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PubMed1994

Proliferating cell nuclear antigen labeling index of preoperative biopsy specimens in gastric carcinoma with special reference to prognosis.

BACKGROUND: Proliferating cell nuclear antigen (PCNA) is an auxiliary protein of DNA polymerase delta and is considered to correlate with the cell's proliferative state. Immunohistochemical methods with a anti-PCNA antibody (PC10) have particular advantages compared with other techniques because of the maintenance of the tissue architecture and simplicity of the methodology. The authors investigated the correlation between the tumor's proliferative activity and progression of gastric carcinoma using immunohistochemical staining with PC10. METHODS: One hundred eighty-nine endoscopic biopsy specimens from patients with gastric carcinoma before operation were investigated by immunohistochemical study, using anti-PCNA monoclonal antibody (PC10). The correlation of PCNA labeling index (percentage of positive cells in more than 500 tumor cells) with various clinicopathologic factors and prognosis was studied. RESULTS: The PCNA labeling index became higher as the histologic stage increased. In patients with lymph node metastasis, vascular invasion, liver metastasis, and peritoneal metastasis, the labeling index was significantly higher. In patients with high PCNA labeling index (50% or greater), prognosis was significantly poorer than in those with a low index (less than 50%). The rate of disease recurrence after curative resection was significantly higher in patients with high PCNA grade group. CONCLUSION: As a result of this study, PCNA labeling index is suggested to be correlated with the depth of invasion, organ metastasis, vascular invasion, and tumor stage and to be effective as a prognostic factor.

Adult↗
PubMed1997

The reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index in patients with systemic lupus erythematosus.

OBJECTIVE: To test the reliability of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in the assessment of patients with SLE. METHODS: Ten patients with SLE, representing a spectrum of damage and activity, were included. Each patient was examined by 6 of 10 physicians from 5 countries, representing 10 lupus clinics. The SLICC/ACR Damage Index was used to assess accumulated damage, and the SLEDAI was used to assess disease activity. The order of the patients and physicians was randomized according to a Youden square design. RESULTS: The SLICC/ACR Damage Index detected differences among patients (P < 0.001). There was no detectable observer difference (P = 0.933), and there was no order effect (P = 0.261). Similar results were obtained with the SLEDAI. There was concordance in the SLICC/ACR Damage Index among observers, despite a wide spectrum of disease activity detected by the SLEDAI. CONCLUSION: Physicians from different centers are able to assess patients with SLE in a reproducible way, using the SLEDAI to assess disease activity and the SLICC/ACR Damage Index to assess accumulated damage.

Adult↗
PubMed1999

Fibrosis in chronic hepatitis C correlates significantly with body mass index and steatosis.

Steatosis is a frequent histological finding in chronic hepatitis C infection; however, the pathophysiology of steatosis and its role in disease progression have not been established. We studied 148 consecutive patients with untreated chronic hepatitis C to assess the effect of body mass index, diabetes mellitus, alcohol consumption, hepatic iron content, and viral load on steatosis and hepatic fibrosis. Ninety-one patients (61%) had steatosis: grade 1 (<30% hepatocytes involved) in 61 (41%), grade 2 (30%-70% hepatocytes involved) in 17 (11%), and grade 3 (>70% hepatocytes involved) in 13 (9%). After adjusting for potential confounding variables, a highly significant relationship was found primarily between steatosis and body mass index (P <.0001). The mean (+/-SD) body mass index of patients with no steatosis was 23.9 +/- 4.3 kg/m2, whereas for grade 1 steatosis it was 26.5 +/- 5.1 kg/m2, and for grade 2 and 3 steatosis combined the body mass index was 28.4 +/- 4. 9 kg/m2. Hepatic fibrosis was significantly associated with age (P =. 002). After adjusting for potential confounding variables, including age, hepatic fibrosis was also significantly associated with steatosis (P <.03). There was no significant association between hepatic iron content, alcohol intake, gender, and viral load and steatosis or fibrosis. These findings suggest that increasing body mass index has a role in the pathogenesis of steatosis in chronic hepatitis C and that steatosis may contribute to fibrosis. The association between body mass index and steatosis and fibrosis has important prognostic and therapeutic implications in the management of patients with chronic hepatitis C virus.

Adult↗
PubMed2006

Glycemic load, glycemic index and carbohydrate intake in relation to risk of stomach cancer: a prospective study.

The glycemic effects of diets high in refined grains and starchy foods might increase stomach cancer risk by affecting circulating glucose, insulin and insulin-like growth factor-I levels. No prospective data on the role of high glycemic load and glycemic index diets on stomach cancer risk have been reported. We therefore prospectively investigated dietary glycemic load, overall glycemic index and carbohydrate intake in relation to the incidence of stomach cancer among 61,433 women in the population-based Swedish Mammography Cohort. Diet was assessed at baseline (1987-1990) and again in 1997. During 903,586 person-years of follow-up, a total of 156 incident cases of stomach cancer were ascertained. We observed no material associations of dietary glycemic load, overall glycemic index and total carbohydrate intake with the risk of stomach cancer. The multivariate hazard ratios for the highest versus the lowest quintile were 0.76 (95% CI = 0.46-1.25) for glycemic load, 0.77 (95% CI = 0.46-1.30) for overall glycemic index and 0.85 (95% CI = 0.50-1.43) for carbohydrate intake. The associations did not vary according to body mass index. Lack of information on Helicobacter pylori infection status did not allow stratification by this potential effect modifier. Findings from this population-based prospective cohort of middle-aged and elderly women did not provide evidence of a positive association between glycemic load, glycemic index and carbohydrate intake with risk of stomach cancer.

Aged↗
PubMed1993

Flow cytometry in comparison with mitotic index in predicting disease outcome in transitional-cell bladder cancer.

The DNA content and S-phase fraction were measured by flow cytometry in 448 tumour biopsy specimens from transitional-cell bladder cancer (TCC). The samples were also analyzed for mitotic index, WHO grade and papillary status, and histological and flow cytometric data were then correlated to clinical behaviour of tumours during a mean follow-up period of 9.9 years. TNM classification, WHO grade, papillary status, mitotic index, DNA ploidy and S phase fraction were significantly interrelated. Twenty-four percent of tumours showed heterogeneous DNA indices when measured from multiple samples (measured in 94 cases). Of the histological parameters, independent predictors of progression in superficial tumours were the S-phase fraction and mitotic index. In superficial tumours, S-phase fraction and the mitotic index included all the available independent prognostic information in survival analysis, whereas in muscle-invasive tumours T category was the most important prognostic factor. The results suggest that DNA ploidy has no independent prognostic value in transitional-cell bladder cancer, whereas proliferation indices (SPF, mitotic index) are important prognostic factors. Accordingly, malignancy classification of papillary bladder tumours can be based on proliferation indices alone. Nodular tumours run an unfavourable course and their malignancy grading by flow cytometry or by mitotic index is not relevant.

Aged↗
PubMed1995

Growth and body mass index of Brazilians ages 9 through 17 years.

Obesity during adolescence is considered a strong predictor of adult obesity, and obesity and overweight have been increasing among Brazilian adults. To gauge the relative frequency of overweight among adolescents in Brazil, we compared the distributions of body mass index (kg/m2) and stature in national population based samples of the U.S. and Brazil. U.S. adolescents were on average about 10 cm taller than Brazilians, although growth spurts occurred at the same age for both populations. Brazilian adolescents were leaner than their U.S. counterparts. This difference was reduced among girls in the postpubertal period. At age 17 years, U.S. boys were about 10 kg heavier than Brazilian boys, but the difference among girls was only 2 kg. In families above the poverty level in the more developed South region, body mass index distribution for boys was closer to that of the U.S., and older girls tended to have higher body mass index than U.S. girls. Within Brazil, body mass index varied by ethnicity with Mulattos, but not Blacks, of both sexes having lower body mass index than Whites of the same age. Urban adolescents had higher body mass index than those living in rural areas. In general, the patterns seen among Brazilian adults were found among children. Among girls, in particular, overweight has become an identifiable problem during adolescence.

Adolescent↗
PubMed1996

Self-esteem and change in body mass index over 3 years in a cohort of adolescents.

Self-esteem has been hypothesized to be lower in obese adolescents relative to their normal weight peers and to be an important factor in preventing or reversing obesity. The present study examined the relationship between obesity and self-esteem cross-sectionally and prospectively over three years in a cohort of 1278 adolescents in grades 7 to 9 at baseline. Cross-sectional analyses revealed an inverse association between physical appearance self-esteem and body mass index in both males and females. In females, body mass index was inversely associated with global self-esteem, close friendship, and behavioral conduct self-esteem. In males, body mass index was inversely associated with athletic and romantic appeal self-esteem. Prospectively, in females, physical appearance and social acceptance self-esteem at baseline were inversely related to body mass index three years later. Baseline self-esteem was unrelated prospectively to change in body mass index in males. All associations were modest in magnitude. These results suggest that in a middle class white sample of adolescents, self-esteem specific to physical appearance is modestly associated with body mass index. Low self-esteem does not appear to predict the development of obesity over time.

Adolescent↗
PubMedDate not supplied

Effect of diffuse fatty infiltration of the liver on hepatic artery resistance index.

PURPOSE: This study was conducted to evaluate the effect of various degrees of diffuse fatty infiltration of the liver on the hepatic artery resistance index. METHODS: One-hundred forty subjects were examined using standard color and spectral Doppler sonography protocols. Fatty infiltration of the liver was identified and graded sonographically. The patients were grouped (n = 35 in each of 4 groups) according to the degree of diffuse fatty infiltration of the liver as follows: normal (group 1), mild (group 2), moderate (group 3), and severe (group 4). The resistance index calculated for each patient was the mean of 3 measurements. Mean resistance index of the hepatic artery was then calculated for each group. RESULTS: The mean resistance index was 0.81 +/- 0.04 for group 1, 0.79 +/- 0.06 for group 2, 0.75 +/- 0.05 for group 3, and 0.73 +/- 0.05 for group 4. We found a statistically significant (p < 0.05) decrease in resistance index when comparing groups 3 and 4 with groups 1 and 2 separately. CONCLUSIONS: Hepatic artery resistance index decreases as the severity of diffuse fatty infiltration increases.

Adult↗
PubMed1994

Hepatitis B surface antigen, hepatitis C virus antibody, body mass index, and alcohol drinking among workers with elevated serum alanine aminotransferase.

METHODS: We conducted a case-control study on liver diseases among Japanese workers to examine associations between elevated serum alanine aminotransferase (alanine aminotransferase value > or = 50 IU/liter) and selected factors such as hepatitis B surface antigen positive, hepatitis C virus antibody positive, body mass index, and alcohol drinking. Out of 3,738 workers (1,477 males and 2,261 females) in a supermarket chain, 91 workers with an elevated serum alanine aminotransferase value (> or = 50 IU/liter) were classified as cases and 182 workers with normal serum alanine aminotransferase value and without an episode of blood transfusion were randomly selected as controls. RESULTS: Prevalence rates of hepatitis B surface antigen positive and hepatitis C virus antibody positive were 4.4 and 23.1% among the overall cases, 2.9 and 11.8% among the cases with 100 > alanine aminotransferase value > or = 50, and 8.7 and 56.5% among the cases with alanine aminotransferase value > or = 100. A logistic regression analysis was conducted. Odds ratios were 4.94 for hepatitis B surface antigen positive (P < 0.05) and 77.19 for hepatitis C virus antibody positive (P < 0.001). Odds ratios for body mass index increased with increasing body mass index values; 3.32 for 26 > body mass index > or = 24 (P < 0.01) and 5.03 for body mass index > or = 26 (P < 0.001). No increased risk was observed among regular drinkers of less than 27 g/day of ethanol (odds ratio is 0.23) or of 27-53 g/day of ethanol (odds ratio is 0.47). A slightly increased odds ratio of 1.35 was observed among regular drinkers of 54-81 g/day of ethanol, but this was not statistically significant. CONCLUSIONS: Our results suggest that hepatitis C virus and high body mass index are predominant factors in elevated serum alanine aminotransferase levels among Japanese workers, while alcohol drinking is a minor factor.

Adult↗
PubMed1996

Expression of MIB-1, mitotic index and S-phase fraction as indicators of cell proliferation in superficial bladder cancer. Finnbladder Group.

Cell proliferation of transitional cell bladder cancer (TCC) was determined by MIB-1 immunolabeling, volume-corrected mitotic index (M/V index) and S-phase fraction measurement in 207 patients with superficial (Ta-T1) bladder cancer. The results were compared to T category, WHO grade and DNA-ploidy. The MIB-1 score was related to T category (P < 0.001), WHO grade (P < 0.001), DNA ploidy (P < 0,0001), M/V index (P < 0.0001) and fraction of cells in S phase (P < 0.0001). The mean MIB-1 score was 6.37% for G1, 14.59% for G2 and 28.59% for G3 carcinomas (P < 0.001). The MIB-1 score for Ta tumors was 9.24% and for T1 tumors 25.34% (P < 0.001). The M/V index was 3.9 for G1, 11.5 for G2 and 25.9 for G3 tumors (P < 0.0001). The M/V index for Ta tumors was 6.4 and 25.3 for T1 tumors (P < 0.0001). WHO grade 1 tumors had 7.7%, grade 2 tumors 13.8% and grade 3 tumors 21.8% of cells in S phase (P < 0.001). Of grade 1 tumors, 97% were diploid and 3% aneuploid, and 78% of grade 2 tumors were diploid and 22% aneuploid. Of grade 3 tumors, 30% were diploid and 70% aneuploid (P < 0.001). Of Ta tumors, 92% were diploid and 8% aneuploid, respectively, whereas 40% of T1 tumors were diploid and 60% aneuploid (P < 0.0001). The results show that quantitative cell proliferation indices are associated with T category and WHO grade in superficial bladder cancer. The prognostic value of the S-phase fraction and mitotic index has been demonstrated in several previous analyses of prognostic factors while the value of MIB-1 score on bladder cancer prognosis remains to be established in further follow-up studies.

Adult↗
PubMed1993

The symptom index. Differential usefulness in suspected acid-related complaints of heartburn and chest pain.

The symptom index is a quantitative measure developed for assessing the relationship between gastroesophageal reflux and symptoms. Controversy exists, however, over its accuracy and the appropriate threshold for defining acid-related symptoms of heartburn and chest pain. Therefore, a retrospective review was done of 153 consecutive patients referred to our esophageal laboratory. Three groups were identified: patients with normal 24-hr pH tests and no esophagitis, patients with abnormal 24-hr pH tests and no esophagitis, and patients with abnormal 24 hr pH values and endoscopic esophagitis. If symptoms occurred during the pH study, a symptom index (number of acid related symptoms/total number of symptoms x 100%) was calculated separately for heartburn and chest pain. Heartburn and chest pain episodes were similar among the three groups. However, the mean symptom index for heartburn was significantly (P < 0.001) higher in the patient groups with abnormal pH values [abnormal pH/no esophagitis: 70 +/- 7.1% (+/- SE); abnormal pH/esophagitis: 85 +/- 4.6%] as compared to those with normal studies, ie, functional heartburn (26 +/- 10.7%). The mean symptom index for chest pain was similar for all three groups. Using receiver operating characteristic curves, a heartburn symptom index > or = 50% had excellent sensitivity (93%) and good specificity (71%) for acid reflux disease, especially if patients complain of multiple episodes of heartburn. In contrast, an optimal symptom index threshold for defining acid-related chest pain episodes could not be defined.

Adult↗
PubMed1986

A prognostic index for patients with malignant melanoma of the conjunctiva.

From 1968 to 1984, 31 patients with histologically proven malignant melanoma of the conjunctiva were treated and followed in the Eye Hospital of the University of München. Histological demonstration of tumor thickness and the mitotic index (number of mitoses per square millimeter) gave a the prognostic index, in which tumor thickness was multiplied by the mitotic index. This index then allowed evaluation of the risk for tumor metastasis. Most tumors measured less than 1.5 mm in thickness, and the metastatic risk was low or medium in these cases. All tumors of the low metastatic risk group had a prognostic index of 1 or less, while all recurrences were associated with a prognostic index that exceeded 1.

Conjunctival Neoplasms↗
PubMed1999

Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index.

PURPOSE: The purpose of this research was to develop and evaluate a severity rating score for fecal incontinence, the Fecal Incontinence Severity Index. METHODS: The Fecal Incontinence Severity Index is based on a type x frequency matrix. The matrix includes four types of leakage commonly found in the fecal incontinent population: gas, mucus, and liquid and solid stool and five frequencies: one to three times per month, once per week, twice per week, once per day, and twice per day. The Fecal Incontinence Severity Index was developed using both colon and rectal surgeons and patient input for the specification of the weighting scores. RESULTS: Surgeons and patients had very similar weightings for each of the type x frequency combinations; significant differences occurred for only 3 of the 20 different weights. The Fecal Incontinence Severity Index score of a group of patients with fecal incontinence (N = 118) demonstrated significant correlations with three of the four scales found in a fecal incontinence quality-of-life scale. CONCLUSIONS: Evaluation of the Fecal Incontinence Severity Index indicates that the index is a tool that can be used to assess severity of fecal incontinence. Overall, patient and surgeon ratings of severity are similar, with minor differences associated with the accidental loss of solid stool.

Adaptation, Psychological↗
PubMed1997

Clinical value of anorectal manometry index in neurogenic fecal incontinence.

PURPOSE: The present communication is an endeavor to assess the value of a simple motility index to separate patients with neurogenic or idiopathic fecal incontinence from those patients with the secondary form of the disease. METHODS: Study population consisted of 23 patients with idiopathic fecal incontinence and 13 patients with fecal incontinence secondary to surgical or obstetric trauma. They all had a standard anorectal manometric study after a 12-hour fast. A motility index was then prepared taking into consideration the peak sphincter pressure values, contractility endurance, and rectal sensory threshold. RESULTS: Despite differences in the mean peak squeeze pressure and sensory threshold between the two groups, there were significant overlaps for all parameters of standard anorectal manometry in both groups. However, patients with idiopathic incontinence had an index of smaller than 28, and the group with the secondary form of incontinence had indexes higher than 30. CONCLUSIONS: 1) None of the four parameters of a conventional anorectal manometry can accurately separate patients with neurogenic incontinence from those with secondary forms of the disorder. 2) The anorectal motility index presented here can accurately separate the two groups. 3) This index is superior to the standard anorectal manometry in evaluating patients with fecal incontinence.

Aged↗
PubMed1997

The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry.

The aim of the study was to identify the possible relationship between body mass index and intra-abdominal pressure as measured by multichannel cystometry. A retrospective chart review of patients presenting for urodynamic evaluation between January 1995 and March 1996 was carried out. Variables identified included weight, height, intra-abdominal pressure and intravesical pressure as recorded on multi-channel cystometrogram at first sensation in the absence of detrusor activity. Body mass index was defined as weight in kilograms divided by height in square meters. Intra-abdominal pressure was measured intravaginally except in those cases of complete procidentia or severe prolapse, where it was measured transrectally. Adequate data were available on 136 patients. The mean age was 60.6 years (range 30-91); mean body mass index was 27.7 kg/m2 (range 12.7-47.7); and mean intra-abdominal pressure was 27.5 cmH2O (range 9.0-48.0). A strong association between intra-abdominal pressure and body mass index was demonstrated, with a Pearson coefficient correlation value of 0.76 (P<0.0001). Strong correlation was still demonstrated when those patients who had had the intra-abdominal pressure measured transrectally were separated out, thus eliminating any possible confounding factors between measurements of intra-abdominal pressure measured transvaginally versus transrectally. In addition a strong correlation between intravesical pressure and body mass index was also demonstrated, with a Pearson coefficient correlation value of 0.71 (P<0.0001). Of the 136 patients, 65 (47.8%) were ultimately diagnosed as having genuine stress urinary incontinence (GSUI), 35 (25.7%) with GSUI and a low-pressure urethra (maximum urethral closure pressure of less than 20 cmH2O), and 18 (13.2%) with detrusor instability. The remaining 13.2% had severe prolapse. Our data demonstrate a significant correlation between body mass index and intra-abdominal pressure. These findings suggest that obesity may stress the pelvic floor secondary to chronic state of increased pressure, and may represent a mechanism which supports the widely held belief that obesity is a common factor in the development and recurrence of GSUI.

Abdomen↗
PubMed2006

Body mass index and functional recovery after hip fracture: a survey study of 510 women.

BACKGROUND AND AIMS: Low body mass index (BMI) is associated with high risk of osteoporosis and fractures, but its impact on functional recovery after fractures is unknown. Our aim was to investigate the association between BMI and both functional recovery and period of rehabilitation in hip-fractured women. METHODS: 510 out of 580 Caucasian women with hip fracture, admitted consecutively to a rehabilitation hospital, were investigated in this retrospective study. Functional recovery was assessed using the Barthel index score. RESULTS: In the 510 women, BMI was 22.8 +/- 4.1 kg/m2 (mean +/- SD). After adjustment for age, femur bone mineral density, and the Barthel index assessed on admission to rehabilitation, a significant negative association was found between BMI and both the Barthel index score after rehabilitation and changes in it resulting from rehabilitation (p < 0.001). After adjustment for age and the Barthel index assessed on admission to rehabilitation, a significant positive association was found between BMI and period of rehabilitation (p < 0.001). The results were similar when BMI was evaluated either as individual values or after categorization according to World Health Organization criteria. CONCLUSIONS: In a sample of hip-fractured women, BMI was negatively associated with Barthel index scores and positively associated with period of rehabilitation. BMI may affect function after hip fracture, apart from hip fracture risk: subjects with higher BMI and low hip fracture risk may have poorer functional recovery in case of hip fracture, despite prolonged rehabilitation. Conversely, subjects with lower BMI and high hip fracture risk may have better functional recovery in case of hip fracture.

Aged↗
PubMed2004

Relationships of body mass index with blood pressure and serum cholesterol concentrations at different ages.

BACKGROUND AND AIMS: Only limited information has been available on the effects of age on the relationship between obesity and other atherosclerotic risk factors, such as blood pressure and serum lipids. The purpose of this study was to investigate the effects of age on the relationships of obesity with blood pressure and serum cholesterol concentrations. METHODS: A community-based cross-sectional study was performed on 157,902 workers in Yamagata, Japan. Blood pressure and serum total and HDL cholesterol concentrations were measured, and body mass index (BMI) and atherogenic index were calculated. The correlations of BMI with blood pressure, serum cholesterol concentrations and atherogenic index in different age groups were compared. RESULTS: BMI showed significant positive correlations with systolic and diastolic blood pressures, serum total cholesterol level and atherogenic index, and showed a significant negative correlation with serum HDL cholesterol level. The relationships of BMI with systolic and diastolic blood pressures became weaker with advancing age in both men and women after 30 and 40 years of age, respectively. The relationships of BMI with serum total cholesterol level and atherogenic index also became weaker with advancing age after 30 years of age in men and after 40 years of age in women. There was no age-dependent tendency in the relationship between BMI and HDL cholesterol, however. The above age-dependent changes were more prominent in men than in women. CONCLUSION: The relationships of obesity with blood pressure, serum total cholesterol level and atherogenic index in the elderly are much weaker than in the young.

Adult↗
PubMed1993

Subscapular and triceps skinfold thicknesses, body mass index and cardiovascular risk factors in a cohort of middle-aged employed men.

Associations of indices of adiposity with cardiovascular risk factors were examined in 1860 middle aged men employed by the Western Electric Company in Chicago in 1960 and 1961. Body mass index and subscapular and triceps skinfolds were examined for associations with systolic and diastolic blood pressure, serum cholesterol, and post-load serum glucose. Correlations of study variables measured one year apart suggest that triceps and subscapular skinfold measurements are less reproducible than body mass index, but more reproducible than measurements of systolic and diastolic blood pressure and serum cholesterol. Associations with blood pressure were stronger for body mass index than for skinfolds, and subscapular skinfold was associated with blood pressure independently of triceps skinfold, as well as age, heart rate, alcohol intake, and family history of cardiovascular disease. Body mass index was also generally more strongly related to serum cholesterol than skinfold measurements. Triceps skinfold was more strongly related to serum cholesterol than subscapular skinfold based on average values for the variables in 1960-61, but subscapular skinfold was more strongly related to one-year change in serum cholesterol. Subscapular skinfold was as strongly related to serum glucose as body mass index. This association was also independent of triceps skinfold and other variables. These analyses demonstrate positive associations of subscapular skinfold, an index of central adiposity, with blood pressure and serum glucose levels. Associations of subscapular and triceps skinfolds with serum cholesterol levels were not consistent in the cross-sectional and longitudinal analyses and require further investigation.

Adult↗