Prevention of chronic disease in risk groups

Selectieve preventie houdt in dat groepen mensen met een verhoogd risico op een chronische ziekte, zoals hart- en vaatziekten, diabetes, kanker, luchtwegaandoeningen, depressie en aandoeningen van het bewegingsapparaat, preventieve interventies krijgen aangeboden. Risicogroepen zijn te definiëren op basis van factoren die het risico op meerdere van deze ziektes verhogen. Deze gemeenschappelijke factoren zijn: hoge leeftijd, vrouw-zijn, niet-westerse afkomst, laagopgeleid, aanwezige familiegeschiedenis, overgewicht, roken, ongezond voedingspatroon (inclusief alcoholgebruik), lichamelijke inactiviteit, eenzaamheid, slechte fysieke inrichting van buurt/wijk, lage sociale cohesie, alleen gaan wonen en verlies/overlijden van partner. Het lijkt veelbelovend om groepen mensen die meer dan een van deze risicofactoren hebben selectieve preventieve interventies aan te bieden. Dergelijke maatregelen, gericht op het individu en de omgeving, verbeteren de gezondheid van een specifieke risicogroep en verminderen de kans op diverse chronische ziekten. Veel van deze chronische ziekten ontstaan pas op oudere leeftijd. Om ze te voorkomen, is het verstandig vroeger in de levensloop in te grijpen. De meest geschikte levensfase verschilt echter per risicofactor. Dit blijkt uit een onderzoek van het RIVM naar selectieve preventie dat in opdracht van het ministerie van Volksgezondheid, Welzijn en Sport (VWS) is uitgevoerd. Uit het onderzoek blijkt ook dat van dit type maatregelen tot nu toe in beperkte mate is onderzocht of ze effectief zijn. Elf interventies bleken (kosten-)effectief op de korte termijn. Onderzoek naar het aantal mensen dat aan deze maatregelen meedoet en naar langetermijneffecten, zou meer kunnen zeggen over de effecten op de volksgezondheid.The high-risk approach to disease prevention consists of targeting preventive interventions to those groups of individuals with an increased risk of chronic disease, such as cardiovascular disease, diabetes, cancer, respiratory disease, depression and musculoskeletal disease. Risk groups are defined on the basis of factors that are known to increase the risk of developing a variety of chronic diseases. These common factors are: advanced age, female gender, non-Western origin, low educational level, family history, overweight, smoking, unhealthy diet (including use of alcohol), physical inactivity, loneliness, poor physical design of neighborhood/district, low social cohesion, living alone and the loss/death of a partner. Providing preventive services to groups of people with more than one of these risk factors appears to be a promising strategy in terms of improving the health of individuals in a specific risk group and lowering their risk of chronic disease. Such preventative measures can target the individual and his/her surroundings/environment. Chronic diseases mostly occur among the elderly population. However, preventive interventions should be implemented at earlier life-course stages to provide the maximum benefit. The most appropriate life-course stage for interventions varies with the risk factor under consideration. This can be concluded from a study conducted by the National Institute for Public Health and the Environment (RIVM) commissioned by the Dutch Ministry of Health, Welfare and Sport (VWS). The study also shows that the effectiveness of most of these interventions has not yet been fully determined. Only eleven of the interventions listed in this report are known to be (cost-)effective over the short term. Studies on the degree of participation and uptake of the interventions among high-risk groups and on long-term health benefits are needed to estimate the impact of high-risk preventive approaches on public health.VW

A high menaquinone intake reduces the incidence of coronary heart disease

Background and Aim: Vitamin K dependent proteins have been demonstrated to inhibit vascular calcification. Data on the effect of vitamin K intake on coronary heart disease (CHD) risk, however, are scarce. To examine the relationship between dietary vitamins K-1 and K-2 intake, and its subtypes, and the incidence of CHD. Methods and Results: We used data from the Prospect-EPIC cohort consisting of 16,057 women, enrolled between 1993 and 1997 and aged 49-70 years, who were free of cardiovascular diseases at baseline. Intake of vitamin K and other nutrients was estimated with a food frequency questionnaire. Multivariate Cox proportional hazards models were used to analyse the data. After a mean +/- SD follow-up of 8.1 +/- 1.6 years, we identified 480 incident cases of CHD. Mean vitamin K-1 intake was 211.7 +/- 100.3 mu g/d and vitamin K-2 intake was 29.1 +/- 12.8 mu g/d. After adjustment for traditional risk factors and dietary factors, we observed an inverse association between vitamin K-2 and risk of CHD with a Hazard Ratio (HR) of 0.91 [95% Cl 0.85-1.00] per 10 mu g/d vitamin K-2 intake. This association was mainly due to vitamin K-2 subtypes MK-7, MK-8 and MK-9. Vitamin K-1 intake was not significantly related to CHD. Conclusions: A high intake of menoquinones, especially MK-7, MK-8 and MK-9, could protect against CHD. However, more research is necessary to define optimal intake levels of vitamin K intake for the prevention of CHD. (C) 2008 Elsevier B.V. All rights reserved