Han CG Kemper is emeritus professor at the VU University Medical Center, EMGO Institute, Amsterdam. His expertise is in Health and Physical Activity in youth. He was the principle investigator of the Amsterdam Growth and Health Longitudinal Study.
Abstract: This paper examines the epidemiology of hypertension and management strategies of cardiovascular diseases (CVDs) in paediatric populations in sub-Saharan Africa and other parts of the world in the 21st century. A computerized literature search was carried out using Medline, Evidence-Based Child Health (A Cochrane Review Journal), the Cochrane Library and Cochrane Child Health Field. A manual search in the African Journal for physical, health education, recreation and dance, the South African Journal for Research in Sports, Physical Education and Recreation and a few individuals in the area were requested to send some of their recent unpublished and published reports in the field. High prevalence rates and high odds ratios for high blood pressure (BP) were recorded in children aged 5-17 years. There is a need for health ministries to improve the public health sector so as to close the gap between the rich and the poor. Although personal and parental responsibility remain crucial, it also falls on the government to help control powerful environmental factors that are leading our children to premature ill-health and mortality. Equally, health professionals are increasingly recognized that they have a significant role to play in delivering medical treatment of hypertension in children.Journal of Human Hypertension (2008) 22, 450-459; doi:10.1038/jhh.2008.21; published online 17 April 2008.
Abstract: Despite lack of convincing evidence that reduced aerobic fitness is associated with chronic back pain (CBP), exercise programs are regarded as being effective for persons with non-specific CBP. It is unsure whether gain in aerobic fitness following intervention is associated with functioning improvement in persons with CBP. The objective of this prospective cohort study was to study the impact of aerobic fitness on functioning in persons with CBP, at baseline and following 3-week intensive interdisciplinary intervention. This study included persons who had passed 8 weeks of sick-listing because of back pain (n = 94) and were referred to a 3-week intensive biopsychosocial rehabilitation program. Aerobic fitness was assessed with a sub-maximal bicycle test at baseline, at admission to and discharge from the rehabilitation program, and at 6 months follow-up. Contextual factors, body function, activity and participation were evaluated before and after intervention. In addition, working ability was recorded at 3-years follow-up. At baseline aerobic fitness was reduced in most subjects, but improved significantly following intervention. Baseline measurements and intervention effects did not differ among the diagnostic sub-groups. Neither contextual factors nor functioning at baseline were associated with aerobic fitness. Increase in aerobic fitness was not associated with improvements in functioning and contextual factors and work-return following intervention either. From this study we conclude that improvement of aerobic fitness seems of limited value as goal of treatment outcome for patients with CBP.
Abstract: The present study investigated the relationship between blood pressure (BP), fat patterns and fitness parameters of Ellisras children aged 7-13 years. Furthermore, an assessment of body fat patterns was done to determine the subjects with the highest risk of overweight, hypertension and waist-to-hip ratio above the 90th percentile. Data were collected from 1,817 subjects (938 boys and 879 girls), aged 7-13 years, participating in the Ellisras Longitudinal Study. Anthropometric measurements were taken according to the standard procedure of the International Society for the Advancement of Kinanthropometry. The EUROFIT test items were used to test the physical fitness of 1,192 subjects (634 boys and 558 girls). Obesity was defined using the international recommended cutoff points for body mass index (BMI) in children. Hypertension was defined as the occurrence of BP levels greater or equal to the 95th percentile of height- and sex-adjusted reference levels. The prevalence of hypertension ranged from 1 to 11.4% and that of overweight 0.6-4.6%. Waist girth, BMI, triceps and subscapular skinfold showed significant (P<0.001-0.05) correlation with other fat pattern parameters (r ranging from -0.157 to 0.978) compared with significant correlations (P<0.001-0.05) with BP (r ranging from -0.071 to 0.164). Children with waist girth greater than the 90th percentile are more likely to have multiple risk factors than the children with a waist girth that is less than or equal to the 90th percentile. Longitudinal studies should verify whether changes in waist girth and skinfolds will indicate changes in cardiovascular risk factors during growth.
Abstract: The objective of this study was to investigate the development and tracking of nutritional status, body composition and physical fitness, and the longitudinal relationship of changes in nutritional status, and body composition with changes in physical fitness over a 1-year period of follow-up. Studied were 380 boys and 322 girls aged 7-14 years from the Ellisras Longitudinal Study. Boys and girls were divided into two groups of pre-adolescence (<11 years) and adolescence (>10 years). High tracking coefficients (>8) were found for nutritional status, body mass index, and fat-free mass, while low tracking coefficients (<4) were found for the sum of skinfolds, fat mass, arm muscle area, and central fat distribution. Moderate and low tracking coefficients were found for the physical fitness items. Longitudinal regression analyses showed that physical fitness performances that require a high energy flux over a short period of time are affected by muscle wasting, whereas having a low body weight appears to be important for a good performance on other fitness items in these malnourished rural South African children.
Abstract: BACKGROUND: Physique has been useful in assessing the outcome of underlying growth and maturity processes, which leads to a better understanding of variation in child and adult health. However, a high endomorphy rating has been associated with hypertension in adults, posing a serious threat to their health status, while receiving little attention in children. AIM: The study examined the association between somatotypes, body mass index (BMI) and blood pressure (BP) in 6-13-year-old rural children, in Ellisras, South Africa. SUBJECTS: A total of 1902 subjects (980 boys and 922 girls) aged 6-13 years were studied as part of the Ellisras Longitudinal Study. Height, weight, four skinfold sites, two breadths, and two girths were measured according to the International Society for the Advancement of Kinanthropometry (ISAK). The Heath-Carter method of somatotyping was used, together with internationally recommended cut-off points for BMI in children. Hypertension, defined as the average of three separate BP readings, where the systolic or diastolic BP is greater than or equal to the 95th percentile for age and sex, was determined. RESULTS: The prevalence of hypertension ranges from 1 to 5.8% in boys and 3.4-11.4% in girls. The prevalence of overweight ranges from 1.1 to 2.9% in boys and 0.6-4.6% in girls. Systolic BP and BMI showed a significant positive correlation at age 6 years (r = 0.436) and 10-13 years (r = 0.180-0.246 in boys and r = 0.221-0.271 in girls). Diastolic BP showed an insignificant correlation with the BMI and somatotype components in boys and girls. CONCLUSION: A significant association exists between BP and BMI, and ectomorphy components even after being adjusted for age, gender and height. The need to manage hypertensive individuals is evident in this sample to combat this chronic disease from an early age. Follow-up studies should investigate the relationship between BP and the dietary intake of these children.
Abstract: BACKGROUND: Body mass index (BMI) during adolescence is predictive of BMI at adult age. However, BMI cannot distinguish between lean and fat body mass. Skinfold thickness may be a better predictor of body fatness. OBJECTIVE: The objective of this study was to evaluate the relations between BMI and skinfold thickness during adolescence and body fatness during adulthood. DESIGN: We included 168 men and 182 women from the Amsterdam Growth and Health Longitudinal Study, a prospective study that conducted 8 measurements of BMI and skinfold thickness between 1976 and 2000. BMI and skinfold thickness during adolescence were analyzed in relation to adult body fatness measured at a mean age of 37 y with dual-energy X-ray absorptiometry. RESULTS: None of the boys and 1.7% of the girls were overweight at baseline, whereas the prevalence of high body fatness during adulthood was 29% in men and 32% in women. At the ages of 12-16 y, skinfold thickness was more strongly associated with adult body fatness than was BMI. Age-specific relative risks for a high level of adult body fatness varied between 2.3 and 4.0 in boys and between 2.1 and 4.3 in girls in the highest versus the lowest tertile of the sum of 4 skinfold thicknesses. For the highest tertile of BMI, the relative risk varied between 0.8 and 2.1 in boys and between 1.3 and 1.8 in girls. CONCLUSION: Skinfold thickness during adolescence is a better predictor of high body fatness during adulthood than is BMI during adolescence.
Abstract: Health-related fitness values during childhood (from age 11 to 16 years) were analyzed in relation to changes in physical activity level. One hundred fifty-eight children were monitored over a 4-year period. Twice a year, they performed six physical fitness tests: standing broad jump, 10 x 5-meter shuttle run, sit-and-reach, handgrip, number of sit-ups in 30 s, and 20-m shuttle run. Height was measured four times per year to assess age at peak height velocity. Physical activity was assessed with a self-administered questionnaire at baseline and at the end of the follow-up. The physical activity level was defined by the frequency and the time spent in moderate-to-vigorous physical activities. Two groups were constituted: regularly active and sedentary. A multiple linear multilevel regression analysis was used to analyze the longitudinal relationships between changes in physical activity and physical fitness levels. Corrections were made for both time-dependent (time) and time-independent (sex) variables. Except for flexibility, boys' fitness performances increased more than that for the girls. Positive and significant (P < 0.05) regression coefficients were found with the regularly active for standing broad jump, 20-m shuttle run, number of sit-ups, 10 x 5-m shuttle run in both sexes, and for the girls' sit-and-reach performance. Increasing or decreasing physical activity level was not associated with changes in fitness performances over time, except for flexibility for the girls and the 20-m shuttle run for the boys. From childhood to adolescence, increasing physical activity is not sufficient to be more fit. The children who are stayed the most active were the fittest, particularly the girls. Am. J. Hum. Biol. 18:51-58, 2006. (c) 2005 Wiley-Liss, Inc.
Abstract: BACKGROUND: Hypertension is one of the major causes of death in developed and underdeveloped nations. Essential hypertension and obesity may have their inception in childhood, with little data in African children to support these findings. Objectives were to determine the prevalence of overweight and hypertension in rural children in South Africa. Additionally, the association between fat-patterning ratios and blood pressure (BP) was investigated. METHODS: Data were collected from 1884 subjects (967 boys and 917 girls), aged 6-13 years, participating in the Ellisras Longitudinal Study. Height; weight; and triceps, biceps, subscapular, and suprailiac skinfolds were measured according to the protocol of the International Society for the Advancement of Kinanthropometry. Skinfold ratio was used as an indicator of the central pattern of body fat. Internationally recommended cut-off points for body mass index (BMI) were used. Hypertension, defined as the average of three separate BP readings where the systolic BP or diastolic BP is >or=95th percentile for age and sex, was determined. RESULTS: The prevalence of hypertension ranged from 1 to 5.8% for boys and 3.1 to 11.4% for girls, and that of overweight from 1.1 to 2.9% for boys and 0.6 to 4.6% for girls. The association between high systolic BP and high BMI was -3.0, while that for high diastolic BP and high BMI was -0.68. CONCLUSIONS: The prevalence of hypertension is evident from the age 6 years for girls, while that of overweight was low. Overweight became evident from the age 10 to 13 years for both sexes. A significant association between high diastolic BP and high BMI was noted, while children with low BMIs were less likely to be hypertensive. Investigating habitual physical activity, fitness and dietary patterns will shed more light on the association of fat patterning and BP in this population.
Abstract: OBJECTIVE: A polymorphism near the promoter region of the IGF-I gene has been associated with serum IGF-I levels, body height and birth weight. In this study, we investigated whether this polymorphism is associated with body composition in young healthy subjects in two cohorts of different generations. DESIGN: Observational study with repeated measurements. METHODS: The study group consisted of two comparable young Dutch cohorts with a generational difference of around 20 years. The older cohort consisted of 359 subjects born between 1961 and 1965. Measurements were performed from 13 until 36 years of age. The younger cohort consisted of 258 subjects born between 1981 and 1989. Measurements were performed from 8 until 14 years of age. Height, body mass index (BMI), fat mass, fat-free mass, waist and hip circumference were compared between wild-type carriers and variant type carriers of the IGF-I polymorphism. RESULTS: In the younger cohort, body weight, BMI, fat mass and waist circumference were significantly higher in female variant carriers of the IGF-I polymorphism. A similar trend was observed in male variant carriers. In contrast, these differences were not observed in the older cohort. Irrespective of genotype, the younger cohort showed a significantly higher total fat mass, body weight and BMI compared with the older cohort. CONCLUSIONS: Because the differences between both genotypes were small, it seems likely that the genetic variability due to this IGF-I polymorphism impacts only slightly on body composition. Importantly, our study suggested that associations between this IGF-I promoter polymorphism and body composition possibly reflect a gene-environmental interaction of this polymorphism and that an environment that promotes obesity leads to a slightly more pronounced fat accumulation in variant carriers of this IGF-I polymorphism.
Abstract: OBJECTIVE: To determine the significance of degree of symptom-specificity in the disablement condition in chronic back pain. DESIGN: Cross-sectional design. SUBJECTS: All inhabitants of a restricted geographical area of Norway, who had had 8 weeks of sick-leave due to back pain during a 2-year period, were included in this study. Following examination they were diagnosed as having "specific back pain" (n=34), "non-specific back pain" (n=113) or "widespread pain" (n=49). METHODS: Functioning of the 3 diagnostic subgroups was described and compared. Functioning assessment was guided by the concepts of the International Classification of Functioning, Disability and Health (ICF): health condition, body function and structure, activity, participation and contextual factors. RESULTS: Pain components and final participation restriction did not differ among the diagnostic subgroups. However, with increasing symptom-specificity, loss of physical body functions and structures and subsequent activity limitation tended to increase. On the other hand, with decreasing symptom-specificity, mental distress, unfavourable contextual factors and dissatisfaction with various factors of life tend to increase, which may raise the impact of pain on restricting participation in activities. CONCLUSION: Functioning description according to the components of the ICF model indicated that the disablement condition in patients with back pain who had been on sick-leave for 8 weeks may appear more complex with decreasing symptom-specificity.
Abstract: BACKGROUND: The mechanisms that link the metabolic syndrome to increased cardiovascular risk are incompletely understood, especially in young people. We therefore examined whether the metabolic syndrome was associated with arterial stiffness and whether any such associations were independent of cardiopulmonary fitness and subcutaneous trunk fat. METHODS: Cross-sectional analyses of data on 364 men and women aged 36 years from the Amsterdam Growth and Health Longitudinal Study (ninth follow-up measurement, year 2000). The prevalence of the metabolic syndrome was defined by a slightly modified National Cholesterol Education Program (NCEP) definition. Arterial stiffness was ultrasonically estimated by distensibility and compliance of the carotid, femoral, and brachial arteries and by the carotid elastic modulus. RESULTS: The prevalence of the metabolic syndrome in this young adult population was 18.3% in men and 3.2% in women. Individuals with the syndrome compared with individuals without risk factors had 11.2% and 17.0% less distensibility and 9.0% and 18.2% less compliance of the carotid and femoral arteries, respectively, and 15.9% higher carotid elastic modulus. After adjustment for cardiopulmonary fitness and subcutaneous trunk fat, the metabolic syndrome remained significantly associated with stiffness of the carotid but not the femoral artery. In addition, poor cardiopulmonary fitness and high subcutaneous trunk fat were associated with arterial stiffness, and this was independent of the metabolic syndrome. CONCLUSIONS: A modified NCEP definition of the metabolic syndrome identified young individuals with increased arterial stiffness. The mechanisms that link the metabolic syndrome, poor cardiopulmonary fitness, and high subcutaneous trunk fat to greater arterial stiffness overlap but are partly independent of each other.
Abstract: OBJECTIVE: To outline the rationale, objectives and strategies used in a systematically designed research programmme to study specific weight gain-inducing behaviours, their social-psychological as well as environmental determinants, and the effects of interventions aimed at the prevention of weight gain. DESIGN: The evidence for potential behavioural determinants and strategies to prevent weight gain was reviewed, and the methods applied within the Netherlands Research programme weight gain prevention (NHF-NRG) project were described. The project is designed according to the Intervention Mapping protocol. SETTING: The Netherlands. SUBJECTS: The main target groups are (a) adolescents (12-16 y) in secondary school, (b) young adults (20-40 y) at the workplace and (c) recently retired people (55-65 y) at home. INTERVENTIONS: Each intervention includes an individual component, in which computer-tailored information is provided. Additionally, interventions are aimed at changing environmental components. RESULTS: The short-term results of this project can be expected by the beginning of 2005. Guidelines for nationwide weight gain prevention, based on this research programme, will become available in 2007. CONCLUSIONS: Based on the few interventions that were evaluated to date, no robust conclusions can be drawn regarding the effectiveness of obesity prevention. The systematic and multidisciplinary design of the NHF-NRG programme enables the identification of potentially effective methods and strategies for the prevention of weight gain.
Abstract: BACKGROUND: Among young adults, the metabolic syndrome is an increasingly frequent risk factor for cardiovascular disease. Its determinants are, however, incompletely understood. We investigated the time course, from adolescence (age, 13 years) to young adulthood (age, 36 years), of important potential determinants (body fatness and fat distribution, cardiopulmonary fitness, and lifestyle) in 364 individuals (189 women). METHODS: Data were derived from the Amsterdam Growth and Health Longitudinal Study and analyzed with the use of generalized estimating equations. RESULTS: The prevalence of the metabolic syndrome at the age of 36 years, as identified with a modified National Cholesterol Education Program definition of the syndrome, was 10.4%. Subjects with the metabolic syndrome at the age of 36 years, compared with those without the syndrome, had (from adolescence to the age of 36 years) the following: (1) a more marked increase in total body fatness and in subcutaneous trunk fat; (2) a more marked decrease in cardiopulmonary fitness levels; (3) a more marked increase in physical activities of light-to-moderate intensity, but a more marked decrease in hard physical activities; (4) a trend toward a higher energy intake throughout the years; and (5) a decreased likelihood of drinking alcoholic beverages. CONCLUSIONS: Fatness, fitness, and lifestyle are important determinants of the metabolic syndrome in young adults. More important, these associations were independent of each other and, therefore, represent separate potential targets for the prevention of the metabolic syndrome. Our study further suggests that intervening early in life (eg, in the period of transition from adolescence to adulthood) may be a fruitful area for prevention of the metabolic syndrome.
Abstract: OBJECTIVE: The purpose of this study was to determine the relationships between the body composition characteristics, body mass index (BMI), sum of skinfolds (SSF), % body fat (%BF), fat-free mass (FFM) and waist-to-hip ratio (WHR), and nine physical fitness items in undernourished rural primary school children in Ellisras, South Africa. DESIGN: A cross-sectional study. SETTING: The study consisted of 462 boys and 393 girls who were aged 7-14 y. MEASUREMENTS: Five body composition measures were assessed: BMI, SSF, %BF, FFM and WHR. Nine physical fitness test items were assessed: standing long jump, bent arm hang, sit-ups, 10 x 5 m shuttle run, 50 m sprint, 1600 m run, flamingo balance, sit and reach, plate tapping. RESULTS: BMI was highly correlated with FFM (r = 0.7, P < 0.001). In line with findings from Western countries, regression coefficients (B) showed that children with higher BMI or SSF performed worse in bent arm hang (girls, B = -0.84, P < 0.001, and B = -0.06, P = 0.02, respectively) and in 1600m run (B = 6.68, P < 0.001). BMI was significantly associated with flamingo balance (B = 0.26, P = 0.04). WHR was positively associated with bent arm hang (B = 9.37, P = 0.03), and inversely with sit and reach (B = -7.48, P = 0.01). In contrast, significant relationships were found between BMI and standing long jump (B = 0.74, P = 0.04), sit and reach (B = 0.51, P < 0.001), flamingo balance (B = 0.26, P = 0.04) and plate tapping (B = -19, P = 0.01). SSF was significantly associated with sit and reach (B = 0.04, P = 0.03). Significant inverse associations were found between FFM and bent arm hang (girls, B = -0.06, P = 0.05), 1600 m run (girls, B = -2.33, P = 0.003) and 50 m run (boys, B = -0.11, P = 0.006). FFM was significantly associated with standing long jump (boys, B = 0.99, P < 0.001; girls, B = 0.73, P < 0.001), flamingo balance (B = 0.17, P < 0.001), and with sit and reach (boys, B = 0.59, P = 0.03). CONCLUSION: In the present study in undernourished children, body composition was significantly related to physical fitness, but not always in the expected direction. It is therefore important to note that in this population, BMI should not be interpreted as a measure of fatness/overweight, but rather as an indicator of muscle mass.
Abstract: OBJECTIVE: To investigate whether IGF-I promoter polymorphism was associated with birth weight and risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2DM), and whether the birth weight--risk factor relationship was the same for each genotype. DESIGN AND PARTICIPANTS: 264 subjects (mean age 36 years) had data available on birth weight, IGF-I promoter polymorphism genotype, CVD and T2DM risk factors. Student's t-test and regression analyses were applied to analyse differences in birth weight and differences in the birth weight--risk factors relationship between the genotypes. RESULTS: Male variant carriers (VCs) of the IGF-I promoter polymorphism had a 0.2 kg lower birth weight than men with the wild type allele (p = 0.009). Of the risk factors for CVD and T2DM, solely LDL concentration was associated with the genotype for the polymorphism. Most birth weight--risk factor relationships were stronger in the VC subjects; among others the birth weight--systolic blood pressure relationship: 1 kg lower birth weight was related to an 8.0 mmHg higher systolic blood pressure CONCLUSION: The polymorphism in the promoter region of the IGF-I gene is related to birth weight in men only, and to LDL concentration only. Furthermore, the genotype for this polymorphism modified the relationships between birth weight and the risk factors, especially for systolic and diastolic blood pressure.
Abstract: OBJECTIVE: Investigating the relationship between birth weight and the metabolic syndrome and the modifying effects of lifestyle in adults (36.5 years). STUDY DESIGN AND SETTING: 273 subjects completed a birth-weight questionnaire; waist circumference, HDL and triglyceride concentrations, blood pressure and HbA1c, physical activity and fitness, smoking status and dietary intake were measured. Risks for the metabolic syndrome and for having at least two of the components of the metabolic syndrome were calculated and the modifying effect of lifestyle factors was assessed by comparing four groups based on birth weight and a lifestyle factor. RESULTS: Birth weight was not associated with the metabolic syndrome (odds ratio OR = 0.67, 95% confidence interval CI = 0.25-1.79). Birth weight lower than the median increased the risk for having at least two components (OR = 2.28, 95% CI = 1.15-4.50). Subjects who smoked and had a birth weight lower than the median had a 6.9 times increased risk. Modification by lifestyle measured at age 36 was not observed, although effect modification using lifestyle data from 32 years was found. CONCLUSIONS: Lower birth weight increased the risk for having at least two components of the metabolic syndrome. Smoking, being less physical active or fit, have an unfavorable diet at age 32 adds to this risk.
Abstract: OBJECTIVE: Serum lipids, blood pressure and body mass may mediate the U-shaped relationship of alcohol consumption with type 2 diabetes mellitus and coronary heart disease. This study examines the cross-sectional and long-term longitudinal relationships of (changes in) alcohol consumption with (changes in) serum lipids, blood pressure and body mass indices. METHOD: In this prospective, observational cohort study, two measurements of alcohol consumption, serum total and high-density lipoprotein cholesterol, triglycerides, blood pressure, body weight, the thickness of four skinfolds and waist circumference were performed 4 years apart in healthy volunteers (143 men and 174 women, 32 years old at the first measurement). Alcohol consumption from beer, wine and distilled spirits was assessed using an extensive dietary history interview. Linear regression analyses were performed to study the cross-sectional relationships between the amount of alcohol consumed at the age of 32 years and the levels of the lipids, blood pressure and body weight indices, and to study the longitudinal relationships between the changes in the amount of alcohol consumed over the 4 years of follow-up and the concurrent changes in the lipids, blood pressure and body weight indices. Nonlinearity was investigated for the cross-sectional relationships. RESULTS: A 10-g/day difference in alcohol consumption was positively related with a 0.05 mmol/L (1.9 mg/dl) difference in high-density lipoprotein cholesterol in both cross-sectional (p = .004), and longitudinal (p < .0001) analyses. This relationship did not differ for men and women or for the consumption of beer, wine or distilled spirits. Relationships with changes in total cholesterol, triglycerides, systolic, diastolic, and pulse pressure, body weight and the sum of four skinfolds were not significant. A borderline significant inverse longitudinal relationship was found with waist circumference. The other lifestyle behaviors (tobacco smoking, physical activity and dietary habits) were major confounders of most cross-sectional relationships between alcohol and serum lipids, blood pressure and body mass indices. The longitudinal relationships, however, were not confounded by changes in the other lifestyle behaviors. A significant nonlinear relationship was found for systolic blood pressure, in which drinkers of about 30 g/day had the lowest values. CONCLUSIONS: Moderate alcohol consumption and moderate long-term changes in alcohol consumption are positively related with the levels and changes in high-density lipoprotein cholesterol in healthy adult men and women. A moderate inverse association between alcohol and waist circumference may be expected. No relationships were found with triglycerides, blood pressure, body weight and the sum of the thickness of four skinfolds. Other lifestyle behaviors confound the cross-sectional, but not the longitudinal, relationships between alcohol consumption and serum lipids, blood pressure and body mass indices. Gender and type of beverage do not modify the relationships between alcohol consumption and these indices.
Abstract: OBJECTIVE: This study investigates how voluntary changes in tobacco consumption are related to changes in biological risk factors for cardiovascular disease in 21- to 36-year-old men and women. STUDY DESIGN AND SETTING: Data of the Amsterdam Growth and Health Longitudinal Study (AGAHLS) were used to study the association between voluntary changes in tobacco consumption and changes in biological risk factors for cardiovascular disease (CVD) during 4-6 years of follow-up in 165 men and 195 women aged 21-36 years. We used multiple linear regression analyses with corrections for age and changes in other lifestyles. RESULTS: In both sexes, we found trends for a reduction in blood pressure, high-density lipoprotein cholesterol (HDL-C), body weight, and waist-to-hip ratio (WHR) and a rise in the ratio between total serum cholesterol (TC) and HDL-C (TC/HDL-C) with increasing tobacco consumption. Opposite trends were found with reducing tobacco consumption. In women, body weight, WHR, and waist circumference reduced significantly and independently with increasing tobacco consumption and increased significantly with decreasing tobacco consumption. CONCLUSION: These results suggest that voluntary changes in tobacco consumption go together with both healthy and unhealthy changes in biological risk factors for CVD.
Abstract: Little is known on the diagnostic characteristics of brief questionnaires on alcohol drinking behaviors. This report investigates the determinants of three short alcohol questionnaires and investigates their diagnostic utility as screening tools for alcohol-related problems in a general population from The Netherlands. This report uses cross-sectional data obtained in the year 2000 from 36-year-old healthy male (N=166) and female (N=165) volunteers who reported to drink alcohol at least occasionally. Since they were 13-years-old these volunteers have been members of the Amsterdam Growth And Health Longitudinal Study, which started as a school-based study in 1977. Among many other variables, quantity-frequency questions (QF), the CAGE questionnaire, and a question on the highest number of alcoholic units consumed on one occasion during the previous month (MAX) were asked. The sensitivity, specificity, Cohen's kappa, and diagnostic odds ratio of QF, CAGE, MAX, and combinations of these three brief questionnaires were calculated using a 7-item questionnaire on alcohol-related problems as reference. Both in women and men, the prevalence of most alcohol-related problems and of a high QF, CAGE, and MAX was low. QF, CAGE, and MAX, as well as all possible combinations of the three questionnaires, were poor in detecting last-year alcohol-related problems. The CAGE appeared to perform worse than the even shorter and easier-to-interpret QF and MAX. In this healthy population of 36-year-old men and women, using the QF, MAX, and especially the CAGE questionnaire as screening instruments for alcohol-related problems resulted in many false positive and false negative classifications.
