Biomedical subjects

D De Bacquer

Publications and source records attributed to D De Bacquer.

At least 55 records · Page 3Linked to original sources

PubMed1999

Trends in mortality from cutaneous malignant melanoma in Belgium.

BACKGROUND AND METHODS: Changes over time of mortality rates from cutaneous malignant melanoma (CMM) in Belgium were analysed, based on people (n = 3695) aged 25-84 years, who died of CMM from 1954 to 1992. All data were collected from the Belgian National Institute of Statistics. For the log-linear analysis and calculation of the average annual change, only the data from 1973 to 1992 were considered. RESULTS: The age-adjusted mortality rates (per 10(5)) for the age group 25-84 years old increased from 0.5 in 1954 to 3.0 in 1992 in men, and from 0.8 in 1954 to 2.2 in 1992 in women. The average annual percentage change in men (-0.003%) was stable over the period 1973-1982, and increased to 4.4% over the period 1983-1992. In women, the average annual increase was 4.6% over the period 1973-1982, and continued to increase to 6.8% over the period 1983-1992. Log-linear analysis showed that the change in rates for both men and women was mainly due to an age-'drift' effect, contrary to the results of the average annual percentage change in men. CONCLUSION: The risk of dying from CMM increased in men and women continuously over the whole period, irrespective of birth cohort. In both men and women, there was approximately a 20% increase in CMM mortality per 5-year period.

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PubMed1999

Effects of a low-intensity worksite-based nutrition intervention.

Male employees from four local worksites were recruited to participate in a short-term and low-intensity nutrition intervention which focused on promoting low-fat dietary habits. The sites were randomized to control conditions or to the intervention programme that consisted of an individualized health risk appraisal, group sessions, mass media activities and environmental changes. Participants were seen before and three months after intervention to measure blood lipids, nutrition knowledge and dietary changes. Eighty-three per cent of all eligible subjects were screened (n = 770) and follow-up measures were obtained for 82%. The score for nutrition knowledge improved significantly in the intervention group. There was also a net reduction in the intake of total calories and in the percentage of energy from total fat. Reported intake of carbohydrates and proteins increased. For all employees assessed, there were no changes in mean total cholesterol level or fatty acid composition. Only among participants with hypercholesterolemia was a significant reduction in blood cholesterol observed. This low-intensity intervention programme achieved some self-reported dietary changes and was successful (at least in part because statistical regression needs to be considered) in obtaining a more short-term beneficial cholesterol level in employees at higher cardiovascular risk.

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PubMed1999

Trends in coronary heart disease in two Belgian areas: results from the MONICA Ghent-Charleroi Study.

SETTING: As part of the WHO-MONICA study, acute coronary events have been registered from 1983 until 1992 in the general population aged 25-69 years in two Belgian cities--Ghent in the northern Dutch speaking part of Belgium and Charleroi in the southern French speaking part. Registration of events was done according to an international standard protocol. OBJECTIVE: To study trends in total, fatal and non-fatal event rates and trends in case fatality rates in these two cities. MAIN RESULTS: Incidence of CHD was on average 50% higher in Charleroi compared with Ghent in both men and women (attack rate ratio Charleroi/Ghent was 1.5 in both sexes). In both men and women, diverging trends were observed between the two cities for total and non-fatal event rates, while parallel declining trends were observed in fatal event rates and in case fatality rates. In both sexes, total attack rates showed a significant decrease in Ghent and a significant increase in Charleroi. Also in the two sexes, attack rates of non-fatal events increased significantly in Charleroi and remained stable in Ghent. Attack rates of fatal events decreased significantly in men and women in Ghent and in men in Charleroi. Both "total" and "in hospital" case fatality rates declined significantly in both sexes in the two cities. CONCLUSIONS: Important differences in coronary heart disease (CHD) incidence and CHD trends between Ghent and Charleroi were observed. These differences and trends are interpreted in the context of existing and still growing differences in the overall socioeconomic situation between the north and the south of the country. On the other hand, the efficacy of medical treatment of CHD is comparable in the two regions, as reflected by similar figures and trends for case fatality rates.

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PubMed1998

Haptoglobin polymorphism, iron metabolism and mortality in HIV infection.

BACKGROUND: Three phenotypes of the antioxidant protein haptoglobin are known: Hp 1-1, Hp 2-1 and Hp 2-2. OBJECTIVES: To investigate the outcome of HIV infection according to haptoglobin type. DESIGN AND METHODS: Haptoglobin phenotypes were determined using starch gel electrophoresis in serum obtained from 653 HIV-infected Caucasians in the AIDS reference centers of Gent (n = 184), Antwerp (n = 309), and Luxembourg (n = 160). Survival was compared between haptoglobin types using Kaplan-Meier curves. Plasma HIV-1 RNA was quantified by reverse transcriptase PCR. Serum iron, transferrin saturation, ferritin, and vitamin C were assayed to evaluate iron-driven oxidative stress in 184 HIV-infected patients and 204 controls. RESULTS: The haptoglobin type distribution amongst the patients (17.6% Hp 1-1, 49.9% Hp 2-1, 32.5% Hp 2-2) corresponded to that of the controls. Kaplan-Meier curves showed a higher mortality for the Hp 2-2 group (P = 0.0001; adjusted mortality risk ratio, 1.78; 95% confidence interval, 1.25-2.54). Median survival time was 11.0 years (Hp 1-1 and Hp 2-1) versus 7.33 years (Hp 2-2). Plasma HIV-1 RNA levels prior to antiviral therapy and their increase over 1 year were highest in Hp 2-2 patients (P = 0.03 and 0.003, respectively). The Hp 2-2 type was associated with higher serum iron, transferrin saturation, and ferritin levels and with low vitamin C concentrations. Furthermore, ferritin concentrations were higher in HIV-infected patients than in controls (P < 0.0001). CONCLUSION: HIV-infected patients carrying the Hp 2-2 phenotype show a worse prognosis, which is reflected by a more rapid rate of viral replication (in the absence of antiviral treatment). They also accumulate more iron and oxidize more vitamin C, suggesting that less efficient protection against haemoglobin/iron-driven oxidative stress may be a direct mechanism for stimulating viral replication.

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PubMed1998

Prognostic value of ischemic electrocardiographic findings for cardiovascular mortality in men and women.

OBJECTIVES: The aim of this study was to investigate the independent prognostic value of ischemic electrocardiographic (ECG) findings for cardiovascular mortality and to evaluate a possible sex-differential in this regard. BACKGROUND: In previous reports, ST segment and T wave changes on the resting ECG were described as independent risk factors for development of coronary heart disease. Although more prevalent in women, they are often given less clinical importance than in men. METHODS: Ten-year follow-up data from the Belgian Interuniversity Research on Nutrition and Health study were used. The results presented here are based on ECGs of the 4,797 men and 4,320 women, aged 25 to 74 years, who were free of angina pectoris at the start of follow-up, had no history of myocardial infarction (MI) and showed no Q wave evidence of an old MI on their ECG. RESULTS: At baseline, the age-standardized prevalence of an "ischemic ECG" (Minnesota codes I3, IV1-3, V1-3 or VII1) was 8.4% in men and 10.6% in women. Cardiovascular mortality rates in men and women with an ischemic ECG were respectively 7.7 and 2.6 per 1,000 person-years, compared with 2.3 and 1.0 in those with no such ECG findings. After correction for the potential confounding effects of established cardiovascular disease (CVD) risk factors, the multivariately adjusted risk ratios were 2.45 (95% confidence interval [CI]: 1.70 to 3.53) for men and 2.16 (95% CI: 1.30 to 3.58) for women. Testing the interaction between an ischemic ECG and sex on CVD mortality revealed that the risk ratios were not significantly changed (p=0.95). The etiologic fraction of CVD deaths attributable to an ischemic ECG was estimated as 19.3% for men and 22.4% for women. Both men and women with major ischemic findings in their baseline electrocardiogram (Minnesota codes IV1,2, V1,2 or VII1) had a fourfold increased risk of CVD death. CONCLUSION: These results support the hypothesis that women with ischemic ECG findings are at the same increased risk for CVD mortality as men.

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PubMed1998

Trends in the prevalence of obesity among Belgian men at work, 1977-1992.

OBJECTIVE: To assess trends in average body mass index (BMI) and the prevalence of obesity between 1977 and 1992, in middle-aged Belgian men at work. SUBJECTS: A subsample of men at work, aged 40-54 y extracted from the base-line data from four independent prospective studies, each representing a period (Physical Fitness Study (1977-1978), Belgian Interuniversity Research on Nutrition and Health (BIRNH) (1979-1984), Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) (1986-1991) and ORCA (1992-1993)). DESIGN: Linear regression of the average body mass index (kg/m2) and logistic regression of the prevalence of obesity (BMI > or = 30kg/m2). Independent variables taken into account in multivariate analysis were: age, educational level, marital status and region. RESULTS: In this subsample of Belgian men at work, aged 40-54 y, prevalence of obesity increased from 9.2% in 1977-1978 to 14.5% in 1992-1993. This rise was present in each five-year age group, in both regions and in all educational groups, but strongest in the lowest educated. After adjustment for sociodemographic covariables, it was estimated that with regard to 1977-1978, the proportion of men with a BMI > or = 30 kg/m2 doubled over the 15-year period (odds ratio OR (95% confidence intervals, 95% CI)): 1.98 (1.40; 2.80). CONCLUSION: Keeping in mind that the trends have been calculated from data from four different studies, presenting some shortcomings, prevalence of obesity has increased between 1977-1992 in men aged 40-54 y at work. This rise is particularly pronounced in the lower educated groups.

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PubMed1998

Impact of previous aspergillosis on the outcome of bone marrow transplantation.

A retrospective analysis of 48 patients with documented or probable invasive aspergillosis (IA) prior to bone marrow transplantation (BMT) was conducted in 16 centers. Treatment of primary IA was medical in all 48 patients and surgical in 20; clinicoradiological resolution of IA occurred in 30 of 48 patients. Pretransplantation risk factors for relapse IA, total mortality, and IA-related mortality were analyzed by multivariate logistic regression with the following dichotomous risk factors: surgery as part of the initial treatment, resolution of IA by the time of BMT, donor type, conditioning regiment, total-body irradiation, T cell depletion, immunosuppressive therapy, type of antifungal prophylaxis, and growth factor prophylaxis. Conditioning with busulfan/cyclophosphamide was associated with a beneficial outcome for total survival and reduced IA-related mortality. Posttransplantation risk factors such as the development of graft-vs.-host disease (GVHD), therapy for GVHD, and the duration of neutropenia did not have a significant effect on relapse IA, IA-related mortality, or total mortality. The overall incidence of relapse IA was lower than expected (33% [16 of 48 patients]), but the mortality rate among relapsed patients was 88% (14 of 16). Patients receiving prophylaxis with absorbable or intravenous antifungals had less relapses of IA than did those not receiving prophylaxis (12 of 41 vs. four of seven, respectively). This finding reflects the need for better prophylaxis and new antifungal treatments for patients undergoing BMT who have a history of IA.

Amphotericin B↗

PubMed1998

Trends in the prevalence, detection, treatment and control of arterial hypertension in the Belgian adult population.

OBJECTIVES: To discuss changes during the past decades in the prevalence and in the patterns of detection, treatment and control of arterial hypertension in the general Belgian population aged 25-64 years. DESIGN: Data from two cross-sectional cardiovascular disease risk factor surveys of the general population aged 25-64 years during the first and second halves of the 1980s (the Belgian Inter-university Research on Nutrition and Health study of 1980-1984 and the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases study of 1985-1992) are compared. PARTICIPANTS: Age-stratified and sex-stratified random samples from the general population yielded 9372 participants in the former study and 4904 participants in the latter. METHODS: In both studies, blood pressure measurements and other variables were collected in the same standardized way and by the same observers. RESULTS: For both sexes, overall age-standardized prevalences of hypertension (subjects with systolic blood pressure > or = 160 mmHg or diastolic blood pressure > or = 95 mmHg or currently being administered antihypertensive drug treatment) were found to be significantly (P< 0.001) higher in the former than they were in the latter study. A significant decline in population mean systolic blood pressure values was observed for both sexes on going from the former data to the latter (falls of 6.0 and 7.3 mmHg for men and women, respectively, P< 0.01). In log-linear models, adjusted for age, a highly significant (P< 0.0001) favourable shift in the population distribution over the various categories of detection, treatment and control of hypertension was observed. This trend exhibited a significant sex difference, however, there being a much more favourable trend for women. CONCLUSIONS: In Belgium, favourable trends in the prevalence and in the patterns of detection, treatment and control of arterial hypertension and in the levels of systolic blood pressure were observed. The so-called 'rule of halves' is no longer valid.

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PubMed1998

Prognostic value of ECG findings for total, cardiovascular disease, and coronary heart disease death in men and women.

OBJECTIVE: To study abnormalities in the resting ECG as independent predictors for all cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in a population based random sample of men and women, and to explore whether their prognostic value is different between sexes. DESIGN AND SUBJECTS: An age and sex stratified random sample was selected from the total Belgian population aged 25 to 74 years. Baseline data were gathered and resting ECGs were classified according to Minnesota code criteria. The sample was then followed for at least 10 years with respect to cause specific death. Results are based on observations from 5208 men and 4746 women free from prevalent CHD at the start of the follow up period. RESULTS: Although the prevalence of major abnormalities in general was comparable between sexes, women had more ischaemic findings, ST segment changes, and abnormal T waves on their baseline ECG, while men showed more arrhythmias, bundle branch blocks, and left ventricular hypertrophy. Fitting the multiplicative effect on subsequent mortality between all ECG classifications under study and sex indicated that the prognostic value of ECG changes was equal in women and men. Independently of other risk factors and other major ECG changes, almost all ECG classifications were significantly related to all cause, CVD, and CHD mortality. The most predictive ECG findings for CVD death were ST segment depression (risk ratio (RR) 4.71), major ECG findings (RR 3.26), left ventricular hypertrophy (RR 2.79), bundle branch blocks (RR 2.58), T wave flattening (RR 2.47), ischaemic ECG findings (RR 2.35), and arrhythmias (RR 2.15). The prognostic value of major ECG findings for CVD and CHD death was more powerful than well established cardiovascular risk factors. CONCLUSIONS: Abnormalities in the baseline ECG are strongly associated with subsequent all cause, CVD, and CHD mortality. Their predictive value was similar for men and women.

Adult↗

PubMed1998

Fat sources in the Belgian diet.

Food consumption data from the Belgian Interuniversity Research on Nutrition and Health study (n = 11,302) were analyzed with regard to fat intake. Intakes of macronutrients were compared between several subgroups in the population. The major objective was to quantify the contribution of food groups and individual food items to the intake of total fat, polyunsaturated (PUFA), monounsaturated (MUFA) and saturated (SFA) fat in the Belgian diet. These results are compared to nutritional guidelines and Italian, US and Dutch data. Major sources of fat are butter (16% of the total intake) and baking margarine (8%). Major sources of SFA are butter (24%) and cheese (8%), of MUFA butter (13%) and baking margarine (9%), and of PUFA diet margarine (23%) and mayonnaise (11%).

Adult↗

PubMed1998

Fatty acid composition of the Belgian diet: estimates derived from the Belgian Interuniversity Research on Nutrition and Health.

The major objective of this study was to determine the fatty acid composition of the Belgian diet. Food consumption data from a large representative sample (n = 11,302) of the Belgian population between 25 and 74 years of age (BIRNH study) were analyzed with regard to the intake of fatty acids. The fatty acid composition of the major fat sources in the Belgian diet was determined and used to calculate average intakes for fatty acids from C4 to C22. In addition, results are compared to other studies and to guidelines for n-3 and n-6 fatty acids. Saturated fatty acids provide 17% of the energy intake in the Belgian diet, polyunsaturated fatty acids 7%, and monounsaturated fatty acids 14%. The intake of total n-6 fatty acids is very high (6 en%), particularly of linoleic acid. The intake of n-3 fatty acids is low, only 0.8 en%, which results in a low ratio of n-3 to n-6 (0.15). The most important sources of n-6 and n-3 fatty acids are margarine and meat, respectively.

Adult↗

PubMed1998

The effect of age and lifestyle factors on plasma levels of apolipoprotein E.

BACKGROUND: The plasma concentration of apolipoprotein E might be an important risk factor for various chronic diseases, including coronary heart disease. OBJECTIVE: To investigate the role of lifestyle-related factors in determining concentrations of apolipoprotein E. METHODS: The independent effects of age and several lifestyle-related factors [body mass index (BMI), smoking, consumption of alcohol, physical activity, educational level and poly-unsaturated:saturated fatty acid intake ratio in diet] on the apolipoprotein E concentration were assessed for a sample of 757 middle-aged working men. Multiple log-linear regression models were fitted with additional correction for the apolipoprotein E polymorphism. RESULTS: The overall mean plasma concentration of apolipoprotein E was 3.44 mg/dl with mean levels varying from 2.42 mg/dl in men with the E4/4 phenotype to 8.32 mg/dl in men in the E2/2 group. In multivariate analysis apolipoprotein E levels were found to be significantly positively correlated to BMI (P<0.0001) and consumption of alcohol (P=0.04). The effect of age on the apolipoprotein E concentration was significantly quadratic (P=0.02) with highest levels found in the men aged 40-44 years (levels 13.3% greater than those in the men aged 35-39 years). Subjects with BMI in the range 27-30 kg/m2 had on average a 16.4% higher apolipoprotein E concentration than did men in the group with BMI lower than 23 kg/m2. This adjusted proportional increase amounted to 22.6% for the severely obese subjects (BMI>30 kg/m2). The independent effect of current smoking was only of borderline stat stical significance. CONCLUSIONS: These results indicate that age and lifestyle-related factors, such as BMI and to a lesser extent consumption of alcohol and smoking, should be taken into account as possible confounders in the study of the plasma concentration of apolipoprotein E as a risk factor for coronary heart disease.

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PubMed1998

Is low serum chloride level a risk factor for cardiovascular mortality?

BACKGROUND: Serum chloride level is routinely assayed in clinical laboratories in the management of patients with kidney disorders and with metabolic diseases. It is a biological parameter that is easily, precisely and relatively cheaply measured. The epidemiological features of serum chloride levels have not been studied before. METHODS: For the random sample of men and women from the Belgian Interuniversity Research on Nutrition and Health aged 25-74 years, free of symptomatic coronary heart disease at baseline, serum chloride concentrations were measured, among those of other electrolytes. The cohort was followed up for 10 years with respect to subsequent cause-specific mortality. RESULTS: The results are based on observations of 4793 men and 4313 women. According to Cox regression analysis serum chloride level was one of the strongest predictors of total, cardiovascular disease (CVD) and non-CVD mortalities independently of age, body mass index, sex, smoking, systolic blood pressure, levels of total and high-density lipoprotein cholesterol, uric acid, serum creatinine and serum total proteins and intake of diuretics. This relation was proved to be independent of levels of other serum electrolytes and similar for men and women. The estimated adjusted risk ratio for CVD death for subjects with a serum chloride level < or =100 mmol/l compared with those with levels above that limit was 1.65 (95% confidence interval 1.06-2.57) for men and 2.16 (95% confidence interval 1.11-4.22) for women. The study of adjusted risk ratios for four groups of subjects defined on the basis of their baseline serum chloride levels revealed a decreasing log-linear 'dose-response' relation to total and cardiovascular mortalities. CONCLUSION: This s the first report from a population-based study to indicate that there is an association between serum chloride level and the incidence of total, CVD and non-CVD mortalities. The risk ratio for CVD mortality associated with a low serum chloride level was comparable to or higher than those observed for well-established CVD risk factors.

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PubMed1997

Haptoglobin polymorphism, a genetic risk factor in coronary artery bypass surgery.

Haptoglobin (Hp) 2-2 type has been associated with accumulation of atherosclerotic lesions in essential hypertension. The aim of this study was to investigate the relationship between Hp type and the extension of coronary lesions in 765 male patients who underwent coronary artery bypass grafting (CABG). In this group, relative Hp1 (0.418) and Hp2 (0.582) allele frequencies were comparable with those of the reference population. Candidate CABG patients with a Hp 2-2 type were overrepresented in the younger (< 45 years) age group (P < 0.05). Hp 2-2 patients needed more bypass grafts than Hp 1-1 patients (relative risk 1.92 95% C.I. 1.24-2.96). The Hp 2-2 type was overrepresented among victims of a previous acute myocardial infarction (P < 0.05) and among patients with a lower (< 45 years) age at infarction (P < 0.05). In patients who already underwent a previous CABG graft survival time was shortest in Hp 2-2 type (P < 0.05). Patients with a Hp 2-2 type more likely develop atherosclerotic lesions despite comparable serum lipid concentrations.

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PubMed1997

Consumption of fatty acids in Belgium and its relationship with cancer mortality.

In this study a description of the consumption of fatty acids in Belgium is given. The results indicate significant differences in the consumption of fatty acids according to region. Furthermore, several sex-, age- and district-specific cancer mortality rates are correlated with sex-, age- and district-specific calorie-adjusted intakes of fatty acids. For colorectal cancer in men but not in women, a significant positive association is found in univariate and multivariate regression with consumption of polyunsaturated fat and with the ratio unsaturated to saturated fat. For prostate cancer, breast cancer and total cancer, no clear associations with the studied dietary factors are found.

Adult↗

PubMed1997

Intra-individual variability of fibrinogen levels.

Elevated fibrinogen concentrations are recognized as playing an important role in the pathogenesis of atherosclerosis. In the framework of a risk factor survey in 342 middle-aged working men, screened twice over a period of five months, plasma fibrinogen levels were found to be fairly unstable as large discrepancies between both measurements were observed. Due to a substantial proportion of within-person variability, the reliability coefficient was only R = 0.56. Repeatability was highest in higher educated and physically more active men. Our data suggest that the impact of elevated fibrinogen levels on the development of ischemic heart disease and stroke, is likely to be under-estimated.

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PubMed1997

Relation between fat intake and mortality: an ecological analysis in Belgium.

A representative sample of the Belgian population, aged 25-74 years, was interviewed between 1980 and 1985. Dietary habits were assessed using a 24 h food record method. Age-, sex- and district-specific energy-adjusted averages of macronutrient intakes were compared with mortality rates from 1988-90, with special emphasis on the association between fat intake and cancer mortality. Univariate analyses were followed by multiple linear regression analyses, controlling for possible confounders such as fibre intake, smoking and educational level. In multivariate analyses, significant positive associations were found between all-causes mortality and saturated fat intake in men, and between all-causes mortality and the ratio of n-3 to n-6 fatty acids in men; colorectal cancer mortality was associated with polyunsaturated fat intake and with the ratio of unsaturated to saturated fat in men. Significant negative associations were found between all-causes mortality and polyunsaturated fat intake in men, and between all-causes mortality and the ratio of unsaturated to saturated fat in men; colorectal cancer mortality was associated with saturated fat intake in men. In women, only breast cancer mortality was associated with saturated and monounsaturated fat intake. Prostate cancer mortality was not related to any of the studied dietary fat components. For total cancer mortality, only weak non-significant associations with fat intake were found.

Age Distribution↗

PubMed1997

Repeated psychiatric referrals to Belgian emergency departments: a survival analysis of the time interval between first and second episodes.

Repetition of psychiatric emergency department use by a relatively small number of patients constitutes a major problem for clinicians and service providers. This study aimed at the identification of risk factors for repetition by addressing the time interval between the first and second visits to the emergency department. The purpose was to investigate what patient characteristics and referral circumstances determine this interval. Over a two year period, data on all psychiatric emergency referrals to the emergency department of four public hospitals were collected with a standardized form. Data collected during the index referral of all patients were used for estimating the risk for repetition using survival analysis techniques. A large proportion of repeaters revisits the emergency department within a short time interval. Younger, male patients who present themselves spontaneously are more likely to repeat than others. Previous inpatient service use and the presence of a diagnosis of substance abuse disorder or psychotic disorder at the first visit further increases the risk for repetition. Previous service use and, to a lesser degree, demographic and clinical characteristics of psychiatric patients are useful in the prediction of variations in time between first and second referrals to the emergency department.

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