The FTO gene is not associated with weight gain during six years of observation in the population of the PURE study in Poland

Introduction: We present the first longitudinal study in Poland analysing the association between fat mass and obesity-associated gene (FTO) polymorphism and changes in anthropometric parameters. Material and methods: 1120 participants of the Prospective Urban Rural (PURE) study in Poland (mean age 53.7 years) were genotyped for FTO gene polymorphism (rs9939609, rs9930506, rs1421085, rs1121980). Anthropometric parameters were measured at three time points (baseline, after three years, and after six years of observation). Results: The mean body mass index (BMI) in the study group was 28 kg/m2. Overall, there was a significant increase in the mean weight, BMI, and waist size during the six years (p ≈ 0). Although males initially weighed more than females (p = 0), over the whole six-year period women had a greater tendency to increase in weight (p = 0.068), BMI (p = 0.014), and waist size (p = 0.041). Subjects with at least one A allele at rs9939609 initially weighed more on average (77.5 vs. 74.7 kg, p = 0.027) and had a greater waist size (92 vs. 89.5 cm, p = 0.025) than those with the TT genotype. The differences in baseline results were more expressed in males than in females. There is no association between the changes in anthropometric parameters over the whole study period of six years and the FTO gene. Conclusions: FTO gene polymorphism is associated with anthropometric parameters in participants from the PURE study in Poland. However, there is no association between the presence of risk alleles and changes of anthropometric parameters over six years of observation

Self-assessment of obesity among women and men in Lower Silesia

WSTĘP. Zmiana stylu życia i łatwa dostępność różnego rodzaju pokarmów sprzyjają rozpowszechnianiu się nadwagi i otyłości. Problem ten jest szczególnie dostrzegalny w krajach rozwiniętych, częściej u kobiet, zwykle w okresie okołomenopauzalnym. Występowanie nadwagi lub otyłości istotnie zwiększa chorobowość i śmiertelność z powodu chorób sercowo-naczyniowych, niektórych nowotworów, cukrzycy, dodatkowo niekorzystnie wpływa na wiele chorób przewlekłych. Celem niniejszej pracy jest ocena stopnia otyłości mieszkańców Dolnego Śląska na podstawie danych podawanych przez respondentów, ze szczególnym uwzględnieniem płci i wieku. MATERIAŁ I METODY. Badanie ankietowe przeprowadzono na 1190-osobowej, losowo wybranej, randomizowanej, reprezentatywnej próbie mieszkańców Dolnego Śląska powyżej 18. roku życia. Analizowano wskaźnik masy ciała (BMI, body mass index), z uwzględnieniem płci i wieku, w następujących grupach wiekowych: 18-44 lat, 45-64 lat, powyżej 65. roku życia. WYNIKI. Prawidłową masę ciała wykazano u 51,1%, nadwagę u 32,8%, otyłość u 12,8%, a niedowagę u 3,3% ankietowanych. Prawidłowy wskaźnik BMI częściej stwierdzano u kobiet (55,7%) niż u mężczyzn (46,3%). Natomiast odsetek badanych z nadwagą jest większy w przypadku mężczyzn (40,9%) niż kobiet (25,4%). Wraz z wiekiem zmienia się rozkład wskaźnika BMI w strukturze społeczeństwa - zmniejsza się odsetek osób z prawidłowym BMI, a zwiększa udział badanych z nadwagą i otyłością. WNIOSKI. W populacji dolnośląskiej zauważalne są niekorzystne tendencje w postaci zwiększania się wskaźnika BMI wraz z wiekiem oraz częstszego występowania większych wartości BMI u mężczyzn niż u kobiet. Nadwaga występuje częściej w populacji mężczyzn. Otyłość częściej dotyczy kobiet niż mężczyzn. Wartości te są mniejsze niż stwierdzane w badaniach ogólnopolskich, sugerując zaniżanie masy ciała w samoocenie. Opisany powyżej wpływ zmian wskaźnika BMI na zwiększenie ryzyka rozwoju chorób zależnych od otyłości odpowiada tendencjom obserwowanym w rozwiniętych ekonomicznie społeczeństwach.INTRODUCTION. The life style changes and food availability promote overweight and obesity dissemination in population. This problem more often occurs in women during perimenopausal period and was observed especially in well-developed countries. Overweight and obesity significantly increase morbidity and mortality due to cardiovascular diseases, neoplasms, diabetes mellitus, and additionally influence unfavourably the course of some chronic diseases. The aim of the study was to assess obesity degree in Lower Silesia inhabitants based on self-reported data with reference to gender and age. MATERIAL AND METHODS. Questionnaire study was carried out in representative sample of randomly selected 1190 subjects over 18 years of age from Lower Silesia. Body mass index (BMI) in relation to gender and age was analyzed in age groups: 18-44 years, 45-64 years, over 65 years. RESULTS. Normal weight was affirmed in 51.1%, overweight in 32.8%, obesity in 12.8%, and underweight in 3,3% of study population. Normal BMI was more often observed in women (55.7%) than in men (46.3%). Percentage of overweight subjects was higher in men (40.9%) than in women (25.4%). The distribution of BMI changes with age in population structure - percentage of subjects with normal BMI decreases and increases in overweight and obese subjects. CONCLUSIONS. Study population shows unfavorable tendencies of BMI, which increases with age and that the higher BMI more frequently occurs in men than in women. Overweight was more often observed in men but women were more obese than men. Reported results in this study are lower than ones in other polish studies, which suggests the underestimation of body weight in self-assessment. Mentioned above BMI changes’ impact on increase of risk factors of obesity-related diseases reflects the tendencies in other economically developed populations

Evaluation of selected risk factors for cardiovascular disease among people in retirement age living in Lower Silesia region

WSTĘP. Za zachorowalność i umieralność osób w podeszłym wieku odpowiadają przede wszystkim choroby układu sercowo-naczyniowego. Autorzy przedstawionego niżej badania skupili się na wybranych czynnikach ryzyka wystąpienia chorób układu krążenia: zwiększonej masie ciała, hipercholesterolemii oraz hiperglikemii. MATERIAŁ I METODY. Badania zostały zrealizowane przez Katedrę i Zakład Medycyny Społecznej Akademii Medycznej we Wrocławiu w latach 2007–2009. Wzięły w nim udział 533 osoby w wieku poprodukcyjnym. U każdego z badanych oceniono stężenie cholesterolu całkowitego i glikemię na czczo oraz określono wskaźnik masy ciała (BMI). Dane zostały przeanalizowane w ujęciu ogólnym, z uwzględnieniem płci i miejsca zamieszkania. Do oceny istotności statystycznej wykorzystano test χ2, p ≤ 0,05. Siłę i kierunek zależności oceniono z użyciem współczynnika korelacji Q–Yule’a. WYNIKI. Prawidłowa masa ciała charakteryzowała tylko 19,0% ogółu badanych; w przypadku 42,2% stwierdzono nadwagę, a u 38,8% — otyłość. Płeć i miejsce zamieszkania były zmiennymi istotnie statystycznie różnicującymi rozkład wartości BMI w badanej populacji. Hipercholesterolemię stwierdzono u 52,5% ogółu badanych, istotnie statystycznie częściej w populacji kobiet niż mężczyzn. Miejsce zamieszkania nie różnicowało istotnie statystycznie częstości występowania hipercholesterolemii. W przypadku niemal połowy (46,3%) badanej populacji stwierdzono nieprawidłową wartość glikemii na czczo — istotnie statystycznie częściej wśród mieszkańców wsi niż miast, bez względu na płeć. WNIOSKI. Wszystkie przeanalizowane w omawianej pracy czynniki ryzyka chorób układu krążenia przedstawiają niekorzystny obraz profilu zdrowotnego osób w wieku poprodukcyjnym. Celowym byłoby przygotowanie szerokich działań prewencyjnych, szczególnie ukierunkowanych na populację wiejską, z uwzględnieniem zmniejszenia masy ciała i normalizacji glikemii.INTRODUCTION. Cardiovascular diseases remain a leading cause of morbidity and mortality in the elderly population. In this study, we focused on selected cardiovascular risk factors: increased body weight, hyperglycemia and hypercholesterolemia. MATERIAL AND METHODS. The study was conducted in the Department of Social Medicine in the years 2007–2009. Five hundred thirty three retired subjects were included in the study. For each participant, total cholesterol and fasting glucose were measured and body mass index (BMI) was calculated. Data were analyzed for the whole population and by gender, place of residence or both. Statistical analysis was performed using χ2 test and Yule’s Q correlation coefficient. RESULTS. Only 19% of all respondents had proper body weight, 42.2% were overweight, 38.8% were obese. Gender and place of residence were significantly associated with BMI distribution differences among studied subjects. Hypercholesterolemia was found in 52.5% of all respondents, significantly more often in women. Place of residence did not influence significantly the incidence of hypercholesterolemia, both in the whole study population and in men and women analyzed separately. Almost half (46.3%) of the study population had abnormal fasting glucose levels, which was significantly more frequent among rural than urban area residents, regardless of gender. CONCLUSIONS. Our study evaluating selected cardiovascular risk factors showed that people in retirement age are characterized by unfavorable health profile. Of particular value would be development of a broad preventive program including weight reduction and normalization of blood glucose and targeted specifically to rural population

Cigarette smoking in Poland in 2019: the continuing decline in smoking prevalence

The aim of the study: To present comprehensive national estimates of prevalence of cigarette smoking by sociodemographic characteristics in Poland in 2019 and to analyse the changes in smoking prevalence in the Polish population after 2014. Material and methods: A cross-sectional survey on a representative sample of adult Polish population was conducted on 4-11 July 2019 by the Public Opinion Research Center (Centrum Badania Opinii Społecznej). A total of 1016 adults (42.4% men and 57.6% women) aged 20 years and older were included in the analysis. Data for smoking prevalence were analysed according to gender, age groups, birth cohorts, place of residence and education. Statistical analysis was done using Statistica 13.1 and assumed a significance level of p < 0.05. Results: Of the total sample population, 21.8% of Polish adults declared they are daily smokers (in the general population this would translate to 6.8 million Poles, including 3.9 million men and 2.9 million women), 27.8% that they are ex-smokers and 50.4% that they never smoked tobacco. More men than women declared they are daily smokers (26.9% vs 18.1%) and ex-smokers (36.2% vs 21.5%), and women were more likely to declare they are never smokers than men (60.3% vs 36.9%). Conclusions: Poland has experienced a decrease in smoking prevalence since 1976 in men and since 1982 in women. In 2019 the most important factor shaping smoking prevalence in Poland was education. Sex differences in smoking rates have been converging since late 1970s. Those with lower levels of education, as well as middle-aged men and women (45-64 years old) were found to have the highest levels of daily smoking and should be offered targeted support promoting smoking cessation. There is an urgent need to bring back and strengthen a national tobacco control strategy in Poland. This should include systematic annual surveys of smoking behaviours on a representative sample of Polish population using a standardised methodolog

Determinants of obesity in population of PURE study from Lower Silesia

Introduction: The knowledge about obesity pathogenesis is insufficient. The aim of our study was to investigate environmental and individual determinants of obesity in population of PURE study from Lower Silesia.Material and methods: This was a cross sectional observation of 1064 inhabitants of Wroclaw and neighbouring rural area (671 women, 393 men), who took part in PURE study in years 2007–2010. Each participant answered PURE questionnaire and International Physical Activity Questionnaire providing information about obesity risk factors. Anthropometric measurements were collected, blood samples were taken for assessment of FTO gene polymorphism. A stepwise logistic regression analysis was performed to identify the most significant predictors of obesity.Results: 31% of the study group had obesity (BMI over 30 kg/m2, no difference between men and women), overweight (BMI 25–29.9 kg/m2) affected 48.1% of men and 36.7% of women. Determinants of obesity in female group were: rural inhabitancy, chronic medication, unemployment, age, sedentary leisure time activity, non-smoking, hypertension in family, family related stress (p = 0.66 in the Hosmer-Lemeshow test). Determinants of obesity in male group were rural inhabitancy, chronic medication, family related stress, diabetes in family (p = 0.27 in the Hosmer-Lemeshow test). Risk factors for central obesity were similar, however in women oral contraception and physical activity were associated with lower obesity risk.Conclusions: Environmental factors, especially rural inhabitancy and family related stress were associated with higher obesity risk in our study. Employment, smoking, physical activity and use of oral contraception seemed to have protective role in women

Five year remission of GHRH secreting bronchial neuroendocrine tumor with symptoms of acromegaly. Utility of chromogranin A in the monitoring of the disease

Akromegalia jest najczęściej spowodowana przez guza przysadki wydzielającego hormon wzrostu (GH, growth hormone). Bardzo rzadko (< 1% przypadków) obserwuje się ją w przebiegu ektopowego wydzielania hormonu uwalniającego hormon wzrostu (GHRH, growth hormone releasing hormone) przez guzy oskrzeli, płuc, trzustki i jelit. Celem pracy jest przedstawienie skutecznego chirurgicznego wyleczenia przypadku akromegalii spowodowanej ektopowym wydzielaniem GHRH przez guz neuroendokrynny oskrzela i przydatności oznaczenia chromograniny A w monitorowaniu przebiegu choroby. Na podstawie typowych objawów klinicznych, potwierdzonych wysokimi wartościami GH i insulinopodobnego czynnika wzrostu 1 (IGF-1, insulin-like growth factor-1), akromegalię rozpoznano u 61-letniej kobiety. W obrazie rezonansu magnetycznego (MRI, magnetic resonance imaging) nie stwierdzono guza przysadki, lecz jej powiększenie. Ponadto wykazano obecność guza w prawym płucu wielkości 10 cm oraz wysokie stężenie GHRH. Po usunięciu rakowiaka prawego oskrzela nastąpiła normalizacja wydzielania GH, IGF-1 i GHRH oraz zatrzymanie postępu akromegalii. Obecnie (5 lat po leczeniu operacyjnym) utrzymuje się remisja choroby potwierdzona przez prawidłowe wyniki GH, IGF-1, chromograniny A oraz badań obrazowych płuc i przysadki. Zwrócono uwagę na przydatność oznaczania chromograniny A do oceny remisji guza przy braku możliwości rutynowego oznaczania GHRH.Acromegaly is usually caused by excess GH (growth hormone) secretion by pituitary adenoma. Extremely rare (< 1% of cases) acromegaly can be a result of ectopic GHRH (growth hormone releasing hormone) secretion by bronchial tubes, lung, pancreatic or intestinal tumor. The aim of this description is to present the case of successfully treated acromegaly caused by ectopic GHRH secretion by bronchial neuroendocrine tumor and the usefulness of chromogranin A assay in the disease monitoring. The diagnosis of acromegaly in 61-year old woman was based on typical clinical picture and elevated GH and IGF-1(insulin-like growth factor-1) levels. MRI (magnetic resonance imaging) images revealed no tumor in the pituitary but only the pituitary enlargement. Moreover, the right lung tumor (10 cm size) and elevated GHRH level were documented. The secretion of GH, IGF-1 and GHRH were normalized and progression of acromegaly was stopped after the carcinoid tumor surgery. Currently, 5 year after surgery, acromegaly is still in the remission, as the normal levels of GH, IGF-1, chromogranin A and normal chest and pituitary images confirm. The authors emphasize usefulness of measurement of chromogranin A concentration for the evaluation of the tumor remission in case the routine GHRH assay is not accessible

Different blood-brain-barrier disruption profiles in multiple sclerosis, neuromyelitis optica spectrum disorders, and neuropsychiatric systemic lupus erythematosus

Aim of the study. To assess differences in BBB damage profiles by measuring serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble platelet endothelial cell adhesion molecule-1 (sPECAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and S100 calcium-binding protein B (S100B) in relapsing-remitting multiple sclerosis (RRMS), neuromyelitis optica spectrum disorders (NMOsd), and neuropsychiatric systemic lupus erythematosus (NPSLE) patients.Clinical rationale for the study. Blood-brain-barrier (BBB) disruption is one of the key pathological processes involved in various demyelinating diseases of the central nervous system (CNS) and is associated with shedding of cell adhesion molecules and S100B into the serum compartment. Therefore, making an assessment of serum levels of the above-mentioned molecules could provide information about disease pathogenesis, severity of BBB disruption, and disease activity.Material and methods. We recruited 42 RRMS, 19 NMOsd and 35 NPSLE patients. Subjects were treated with beta-interferons or glatiramer acetate (RRMS), oral steroids and/or azathioprine (NMOsd, NPSLE), other immunosuppressants (NPSLE), or antimalarials (NPSLE). The clinical condition of the patients was assessed using the Kurtzke Expanded Disability Status Scale for MS and NMOsd, and the Systemic Lupus Erythematosus Disease Activity Index for NPSLE. Serum levels of sVCAM-1, sPECAM-1, sICAM-1 and S100B were determined using enzyme-linked immunosorbent assay (ELISA).Results. We found the lowest levels of sPECAM-1, sICAM-1 and S100B in sera from NMOsd patients. The highest levels of sPECAM-1 and sICAM-1 were observed in NPSLE, and in NPSLE and MS, respectively. There were no statistically significant differences in sVCAM-1 levels between the examined groups. In MS and NMOsd, there was a negative correlation between the EDSS score and the following molecules: sPECAM-1, sICAM-1 and S100B.Conclusions and clinical implications. We conclude that there is a different profile of blood-brain-barrier disruption reflected by cell adhesion molecules shedding in the spectrum of autoimmune CNS disorders with disseminated white matter lesions. These molecules could become new biomarkers to be used in CNS demyelinating diseases differential diagnoses and monitoring disease activity, but further studies on larger groups of patients are necessary

Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study.

BACKGROUND: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. FINDINGS: The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. INTERPRETATION: Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. FUNDING: Full funding sources listed at the end of the paper (see Acknowledgments)

Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

Background: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from −1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings: The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0–1·7), Tanzania (0–3·6), and Zimbabwe (0–5·1), to 49·3% in Canada (44·4–54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5–6·9) in Tanzania to 91·4% (86·6–94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation: Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Funding: Full funding sources listed at the end of the paper (see Acknowledgments)

Obesity and Chosen Non-Communicable Diseases in PURE Poland Cohort Study

Introduction: Obesity has been associated with a higher risk of morbidity, disability, and death. The objective of this study was to assess the prevalence of obesity and chosen non-communicable diseases (NCDs) in the PURE Poland cohort study. Material and Methods: The study covers a group of 2035 people (1281 women and 754 men), who live in urban and rural areas of Lower Silesian voivodeship. The baseline study was conducted between 2007–2010. The data on demographic status and history of diseases were collected using questionnaires. The anthropometric parameters, blood pressure, blood lipids, and glucose level were measured. Results: Normal body weight was observed in 28.1% of participants, whereas overweight and obesity were observed in 40.1% and 31.1% of participants, respectively. Moreover, there was a significant difference in the body weight between genders. Prevalence of obesity was similar in men and women (31.0% and 31.1%, respectively). Obesity was more prevalent in rural vs. urban residents (38.5% and 26.0%, respectively). In a logistic regression analysis, the odds for obesity was two-fold higher in participants aged &gt;64 years and rural inhabitants (OR 1.91; 95% CI 1.36–2.70; OR 1.79; 95% CI 1.48–2.16, respectively). Participants with obesity had 2.5-fold higher odds for diabetes and hypertension and two-fold higher odds for CHD in comparison with non-obese individuals (OR 2.74; 95% CI 2.01–3.73, OR 2.54; 95% CI 2.03–3.17, OR 1.88; 95% CI 1.26–2.80, respectively). Conclusions: Taken together, the prevalence of obesity was associated with particular socio-demographic factors (age, place of residence, and level of education) as well as diabetes, hypertension, and coronary heart disease