Low cholesterol concentrations in free-living elderly subjects: relations with dietary intake and nutritional status.

Hypocholesterolemia has been reported in epidemiologic studies to be associated with increased mortality from noncardiovascular causes. Low cholesterol concentrations have been reported in various pathologic conditions and in institutionalized elderly patients, and seem to be associated with poor outcome. The role of nutritional factors in the genesis of hypocholesterolemia was investigated in 380 free-living elderly subjects. Subjects in the lowest cholesterol quartile had lower free triidothyronine and prealbumin concentrations and a lower Folstein's score (a minimental test) than did those in the other quartiles. They did not differ from the other subjects for energy or nutrient intakes. Only 12 subjects (9 men and 3 women) had cholesterol concentrations < 3.62 mmol/L: the men had low free triidothyronine, free thyroxine, and prealbumin concentrations but normal energy and nutrient intakes, whereas the women differed from those with normal cholesterol concentrations for biological and nutritional data. These results indicate that low cholesterol concentration is a nonspecific feature of poor health status that is independent of nutrient or energy intake. The role of nutrient factors as a determinant of cholesterol concentration appears marginal in free-living elderly subjects.

[Lipid profile in adult population representative of a French district (Bas-Rhin)]. / Bilan lipidique dans une population adulte représentative d'une région française (Bas-Rhin).

Serum total cholesterol (TC), HDL-cholesterol (HDL-C) and A1, A2 and B apoprotein levels were determined in a population of 967 adults aged 25 to 64 years representative of the general population of the Bas-Rhin region localized in North-Eastern France. Age and sex were found to have a significant influence on most parameters studied; however, HDL-cholesterol, Apo A1, and Apo A2 were independent from age in males. HDL-cholesterol levels were consistently found to be higher in females than in males. Cholesterol, HDL-cholesterol, Apo A1, Apo A2 and Apo B levels, but not the HDL-cholesterol/cholesterol ratio, were higher in females above 45 years of age. A cholesterol level indicating increased cardiovascular risk, i.e., above 5.1 mmol/l, was found in 55% of males and 53% of females; HDL-cholesterol was under 0.9 mmol/l in 46% of males and 29% of females. The close linear correlations seen between cholesterol and Apo B (r = 0.820) and between HDL-cholesterol and Apo A1 (r = 0.580) were used to estimate theoretical threshold levels of apoproteins indicating increased risk: the Apo B level was greater than 0.77 g/l in 60% of males and 45% of females and the Apo A1 level was smaller than 1.58 g/l in 42% of males and 28% of females. Apo A2 level seems less useful as marker of increased risk. In conclusion, increased vascular risk due to unfavorable lipid profiles was common in the studied population especially among males and among females above 45 years of age. Apoproteins A1 and B reliably reflect cholesterol and HDL-cholesterol levels and can help evaluate cardiovascular risk.

[Cardiovascular risk factors in the population of 2 regions covered by the MONICA-France regions: Strasbourg and Toulouse]. / Facteurs de risque cardio-vasculaire dans la population de deux régions couvertes par les registres MONICA-France: Strasbourg et Toulouse.

Cardiovascular risk factors were studied from 1985 to 1987 in two population samples from the French regions of the Bas-Rhin (BR) (Strasbourg) and the Haute-Garonne (HG) (Toulouse). 1,257 men and women in the BR and 1,323 in the HG, aged 35-64, participated in the survey. A common investigation methodology in harmony with the MONICA protocol, was used. The mean weight was higher among the male (5 kg) and female (6 kg) populations living in the BR than in the HG. Even after age, body mass index and tobacco consumption adjustments, arterial systolic blood pressure was higher in the male population of the BR (145 mm Hg) than in the HG (133 mm Hg). Similar differences were observed among the female population. A higher proportion of hypertensive subjects whatever the sex and the age group was noted in the BR. The proportion of smokers, and the quantity of tobacco they smoked, did not differ between the two centers. Adjusted total cholesterolemia was higher in the HG, with mean differences of 0.32 mmol/l among the men and 0.35 mmol/l among the women. In the case of HDL cholesterol, the differences were 0.23 mmol/l among the men and 0.34 mmol/l among the women, explaining in large part the differences of the mean levels of total cholesterol.

Comparison of cardiovascular risk factor levels in two French populations: Haute-Garonne (Toulouse) and Bas-Rhin (Strasbourg).

Cardiovascular risk factors were studied from 1985 to 1987 in population samples in two French regions with different ischaemic heart disease mortality rates in Bas-Rhin (Strasbourg MONICA centre) and in Haute-Garonne (Toulouse MONICA centre). These rates were, among men, 109/100,000 in Bas-Rhin, and 72/100,000 in Haute-Garonne. 1,253 and 1,319 men and women aged 35-64 participated in the survey. In each region, identical investigation methodology was used, according to MONICA protocol. The average weight in both sexes was higher in Bas-Rhin than in Haute-Garonne (5 Kg more for men and 6 Kg more for women). After adjustment for age, body mass index and tobacco consumption, arterial systolic blood pressure was higher for men in Bas-Rhin (145 mm Hg) than in Haute-Garonne (133 mm Hg). Similar differences were observed in women. Higher proportions of hypertensive participants of both sexes and in all age groups were registered in Bas-Rhin than in Haute-Garonne. The number of smokers and the amount of tobacco consumption did not differ between the two centres. Mean serum cholesterol was higher in Haute Garonne (5.95 mmol/L for men and 5.88 mmol/L for women) than in Bas-Rhin (5.57 mmol/L for men and 5.51 mmol/L for women). Also high-density lipoprotein (HDL)-cholesterol values were higher in Haute-Garonne, and can partly explain the regional difference in total cholesterol.

[Abetalipoproteinemia. Apropos of 2 cases]. / L'abêtalipoprotéinémie. A propos de deux cas.

The cases of two sisters with abetalipoproteinemia are reported. Both presented the complete clinical and biological features of the disease: ataxia, retinitis pigmentosa, lack of apolipoprotein B, chylomicrons, LDL and VLDL, reduced titers of serum cholesterol and triglycerides, acanthocytosis, very low levels of serum vitamin A and E. Abetalipoproteinemia is a rare autosomal inherited disease. It is usually revealed during early childhood by steatorrhea and failure to thrive; ataxia and retinitis pigmentosa appear later. The originality of these two cases stems from: 1) their late and fortuitous diagnosis: the first sister was investigated at the age of 42 after the discovery of a vitamin K induced coagulation disorder. The other sister was 39 when she was routinely examined as a family member; 2) the presence of constipation without any other suggestive digestive complaint. However, white discoloration of the duodenal mucosa seen at endoscopy and lipid droplets within the intestinal absorptive cells at biopsy were characteristic. Barium studies showed diffuse involvement of the small bowel which was displaced by an enlarged sigmoid. Treatment consists of administration of vitamin A and vitamin E which prevent or delay ocular and neurologic symptoms. Vitamin K is associated whenever necessary.

[Clinical value of nephelometric assay of C-reactive protein]. / Intérêt clinique du dosage néphélométrique de la protéine C réactive (CRP).

Laser immunonephelometry is a sensitive, specific and rapid method for assaying plasma C-reactive protein (CRP). This "acute phase" protein has recently been shown to be of significance in the regulation of immunological responses. It is released from hepatocytes early during infection, inflammation or necrosis. Nephelometry provides a good means for detection, monitoring and evaluation of therapeutic efficiency in these conditions. The increase in CRP may precede the positivity of the usual biological tests and is of value in situations where these tests cannot be interpreted.