Modeling predicted that tobacco control policies targeted at lower educated will reduce the differences in life expectancy.

Background and Objective: To estimate the effects of reducing the prevalence of smoking in lower educated groups on educational differences in life expectancy. Methods: A dynamic Markov-type multistate transition model estimated the effects on life expectancy of two scenarios. A "maximum scenario" where educational differences in prevalence of smoking disappear immediately, and a "policy target-scenario" where difference in prevalence of smoking is halved over a 20-year period. The two scenarios were compared to a reference scenario, where smoking prevalences do not change. Five Dutch cohort studies, involving over 67,000 participants aged 20 to 90 years, provided relative mortality risks by educational level, and smoking habits were assessed using national data of more than 120,000 persons. Results: In the reference scenario, the difference in life expectancy at age 40 between highest and lowest educated groups was 5.1 years for men and 2.7 years for women. In the "maximum scenario" these differences were reduced to 3.6 years for men and 1.7 years for women (reduction ≈30%), and in the "policy target-scenario" differences were 4.7 years for men and 2.4 years for women (reduction ≈10%). Conclusion: Theoretically, educational differences in life expectancy would be reduced by 30% at maximum, if variations in smoking prevalence were eliminated completely. In practice, tobacco control policies that are targeted at the lower educated may reduce the differences in life expectancy by approximately 10%. © 2006 Elsevier Inc. All rights reserved

The prevalence of chronic psychological complaints and emotional exhaustion among overweight and obese workers

Purpose:Literature suggests a relationship between overweight and obesity, and mental health problems, but data regarding prevalence rates are scarce. This study aimed to determine the prevalence of chronic psychological complaints and emotional exhaustion among overweight and obese workers. Methods:Data were used from the Netherlands Working Conditions Survey (NWCS), which is representative for Dutch employees (n = 43,928). Based on self-reported body mass index (BMI), workers were classified into underweight, healthy weight, overweight, and obesity. Respondents indicated whether they suffered from chronic psychological complaints. Emotional exhaustion was measured by using the UBOS subscale. Logistic regression analyses were used to test differences in prevalence across weight categories, with healthy weight as the reference group. Analyses were stratified for gender, age, education, and occupation. Results:Of the obese workers, 15.7% reported emotional exhaustion and 3.7% reported chronic psychological complaints. These prevalence rates were significantly higher than among healthy weight workers. A significant J shape was found with healthy weight workers reporting the lowest prevalence of both indicators of mental health problems. This J shape was generally also seen among the gender, age, education, and occupation subgroups, though not consistently significant.Conclusion:Considering the proportion of obese workers that also suffers from psychological co-morbidities, interventions targeting obesity should take this into account. As weight-related stigma may play a role in the risk for mental health problems among obese workers, future longitudinal research on the mechanisms for the relation between overweight and mental health problems are recommended

Health care costs attributable to overweight calculated in a standardized way for three European countries

This article presents a tool to calculate health care costs attributable to overweight in a comparable and standardized way. The purpose is to describe the methodological principles of the tool and to put it into use by calculating and comparing the costs attributable to overweight for The Netherlands, Germany and Czech Republic. The tool uses a top-down and prevalence-based approach, consisting of five steps. Step one identifies overweightrelated diseases and age- and gender-specific relative risks. Included diseases are ischemic heart disease, stroke, hypertension, type 2 diabetes mellitus, colorectal cancer, postmenopausal breast cancer, endometrial cancer, kidney cancer and osteoarthritis. Step two consists of collecting data on the age- and gender-specific prevalence of these diseases. Step three uses the population-attributable prevalence to determine the part of the prevalence of these diseases that is attributable to overweight. Step four calculates the health care costs associated with these diseases. Step five calculates the costs of these diseases that are attributable to overweight. Overweight is responsible for 20–26 % of the direct costs of included diseases, with sensitivity analyses varying this percentage between 15–31 %. Percentage of costs attributable to obesity and preobesity is about the same. Diseases with the highest percentage of costs due to overweight are diabetes, endometrial cancer and osteoarthritis. Disease costs attributable to overweight as a percentage of total health care expenditures range from 2 to 4 %. Data are consistent for all three countries, resulting in roughly a quarter of costs of included diseases being attributable to overweight

Change in saturated fat intake is associated with progression of carotid and femoral intima-media thickness, and with levels of soluble intercellular adhesion molecule-1

BACKGROUND: A high saturated fat (SFA) intake may stimulate progression of atherosclerosis, and may be positively associated with expression of adhesion molecules. METHODS: In moderately hypercholesterolaemic participants of a dietary intervention study (n=103; 55+/-10 years), we examined associations between reported changes in SFA intake and changes in carotid and femoral intima-media thickness (IMT) and soluble intercellular adhesion molecule-1 (sICAM-1) levels after 2 years. The carotid and femoral IMT was assessed by high-resolution B-mode ultrasound images. RESULTS: After 2 years, dietary intake of SFA decreased with 1.8+/-2.6% of energy (P<0.01). In the lowest quintile of change in SFA intake (-5.9+/-1.4% of energy), changes in carotid and femoral IMT were +0.03 mm (SEM 0.03) and -0.09 mm (SEM 0.07), respectively, versus +0.10 mm (SEM 0.03), +0.17 mm (SEM 0.07) in the top quintile (+1.6+/-0.7% of energy) (P linear trend 0.07 (carotis), 0.02 (femoralis)). Changes in sICAM-1 were -19.0 ng/nl (SEM 5.6) in the lowest quintile, versus +8.6 ng/ml (SEM 5.3) in the top quintile (P linear trend <0.001), adjusted for baseline level, SFA intake, body mass index, age, changes in intake of fruit, polyunsaturated fat, and dietary cholesterol. Adjustments for changes in established risk factors did not alter these results. CONCLUSIONS: Decreased SFA intake may reduce progression of atherosclerosis, as assessed by IMT, and is associated with reduced levels of sICAM-1 after 2 years. Further research using randomised placebo-controlled trials is necessary to exclude potential confounding variables and to confirm causality. Record 6 of 32 - SilverPlatter MEDLINE(R)

Preventing weight gain: one-year results of a randomized lifestyle intervention

BACKGROUND: Lifestyle interventions targeting prevention of weight gain may have better long-term success than when aimed at weight loss. Limited evidence exists about such an approach in the primary care setting. DESIGN: An RTC was conducted. SETTING/PARTICIPANTS: Participants were 457 overweight or obese patients (BMI=25-40 kg/m(2), mean age 56 years, 52% women) with either hypertension or dyslipidemia, or both, from 11 general practice locations in The Netherlands. INTERVENTION: In the intervention group, four individual visits to a nurse practitioner (NP) and one feedback session by telephone were scheduled for lifestyle counseling with guidance of the NP using a standardized computerized software program. The control group received usual care from their general practitioner (GP). MAIN OUTCOME MEASURES: Changes in body weight, waist circumference, blood pressure, and blood lipids after 1 year (dropout <10%). Data were collected in 2006 and 2007. Statistical analyses were conducted in 2007 and 2008. RESULTS: There were more weight losers and stabilizers in the NP group than in the general practitioner usual care (GP-UC) group (77% vs 65%; p<0.05). In men, mean weight losses were 2.3% for the NP group and 0.1% for the GP-UC group (p<0.05). Significant reductions occurred also in waist circumference but not in blood pressure, blood lipids, and fasting glucose. In women, mean weight losses were in both groups 1.6%. In the NP group, obese people lost more weight (-3.0%) than the non-obese (-1.3%; p<0.05). CONCLUSIONS: Standardized computer-guided counseling by NPs may be an effective strategy to support weight-gain prevention and weight loss in primary care, in the current trial, particularly among men. TRIAL REGISTRATION: The study was registered with the Netherlands Trial Register (NTR), www.trialregister.nl, study no. TC 1365

Identification of nutritionally adequate mixtures of vegetable oils by linear programming.

OBJECTIVE: To determine the types and proportions of vegetable oils to recommend for a healthy diet. METHODS: Optimal vegetable oil combinations were designed, using linear programming and, as decision variables, nine single oils and 29 basic food items. 'Oil models' were run to determine whether reasonable amounts of individuals oils or oil mixtures satisfied a set of constraints on essential fatty acids and vitamin E. 'Meal models' were run to test whether selected mixtures could be used as the sole source of added fat in a meal that met micronutrient and macronutrient recommendations. RESULTS: The cheapest mixture (0.97 euro L(-1)) that solved the oil models contained 81% rapeseed and 19% sunflower oils. About 10-15 g of this mixture, alone or with olive, soya bean, wheat germ or walnut oils, also solved the meal models. Mixtures that contained a high proportion (>or=50%) of the tasty olive and walnut oils also solved the models but were more expensive (4.9 euro L(-1) and 8.5 euro L(-1), respectively). CONCLUSIONS: The consumption of a mixture composed of rapeseed and sunflower oils in a 4 : 1 proportion is an inexpensive and simple way to meet current dietary recommendations for essential fatty acids and vitamin E, favouring overall dietary nutrient adequacy

Effect of an increased intake of alpha-linolenic acid and group nutritional education on cardiovascular risk factors: the Mediterranean Alpha-linolenic Enriched Groningen Dietary Intervention (MARGARIN) study

BACKGROUND: The effect of long-term increased intakes of alpha-linolenic acid (ALA; 18:3n-3) on cardiovascular risk factors is unknown. OBJECTIVES: Our objectives were to assess the effect of increased ALA intakes on cardiovascular risk factors and the estimated risk of ischemic heart disease (IHD) at 2 y and the effect of nutritional education on dietary habits. DESIGN: Subjects with multiple cardiovascular risk factors (124 men and 158 women) were randomly assigned in a double-blind fashion to consume a margarine rich in either ALA [46% linoleic acid (LA; 18:2n-6) and 15% ALA; n = 114] or LA (58% LA and 0.3% ALA; n = 168). An intervention group (n = 110; 50% ALA) obtained group nutritional education, and a control group (n = 172; 34% ALA) received a posted leaflet containing the standard Dutch dietary guidelines. RESULTS: Average ALA intakes were 6.3 and 1.0 g/d in the ALA and LA groups, respectively. After 2 y, the ALA group had a higher ratio of total to HDL cholesterol (+0.34; 95% CI: 0.12, 0.56), lower HDL cholesterol (-0.05 mmol/L; -0.10, 0), higher serum triacylglycerol (+0.24 mmol/L; 0.02, 0.46), and lower plasma fibrinogen (-0.18 g/L; -0.31, -0.04; after 1 y) than did the LA group (adjusted for baseline values, sex, and lipid-lowering drugs). No significant difference existed in 10-y estimated IHD risk. After 2 y, the intervention group had lower saturated fat intakes and higher fish intakes than did the control group. CONCLUSIONS: Increased ALA intakes decrease the estimated IHD risk to an extent similar to that found with increased LA intakes. Group nutritional education can effectively increase fish intake. Record 4 of 4 - SilverPlatter MEDLINE(R)