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D Kromhout

Publications and source records attributed to D Kromhout.

At least 127 records · Page 7Linked to original sources
PubMed1997

The Dutch EPIC food frequency questionnaire. I. Description of the questionnaire, and relative validity and reproducibility for food groups.

BACKGROUND: A self-administered food frequency questionnaire was developed for the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Habitual consumption of 178 food items can be calculated from the questionnaire data. METHODS: Reproducibility and relative validity for food group intake were investigated in a population of 121 Dutch men and Women. The questionnaire was administered three times at 6-month intervals in order to determine the reproducibility. To assess the relative validity 12 monthly 24-hour recalls served as the reference method. RESULTS: Spearman rank order correlation coefficients between estimates of food group intake assessed by repeated questionnaires ranged from 0.45 to 0.92. For men, Spearman correlation coefficients between estimates of food group intake based on the questionnaire and those based on 24-hour recalls ranged from 0.21 for cooked vegetables to 0.78 for sugar and sweet products, with a range of 0.61. For women the median was 0.53, with a minimum of 0.31 for vegetables and a maximum of 0.87 for alcoholic beverages. The photographs in the questionnaire for the estimation of portion sizes contributed little to the relative validity of the ranking of subjects. However, on the group level most median food group estimates based on photographic portion sizes were closer to the median intakes as assessed by 24-hour recalls than those based on standard portion sizes. CONCLUSIONS: The questionnaire seems adequate for ranking Dutch EPIC subjects according to intake of most food groups, although the relative validity for some food groups, such as vegetables and fish, remains of concern.

Adult↗
PubMed1997

The Dutch EPIC food frequency questionnaire. II. Relative validity and reproducibility for nutrients.

BACKGROUND: A self-administered semi-quantitative food frequency questionnaire (FFQ) was developed for the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: The reproducibility and relative validity of nutrient intake as assessed by this questionnaire were investigated in a population of 121 men and women. To assess the relative validity, 12 monthly 24-hour recalls served as reference method, together with four determinations of 24-hour urinary nitrogen excretion, predicted basal metabolic rate, and serum beta-carotene and alpha-tocopherol levels. RESULTS: Protein and among women, energy intake were underestimated by the questionnaire compared to urinary nitrogen excretion and the basal metabolic rate, respectively. The underestimation for protein decreased with increasing protein intake. Pearson correlation coefficients between nutrient intakes assessed by repeated questionnaires ranged from 0.70 to 0.94 among men and from 0.59 to 0.94 among women. Correlation coefficients between nutrient intakes assessed by the questionnaire and 24-hour recalls ranged from 0.26 to 0.83 for men and from 0.35 to 0.90 for women, with medians of 0.59 and 0.58, respectively. Correlation coefficients between 0.2 and 0.5 were observed for beta-carotene and vitamin C for men and for beta-carotene and vitamin E for women. Associations with serum beta-carotene (r = -0.16 for men; 0.13 for women) and alpha-tocopherol (0.23 and 0.15, respectively) were much poorer than those obtained with 24-hour recalls. Correlations between protein intake and 24-hour urinary nitrogen excretion were 0.47 and 0.53, respectively. CONCLUSIONS: The FFQ seems adequate for ranking subjects according to intake of energy, macronutrients, dietary fibre and retinol, but it does not yield such good results for beta-carotene, vitamin C for men, vitamin E for women.

Adult↗
PubMed1997

Changes in population cholesterol levels and coronary heart disease deaths in seven countries.

BACKGROUND: Are trends in coronary heart disease deaths based on risk factor changes? OBJECTIVE: To study the relationship between trends in coronary deaths and changes in blood cholesterol in the Seven Countries Study. MATERIAL AND METHODS: Sixteen cohorts of men aged 40-59 years from seven countries (U.S.A., Finland, the Netherlands, Italy, Croatia (former Yugoslavia), Serbia (former Yugoslavia), Greece, Japan) were units for the analyses of serum cholesterol measured at entry and after 5 and 10 years, and for mortality over 25 years. RESULTS: In the populations, the ecological relationship of mean serum cholesterol at entry to late coronary heart disease death rates during the 10- to 25-year follow-up was weak, with an R-square of 0.31. Cholesterol measurements made at year 10, and an indicator of cholesterol change during the first 10 years, increased the association (R-square, 0.49). A negative and significant interaction was shown between baseline population cholesterol levels and their 10-year change. As an indicator of acceleration in mortality, cholesterol change over 10 years was also positively correlated (partial R-square 0.44) with the ratio of 25-year to 5-year deaths. CONCLUSIONS: In the Seven Countries Study, late coronary heart disease death rates are largely "explained' by changes in blood cholesterol levels during the early phases of the study, mainly due to increases in lower cholesterol levels among some cohorts.

Adult↗
PubMed1997

Serum albumin, coronary heart disease risk, and mortality in an elderly cohort.

We investigated associations of serum albumin with the incidence and mortality of coronary heart disease among men from the Zutphen Elderly Study. In 1985, 820 men were randomly selected from a population age 64-84 years and were followed for 5 years. We adjusted relative risks for traditional risk factors (age, body mass index, diastolic blood pressure, total and high-density lipoprotein cholesterol, smoking, and alcohol consumption) and also for baseline health status indicators (white blood cell count, physician's health score, self-rated health, and history of relevant diseases). Albumin was inversely associated with the incidence of coronary heart disease only among men with elevated total cholesterol levels (> or = 6.5 mmol per liter). The relative risk for a 1-standard deviation increase (2.5 gm per liter) in albumin was 0.60 [95% confidence interval (CI) = 0.38-0.96] and was not altered after additional adjustment for baseline health status. In all men, the relative risk for death due to coronary heart disease was 0.67 (95% CI = 0.49-0.92), and the relative risk was reduced to 0.84 (95% CI = 0.61-1.15) after adjustment for health status. We found comparable health status-adjusted relative risks for mortality from cardiovascular diseases (relative risk = 0.83; 95% CI = 0.67-1.02) and for mortality from all causes (relative risk = 0.86; 0.73-0.99). Independent of traditional risk factors, moderately low serum albumin is predictive of coronary heart disease and all-cause mortality in elderly men. Only part of this relation could be explained by baseline health status.

Age Distribution↗
PubMed1997

Age, time, and cohort effects on functional status and self-rated health in elderly men.

OBJECTIVES: This study investigated age-related changes in functional status and self-rated health in elderly men, taking into account changes over time and differences between birth cohorts. METHODS: The Zutphen Elderly Study is a longitudinal study of men born in the Netherlands between 1900 and 1920. Functional status and self-rated health were measured in 513 men in 1990, in 381 men in 1993, and in 340 men in 1995. Age, time, and cohort effects were analyzed in a mixed longitudinal model. RESULTS: Longitudinal analyses showed that during 5 years of follow-up, the proportion of men without disabilities decreased from 53% to 39%, whereas the percentage who rated themselves as healthy decreased from 50% to 35%. Cross-sectional analyses confirmed changes in functional status, suggesting an age effect. Time-series analyses confirmed changes in self-rated health, suggesting a time effect. No birth-cohort effects were found. CONCLUSIONS: Functional status deteriorates with age, whereas self-rated health is not related to age in men aged 70 years and older. The observed 5-year decline in self-rated health seemed to be due to a secular trend.

Activities of Daily Living↗
PubMed1997

The relation of chronic diseases to all-cause mortality risk--the Seven Countries Study.

The relation of chronic conditions on all-cause mortality in population samples was studied based on observations from the Seven Countries Study. The objective of this work was to study the risk of death during a 15-year follow-up of middle-aged men in relation to six chronic diseases. Fifteen cohorts of men aged 50-69, totalling 8122 subjects, were examined around 1970 in seven countries: Finland, The Netherlands, Italy, Croatia (former Yugoslavia), Serbia (former Yugoslavia), Greece and Japan. Clinical diagnoses findings were made for coronary heart disease (CHD), 'other heart diseases' (OTH), peripheral arterial disease (PAD), stroke (STR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DIAB). All-cause mortality was assessed in the subsequent 15 years. Death rates and relative risks were estimated from crude data, and in proportional hazards models after adjustment for age, systolic blood pressure and serum cholesterol level, cigarette smoking and body mass index. Large regional differences were found in the prevalence of the six conditions. Weak relations were found between population prevalence of each disease and population death rates for that disease. Among cohorts the relative risk of death in 15 years from any cause, adjusted for other risk factors, showed little variation among countries. Pooled relative risks, adjusted by the inverse of variance (with 95% CI) were: for CHD, 1.81 (1.60-2.06); for OTH, 1.47 (1.28-1.69); for PAD, 1.64 (1.39-1.93); for STR, 1.56 (1.23-1.98); for COPD, 1.67 (1.48-1.88); and for DIAB, 1.75 (1.43-2.15). The smallest variability of prognosis among countries was found for CHD, OTH and DIAB; the largest for PAD, STR and COPD. Despite simple clinical diagnostic procedures and large differences in prevalence, the relation of established prevalent conditions to subsequent all-cause mortality is relatively uniform among countries and across these conditions, with a relative risk of dying in 15 years usually ranging between 1.5 and 2.0.

Aged↗
PubMed1996

Overweight, underweight, and mortality. A prospective study of 48,287 men and women.

BACKGROUND: The relative contributions of a low and high body mass index (BMI [weight in kilograms divided by height in meters squared]) to all-cause and cause-specific mortality are still controversial. OBJECTIVE: To examine mortality rates in relation to BMI in a prospective cohort study of 48,287 Dutch men and women aged 30 to 54 years at baseline from 1974 to 1980. METHODS: During an average 12-year follow-up, 1319 deaths occurred. Relative risks (RRs) were calculated from the Cox proportional hazard model by using a BMI between 18.5 and 24.9 kg/m2 as the reference category. RESULTS: All-cause mortality was significantly increased in obese men (BMI, > or = 30 kg/m2; RR, 1.5; 95% confidence interval [CI], 1.1-2.0) and in underweight men (BMI, < 18.5 kg/m2; RR, 2.6; 95% CI, 1.8-3.9) but not in women. The increased risk in underweight men could be attributed to deaths within the first 5 years of follow-up and to lung cancer mortality among smokers. Coronary heart disease (CHD) mortality was about 3-fold higher among obese men and women. About 21% and 28% of CHD mortality in men and women, respectively, could be attributed to being overweight (BMI, > or = 25 kg/m2). The RR (but not the absolute risk) for CHD among obese men was still significant after adjustment for the presence of smoking, hypertension, hypercholesterolemia, and diabetes mellitus at baseline, and it was more pronounced for CHD among nonsmokers than among smokers (RR, 7.1; 95% CI, 2.3-21.7; and RR, 2.7; 95% CI, 1.5-4.7, respectively). CONCLUSIONS: Total mortality was increased in obese and underweight men but not in women. The increased mortality in overweight men was mainly attributable to CHD and, in underweight men, to early mortality and especially lung cancer mortality among smokers.

Adult↗
PubMed1996

Circulation of poliovirus during the poliomyelitis outbreak in The Netherlands in 1992-1993.

A population-based study on the circulation of epidemic poliovirus during 1992-1993 outbreak in the Netherlands was carried out in order to assess whether the virus circulated outside the group of people who reject vaccinations on religious grounds and outside the area where these groups form sociodemographically closely knit network. The prevalence of poliovirus excretion was estimated in a cross-sectional study with a random sample of 2,400 children aged 5-14 years and 3,000 adults age 40-64 years; the sample was drawn from the municipal population registers in four regions (three inside and one outside the risk area). Fecal samples of virus isolation and characterization were submitted by mail, and a questionnaire was completed with age, sex, type and level of education, vaccination history, and religious denomination. Both a completed questionnaire and a fecal sample were received from 3,182 persons (response, 58.9%). Wild poliovirus was isolated only from children within the risk group and in the area at risk. The crude excretion rate of the epidemic poliovirus type 3 per 1,000 persons was 2.5, but it amounted to 70.7 for those belonging to Orthodox Reformed churches. The prevalence of vaccine virus excretion per 1,000 persons was 10.2 for children and 5.2 for adults. It was concluded that, during the 1992-1993 outbreak, the risk of poliovirus was restricted to religious subpopulations rejecting vaccination. The lack of evidence of poliovirus circulation outside these groups at risk supports the hypothesis that herd immunity is sufficiently maintained in a population vaccinated with inactivated polio vaccine.

Adolescent↗
PubMed1996

Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study.

BACKGROUND: Epidemiological studies suggested that consumption of fruit and vegetables may protect against stroke. The hypothesis that dietary antioxidant vitamins and flavonoids account for this observation is investigated in a prospective study. METHODS: A cohort of 552 men aged 50 to 69 years was examined in 1970 and followed up for 15 years. Mean nutrient and food intake was calculated from cross-check dietary histories taken in 1960, 1965, and 1970. The association between antioxidants, selected foods, and stroke incidence was assessed by Cox proportional hazards regression analysis. Adjustment was made for confounding by age, systolic blood pressure, serum cholesterol, cigarette smoking, energy intake, and consumption of fish and alcohol. RESULTS: Forty-two cases of first fatal or nonfatal stroke were documented. Dietary flavonoids (mainly quercetin) were inversely associated with stroke incidence after adjustment for potential confounders, including antioxidant vitamins. The relative risk (RR) of the highest vs the lowest quartile of flavonoid intake ( > or = 28.6 mg/d vs <18.3 mg/d) was 0.27 (95% confidence interval [CI], 0.11 to 0.70). A lower stroke risk was also observed for the highest quartile of beta-carotene intake (RR, 0.54; 95% CI, 0.22 to 1.33). The intake of vitamin C and vitamin E was not associated with stroke risk. Black tea contributed about 70% to flavonoid intake. The RR for a daily consumption of 4.7 cups or more of tea vs less than 2.6 cups of tea was 0.31 (95% CI, 0.12 to 0.84). CONCLUSION: The habitual intake of flavonoids and their major source (tea) may protect against stroke.

Aged↗
PubMed1996

Physical activity and cardiovascular risk factors among elderly men in Finland, Italy, and the Netherlands.

Physical activity pattern and its relation with cardiovascular risk factors was investigated in 1,402 men aged 69-90 years who participated in the 30-year follow-up survey of the Finnish (Eastern and Western Finland), Italian (Montegiorgio and Crevalcore), and Dutch (Zutphen) cohorts of the Seven Countries Study. Physical activity was assessed with a validated self-administered questionnaire designed for retired men. Total physical activity varied largely within cohorts. Median total reported physical activity ranged from 50 minutes/day in Montegiorgio to 89 minutes/day in Crevalcore. Walking, gardening, and bicycling together contributed more than 70% of total physical activity in all cohorts. Depending on the definition of physical inactivity, the estimated prevalence of inactivity varied between 5% and 33% in Zutphen and between 18% and 68% in Montegiorgio. Total physical activity was inversely associated with resting heart rate (r= -0.11, p < 0.001) and was positively associated with high density lipoprotein (HDL) cholesterol (r = 0.08, p < 0.01) in pooled data. These associations remained statistically significant after adjustment for age, cohort, smoking, body mass index, and alcohol intake. Total activity was not associated with total cholesterol, non-HDL cholesterol, blood pressure, or body mass index. The authors conclude that physical activity may have a beneficial effect on HDL cholesterol levels in elderly men. Walking, gardening, and bicycling contribute substantially to their physical activity pattern.

Aged↗
PubMed1996

Smoking, drinking, and thinking. The Zutphen Elderly Study.

The authors examine the cross-sectional and longitudinal relation of smoking habits and current alcohol intake to cognitive status and decline over a 3-year period as well as the extent to which these relations are modified by the presence of clinical conditions indicating atherosclerosis (cardiovascular disease (CVD)/diabetes). Data are from the cohort of men followed in the longitudinal Zutphen Elderly Study in 1990 (n = 489) and 1993 (n = 333). Cognitive function was measured in 1990 and 1993 with the 30-point Mini-Mental State Examination (MMSE). After adjustment for age, education, and alcohol intake, current smokers made 20% more errors on the MMSE than never smokers in the cross-sectional analyses. Cognitive decline was greatest in those with CVD/diabetes who currently smoked and never smoked (-1.9 and -1.3 points, respectively). After adjustment for age, education, and smoking status, men with CVD/diabetes and low-to-moderate alcohol intake had a significantly lower risk for poor cognitive function (MMSE < or = 25) than abstainers (odds ratios of 0.3 for less than one drink and 0.2 for one to two drinks per day). Alcohol intake was not associated with cognitive decline. These findings do not support the hypothesis of a protective effect of smoking on cognitive function; they suggest that smoking may be harmful among those with CVD/diabetes. Alcohol may result in an acute beneficial effect on cognitive function among those with CVD/diabetes. However, selection bias and unmeasured confounding should be of concern when evaluating these results.

Age Factors↗
PubMed1996

Total and high density lipoprotein cholesterol as risk factors for coronary heart disease in elderly men during 5 years of follow-up. The Zutphen Elderly Study.

The associations of serum total and high density lipoprotein (HDL) cholesterol with coronary heart disease were investigated in men aged 64-84 years from the Dutch town of Zutphen during 5 years of follow-up. In 1985, 885 randomly selected men, 710 of whom did not have a history of clinical coronary heart disease, participated in the study. Associations were adjusted for age, body mass index, systolic blood pressure, cigarette smoking, and alcohol consumption. Total cholesterol was not significantly associated with the incidence of coronary heart disease, but for mortality the relative risk corresponding to a 1.00 mmol/liter increase was 1.40 (95 percent confidence interval (CI) 1.07-1.83). HDL cholesterol was not associated with mortality from coronary heart disease. The relative risk for the incidence of the disease, corresponding to a 0.26 mmol/liter increase, was 0.80 (95 percent CI 0.60-1.08). For the ratio of HDL cholesterol to total cholesterol, the relative risk for coronary heart disease incidence corresponding to a 0.05 increase amounted to 0.70 (95 percent CI 0.51-0.95). These results show that in elderly men followed for 5 years, both total and HDL cholesterol are important in predicting coronary heart disease. Total cholesterol seems to be a stronger risk factor for mortality from the disease, whereas HDL cholesterol is more strongly associated with the incidence of a first coronary heart disease event.

Age Distribution↗
PubMed1996

Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993).

We investigated cross-sectional as well as longitudinal associations between performance-based measures of functional status and self-reported measures of functional status. In the Zutphen Elderly Study, 494 men, born between 1900 and 1920, were examined in 1990, of whom 303 were reexamined in 1993. A performance score was constructed on the basis of four tests: standing balance, walking speed, ability to rise from a chair, and external shoulder rotation. Self-reported functional status was based on disabilities in basic activities of daily living, mobility, and instrumental activities of daily living. A hierarchic disability scale was constructed. Cross-sectional correlation coefficients between the performance score and the disability scale were 0.22 in 1990 and 0.39 in 1993. Correlations were highest between the test for walking speed and self-reported mobility and IADL, and between the test for external shoulder rotation and self-reported disabilities in basic activities of daily living. The correlation between the 3-year changes in performance and in self-report was 0.20 (p < 0.001). Both performance and self-report at baseline predicted performance and self-report after 3 years. Performance-based measures of functional status are cross-sectionally and longitudinally associated at modest levels with self-reported disabilities. Performance measures and self-reported measures are complementary, but do not measure the same construct.

Activities of Daily Living↗
PubMed1996

Characteristics of non-insulin-dependent diabetes mellitus in elderly men: effect modification by family history.

BACKGROUND: Heredity, obesity and fat distribution may interact with each other in their association with diabetes risk. Therefore we tried to elucidate the role of familial diabetes as effect modifier in the association of obesity, glucose metabolism and lipoproteins with non-insulin-dependent diabetes mellitus. METHODS: A cross-sectional study was carried out among 468 elderly men. Within strata of family history, men with diabetes and normal glucose tolerance were compared with respect to anthropometry, characteristics of glucose metabolism and serum lipids. RESULTS: Of the participants, 14.5 percent were diabetic. In diabetic men a family history of diabetes occurred more often (22.1 percent) than in men with normal (6.8 percent, P < 0.001) or impaired glucose tolerance (8.5 percent). In diabetic men with a family history, the ratio of fasting insulin to glucose and the ratio of areas under the insulin and glucose curves during oral glucose tolerance testing were lower compared to men with normal glucose tolerance. In men without a family history, these differences were smaller (interaction P = 0.06). In diabetic men without a family history, fasting insulin levels were markedly elevated (P < 0.001), whereas in men with a family history there was only a slight elevation. The presence of a family history resulted in more severe deteriorations in lipids, especially in fasting triglycerides (interaction P = 0.075). No interaction between indices of obesity and a family history was observed. CONCLUSIONS: Our findings suggest that elderly diabetic men with a family history of diabetes represent a different subgroup than elderly men without such a history, characterized by larger deteriorations in indices for beta-cell function and higher triglyceride levels.

Aged↗
PubMed1996

Alcohol, fish, fibre and antioxidant vitamins intake do not explain population differences in coronary heart disease mortality.

BACKGROUND: Within the Seven Countries Study data we investigated whether population differences in 25-year mortality rates from coronary heart disease could be explained by population differences in alcohol, fish, fibre and antioxidant intake. METHODS: Baseline surveys were carried out between 1958 and 1964, on 12 763 middle-aged men constituting 16 cohorts in seven countries. In 1987 and 1988 equivalent food composites representing the average food intake of each cohort at baseline were collected locally and analysed for their fibre and antioxidant content in one central laboratory. The vital status of all participants was verified at regular intervals over 25 years. RESULTS: Alcohol and fish intake were inversely related to 25-year mortality from coronary heart disease in univariate analyses. These associations became non-significant when the confounding effects of saturated fatty acids, flavonoids and smoking were taken into account. Fibre and antioxidant vitamins intake were not related to coronary heart disease mortality in either uni- or multivariate analysis. CONCLUSION: These cross-cultural analyses show that alcohol, fish, fibre and antioxidant vitamins do not explain population differences in coronary heart disease mortality, independently of saturated fatty acids and flavonoids intake and cigarette smoking.

Adult↗