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Immigration almost always involves major cultural changes in dietary, social and health-related beliefs and behaviour. Two years after the arrival of the earliest Yemenite immigration wave to Israel, about 30 years ago, the prevalence rate of diabetes in that population was almost nonexistent (approximately 0.06%), increasing to approximately 12% 25 years later. Obesity and hyperlipoproteinemia were not always correlated with diabetes. Ethiopians, mainly from the northern regions, first immigrated to Israel ten years ago. At that time, their prevalence rate of diabetes was 0-0.4%. Though it is too early to determine the overall prevalence rate in this population, 5-8% rates have been reported after up to 5 years in Israel. The objective of the present work was to study the effect of the diversity of ethnic food patterns and adaptability on the nutritional status of Ethiopian immigrants. Two groups were studied--teenagers and adults. After 2 and 18 months in Israel, adult Ethiopians who arrived in Israel in 1991 (n = 426) had an average body mass index (BMI) of 20-22 kg/m2, which was below western values; a waist:hip ratio (WHR) of 0.9 suggested abdominal fat accumulation. Fasting serum- glucose levels were within the norm, whereas insulin levels were high (24 micrograms/mL). Plasma triglycerides (TG) increased with age, from about 100 to 150 mg/dL, whereas cholesterol and lipoprotein levels remained stable and normal. The BMI of Ethiopian teenagers (n = 15) 5-7 years in Israel was similar to that found in adults. Fasting serum insulin levels were significantly lower in boys than in girls (approximately 16.6 vs approximately 18.6 microU/mL, respectively). Cholesterol values were significantly higher in girls than in boys (approximately 184 vs approximately 150 mg/dL); TG, high density and low density lipoprotein values were normal. These data indicate the existence of early signs of risk factors for diabetes, which may not manifest itself clinically unless provoked. Several causes, rendered detrimental by progress, could be setting the stage for early manifestation of risk factors for cardiovascular disease and diabetes. Of these, two are of pertinence to this work: a genetic endowment for low-energy output and the thrifty genotype, and maternal undernutrition.
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PMID:Health risks of immigration: the Yemenite and Ethiopian cases in Israel. 943 30

Although low-density lipoprotein (LDL) cholesterol is a critically important factor in the development of atherosclerosis, nearly half the patients with coronary artery disease have LDL cholesterol levels within the National Cholesterol Education Program (NCEP) guidelines. Therefore, attention has focused on other modifiable risk factors that could strongly impact the development of coronary artery disease. Type 2 diabetics have a 3-fold increased risk of coronary artery disease; prediabetics, without chronic hyperglycemia, have a 2-fold increased risk compared with normal subjects. Insulin resistance has also been implicated as the cause of atherosclerosis. Insulin resistance is associated with hyperinsulinemia and a constellation of other factors, some of which are themselves independent risk factors for coronary artery disease. These include reduced levels of high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, increased small dense LDL particles, hypertension, visceral obesity, and increased levels of plasminogen activator inhibitor-1 (PAI-1). Hyperinsulinemia and insulin resistance at the vascular level also may contribute to vascular injury and the atherosclerotic process. Current studies suggest that controlling hyperglycemia, LDL cholesterol, and blood pressure are important to protect the diabetic from atherosclerosis. A key question, particularly in type 2 diabetes, is to define the best regimen for glucose control that will protect the vasculature. Sulfonylureas, metformin, and troglitazone have direct vascular actions. Metformin lowers LDL cholesterol and triglycerides, while troglitazone reverses many of the components associated with the insulin resistance syndrome. Clinical trials focusing on coronary artery disease outcomes are now warranted to prevent coronary artery disease, the major vascular complication and cause of mortality in diabetes.
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PMID:Cardiovascular risk continuum: implications of insulin resistance and diabetes. 970 62

High serum levels of total and LDL cholesterol are important risk factors in the development of atherosclerotic coronary artery disease. Cholesterol metabolism is affected by nutritional, environmental and genetic factors. Neuropeptide Y (NPY), which is widely expressed in both the central and peripheral nervous systems, has an important role in the hypothalamic regulation of energy balance by stimulating food intake and favoring energy storage through increased lipoprotein lipase activity in white adipose tissue. As a part of ongoing study of the genetic basis of obesity, we screened the NPY gene for sequence variants. We report here the identification of a common Leu(7)-to-Pro(7) polymorphism in the signal peptide of NPY. Presence of this Pro(7) in NPY was associated with higher serum levels of total and LDL cholesterol in obese subjects participating in two independent Finnish and Dutch studies. Furthermore, normal-weight Finns with Pro(7) also had higher serum levels of total and LDL cholesterol than did subjects with Leu(7)/Leu(7), as analyzed in three subsequent determinations at 5-year intervals during a 10-year follow-up period. The NPY polymorphism was not associated with higher cholesterol levels in normal-weight Dutch. Our study provides evidence that NPY is linked to cholesterol metabolism and that the polymorphism producing Pro(7) in NPY is one of the strongest genetic factors identified thus far affecting serum cholesterol, particularly in obese subjects.
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PMID:Association of a leucine(7)-to-proline(7) polymorphism in the signal peptide of neuropeptide Y with high serum cholesterol and LDL cholesterol levels. 984 84

The clinical benefit of cholesterol-lowering treatment is unknown in the Japanese elderly in whom the prevalence of morbidity and mortality related to coronary artery disease are known to be low. To evaluate the efficacy of cholesterol-lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor in Japanese elderly patients with documented coronary artery disease, 121 patients with serum cholesterol > or = 150 mg/dl prospectively received HMG-CoA reductase inhibitor, and 271 patients undergoing cholesterol-lowering treatment based on dietary therapy alone served as historical controls. The 143 elderly patients age > or = 65 years in the 2 groups had similar baseline serum total cholesterol level (201 +/- 30 vs 202 +/- 31 mg/dl), age (71 +/- 4 vs 70 +/- 4 years), proportion of men (37/53 vs 64/90), number of diseased vessels (1.7 +/- 0.9 vs 1.5 +/- 1.0), and incidences of other classical coronary risk factors, including hypertension, diabetes mellitus, smoking, obesity and family history of coronary artery disease. In all 392 patients, similar trends were observed, including serum total cholesterol level (208 +/- 33 vs 201 +/- 34 mg/dl). With HMG-CoA reductase inhibitors, serum total cholesterol level was reduced by 14% in the elderly subjects and by 13% in all patients. During the follow-up of approximately 3 years, cardiac events occurred in 5 patients (one elderly) in the treatment group and 38 patients (12 elderly) in the control group. Kaplan-Meier survival estimates revealed a higher event-free survival rate with HMG-CoA reductase inhibitors in the elderly subjects (98% vs 85%, p < 0.05) and in all patients (94% vs 86%, p < 0.05). Cox proportional hazard modeling also demonstrated a significant reduction in risk for cardiac events with drug therapy (relative risk 0.32, p < 0.05), in addition to the number of diseased vessels (relative risk 1.8, p < 0.01). In contrast, no additional risk was observed with advancing age. Cholesterol-lowering treatment with HMG-CoA reductase inhibitors is effective to improve the prognosis of Japanese elderly patients, including those with normal serum cholesterol level.
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PMID:Efficacy of cholesterol-lowering treatment in Japanese elderly patients with coronary artery disease and normal cholesterol level using 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor. 1071 30

Alterations in plasmatic lipid profile are known to be risk factors for atherosclerotic disease and have been associated with obesity. This research was designed in order to study the incidence of these alterations in obese children and adolescents according to two different reference patterns. Analyses of seric levels of Total Cholesterol (CT) and fractions and of Triglycerides (TG) were done. The sample included 74 obese children and adolescents with average age equal to 11 years and 10 months for boys and 10 years and 9 months for girls and with mean weight/height ratio (W/H) equal to 151 and 149% for boys and for girls, respectively. Plasmatic lipid values obtained were classified according to the American Heart Position Statement Circulation (AHPSC) and to Kwiterovich reference patterns. It was observed that patients with abnormal seric HDL-cholesterol (HDL) levels had a significantly greater (W/H) then the other group. It was also noticed that a greater number of individuals presented abnormal or borderline plasmatic lipid levels (91.9%), specially HDL (93.6%) and TG (67.6%), according to Kwiterovich than AHPSC. Obesity showed to be an important factor in determining lipid profile values and should be included as a variable to indicate screening of these lipoproteins in childhood and adolescence.
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PMID:[Changes in lipid profile in obese children and adolescents]. 1088 98

Findings of studies designated by the acronyms 45, WOSCOP, LIPID and CARE have provided data that led physicians to rethink their "cholesterol testing behavior." Twelve physicians participated in a study conducted in cooperation with the quality circle of the Brugg region in Aargau. Each doctor collected data from the files of 100 patients and filled in a questionnaire. Cardiovascular risk factors and arteriosclerotic secondary illnesses were compiled along with demographic data. Moreover, information was gathered on whether the patient's cholesterol levels had been checked within the last five years. In total, 1183 questionnaires were evaluated, comprising 691 women and 492 men with an average age of 48.6 years. Cholesterol levels had been determined within the last five years in 61.2%. The individual testing behavior of the physicians varied. One-third tested all three blood lipid values (total cholesterol, HDL and triglyzerides) with an equivalent frequency. By contrast, one-third primarily only determined total cholesterol. The last one-third mostly tested total cholesterol and triglyzeride levels. The frequency of serum lipid tests increased proportionally to the number of risk factors. Cholesterol levels were tested less frequently (approx. 55%) in smokers and patients who never practiced sports than in patients with other risk factors (approx. 85%). The testing rate increased proportionally to the increasing number of arteriosclerotic secondary illnesses, but did not reach the one-hundred percent mark until 3 secondary illnesses were involved. Dietary counseling was the primary therapeutic intervention; medication was prescribed with a much rarer frequency. Although 75% of the patients with arteriosclerotic secondary illnesses had measurably higher cholesterol levels (> 5.2 mm/l), approx. one-third of the patients with coronary heart disease received therapy with cholesterol-lowering drugs as compared to only 16% of the patients with peripheral occlusive arterial disease. The conclusions that we can draw from these results for clinical practice are: if cholesterol levels are to be determined in order to evaluate a patient's cardiovascular risk, HDL cholesterol levels should also be tested since the ratio of these two values is a good predictor. To date, triglyzeride levels have not been identified as relevant risk factors for vascular events. Physicians evaluated the other risk factors variably, in particular with regard to obesity. For clinical practice, the potential risk factor of lack of exercise should be defined more accurately. In patients with clinically manifest arteriosclerotic secondary illnesses, serum lipids should be tested routinely and appropriate therapy induced when required.
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PMID:[Cholesterol determination in ambulatory general practice within the scope of the Brugg/AG quality circle]. 1103 57

Thirty-eight obese children and adolescents were investigated for a possible relation between cholesterol and markers of platelet activation, endothelial cell dysfunction, and activation of the coagulation system. Soluble P-selectin, von Willebrand factor antigen (vWf-Ag), D-dimer, and prothrombin fragment 1 + 2 (F1 + 2) were determined by enzyme-linked immunosorbent assays, and factor VIII coagulant activity (VIIIc) was measured by means of one-stage clotting assay. Cholesterol correlated significantly with log P-selectin (r = 0.43, P = 0.003) and log D-dimer (r = 0.33, P = 0.02). Cholesterol did not correlate with vWf-Ag, factor VIIIc, and F1 + 2. Log P-selectin correlated significantly with log D-dimer (r = 0.42, P = 0.003), which remained significant after adjustment for cholesterol (P = 0.02). Log D-dimer correlated significantly with F1 + 2 (r = 0.38, P = 0.01). Our study demonstrates that, in obese children and adolescents, cholesterol is significantly associated with P-selectin and D-dimer, and suggests an unfavorable intercorrelation between metabolic and hemostatic risk factors for coronary heart disease in childhood obesity.
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PMID:Correlation between cholesterol, soluble P-selectin, and D-dimer in obese children and adolescents. 1113 54

The authors examined seasonal variation in physical activity in longitudinal analyses of 580 healthy adults from Worcester, Massachusetts (the Seasonal Variation of Blood Cholesterol Study, 1994-1998). Three 24-hour physical activity recalls administered five times during 12 months of follow-up were used to estimate household, occupational, leisure time, and total physical activity levels in metabolic equivalent (MET)-hours/day. Trigonometric models were used to estimate the peak-to-trough amplitude and phase of the peaks in activity during the year. Total activity increased by 1.4 MET-hours/day (121 kcal/day) in men and 1.0 MET-hours/day (70 kcal/day) in women during the summer in comparison with winter. Moderate intensity nonoccupational activity increased by 2.0-2.4 MET-hours/day in the summer. During the summer, objectively measured mean physical activity increased by 51 minutes/day (95% confidence interval: 20, 82) in men and by 16 minutes/day (95% confidence interval: -12, 45) in women. The authors observed complex patterns of seasonal change that varied in amplitude and phase by type and intensity of activity and by subject characteristics (i.e., age, obesity, and exercise). These findings have important implications for clinical research studies examining the health effects of physical activity and for health promotion efforts designed to increase population levels of physical activity.
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PMID:Seasonal variation in household, occupational, and leisure time physical activity: longitudinal analyses from the seasonal variation of blood cholesterol study. 1115 63

We conducted a prevalence survey of conventional risk factors of coronary artery disease in 3,615 Shinawatra employees and we planned to prospectively follow up this population to determine the impact of the risk factors in the development of coronary disease. The prevalence of hypertension, diabetes mellitus, hyperlipidemia, obesity, physical inactivity and smoking were 7.4 per cent, 1.4 per cent, 21.1 per cent, 13.9 per cent, 76.3 per cent and 16.3 per cent respectively. The awareness of hypertension, diabetes mellitus and hyperlipidemia were 42.2 per cent, 78 per cent and 32.9 per cent respectively. The prevalence of the risk factors was more common in males and increased with increasing age. Dependent variables which were associated with hypertension included: excessive weight; male sex; increasing age; hypercholesterolemia and diabetes mellitus. Variables which were associated with diabetes mellitus were hypertriglyceridemia, hypertension, male sex, increasing age and excessive weight.. Variables which were associated with hypercholesterolemia were hypertriglyceridemia, high HDL-cholesterol, increasing age, excessive weight and hematocrit level while overweight, hypercholesterolemia, low HDL-cholesterol, smoking, hematocrit level, low income and increasing age were associated with hypertriglyceridemia. Excessive weight was associated with hypertriglyceridemia, low HDL-Cholesterol, presence of hypertension, hypercholesterolemia, diabetes mellitus, increasing age and low education.
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PMID:A 5-year prospective study of conventional risk factors of coronary artery disease in Shinawatra employees: a preliminary prevalence survey of 3,615 employees. 1119 29

Cardiovascular disease (CVD) is the leading cause of death and disability in the United States and in most industrialized nations. Major breakthroughs to modern day cardiovascular/lipid research have been attributed to the findings of the Framingham Heart Study and Gofman and colleagues who made associations between lipoprotein levels (LDL, VLDL and HDL) and CVD. Unfortunately, half of all CVD patients have none of the established coronary risk factors (hypertension, hypercholesterolemia, cigarette smoking, diabetes mellitus, obesity) and new strategies for identifying patients need be considered. Although there remains little disagreement regarding the necessity to lower elevated plasma cholesterol levels, there remains much controversy regarding appropriate dietary means of accomplish this goal. The National Cholesterol Education Program (1993) proposed a dietary reduction (Step I and Step II diets) to the percent saturated fat and cholesterol consumed by at-risk patients. Many currently question about the effectiveness of these diets and an alternative diet, replacing saturated fats by monounsaturated fats (olive oil), has attracted recent attention. While diet modification is considered the foundation of primary treatment, other interventions are frequently required. Although early drug trials demonstrated that agents such as nicotinic acid, clofibrate, gemfibrozil, bile acid-binding resins generally slowed progression of atherosclerotic lesions, lowered plasma cholesterol levels and decreased mortality from CVD, the greatest advance to current drug therapy involved the discovery of the "statins" (HMG-CoA reductase inhibitors). In the current work, mechanisms for vascular dysfunction resulting in myocardial ischemia were explored and potential nutritional (dietary) and pharmacologic interventions were reviewed.
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PMID:Cardiovascular disease: a historic perspective. 1123 77


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