Biomedical subjects

J Tuomilehto

Publications and source records attributed to J Tuomilehto.

At least 19 recordsLinked to original sources

PubMed1995

Prospective observational study to assess value of prostate specific antigen as screening test for prostate cancer.

OBJECTIVE: To evaluate measurement of serum prostate specific antigen as a potential screening test for future clinical prostate cancer among healthy men. DESIGN: Nested case-control study with stored serum samples collected from 49,261 men with follow up using national death and cancer registration systems. SUBJECTS: 265 asymptomatic men who subsequently developed clinical prostate cancer and 1055 controls matched for age, study centre, and duration of storage of samples. MAIN OUTCOME MEASURES: Distribution of concentrations of the antigen in men who developed prostate cancer and in controls. RESULTS: Prostate specific antigen concentrations were significantly higher in men who subsequently developed prostate cancer than in controls. In the first three years after blood collection the median concentration was 23 times greater in cases than in controls of the same age at the same centre (that is, 23 multiples of the median). A smaller difference persisted thereafter; 4.0 multiples of the median 3-6 years after blood collection, 3.6 6-10 years, and 1.8 after 10 years. In the first three years the proportion of men who developed prostate cancer and had raised levels of the antigen (> or = 12 multiples of the median) (detection rate or sensitivity) was 81% (95% confidence interval 54% to 96%). The proportion of men who did not develop prostate cancer but had levels this high (false positive rate) was only 0.5%. CONCLUSION: Prostate specific antigen measurement is a highly discriminatory screening test for prostate cancer among healthy men. In the general population, 60-74 year old men who had > or = 12 times the normal median level would have about a 50% chance of developing clinical prostate cancer in the next three years. Measurement of this antigen is a good enough screening test to justify a randomised controlled trial to determine any reduction in mortality from prostate cancer.

Aged↗

PubMed1995

Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius. Mauritius Non-communicable Disease Study Group.

OBJECTIVE: To study changes in the prevalence of risk factors for cardiovascular disease after a five year population-wide intervention programme promoting a healthy lifestyle in a developing country. DESIGN: Cross sectional cluster surveys in 1987 and 1992. Methodology included a two hour 75 g oral glucose tolerance test, measurement of body mass index, waist:hip ratio, basal lipid concentrations, and blood pressure; and a lifestyle questionnaire. SETTING: Mauritius, in the Indian Ocean. SUBJECTS: All adults aged 25-74 years residing in geographically defined clusters. MAIN OUTCOME MEASURES: Age standardised prevalence of categorical disease and risk factor conditions and mean levels and frequency distributions of continuous variables. RESULTS: Response rates were 86.2% (5080/5892) in 1987 and 89.5% (5162/5770) in 1992. Significant decreases were found in the prevalence of hypertension (15.0% to 12.1% in men and 12.4% to 10.9% in women); cigarette smoking (58.2% to 47.2% and 6.9% to 3.7% respectively); and heavy alcohol consumption (38.2% to 14.4% and 2.6% to 0.6% respectively). Moderate leisure physical activity increased from 16.9% to 22.1% in men and from 1.3% to 2.7% in women. Mean population serum total cholesterol concentration fell appreciably from 5.5 mmol/l to 4.7 mmol/l (P < 0.001). The prevalence of overweight or obesity increased, and the rates of glucose intolerance changed little. The population frequency distributions of blood pressure, serum lipid concentration, and a composite risk factor score shifted advantageously. CONCLUSIONS: Lifestyle intervention projects can be implemented and have positive effects in developing countries. A pronounced improvement in the population lipid profile in Mauritius was probably related to a change in the saturated fat content of a widely used cooking oil.

Adult↗

PubMed1995

Social class, health behaviour, and mortality among men and women in eastern Finland.

OBJECTIVE: To evaluate the associations between social class as defined by occupation, health behaviour, and mortality from all causes and coronary heart disease among middle aged men and women in eastern Finland. DESIGN: Prospective observational study of two independent, random population samples examined in 1972 and 1977. SETTING: North Karelia and Kuopio, Finland. SUBJECTS: 8967 men and 9694 women aged 30-64 years at the beginning of the follow up study. The subjects were followed up for mortality up till 1987 by using the National Death Registry. MEASUREMENTS AND MAIN RESULTS: Altogether 1429 men and 620 women died during the follow up, 603 men and 164 women of coronary heart disease. Among both sexes, compared with white collar workers unskilled blue collar workers had more adverse risk factors and also higher mortality due to coronary heart disease, other cardiovascular diseases, cancer, violent causes, and all other causes. Among men the age adjusted relative risk for all cause mortality in unskilled blue collar workers v white collar workers was reduced from 1.86 (95% confidence interval 1.55 to 2.22) to 1.47 (1.23 to 1.77) when adjusted for smoking, serum cholesterol concentration, hypertension, body mass index, and physical activity in leisure time. Among women the corresponding reduction in hazard ratio was from 1.49 (1.15 to 1.92) to 1.39 (1.07 to 1.81). The respective hazard ratios for coronary heart disease were 1.54 (1.16 to 2.02) and 1.22 (0.92 to 1.61) among men and 1.74 (1.05 to 2.90) and 1.66 (0.99 to 2.79) among women. CONCLUSIONS: Unfavourable cardiovascular risk factors and high mortality are concentrated among lower social classes in Finland. Among men about half of the excess coronary and all cause mortality among unskilled blue collar workers was associated with their unfavourable risk factor profile. The association was smaller in women.

Adult↗

PubMed1995

Do changes in cardiovascular risk factors explain changes in mortality from stroke in Finland?

OBJECTIVES: To estimate the extent to which the changes in the main cardiovascular risk factors (blood pressure, smoking, and serum cholesterol concentration) can explain the observed changes in mortality from stroke in Finland during the past 20 years. DESIGN: Predicted changes in mortality from cerebrovascular disease mortality were calculated by a proportional hazards model from data obtained in cross sectional population surveys in 1972, 1977, 1982, 1987, and 1992. Predicted changes were compared with the observed changes in mortality statistics. SETTING: North Karelia and Kuopio provinces, Finland. SUBJECTS: 16,741 men and 16,389 women aged 30-59 randomly selected from the national population register, of whom 14,054 men and 14,546 women participated. MAIN OUTCOME MEASURES: Levels of risk factors and predicted and observed changes in mortality from cerebrovascular disease. RESULTS: The observed changes in diastolic blood pressure, total serum cholesterol concentration, and smoking in the population from 1972 to 1992 predicted a 44% fall in mortality from stroke in men and changes in diastolic blood pressure and smoking predicted a 34% fall in women. The observed fall in mortality from stroke was 66% in men and 60% in women. CONCLUSIONS: Two thirds of the fall in mortality from stroke in men and half in women can be explained by changes in the three main cardiovascular risk factors.

Adult↗

PubMed1995

Intake of mercury from fish, lipid peroxidation, and the risk of myocardial infarction and coronary, cardiovascular, and any death in eastern Finnish men.

BACKGROUND: Even though previous studies have suggested an association between high fish intake and reduced coronary heart disease (CHD) mortality, men in Eastern Finland, who have a high fish intake, have an exceptionally high CHD mortality. We hypothesized that this paradox could be in part explained by high mercury content in fish. METHODS AND RESULTS: We studied the relation of the dietary intake of fish and mercury, as well as hair content and urinary excretion of mercury, to the risk of acute myocardial infarction (AMI) and death from CHD, cardiovascular disease (CVD), and any cause in 1833 men aged 42 to 60 years who were free of clinical CHD, stroke, claudication, and cancer. Of these, 73 experienced an AMI in 2 to 7 years. Of the 78 decreased men, 18 died of CHD and 24 died of CVD. Men who had consumed local nonfatty fish species had elevated hair mercury contents. In Cox models with the major cardiovascular risk factors as covariates, dietary intakes of fish and mercury were associated with significantly increased risk of AMI and death from CHD, CVD, and any death. Men in the highest tertile (> or = 2.0 micrograms/g) of hair mercury content had a 2.0-fold (95% confidence interval, 1.2 to 3.1; P = .005) age- and CHD-adjusted risk of AMI and a 2.9-fold (95% CI, 1.2 to 6.6; P = .014) adjusted risk of cardiovascular death compared with those with a lower hair mercury content. In a nested case-control subsample, the 24-hour urinary mercury excretion had a significant (P = .042) independent association with the risk of AMI. Both the hair and urinary mercury associated significantly with titers of immune complexes containing oxidized LDL. CONCLUSIONS: These data suggest that a high intake of mercury from nonfatty freshwater fish and the consequent accumulation of mercury in the body are associated with an excess risk of AMI as well as death from CHD, CVD, and any cause in Eastern Finnish men and this increased risk may be due to the promotion of lipid peroxidation by mercury.

Adult↗

PubMed1995

Effect of risk factors and changes in risk factors on coronary mortality in three cohorts of middle-aged people in eastern Finland.

The association of smoking, serum cholesterol, and blood pressure with coronary mortality and the contribution of changes in these risk factors to the decline in coronary mortality was assessed in three cohorts of middle-aged population examined in 1972, 1977, and 1982 in Eastern Finland. A total of 10,758 men and 11,112 women were included in this study. The follow-up time of each subject was 8 years. Age-adjusted coronary mortality decreased from 54 per 10,000 person-years in the 1972 cohort to 30 per 10,000 person-years in the 1982 cohort among men and from eight per 10,000 person-years to four per 10,000 person-years among women in the 1972 and 1982 cohorts, respectively. Concomitantly with the decrease in coronary mortality, there was a marked decrease in cardiovascular risk factors. Among men, the age- and geographic area-adjusted hazard rate ratio of coronary mortality between 1972 and 1982 cohorts was 0.52 (95% confidence interval (CI) 0.38-0.72). After further adjustment for smoking, serum cholesterol, and blood pressure, the hazard rate ratio was 0.74 (95% CI 0.54-1.02). Among women, the corresponding hazard rate ratios were 0.49 (95% CI 0.21-1.12) and 0.73 (95% CI 0.30-1.71), respectively. Therefore, it can be estimated that in both sexes nearly half of the decrease in coronary mortality hazard was associated with the changes in risk factors. The fall in serum cholesterol level among men and the decrease in blood pressure among women contributed most of the decrease in coronary mortality hazard.

Adult↗

PubMed1995

Evidence for importance of gender and birth cohort for risk of IDDM in offspring of IDDM parents.

The risk of developing diabetes is higher in offspring of fathers than of mothers with insulin-dependent diabetes mellitus (IDDM). The reasons for this sex differential are unclear, as early studies were often selected and relatively small. We conducted a prospective study on the risk of IDDM in a cohort of 9,453 offspring from 5,255 Finnish parents with diabetes diagnosed before age 30 years. Age of first admission to the hospital was considered to be the age of diagnosis of IDDM in the offspring; IDDM occurred in 248 offspring. The risk of IDDM tended to be lower in the offspring of the same gender as the diabetic parent (adjusted risk ratio (RR) 0.78; p = 0.50). When offspring were of same gender as the diabetic parent, male offspring had a higher risk of IDDM than female offspring (RR 2.28; 95% confidence interval 1.53-3.38), whereas if the gender of the diabetic parent and the offspring were different, the risk in male offspring was lower (RR 0.43; 95% confidence interval 0.31-0.62). For the offspring of diabetic fathers, the cumulative risk by the age of 20 was higher (7.6%) than for those with diabetic mothers (3.5%) (p < 0.0001). In a multivariate analysis statistically significant predictors of IDDM in the offspring were the sex of the parent, the year of birth and the birth order of the offspring. The risk of IDDM in the offspring increased by 9% per year of birth cohort. By age 20, the cumulative risk of developing IDDM in the offspring of diabetic parents was 5.3%, 10 times higher than in the background population. It is likely that genetic factors seem to have played a major role in the continuous increase of IDDM incidence in Finnish children.

Adolescent↗

PubMed1995

Insulin receptor substrate-1 gene mutations in NIDDM; implications for the study of polygenic disease.

Variations in the coding regions of the insulin receptor substrate-1 (IRS-1) gene have recently been suggested to contribute to the susceptibility of non-insulin-dependent diabetes mellitus (NIDDM). The purpose of this study was to examine the role of the IRS-1 missense mutations at codons 972 (glycine to arginine) and 513 (alanine to proline) in two diverse populations from South India and Finland at high risk for NIDDM. DNA was amplified and digested with restriction enzymes BstN1 to detect the codon 972 mutation and Dra III to detect the codon 513 mutation. The codon 513 mutation was not found in the study subjects. The codon 972 mutation was present in 10.3% of 126 middle-aged NIDDM subjects and 5.3% of 95 matched control subjects in the South Indians (p = 0.17). In elderly Finnish subjects the frequency of the mutation was 7.5% in 40 NIDDM subjects and 7% in 42 matched control subjects. The frequency of codon 972 mutation in the South Indian NIDDM subjects was very similar to the two previously published studies in Danish and French subjects although each study individually fails to reach conventional levels of significance. The data from all four ethnic groups were analysed together after ascertaining that significant heterogeneity did not exist between the studies. Overall, the frequency of the codon 972 mutation is found in 10.7% NIDDM subjects and 5.8% control subjects (p = 0.02). These studies suggest that the codon 972 mutation of the IRS-1 gene might act as a susceptibility gene predisposing to NIDDM in certain ethnic groups.

Adult↗

PubMed1995

Hypertension and overweight associated with hyperinsulinaemia and glucose tolerance: a longitudinal study of the Finnish and Dutch cohorts of the Seven Countries Study.

To elucidate the role of hypertension as part of the insulin resistance syndrome, the longitudinal relationships of hypertension and overweight with hyperinsulinaemia and glucose tolerance were examined in the Dutch and Finnish cohorts of the Seven Countries Study (Zutphen, and east and west Finland). Three cohorts of men, born between 1900 and 1919, were first examined in 1959/1960. At the 30-year follow-up survey a 2-h glucose tolerance test was carried out on 619 of the surviving men, and fasting insulin was also measured. Blood pressure and body mass index (BMI) were measured several times during the entire 30-year follow-up period. In cross-sectional analyses, men with diabetes and impaired glucose tolerance at the 30-year follow-up examination had a significantly higher systolic blood pressure and a higher prevalence of hypertension than men with normal glucose tolerance, independent of age, cohort and BMI (p < 0.01). These differences had already been seen 5, 20 and 30 years earlier. Subjects with hyperinsulinaemia (fasting insulin > or = 9.2 mU/l) had a higher BMI and a higher prevalence of hypertension. This cross-sectional association with hypertension was independent of age, cohort and BMI. BMI levels of men with hyperinsulinaemia had been shown to be higher 5, 20 and 30 years earlier, but blood pressure levels had not. These results indicate that hypertension is independently associated with glucose tolerance and insulin resistance in three Caucasian cohorts. Changes in blood pressure precede abnormal glucose tolerance but not hyperinsulinaemia; therefore, glucose tolerance appears to be a stronger correlate of hypertension than hyperinsulinaemia.

Aged↗

PubMed1995

Diagnostic features of acute myocardial infarction--changes over time from 1983 to 1990: results from the FINMONICA AMI Register Study.

OBJECTIVES: To examine, whether the acute myocardial infarctions (AMIs) are becoming smaller. DESIGN: Analysis of electrocardiogram (ECG) and enzyme findings of community-based AMI registers in three geographical areas of Finland during the 8-year period 1983-90. SETTING: In the FINMONICA AMI Register, all suspected coronary events in persons aged 25-64 years have been registered since 1983 according to the protocol of the WHO MONICA project in the provinces of North Karelia and Kuopio in eastern Finland and Turku/Loimaa area in south-western Finland. SUBJECTS: Each consecutive case of suspected AMI originating from the monitored populations. During the study period, 11,487 definite or possible AMIs were registered. MAIN OUTCOME MEASURES: Trends in ECG findings classified as definite or probable, and trends in enzyme findings classified as abnormal or equivocal. RESULTS: Of the registered AMIs, 8439 (73.5%) reached the hospital alive and survived > or = 24 h from the beginning of the symptoms. They were included in the analyses of this report and divided further, to first ever AMIs (n = 5392) and to recurrent AMIs (3047). During the study period, the proportion of ECG findings classified as definite on the basis of the serial Minnesota coding declined in men 3.1% year-1 (P < 0.0001) on average for first AMIs and 1.9% year-1 (P = 0.004) for recurrent AMIs. In women, the corresponding declines were 1.9% year-1 (P = 0.007) and 1.6% year-1 (P = 0.02), respectively. Also, the proportion of enzymes classified as abnormal declined amongst men 2.2% year (P < 0.0001) for first AMIs and 2.8% year-1 (P < 0.0001) for recurrent AMIs. In women, the corresponding declines for abnormal enzymes was 1.3% year-1 (P = 0.13) and 3.0% year-1 (P = 0.02). These findings were consistent in all three areas with different registration teams and different laboratories. The proportion of definite ECG findings amongst patients hospitalized for AMI declined almost by half and the proportion of abnormal enzyme findings declined almost by one-third during the study period. CONCLUSIONS: Our findings are compatible with the clinical observation that the hospitalized AMIs are becoming smaller. The timing and magnitude of the changes suggest that they are mainly caused by decreased risk-factor levels in the population. Improved treatment of coronary heart disease and changed hospital admission policy are likely to be contributing factors.

Adult↗

PubMed1995

Coronary risk factor levels: differences between educational groups in 1972-87 in eastern Finland.

STUDY OBJECTIVE: To compare differences in coronary heart disease (CHD) risk factor levels between educational groups in the 1970s and 1980s in eastern Finland. DESIGN AND PARTICIPANTS: Independent, cross sectional population surveys were undertaken in 1972, 1977, 1982, and 1987 of randomly selected men and women aged 30-59 living in two provinces in eastern Finland. Altogether 20,096 subjects participated. The lowest observed level of participation in either sex or province in any year was 77%. Serum cholesterol values and blood pressure measurements, body mass index, smoking, and the level of education were determined in each survey using comparable methodology. MAIN RESULTS: More poorly educated men and women had higher levels of all risk factors at the end of the study period (1987). There was no change between 1972 and 1987 in differences between educational groups in mean serum cholesterol values and the diastolic blood pressure level in either sex, and in smoking in men. In women, the proportion of smokers was highest in the better educated in the 1970s but lowest in this group in the 1980s (interaction between year of examination and educational level p < 0.01). Differences between educational groups in mean body mass index increased with time in both men (p < 0.001) and women (p = 0.06). CONCLUSIONS: Relative differences between socioeconomic groups in CHD mortality have increased in Finland in the 1970s and 1980s. Present results from eastern Finland show no reduction in differences between educational groups in risk factor levels, and even some evidence of increasing differences. Although a comparison between mortality trends and risk factor trends is problematic, trends in the risk factors analysed do not seem to be a major cause for the increasing differences in CHD mortality in Finland, at least in men. On the other hand, the risk factor trends analysed show no progress towards reducing inequalities in health, a major goal of public health policy.

Adult↗

PubMed1995

Association of hormone replacement therapy with hemostatic and other cardiovascular risk factors. The FINRISK Hemostasis Study.

The risk of cardiovascular diseases in women is small until menopause but increases considerably afterwards. When all age groups are considered, cardiovascular diseases are responsible for approximately half of the total mortality in women. It has been suggested that hormone replacement therapy (HRT) in perimenopausal and postmenopausal women could be useful in the prevention of cardiovascular diseases, but its effects are insufficiently known. We performed a cross-sectional study on the associations of menopause and HRT with cardiovascular risk factors, in particular with hemostatic factors, on female participants of the FINRISK Hemostasis Study. The participants, aged 45 to 64 years, were recruited from the Finnish population register by random sampling from three geographically defined areas. The participation rate of women was 83.2%. Of the 1202 women included in the study, 29.2% were current users of HRT. Differences in cardiovascular risk factors by menopausal status and by HRT use were examined after adjustment for age, study area, current smoking, body mass index, self-reported diabetes, and years of education. Postmenopausal women not using exogenous sex hormones had on average a total cholesterol level 0.5 mmol/L (8.9%) higher and an LDL cholesterol level 0.4 mmol/L (11.4%) higher than premenopausal women. Women reporting irregular menstruation (presumably due to perimenopause) had higher adjusted plasma fibrinogen, factor VII coagulant activity, and factor VII antigen than women with regular menstruation or no menstrual periods.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation↗

PubMed1995

Epidemiology of stroke in Kaunas, Lithuania. First results from the Kaunas Stroke Register.

BACKGROUND AND PURPOSE: In Lithuania, only routine mortality statistics have thus far provided data on the epidemiology of stroke. This study aims to assess the mortality, incidence, and case-fatality rate of stroke in the city of Kaunas, Lithuania, during 1986 to 1988. METHODS: A community-based stroke register was set up in 1986 to collect data on all suspected events of acute stroke that occurred in the population aged 35 to 64 years permanently residing in Kaunas. Crude and age-standardized attack rates, incidence, mortality, and case-fatality rates were calculated for the period studied. RESULTS: Among men, the average age-standardized incidence of stroke (referring to first-ever events) was 230/100,000, the attack rate (all events) was 300/100,000, and the mortality from all strokes was 68/100,000. Among women, the corresponding rates were 131/100,000, 154/100,000, and 35/100,000, respectively. Of 973 acute stroke events registered, 80% were first-ever strokes. The age-adjusted 28-day overall case-fatality rate and the case-fatality rate of first-ever stroke were 23.3% and 19.8% in men and 21.8% and 21.3% in women, respectively. CONCLUSIONS: The findings from this first assessment of the incidence and mortality of stroke show that in the mid-1980s both were high in Kaunas compared with other countries. The case-fatality rate was similar to that reported for most other European countries. Further investigations are being carried out to assess the trends in mortality, incidence, and risk factors of stroke in the Kaunas population.

Adult↗

PubMed1995

Multinational comparisons of stroke epidemiology. Evaluation of case ascertainment in the WHO MONICA Stroke Study. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease.

BACKGROUND AND PURPOSE: As part of the WHO MONICA Project (World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease), mortality and incidence rates of acute stroke in 14 centers covering 21 populations from 11 countries were compared. METHODS: In this report, coverage and quality of the MONICA stroke registers were evaluated on five key indicators using data submitted to the MONICA Data Center. RESULTS: A low ratio of MONICA stroke register to routine statistics of stroke mortality and a low proportion of nonfatal out-of-hospital events were the most common biases; they indicate that identifications of fatal cases and/or case finding of nonfatal events occurring outside the hospital were inadequate in many MONICA centers. In 10 populations, the data quality analyses suggested that clarification of possible biases would be needed before these populations can be included in a comparative study. Data from the remaining 11 populations meet the data quality standards for multinational comparisons with respect to case ascertainment. CONCLUSIONS: These results show that multinational comparisons of stroke incidence involve considerable problems in developing and maintaining appropriate standards of data quality. However, after considerable efforts to ensure quality, comparisons of stroke data within the MONICA Project are possible among a large number of the MONICA populations. Our observations also indicate that results from multinational comparisons of stroke mortality based on routine statistics must be interpreted with caution.

Acute Disease↗

PubMed1995

Psychosocial and health status in stroke survivors after 14 years.

BACKGROUND AND PURPOSE: Most studies of long-term survival and assessment of health status in survivors of stroke are hospital based and are often based only on a relatively short follow-up. This study was aimed at evaluating survival of acute stroke after 14 years. We also assessed psychosocial and health status among the long-term stroke survivors. METHODS: This study is a follow-up of the Finnish part of the collaborative World Health Organization Stroke Study that took place during 1972 through 1974. All survivors were interviewed by telephone after being sent a structured questionnaire approximately 14 years after the initial stroke attack. Information on clinical history, socioeconomic situation, self-reported functional capacity, psychosomatic status, perceived mental status, and perceived health was collected. RESULTS: Of the 1241 persons who had been entered in the stroke register from 1972 through 1974, 241 (19.4%) were still alive after 14 years. Participation rate in the telephone interview was 83.4%. Over 80% of all stroke survivors lived at home or with relatives at the time of interview. Functional capacity was good in about two thirds of the stroke survivors. Only 10% to 15% of all respondents felt depressed. About half of both men and women aged 64 years or younger perceived their health as good, while only 25% of men aged 65 years or over did. CONCLUSIONS: Most stroke survivors did not need institutionalized care in the long term. Although a large proportion of them suffered from various somatic diseases, their functional capacity was found to be good.

Activities of Daily Living↗

PubMed1995

Fluoride and sugar intake among adults and youth in Mauritius: preliminary results.

The potential use of different vehicles for delivering fluoride to prevent dental caries has been discussed recently in Mauritius. Water fluoridation was found not to be feasible, and extending the fluoride tablet program would not be easy. Thus, sugar fluoridation as one possibility was considered. For these purposes, the average fluoride and sugar intake was estimated in Mauritius. The results are based on two studies--a Survey on Diet, Health and Lifestyle of Youth in Mauritius (1990) and the Mauritius Diet and Health Survey. Information was collected by trained interviewers using food-frequency and 24-hour-recall questionnaires. The daily total sugar intake, manufactured and natural, was found to be 62 g per day in young people and 50 g per day in adults. In the younger groups, daily frequencies of raw sugar, sweets, and biscuit (cookie) consumption were 1.5, 0.2, and 0.2 times a day, respectively. For adults, the mean daily frequency of consuming sugar-containing foods was 2.6 (SD = 1.3). The daily sucrose intake was rather high, representing about 10% of the daily energy intake. The fluoride levels of foods were calculated by use of Finnish and other available fluoride tables. The mean fluoride intakes per day were 0.64, 0.72, and 0.62 mg per day for 8-17-year-, 18-24-year-, and 30-64-year-old groups, respectively. The median fluoride intake for the oldest group was 0.62 mg/day. The estimated fluoride intake from food did not correspond with the proposed level for the prevention of caries (Murray, 1986) except for the 18-24-year-olds, where it might have been just above the lower recommended limit. However, further data based on analysis of the fluoride contents of Mauritian food samples, especially of whole daily diet, are needed.

Adolescent↗

PubMed1995

Preventing non-insulin-dependent diabetes.

Many risk factors for non-insulin-dependent diabetes mellitus (NIDDM), such as obesity, physical inactivity, and high-fat diet, can potentially be modified. Furthermore, some of the metabolic abnormalities, such as insulin resistance and impaired glucose tolerance, that predict diabetes can be improved by behavior modification and drug treatment. Thus, at least to some extent, NIDDM may be preventable. Several small clinical trials have addressed the hypothesis that NIDDM can be prevented by dietary modification, physical activity, or drug treatment. Some studies suggest a preventive effect, but the conclusions are limited by considerations of sample size, randomization, or intensity of the interventions. Consequently, the hypothesis that NIDDM is preventable requires further testing.

Behavior Therapy↗

PubMed1995

Dietary factors determining diabetes and impaired glucose tolerance. A 20-year follow-up of the Finnish and Dutch cohorts of the Seven Countries Study.

OBJECTIVE: To investigate the role of diet as a predictor of glucose intolerance and non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: At the 30-year follow-up survey of the Dutch and Finnish cohorts of the Seven Countries Study, in 1989/1990, men were examined according to a standardized protocol including a 2-h oral glucose tolerance test. Information on habitual food consumption was obtained using the cross-check dietary history method. Those 338 men in whom information on habitual diet was also available 20 years earlier were included in this study. Subjects known as having diabetes in 1989/1990 were excluded from the analyses. RESULTS: Adjusting for age and cohort, the intake of total, saturated, and monounsaturated fatty acids and dietary cholesterol 20 years before diagnosis was higher in men with newly diagnosed diabetes in the survey than in men with normal or impaired glucose tolerance. After adjustment for cohort, age, past body mass index, and past energy intake, the past intake of total fat was positively associated with 2-h postload glucose level (P < 0.05). An independent inverse association with the past intake of vitamin C was observed (P < 0.05). These associations were independent of changes in the intake of fat and vitamin C during the 20-year follow-up. An increase in the consumption of vegetables and legumes, potatoes, and fish during the 20-year follow-up was inversely related with 2-h glucose level (P < 0.05). CONCLUSIONS: Although the regression coefficients were in general not very large, these results indicate that a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and NIDDM. Foods such as fish, potatoes, vegetables, and legumes may have a protective effect. In addition, the observed inverse association between vitamin C and glucose intolerance suggests that antioxidants may also play a role in the development of derangements in glucose metabolism.

Cohort Studies↗