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D Kromhout

Publications and source records attributed to D Kromhout.

At least 19 recordsLinked to original sources
PubMed1992

Performance of two general job-exposure matrices in a study of lung cancer morbidity in the Zutphen cohort.

Data from a general population cohort of 878 men from the town of Zutphen, The Netherlands, were used to evaluate the performance of two general job-exposure matrices. Exposures generated by the job-exposure matrices on the basis of job histories were compared. The validity of those exposures was measured against exposures reported by the participants in 1977/1978. The performance of the different exposure measures was assessed in proportional hazards analyses of lung cancer morbidity incidence. The two general job-exposure matrices generally disagreed with regard to exposure classification because of differences in exposure assessment and level of detail of the job axis. When compared with self-reported exposures, the sensitivity of both job-exposure matrices was low (on average, below 0.51), while the specificity was generally high (on average, above 0.90). Self-reported exposures to asbestos, pesticides, and welding fumes showed elevated risk ratios for lung cancer which were absent for exposures generated by the two job-exposure matrices. Thus, a population-specific job-exposure matrix is proposed as an alternative to general job-exposure matrices developed elsewhere. Such a matrix can be constructed from the results of in-depth interviews of a job-stratified sample of cohort members. Sound validation and documentation of exposure assessment methods used in job-exposure matrices are recommended.

Adult↗
PubMed1992

[The importance of HDL-cholesterol level determination in the classification of persons at increased risk of coronary heart disease].

The evidence is growing that not only total cholesterol, but also HDL cholesterol is an important predictor of coronary heart disease. In the Framingham Study, the total cholesterol/HDL cholesterol ratio gave the best prediction for the coronary heart disease risk. With data of the Netherlands Monitoring Risk Factor Project it was investigated to what extent persons with a high ratio (greater than or equal to 7) were identified when the criteria of the Netherlands Cholesterol Consensus were applied. Between 1987 and 1989 total and HDL cholesterol were determined in about 22,000 men and women aged 20-59. Twenty per cent of the men had hypercholesterolaemia (total cholesterol greater than or equal to 6.5 mmol/l). Of the hypercholesterolaemic men, 60 per cent did not have a high total/HDL cholesterol ratio. Eighteen per cent of the women were hypercholesterolaemic. Of all hypercholesterolaemic women, 80 per cent did not have a high total/HDL cholesterol ratio. Therefore, it is important that after a first screening on total cholesterol, HDL cholesterol is measured at the second cholesterol determination. Subsequently, a decision about treatment should be made, based on the total/HDL cholesterol ratio and the presence of other risk factors (hypertension, smoking, obesity, diabetes and a family history of cardiovascular disease.

Adult↗
PubMed1992

Long-term follow-up of cardiovascular risk factors in patients given chemotherapy for disseminated nonseminomatous testicular cancer.

OBJECTIVE: To assess cardiovascular risk factors over time in patients who received chemotherapy for disseminated testicular cancer and were apparently cured. DESIGN: Cohort study. SETTING: Referral center. PATIENTS: Fifty-seven consecutive patients (median age, 28 years; range, 16 to 43 years) who received cisplatin-containing chemotherapy between 1978 and 1985. MEASUREMENTS: Serum cholesterol and high-density lipoprotein (HDL) levels, body mass index (BMI), blood pressure, kidney function, and hormonal status were monitored during follow-up after chemotherapy (median follow-up, 88 months; range, 56 to 143 months). The BMI and cholesterol values obtained 4 to 6 years after chemotherapy were compared with values from a sample of healthy, age-matched Dutch men; the cholesterol level was also compared with that of 31 patients treated with orchidectomy for stage I disease. RESULTS: The mean cholesterol level in patients at the start of chemotherapy was 3.96 +/- 0.98 mmol/L [153 +/- 38 mg/dL], increasing 4 to 6 years later to 6.12 +/- 1.20 mmol/L [237 +/- 46 mg/dL] (P less than 0.001); 49 of 57 patients had an elevated low-density lipoprotein (LDL) cholesterol level (greater than 3.4 mmol/L [130 mg/dL]), with a mean level of 4.47 +/- 1.05 mmol/L [173 +/- 41 mg/dL]. Compared with a sample of healthy Dutch men, the chemotherapy group had an elevated cholesterol level (P less than 0.05). At 4 to 6 years, the mean HDL cholesterol level was 0.76 +/- 0.18 mmol/L [29 +/- 7 mg/dL], which was low compared with that of the healthy Dutch men (P less than 0.05). The mean BMI for all patients was 2.8% higher than expected 4 to 6 years after chemotherapy (P less than 0.01) but was not higher than expected 7 to 10 years after chemotherapy. CONCLUSIONS: In addition to other known late side effects of chemotherapy in patients with testicular cancer, hypercholesterolemia and overweight might represent risk factors for cardiovascular disease in such patients, especially in those who are younger.

Adolescent↗
PubMed1992

A longitudinal study on glucose tolerance and other cardiovascular risk factors: associations within an elderly population.

From 1971 until 1975, 204 patients from a general practice, aged 64-87 at entry, were examined annually. At every examination body weight, serum lipids, and systolic blood pressure were measured, and a complete glucose tolerance test was carried out. Clinically diagnosed diabetics were excluded. Adjusted for age and sex, the annual change in the area under the glucose curve (AUC) was significantly associated with body weight change. Changes in serum total cholesterol, serum triglycerides, and systolic blood pressure were also associated with body weight change. The results were independent of potential confounders such as alcohol use, smoking habits, presence of cardiovascular disease, and baseline levels of the different risk factors. The change in AUC was also associated with changes in serum total cholesterol, independent of confounders such as body weight. Changes in AUC were not related to changes in systolic blood pressure and serum triglycerides. The results of this study suggest that changes in glucose tolerance are not only related to changes in body weight, but also to changes in serum cholesterol.

Aged↗
PubMed1992

Glucose tolerance and the risk of cardiovascular disease: the Zutphen Study.

The impact of glucose tolerance on the incidence of ischemic heart disease (IHD), cerebrovascular disease (CVA), and peripheral arterial disease (PAD) was investigated in the Zutphen Study. In 1970 a complete oral glucose tolerance test (GTT) was carried out on 400 normoglycemic men aged 50-70 yr. A morbidity follow-up was completed in 1985. With GTT classified as the dichotomous variable using the median value of the area under the curve, elevated risks for IHD (RR = 1.6, p < 0.05), fatal IHD (RR = 2.3, p < 0.01), and CVA (RR = 1.9, p < 0.10) were observed, adjusted for potential confounders. No association with PAD was found. Also the risk among non-insulin-dependent diabetics (n = 46) was assessed. These men were clinically diagnosed between 1960 and 1985, median year of diagnosis being 1973, at age 61 yr. Compared with 230 matched non-diabetics increased risks were observed for fatal IHD (p = 0.05), CVA (p = 0.10) as well as PAD (p = 0.05). Thus an elevated risk for IHD, and possibly CVA, may have been found with lower levels of glucose than assumed previously, suggesting a continuous risk gradient. For PAD the relations with glucose tolerance are more complex.

Aged↗
PubMed1992

Relations between occupation, smoking, lung function, and incidence and mortality of chronic non-specific lung disease: the Zutphen Study.

Information gathered in the "Zutphen study", the Dutch contribution to the Seven Countries Study was used for the present study. Follow up data from 1965 to 1 July 1985 were used. During this follow up, the morbidity state of the participants was verified at regular intervals. In 1965 lung function was measured by spirometry and the vital capacity (VC) and forced expiratory volume in one second (FEV1) were available. A complete set of data was available for 668 men. The occurrence of chronic non-specific lung disease (CNSLD) at a specific time was coded by one physician, using strict criteria. Information about the cause of death was obtained and coded by one physician in 1985. Occupation was coded and a distinction between blue and white collar workers was made. For the analysis of the relation between age, lung function, smoking habits, and occupational state with CNSLD incidence and mortality, proportional hazard models were used. Blue collar workers had a significantly raised risk for incidence of CNSLD only. The hazard ratio for blue v white collar workers with CNSLD mortality was 1.4 but not statistically significant. It was concluded that occupation is clearly related to incidence of CNSLD. There were indications that occupation is related to mortality from CNSLD. A reduced FEV1 was a strong predictor of both CNSLD incidence and mortality. It is noteworthy that small differences in age and height standardised lung function were significantly related to incidence of CNSLD, mortality from CNSLD, and total mortality. Although these differences in lung function have no direct clinical importance for the individual subject, they indicate a raised morbidity and mortality risk for the population.

Age Factors↗
PubMed1992

Predictive value of repeated systolic blood pressure measurements for stroke risk. The Zutphen Study.

BACKGROUND AND PURPOSE: The strength of the association between blood pressure and stroke incidence is dependent on the number of blood pressure measurements. Different summary variables of repeated blood pressure measurements taken during 10 years were evaluated in relation to the long-term risk of stroke in the Zutphen Study. METHODS: During the period 1960-1970 repeated blood pressure measures were taken yearly in 603 men aged 50-69 years in 1970 in the town of Zutphen, The Netherlands. The individual average systolic blood pressure between 1960 and 1970, the predicted systolic blood pressure for 1970 (based on regression of blood pressure readings on time), and the single observed systolic blood pressure in 1970 were used as systolic blood pressure estimates. Their strength in predicting the 15-year stroke incidence was assessed using Cox proportional hazards models. Adjustment was made for the confounding effects of age, cigarette smoking, and serum total cholesterol. RESULTS: The average systolic blood pressure between 1960 and 1970 was the strongest predictor of 15-year stroke incidence. The strength of the association was underestimated by 55% when a casual systolic blood pressure measurement was used instead of 11 yearly measurements. CONCLUSIONS: It can be concluded that a casual blood pressure measurement leads to a substantial underestimation of the long-term stroke risk of an individual.

Adult↗
PubMed1991

Trend in serum total cholesterol level in 110,000 young adults in The Netherlands, 1974 to 1986.

Data from two screening projects on cardiovascular risk factors were used to analyze the trend in serum total cholesterol level in the Netherlands between 1974 and 1986. Cholesterol levels were measured in a single reference laboratory of the World Health Organization throughout the entire study period. Between 1974 and 1980, about 30,000 men and women aged 37 to 43 years (mean age, approximately 40 years) were screened. A decrease in mean serum total cholesterol level was observed until the end of 1977, when it was followed by an increase. This resulted in a net change over the entire study period of -0.07 mmol/liter (3 mg/dl) in men and -0.03 mmol/liter (1 mg/dl) in women. Between 1981 and 1986, about 80,000 men aged 33 to 37 years (mean age, 35 years) were screened. During this period, a decrease of 0.20 mmol/liter (8 mg/dl) in the mean total cholesterol level was observed. In spite of the decline in the mean total cholesterol level, the prevalence of cholesterol values of greater than or equal to 6.5 mmol/liter (greater than or equal to 251 mg/dl) in young adult men was still high in 1986 (16 percent). A further reduction is therefore desirable. The decline in the mean total cholesterol level in young adults might indicate that a further decline in mortality from coronary heart disease can be expected.

Adult↗
PubMed1991

The impact of the Guidelines for a Healthy Diet of The Netherlands Nutrition Council on total and high density lipoprotein cholesterol in hypercholesterolemic free-living men.

To study the impact of dietary intervention on the plasma total and high density lipoprotein cholesterol (HDL cholesterol) levels in hypercholesterolemic men, the authors selected 80 male participants in a monitoring risk factor project carried out in Amsterdam, The Netherlands. These men had plasma total cholesterol levels of between 6.5 and 10.0 mmol/liter (between 251 and 387 mg/dl) and were randomly assigned to either the intervention (n = 39) or the control (n = 41) group. At the start of the intervention period, after 5 weeks, and after 26 weeks, both the intervention and the control groups were examined. This examination consisted of a measurement of height, weight, plasma total and HDL cholesterol, and a dietary interview. The intervention program consisted of a personalized dietary advice to the respondent, based on the report of the Netherlands Nutrition Council. The study took place between September 1987 and November 1988. Because of this intervention program, the plasma total and HDL cholesterol levels decreased. The difference in change in plasma total cholesterol between the intervention and control groups was 0.47 mmol/liter (18 mg/dl) after 5 weeks and 0.30 mmol/liter (12 mg/dl) after 26 weeks. For HDL cholesterol, a significant difference in change after 5 weeks disappeared after 26 weeks. The public health implications of the decrease in plasma total cholesterol are discussed.

Adult↗
PubMed1991

The prevalence of selected physical activities and their relation with coronary heart disease risk factors in elderly men: the Zutphen Study, 1985.

Physical activity patterns and their relation with coronary heart disease risk factors are described for a representative sample of 863 Dutch men, 65-84 years old, who participated in the 1985 survey of the Zutphen cohort of the Seven Countries Study. Cross-sectional results revealed a median total of reported physical activity of about 1 hour and 20 minutes per day; only 5.8% reported no physical activity. The percentage of participation and total weekly time spent in physical activity decreased as age increased; the decrease was less pronounced for walking, bicycling, gardening, and doing odd jobs than for sports, hobbies, and work. Statistically significant mean differences were found among quartiles of total weekly physical activity for both total cholesterol and high-density lipoprotein cholesterol (HDL cholesterol); however, only the differences for HDL cholesterol remained significant (p = 0.045) after adjusting for potential confounders. Statistically significant regression coefficients (p less than 0.05) were found for the independent association between walking and total cholesterol and between gardening and total cholesterol, HDL cholesterol, and systolic blood pressure, after adjusting for confounders. Total weekly physical activity and specific activities, e.g., gardening and walking, demonstrated generally favorable associations with cholesterol and systolic blood pressure.

Aged↗
PubMed1991

Intra- and interindividual variability of glucose tolerance in an elderly population.

The intra- and interindividual variability of the oral glucose tolerance test (OGTT) and other risk factors was investigated in 237 subjects, aged 64-87, examined annually in the period 1971-1975. Coefficients of intraindividual variation (CVa) were calculated from individual regressions on time. The lowest CVa was found for the summary index including fasting glucose (area under the curve, AUC): 10.0 +/- 4.9%. For fasting and 30, 60, and 120 min glucose the values ranged from 12 to 18%. The CVa's were not associated with age, gender, drug use, and disease prevalence, and may also be applied to other populations. The reliability coefficient depended on the prevalence of diabetes in the population and was higher than observed in younger populations. The highest reliability coefficient was observed for AUC: 0.81. For the combined information of OGTT, reflected by AUC or by classification according to WHO criteria, the variability was comparable to that of other cardiovascular risk factors such as serum total cholesterol.

Aged↗
PubMed1991

Carbohydrate intake and body mass index in relation to the risk of glucose intolerance in an elderly population.

The association between the intake of carbohydrates, body mass index (BMI), and the 4-y incidence of impaired glucose tolerance and diabetes mellitus (glucose intolerance) was investigated in elderly men and women aged 64-87 y. In 1971 the baseline population consisted of 175 normoglycemic subjects. During the follow-up period (1972-1975) an oral glucose-tolerance test (OGTT) was carried out annually. In univariate analyses, baseline BMI and the habitual intake of carbohydrates and pastries, as determined from a cross-check dietary history, were positively associated with the incidence of glucose intolerance. The habitual intake of legumes was inversely related to the incidence of glucose intolerance. These results could not be explained by potential confounding factors such as age, gender, alcohol use, energy intake, prescribed diet, medication use, and comorbidity. These results suggest that energy balance and the use of carbohydrate-rich foods are related to the development of glucose intolerance in an elderly population.

Aged↗
PubMed1991

All cause mortality and its determinants in middle aged men in Finland, The Netherlands, and Italy in a 25 year follow up.

STUDY OBJECTIVE: The aims were (1) to compare all cause mortality in population samples of different cultures; and (2) to cross predict fatal event by risk functions involving risk factors usually measured in cardiovascular epidemiology. DESIGN: The study was a 25 year prospective cohort study. The prediction of all cause mortality was made using the multiple logistic equation as a function of 12 risk factors; the prediction of months lived after entry examination was made by the multiple linear regression using the same factors. POPULATION SAMPLES: There were five cohorts of men aged 40-59 years, from Finland (two cohorts, 1677 men), from The Netherlands (one cohort, 878 men), and from Italy (two cohorts, 1712 men). SETTING: The Finnish cohorts came from geographically defined rural areas, the Dutch cohort from a small town in central Holland, and the Italian cohorts from rural villages in northern and central Italy. MEASUREMENTS AND MAIN RESULTS: All cause mortality was highest in Finland (557 per 1000), and lower in The Netherlands (477) and in Italy (475). The solutions of the multiple logistic function showed the significant and almost universal predictive role of certain factors, with rare exceptions. These were age, blood pressure, cigarette smoking, and arm circumference (the latter with a negative relationship). Similar results were obtained when solving a multiple linear regression equation predicting the number of months lived after entry examination as a function of the same factors. The prediction of fatal events in each country, using the risk functions of the others, produced limited errors, the smallest one being -2% and the largest +11%. When solving the logistic model in the pool of all the cohorts with the addition of dummy variables for the identification of nationality, it also appeared that only a small part of the mortality differences between countries is not explained by 12 available risk factors. CONCLUSIONS: A small set of risk factors seems to explain the intercohort differences of 25 year all cause mortality in population samples of three rather different cultures.

Adult↗
PubMed1991

Long-term prospective studies: the only solution?

One of the advantages of prospective studies in nutritional epidemiology is that dietary patterns and nutrient intake data are collected before the occurrence of the disease. With such a design it is possible to study the contribution of dietary variables in explaining the occurrence of diseases between different cultures and within populations. In order to make a good estimate of the relation between a dietary variable and the occurrence of a disease in long-term prospective studies, it is necessary to have insight in the changes of dietary variables with time. For prospective cohort studies also information about the reproducibility of a dietary variable is needed. Long-term prospective studies with repeated dietary measures provide a powerful tool in studying diet-disease relations, but practical limitations may prevent the implementation of such designs.

Cohort Studies↗
PubMed1991

Inverse association between fish intake and risk of glucose intolerance in normoglycemic elderly men and women.

OBJECTIVE: To examine the association of fish intake with the subsequent risk of impaired glucose tolerance and diabetes mellitus (glucose intolerance). RESEARCH DESIGN AND METHODS: In 1971, information about food intake was obtained by the cross-check dietary history method on 175 men and women aged 64-87 yr who were normoglycemic and free of clinical diabetes. During the follow-up period from 1972 to 1975, an oral glucose tolerance test was performed annually, and in 59 of 175 elderly people a diagnosis of glucose intolerance was made at least once. RESULTS: In 1971, approximately 60% of the subjects usually ate fish, with a mean daily intake of 24.2 g. In fish eaters, the incidence of glucose intolerance was significantly lower compared with nonfish eaters (odds ratio [OR] 0.40, 95% confidence interval [CI] 0.21-0.77). With logistic regression analysis, this inverse association could not be explained by taking into account age and sex or possible confounding baseline characteristics, such as the prevalence of myocardial infarction, body mass index, energy intake per kilogram body weight, or intake of carbohydrates (OR 0.47, 95% CI 0.23-0.93). Baseline characteristics of the oral glucose tolerance test and serum triglyceride levels could also not account for this result. CONCLUSIONS: These results suggest that, in an elderly population, the habitual consumption of a small amount of fish may protect against the development of impaired glucose tolerance and diabetes mellitus.

Aged↗