Determinants of attaining and maintaining a low cardiovascular risk profile - The Doetinchem Cohort Study

Background: While maintenance of a low cardiovascular risk profile is essential for cardiovascular disease (CVD) prevention, few people maintain a low CVD risk profile throughout their life. We studied the association of demographic, lifestyle, psychological factors and family history of CVD with attainment and maintenance of a low risk profile over three subsequent 5-year periods. Methods: Measurements of 6390 adults aged 26-65 years at baseline were completed from 1993 to 97 and subsequently at 5-year intervals until 2013. At each wave, participants were categorized into low risk profile (ideal levels of blood pressure, cholesterol and body mass index, non-smoking and no diabetes) and medium/high risk profile (all others). Multivariable-adjusted modified Poisson regression analyses were used to examine determinants of attainment and maintenance of low risk; risk ratios (RR) and 95% confidence intervals (95% CI) were obtained. Generalized estimating equations were used to combine multiple 5-year comparisons. Results: Younger age, female gender and high educational level were associated with higher likelihood of both maintaining and attaining low risk profile (P < 0.05). In addition, likelihood of attaining low risk was 9% higher with each 1-unit increment in Mediterranean diet score (RR: 1.09, 95% CI: 1.02-1.16), twice as high with any physical activity versus none (RR: 2.17, 95% CI: 1.16-4.04) and 35% higher with moderate alcohol consumption versus heavy consumption (RR: 1.35, 95% CI: 1.06-1.73). Conclusion: Healthy lifestyle factors such as adherence to a Mediterranean diet, physical activity and moderate as opposed to heavy alcohol consumption were associated with a higher likelihood of attaining a low risk profile

Long-term patterns of chronic complaints of the arms, neck, and shoulders and their determinants - The Doetinchem Cohort Study

Complaints of the arms, neck, and shoulders (CANS) represent a major public health problem but the long-term course is largely unknown. Our objective was to explore the 15-year course of chronic CANS and its determinants in a population-based cohort. During 1993 to 2012, 3050 men and women aged 26 to 65 years at baseline were measured every 5 years, up to 4 times. Complaints of the arms, neck, and shoulders and sociodemographic, lifestyle, mental health, and physical load determinants were obtained by self-reported questionnaires and physical examinations. Information on chronic CANS was used to create patterns of the 15-year course: persistence, recovery, variable, no CANS, and the development of CANS. Only 47% were free of chronic CANS throughout the total 15-year period. The prevalence of other patterns was development (18.3%), persistence (8.5%), recovery (7.5%), and variable (18.7%). In multivariable logistic regression analyses, female gender, age 46 to 55 years, being not employed, former smoking, physical inactivity, an episode of CANS during the past 12 months, and high physical load in daily life (eg, often adopting awkward postures, frequent lifting, carrying, pushing, or pulling) were associated with the development of chronic CANS. Female gender, age 36 to 45 years, being not employed, and awkward postures in daily life were associated with persistent CANS. We conclude that chronic CANS represent a dynamic condition and affect the majority of the general population at least once in 15 years. Determinants associated with chronic CANS, especially physical load in daily life, can be used to develop preventive interventions and give guidance to treatment

Predicted burden could replace predicted risk in preventive strategies for cardiovascular disease

Objectives: The objective of this study was to explore the extent of the differences in definitions of composite end points and assess how these differences influence estimates of cardiovascular disease (CVD) burden. Study Design and Settings: Data from a Dutch cohort study (n = 19,484) was used to calculate 10-year risks according to four CVD risk prediction models: Adult Treatment Panel (ATP) III, Framingham Global Risk Score (FRS), Pooled Cohort Equations (PCE), and SCORE. Health loss was estimated based on the impact of event types included in the corresponding composite end points. Finally, each prediction model was used to estimate the expected CVD burden in high-risk individuals, expressed as Quality-Adjusted Life Years (QALYs) lost. Results: The definition of the composite end points varied widely across the four models. FRS predicted the highest CVD risks, and the composite end point used in SCORE was associated with the highest health burden. The predicted CVD burden in high-risk individuals was 0.23, 0.74, 0.43, and 0.39 QALYs lost per individual when using ATP, FRS, PCE, and SCORE, respectively. Conclusion: The investigated CVD risk prediction models showed huge variation in definition of composite end points and associated health burden. Therefore, health consequences related to predicted risks cannot be readily compared across prediction models, and estimates of burden of disease depend crucially on the prediction model used

Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes

Background: It has been suggested that the inverse association between alcohol and type 2 diabetes could be explained by moderate drinkers' healthier lifestyles. Objective: We studied whether moderate alcohol consumption is associated with a lower risk of type 2 diabetes in adults with combined low-risk lifestyle behaviors. Design: We prospectively examined 35,625 adults of the Dutch European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort aged 20-70 y, who were free of diabetes, cardiovascular disease, and cancer at baseline (1993-1997). In addition to moderate alcohol consumption (women: 5.0-14.9 g/d; men: 5.0-29.9 g/d), we defined low-risk categories of 4 lifestyle behaviors: optimal weight [body mass index (in kg/m2) <25], physically active (≥30 min of physical activity/d), current nonsmoker, and a healthy diet [upper 2 quintiles of the Dietary Approaches to Stop Hypertension (DASH) diet]. Results: During a median of 10.3 y, we identified 796 incident cases of type 2 diabetes. Compared with teetotalers, hazard ratios of moderate alcohol consumers for risk of type 2 diabetes in low-risk lifestyle strata after multivariable adjustments were 0.35 (95% CI: 0.17, 0.72) when of a normal weight, 0.65 (95% CI: 0.46, 0.91) when physically active, 0.54 (95% CI: 0.41, 0.71) when nonsmoking, and 0.57 (95% CI: 0.39, 0.84) when consuming a healthy diet. When ≥3 low-risk lifestyle behaviors were combined, the hazard ratio for incidence of type 2 diabetes in moderate alcohol consumers after multivariable adjustments was 0.56 (95% CI: 0.32, 1.00). Conclusion: In subjects already at lower risk of type 2 diabetes on the basis of multiple low-risk lifestyle behaviors, moderate alcohol consumption was associated with an ≈40% lower risk compared with abstention

Substitutions between dairy products and risk of stroke : Results from the European Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort

The association between intake of different dairy products and the risk of stroke remains unclear. We therefore investigated substitutions between dairy product subgroups and risk of stroke. We included 36,886 Dutch men and women. Information about dairy product intake was collected through a food frequency questionnaire. Dairy products were grouped as low-fat milk, whole-fat milk, buttermilk, low-fat yoghurt, whole-fat yoghurt, cheese and butter. Incident stroke cases were identified in national registers. We used Cox proportional hazards regression to calculate associations for substitutions between dairy products with the rate of stroke. During a median follow-up of 15.2 years we identified 884 stroke cases (503 ischemic and 244 hemorrhagic). Median intake of total dairy products was 4 servings/day. Low-fat yoghurt substituted for whole fat yoghurt was associated with a higher rate of ischemic stroke (HR = 2.58, 95 % CI: 1.11, 5.97 per serving/day). Whole fat yoghurt as a substitution for any other subgroup was associated with a lower rate of ischemic stroke (HRs between 0.33 and 0.36 per serving/day). We did not observe any associations for hemorrhagic stroke. In conclusion, whole-fat yoghurt as a substitution for low-fat yoghurt, cheese, butter, buttermilk or milk regardless of fat content was associated with a lower rate of ischemic stroke

Can Menopause Prediction Be Improved with Multiple AMH Measurements? Results from the Prospective Doetinchem Cohort Study

Context: Anti-Müllerian hormone (AMH) levels are used worldwide as a screening tool for the duration of the female reproductive lifespan. Although AMH levels are associated with age at menopause, individual predictions of menopause with a single AMH measurement are unreliable. Objective: This study investigated whether individual AMH decline patterns can improve the prediction of menopause compared with a single measurement. Design: The study population comprised 2434 premenopausal women from the population-based Doetinchem Cohort Study. Participants were followed up every 5 years for a total of 20 years, and AMH was measured in 6699 plasma samples with the picoAMH assay. Longitudinal statistical modeling was combined with time varying Cox modeling, to integrate multiple AMH measurements per woman. Results: The mean age at menopause was 50 years, and 7.4% of the women who reached menopause during follow-up did so before age 45 years. For a 25-year-old, the AMH decline rate between ages 20 and 25 years increased the C-statistic of menopause prediction from 0.64 to 0.69. Beyond that age, the AMH decline rate did not improve predictions of menopause or early menopause. For women younger than age 30 years, for whom menopause prediction is arguably most relevant, the models underestimated the risk of early menopause. Conclusion: These results suggest that knowledge of the AMH decline rate does not improve the prediction of menopause. Based on the low discriminative ability and underestimation of the risk of early menopause, the use of AMH as a screening method for the timing of menopause cannot currently be advocated

Int J STD AIDS

We describe incident human immunodeficiency virus (HIV) and syphilis trends in men who have sex with men (MSM) and transgender women (TGW) presenting for HIV voluntary counseling and testing (VCT) services and sexually transmitted infection (STI) management at the Silom Community Clinic, Bangkok, Thailand. Clients underwent rapid HIV testing and syphilis rapid plasma reagin (RPR) testing. For incidence analysis, we included clients with >1 follow-up visit. Initial negative HIV with subsequent positive HIV defined incident HIV infection; incident syphilis infection was defined as negative RPR followed by positive RPR (titer 651:8) and confirmatory anti- Treponema pallidum antibodies. Calculation of incidence using Poisson regression assumed a uniform probability distribution throughout the seroconversion interval. From 15 September 2005 to 31 December 2015, we tested 10,158 clients for HIV and 10,324 for syphilis. Overall, 7109 clients tested HIV-seronegative and contributed 7157 person-years (PY). Three-hundred forty-seven incident HIV infections resulted in an incidence rate of 4.8 per 100 PY (95% confidence interval [CI] 4.4-5.4). We found an inverted U-shape trend of HIV incidence over time with a peak of 6.4 per 100 PY in quarter 2/2011 ( p\u2009<\u20090.01) (Poisson with RCS function, p\u2009=\u20090.001). Overall, 8713 clients tested seronegative for syphilis and contributed 8623 PY. The incidence of syphilis infection was 4.4 per 100 PY (95% CI 3.9-4.8). Despite an apparent decline in HIV incidence among MSM and TGW attending VCT services, syphilis incidence rose and remained high. Evaluating temporal trends of HIV and syphilis incidence provides an opportunity to evaluate epidemic trajectories and target limited program funding. We recommend focused HIV and STI prevention interventions for MSM in Bangkok.CC999999/Intramural CDC HHS/United States2019-04-19T00:00:00Z30626283PMC6474786616

Adherence to dietary guidelines and cognitive decline from middle age: the Doetinchem Cohort Study

BACKGROUND: Diet, in particular the Mediterranean diet, has been associated with better cognitive function and less cognitive decline in older populations. OBJECTIVES: To quantify associations of a healthy diet, defined by adherence to either the Mediterranean diet, the WHO guidelines, or Dutch Health Council dietary guidelines, with cognitive function and cognitive decline from middle age into old age. METHODS: From the Doetinchem Cohort Study, a large population-based longitudinal study, 3644 participants (51% females) aged 45-75 y at baseline, were included. Global cognitive function, memory, processing speed, and cognitive flexibility were assessed at 5-y time intervals up to 20-y follow-up. Adherence to the Mediterranean diet was measured with the modified Mediterranean Diet Score (mMDS), adherence to the WHO dietary guidelines with the Healthy Diet Indicator (HDI), and adherence to the Dutch Health Council dietary guidelines 2015 with the modified Dutch Healthy Diet 2015 index (mDHD15-index). The scores on the dietary indices were classified in tertiles (low, medium, high adherence). Linear mixed models were used to model level and change in cognitive function by adherence to healthy diets. RESULTS: The highest tertiles of the mMDS, HDI, and mDHD15-index were associated with better cognitive function compared with the lowest tertiles (P values <0.01), for instance at age 65 y equal to being 2 y cognitively younger in global cognition. In addition, compared with the lowest tertiles, the highest tertiles of the mMDS, HDI, and mDHD15-index were statistically significantly associated with 6-7% slower global cognitive decline from age 55 to 75 y, but also slower decline in processing speed (for mMDS: 10%; 95% CI: 2, 18%; for mDHD15: 12%; 95% CI: 6, 21%) and cognitive flexibility (for mDHD15: 10%; 95% CI: 4, 18%). CONCLUSIONS: Healthier dietary habits, determined by higher adherence to dietary guidelines, are associated with better cognitive function and slower cognitive decline with aging from middle age onwards

Dairy intake and coronary heart disease or stroke - A population-based cohort study

Aim: This study aimed to investigate the relationship between total dairy intake and dairy subtypes (high-fat dairy, low-fat dairy, milk and milk products, cheese and fermented dairy) with incident coronary heart disease (CHD) and stroke. Methods: EPIC-NL is a prospective cohort study among 33,625 Dutch men and women. At baseline (1993-1997), dairy intake was measured with a validated food frequency questionnaire (FFQ). The incidence of both fatal and non-fatal CHD and stroke was obtained by linkage to the national registers. Results: During 13 years follow-up, 1648 cases of CHD and 531 cases of stroke were documented. Total dairy intake was not significantly associated with risk of CHD (hazard ratio per standard deviation (SD) increase = 0.99; 95%-CI: 0.94-1.05) or stroke (0.95; 0.85-1.05) adjusted for lifestyle and dietary factors. None of the dairy subtypes was to CHD, while only fermented dairy tended to be associated (p = 0.07) with a lower risk of stroke (0.92; 0.83-1.01). Hypertension appeared to modify the association of total and low-fat dairy with CHD (p interaction < 0.02). Among participants without hypertension, but not among hypertensive participants, total (0.92; 0.85-1.02) and low-fat (0.94; 0.87-1.02) dairy tended to be associated with a lower risk of CHD. Conclusion: Our results provide no evidence that dairy products are associated with risk of CHD or stroke. High intakes of total and low-fat dairy may be associated with a lower risk of CHD among participants without hypertension, while fermented dairy could be associated with a reduced risk of stroke

The mediating role of unhealthy behavior in the relationship between shift work and perceived health

Background: Little is known about the relationship between shift work and perceived health, including potential underlying