in East Finland). In Zutphen this association was borderline significant (OR=0.81; 95% CI 0.63-1.04) after adjustment for age, education, cigarette smoking, alcohol consumption and energy intake. In Crevalcore the association was statistically significant (OR = 0.75; 95% CI 0.58-0.97). CONCLUSIONS: A healthy diet might be associated with a better cognitive function in elderly men. However, since the results were not consistent over all five cohorts, further research is needed to confirm this finding and to decide whether this association is causal.

Aged↗
PubMed1998

The incidence of suspected myocardial infarction in Dutch general practice in the period 1978-1994.

AIM: To evaluate how the incidence of suspected myocardial infarction has developed from 1978 to 1994 and to study the incidence of confirmed acute myocardial infarction in Dutch general practices during the period 1991-1994. METHODS: In three periods (1978, 1983-1985 and 1991-1994) the incidence of suspected myocardial infarction has been registered by the 'Dutch Sentinel Practice Network'. This is a registration system that obtains data from general practitioners covering about 150,000 persons. During the period 1991-1994 the incidence of confirmed myocardial infarction was also registered. RESULTS: For men, the incidence rate of suspected myocardial infarction decreased by 28% from 4.7 per 1000 in 1978 to 3.4 per 1000 in the period 1991-1994. For women, the incidence fell by 23% from 2.6 per 1000 in 1978 to 2.0 per 1000 in the period 1983-1985 and stabilized thereafter. The most pronounced decrease in the incidence of suspected myocardial infarction during the period 1978-1994 occurred in both men and women aged 45-64. In the period 1991-1994, the standardized incidence rate of confirmed myocardial infarction is 1.7 per 1000 for men and 0.9 per 1000 for women. CONCLUSIONS: These data suggest that the incidence of suspected myocardial infarction has declined substantially between 1978 and 1994 both for men and for women; this decline is most pronounced in the age group 45-64.

Adult↗
PubMed1998

Adherence to the European Code Against Cancer in relation to long-term cancer mortality: intercohort comparisons from the Seven Countries Study.

Within the Seven Countries Study, we investigated whether population differences in 25-year cancer mortality and mortality due to cancer of the lung, stomach, and colorectum could be explained by population differences in adherence to the European Code Against Cancer. Baseline surveys were carried out around 1960 on 12,763 middle-aged men constituting 16 cohorts in seven countries; small samples of the cohorts kept dietary records. In 1987, food equivalent composites representing the average food intake of each cohort at baseline were collected locally and analyzed in one central laboratory. The vital status of all participants was verified after 25 years of follow-up. Overall adherence to the first four recommendations of the European Code Against Cancer was inversely related to 25-year total cancer mortality but not to all-cause mortality. The association with cancer mortality was essentially due to the inverse association for adherence to the guideline on smoking only. Each decrease in the percentage of smokers of 3.4% (10% of range) was associated with a relative risk of 0.93 of dying from cancer. Adherence to the recommendation on consumption of vegetables, fruits, and fiber-rich cereals was inversely related to stomach cancer mortality, whereas adherence to the recommendation on body weight, physical activity, and intake of fat was associated with higher stomach cancer mortality.

Body Weight↗
PubMed1998

Non-response bias in a study of cardiovascular diseases, functional status and self-rated health among elderly men.

OBJECTIVES: To investigate to what extent differences in health status between respondents and drop-outs affected the associations between cardiovascular diseases and functional status and self-rated health in a population-based longitudinal health survey in elderly men. METHODS: During the 1993 survey of the Zutphen Elderly Study, a non-response survey was carried out. The prevalence of myocardial infarction and stroke, disabilities in basic activities of daily living (BADL) and mobility, and self-rated health were compared between non-respondents (n = 99) and respondents (n = 381). Associations between myocardial infarction and stroke on the one hand and functional status and self-rated health on the other were calculated for the total population and for the respondents to assess the amount of under- or overestimation of these associations. RESULTS: The health of non-respondents was worse than that of respondents in terms of stroke, disabilities in BADL and mobility and self-rated health. Due to this selective non-response, the associations between cardiovascular diseases and functional status and self-rated health were biased. Although most of the associations were slightly overestimated, the most important bias was the underestimation by 57% of the association between stroke and disabilities in BADL [total population: odds ratios (OR) = 6.1, 95% confidence interval (CI) = 2.7-13.9; respondents only: OR = 2.6, CI = 0.7-9.9]. CONCLUSION: Selective non-response might lead to bias in the prevalence of disease, disabilities and self-rated health as well as in the associations between disease and functional status and self-rated health. The direction and magnitude of this bias varies according to type of disease and health outcome and is therefore difficult to predict. The need to minimize non-response and to investigate its implications is recommended in every study.

Activities of Daily Living↗