Impact of 'Mad Cow Disease' publicity on trends in meat and total vitamin A consumption in Geneva between 1993 and 2000.

BACKGROUND: In March 1996, revelations about the possible risk for humans of the 'mad cow disease' epidemic had a sudden impact on the diets of European populations. OBJECTIVE: To assess changes in meat and nutrient intakes in adults living in Geneva, Switzerland from 1993 to 2000. DESIGN: Independent annual cross-sectional surveys (4047 women and 4092 men total). MAIN OUTCOME MEASURE: Dietary habits assessed and compared to baseline (January 1993-April 1996) via validated semi-quantitative food-frequency questionnaire. RESULTS: Women beef abstainers increased from 8.9 to 14.9% in late 1996 (P<0.001) and 13.3% in 1997 (P<0.05); among meat consumers, in late 1996 meat/beef intakes declined -10/-12% (both P<0.05). From 1997 to 2000 most intake levels drifted back toward those at baseline, but chicken intakes were significantly (all P<0.05) greater each year (+19% in 2000 (P<0.001). Consistent but less dramatic changes were observed among men. From late 1996 until 2000, liver abstention was significantly (all P<0.05) greater (women from 60 to 78%; men from 61 to 73% in 2000; (both P<0.001). The only nutrient intakes that decreased significantly (all P<0.05) each year from 1997 through 2000 were retinol and total vitamin A women: -22% (P<0.001); -11% (P<0.05) respectively; men: -16% (P<0.001); -10% (P<0.05) respectively, in 2000). Total vitamin A intakes exceeded the dietary reference intake (DRI) for liver eaters (women 185%, men 153%), but were below the DRI for liver abstainers (women 83%; men 66%) in 2000. CONCLUSION: The decreases in beef and liver consumption since late 1996 led to the discovery of a long-term disparity in the retinol and total vitamin A intakes of liver eaters vs abstainers.

Can the declining prevalence of left-handedness with age be due to smoking?

The objective of this study was to assess whether smoking habits can explain the decline in left-handedness prevalence with age. Subjects participating in a population-based survey (n = 3,071) in Geneva, Switzerland, completed a questionnaire on innate hand preference, current hand preference for writing and smoking habits. The prevalence of innate left-handedness in the Geneva population was 9.4% in men and 7.4% in women. There was no association between smoking and left-handedness. It is concluded that smoking is not associated with hand preference and is an unlikely cause of overmortality in left-handed subjects.

Diet and socioeconomic position: does the use of different indicators matter?

OBJECTIVES: To describe the association of diet and socioeconomic position and to assess whether two different indicators, education and occupation, independently contribute in determining diet. METHODS: A community-based random sample of men and women residents of Geneva canton, aged 35 to 74, participated in a survey of cardiovascular risk factors conducted annually since 1993. Lifetime occupational and educational history and a semi-quantitative food frequency questionnaire were obtained from 2929 men and 2767 women. RESULTS: Subjects from lower education and/or occupation consumed less fish and vegetables but more fried foods, pasta and potatoes, table sugar and beer. Iron, calcium, vitamin A and vitamin D intake were lower in the lower educational and occupational groups. Both indicators significantly contributed to determining a less healthy dietary pattern for those from low social class. The effects of education and occupation on dietary habits were usually additive and synergistic for some food groups. CONCLUSION: Assessing both education and occupation, improves the description of social class inequalities in dietary habits, as they act, most of the time, as independent factors.

Physical activity of urban adults: a general population survey in Geneva.

OBJECTIVES: Describing the distribution of physical activity in populations is of major importance for developing public health campaigns to prevent sedentarism. METHODS: A population-based survey conducted during 1997-1999 in Geneva, Switzerland, included 3410 randomly selected men (n = 1707) and women (n = 1703), aged 35 to 74 years. Percentiles P10, P50, and P90 summarised the distributions of the total energy expenditure and of the percents used in moderate intensity activities (3 to 3.9 times the basal metabolism rate (BMR), e.g., normal walking, household chores), and in high and very high intensity activities (> or = 4 BMR, e.g., brisk walking, sports). RESULTS: The total energy expenditure (median 2929 kcal/day in men, 2212 kcal/day in women) decreased with age. Prevalence of sedentarism, defined as less than 10% of total energy expended in > or = 4 BMR activities, was 57% in men and 70% in women. Men expended 12% (median) of their total energy in 3 to 3.9 BMR and 8% in > or = 4 BMR activities. Corresponding percentages in women were 11% and 5%. The highest prevalence of sedentarism was in older age, women, and lower socio-economic status persons. CONCLUSION: Most of Geneva population is sedentary. Promoting physical activity should target children, adults and elderly, and physical activities which would be both attractive and financially affordable by most people.

Validation of self-reported smoking status by simultaneous measurement of carbon monoxide and salivary thiocyanate.

OBJECTIVE: The objective of this study was to determine the validity of tobacco questionnaires when using as gold standard either a single biomarker or a combination of two biomarkers. METHODS: The methods were self-reported smoking compared with salivary thiocyanate and expired carbon monoxide in a 1996, population-based, Swiss survey of 552 men and 565 women. RESULTS: Sensitivity of self-reported smoking relative to salivary thiocynate or carbon monoxide alone was low (38.2% for salivary thiocyanate > or = 100 mg/L, 56.4% for salivary thiocyanate > or = 150 mg/L and 62.6% for carbon monoxide > or = 9 ppm). When defining true positive smokers as people with high concentration of both salivary thiocyanate and carbon monoxide, overall, sensitivity was 88.6% and specificity was 87.2%. In women, sensitivity increased from 85 to 89% when removing subjects exposed to passive smoking. When excluding heavy smokers, sensitivity decreased to 63% in men and to 71% in women. Older women had tendency to misreport smoking. CONCLUSIONS: This comparison of questionnaire data with the simultaneous measurement of salivary thiocyanate and expired carbon monoxide indicates that valid responses can be obtained for self-reported, current smoking in population-based surveys. However, the validity of questionnaires can be underestimated if the gold standard (of exposure to tobacco smoke) is either high levels of carbon monoxide or high levels of salivary thiocyanate.

The differential effect of education and occupation on body mass and overweight in a sample of working people of the general population.

PURPOSE: To assess whether two indicators of social class, education and occupation, have independent and/or synergistic effects in determining the body mass and overweight. METHODS: Body mass index (BMI), education, and occupation were assessed in a survey of 1767 men and 1268 women from a representative sample of currently working people of the general population of Geneva, Switzerland. Education and occupation were categorized as low, medium, and high. Overweight was defined as BMI > or = 25 kg/m(2). RESULTS: The prevalence of overweight was 52.1% in men and 28.7% in women. Men with overweight were more likely to have low education while women with overweight had lower education and lower occupation. Education and occupation were inversely related to BMI in both genders and, in women, had a synergistic effect (p-value for the interaction = 0.03). CONCLUSIONS: Education and occupation have independent and, in women, synergistic effects on BMI. The two indicators may express different mechanisms through which low social class is related to high body mass.

Smoking, dietary calcium and vitamin D deficiency in women: a population-based study.

OBJECTIVE: To determine differences in dietary calcium and vitamin D intakes between female never, former and current smokers. DESIGN: Population-based survey using a validated food frequency questionnaire. SETTING: The Bus Santé 2000, epidemiologic observatory of Geneva, Switzerland. SUBJECTS: 2319 women resident in Geneva, Switzerland between 1993 and 1997. RESULTS: Daily calcium intake was 798 mg among current heavy smokers (>/=20 cigarettes/day), 882 mg among current moderate smokers (1-19 cigarettes/day) and 945 mg among never smokers (P=0.0001). There was a difference of almost 50 mg/day in median calcium intake from cheese (P=0.04), which corresponded to about one-third of the total difference in calcium intake between heavy smokers and never smokers. Of the current heavy smokers, 21% did not eat yogurt compared to 10% of never smokers (P=0.001). Among yogurt eaters, heavy smokers consumed 90 mg/day of calcium from yogurt vs 115 mg/day in never smokers (P=0.003). Smokers ate more butter and cream (P=0.02) or milk (P=0.06) than never smokers, but these were minor sources of calcium. Fish was the main cause of higher intake of vitamin D in never smokers (0.81 microg/day) compared with heavy smokers (0.53 microg/day) and moderate smokers (0.70 microg/day). The diet of ex-smokers after 5 y or more of smoking cessation tended to resemble that of never smokers for calcium (about 900 mg/day) and vitamin D (about 2.55 microg/day). CONCLUSION: Female current smokers have lower dietary intakes of calcium and vitamin D than never smokers. SPONSORSHIP: This study was funded by the Swiss National Fund for Scientific Research (grants 32.31.326.91, 32-37986.93 and 32-49847.96).

Breast cancer and active and passive smoking: the role of the N-acetyltransferase 2 genotype.

The association of breast cancer with passive and active smoking was investigated in slow and fast acetylators of aromatic amines in a Geneva, Switzerland, study in 1996-1997. A slow acetylator was homozygous for one, or heterozygous for two, of three N-acetyltransferase 2 (NAT2) polymorphisms determined on buccal cell DNA from 177 breast cancer cases and 170 age-matched, population controls. The reference group consisted of women never regularly exposed to active or passive smoke. Among premenopausal women, the odds ratios were homogeneous in slow and fast acetylators: 3.2 (95% confidence interval (CI): 1.2, 8.7) for passive smoking and 2.9 (95% CI: 1.1, 7.5) for active smoking. Among postmenopausal women, the odds ratios for fast acetylators were 11.6 (95% CI: 2.2, 62.2) for passive and 8.2 (95% CI: 1.4, 46.0) for active smoking; the corresponding effects were also apparent but less strong in slow acetylators. After the nonexposed and the passive smokers were grouped in a single reference category, active smoking was associated with postmenopausal breast cancer in slow acetylators (odds ratio (OR) = 2.5, 95% CI: 1.0, 6.2) but not in fast acetylators (OR = 1.3, 95% CI: 0.5, 3.3). Thus, the associations of both passive and active smoking with breast cancer appear stronger in fast than in slow NAT2 genotypes. Separating passive smokers from the nonexposed impacts on the inference about a possible NAT2-smoking interaction.

Obesity and other health determinants across Europe: the EURALIM project.

STUDY OBJECTIVE: EURALIM (EURope ALIMentation), a European collaborative study, aimed to determine and describe the extent to which European data on risk factor distributions from different populations could be pooled and harmonised in a common database for international comparisons. SETTING: Seven independent population-based surveys from six European countries (France, Italy, Northern Ireland/United Kingdom, Spain, Switzerland, the Netherlands). METHODS: Data for 18 381 women and 12 908 men aged 40-59 were pooled in a common database. Central statistical analyses on major cardiovascular risk factors were conducted with careful consideration of methodological issues, including differences in study designs, data assessment tools, and analytic techniques used. MAIN RESULTS: Because of the detected variability among methods used, direct comparisons of risk factor distributions and prevalences between studies were problematic. None the less, comparisons of within population contrasts by sex, age group, and other health determinants were considered to be meaningful and apt, as illustrated here for obesity. Results were targeted and disseminated to both the general public and public health professionals and framed in the context of a European information campaign. CONCLUSIONS: International and national comparisons between existing locally run studies are feasible and useful, but harmonisation methods need improvement. Development of an international risk factor surveillance programme based on decentralised data collection is warranted. In the meantime, risk factor contrasts across populations can be used as a basis for targeting needed public health intervention programmes.

Dietary patterns in six european populations: results from EURALIM, a collaborative European data harmonization and information campaign.

OBJECTIVE: To determine and describe the extent to which European dietary data collected in disparate surveys can be meaningfully compared. DESIGN: Seven independent population-based surveys from six European countries were initially included. Differences in study designs and methodological approaches were examined. Risk factor data for 31,289 adults aged 40-59 y were harmonized and pooled in a common, centralized database. RESULTS: Direct comparisons of dietary measures across studies were not deemed appropriate due to methodological heterogeneity. Nonetheless, comparisons of intra-population contrasts by gender across sites were considered valid. Women consumed fruit and vegetables more often than men. Age-standardized gender differences in the prevalence of low fruit and vegetable consumption ranged from 7 to 18% and 5 to 15%, respectively. Data on energy intake showed good agreement across study populations. The proportion of total energy from macronutrients was similar for women and men. Gender differences for relative intakes of saturated fatty acids (percentage energy) were small and only in France were they significant. Dietary fibre density was significantly higher in women than in men. Overall, the participating Southern European populations from Italy and Spain exhibited more healthful food composition patterns. CONCLUSIONS: Contrasts in dietary patterns by gender across populations may provide the basis for health promotion campaigns. The most favourable patterns observed may serve as attainable goals for other populations. An international risk factor surveillance programme based upon locally run, good quality studies has the potential to provide the needed data. SPONSORSHIP: European Community (DG V), project 96CVVF3-446-0; Swiss Federal Office for Education and Science, OFES 96.0089.

The association between switching hand preference and the declining prevalence of left-handedness with age.

OBJECTIVES: This study determined the prevalence of left-handedness and of switching hand preference among innately left-handed subjects. METHODS: Subjects of Swiss nationality (n = 1692), participating in a population-based survey in Geneva, Switzerland, completed a questionnaire on innate hand preference and current hand preference for writing. RESULTS: From 35 to 44 years of age to 65 to 74 years of age, the prevalence of innate left-handedness declined from 11.9% to 6.2% (trend P = .007). In these same age groups, the proportion of innately left-handed subjects who switched to the right hand for writing increased from 26.6% to 88.9% (trend P = .0001). CONCLUSIONS: Across generations, we found an increase in the prevalence of switching hand preference among innately left-handed subjects. This phenomenon could be explained by social and parental pressure to use the right hand.

Relation of environmental tobacco smoke to diet and health habits: variations according to the site of exposure.

It has been postulated that the relationship of environmental tobacco smoke (ETS) exposure to cancer or cardiovascular diseases may be confounded by social class or diet because women exposed to ETS by their smoker spouse belong to lower social classes and have an unhealthy diet. In a population survey in Geneva, Switzerland, 914 female never-smokers were interviewed about sociodemographic factors, health habits including a semiquantitative food frequency questionnaire, and exposure to ETS according to the site (home, work, leisure). Compared to women unexposed to ETS, those exposed to ETS at work ate less fibers, cereals, vegetables, lean meat, had a lower intake of iron and beta-carotene, and had a lower total energy intake; women exposed during leisure time ate less cereals, drank less skim milk, and had a lower intake of complex carbohydrates. But the diet of women exposed at home did not differ from the diet of those unexposed to ETS. Thus, "living with a smoker" in Geneva does not necessarily imply adopting his health and dietary habits. We conclude that confounding factors of the association of ETS and disease vary according to site and populations and therefore should not be invoked as a systematic source of bias in all studies.

Definition and prevalence of sedentarism in an urban population.

OBJECTIVES: The present study sought to formulate a precise definition of sedentarism and to identify activities performed by active people that could serve as effective preventive goals. METHODS: A population-based sample of 919 residents of Geneva, Switzerland, aged 35 to 74 years, completed a 24-hour recall. Sedentary people were defined as those expending less than 10% of their daily energy in the performance of moderate- and high-intensity activities (at least 4 times the basal metabolism rate). RESULTS: The rates of sedentarism were 79.5% in men and 87.2% in women. Among sedentary and active men, average daily energy expenditures were 2600 kcal (95% confidence interval [CI] = 2552, 2648) and 3226 kcal (95% CI = 3110, 3346), respectively; the corresponding averages for women were 2092 kcal (95% CI = 2064, 2120) and 2356 kcal (95% CI = 2274, 2440). The main moderate- and high-intensity activities among active people were sports (tennis, gymnastics, skiing), walking, climbing stairs, gardening, and (for men only) occupational activities. CONCLUSIONS: The definition of sedentarism outlined in this article can be reproduced in other populations, allows comparisons across studies, and provides preventive guidelines in that the activities most frequently performed by active people are the ones most likely to be adopted by their sedentary peers.

Effects of smoking and smoking cessation on dietary habits of a Swiss urban population.

OBJECTIVES: To assess whether current smokers eat differently than never smokers and the relation of smoking cessation to dietary change. DESIGN: Population-based survey from 1993-1997. SETTING: The Bus Sante 2000, epidemiologic observatory of Geneva, Switzerland. SUBJECTS: A representative sample of 2301 men and 2306 women resident of Geneva, Switzerland. RESULTS: In both genders, compared to never smokers, current heavy smokers (> or = 20 cigarettes/d) consumed daily less total vegetables proteins (P <0.03), carbohydrates (P<0.0001), saccharose (P<0.01), fibers (P < 0.0001), beta-carotene (P < 0.001), fruit (P < 0.0001) and vegetables (P < 0.04), but they drank more alcohol (P < 0.0001) and more coffee (P < 0.005). In addition, female current smokers ate less energy (P < 0.4), complex carbohydrates (P < 0.002), cereals (P < 0.003), vegetables (P < 0.0001) and less iron (P < 0.02). The diet of ex-smokers tended to become more similar to that of never smokers. When longer duration of smoking cessation increased, the consumption of total carbohydrates and complex carbohydrates increased (P < 0.01 and P < 0.06), and alcohol decreased (P < 0.07) in both genders. CONCLUSIONS: As in other Western countries, the diet of Swiss smokers appears less healthy than that of never smokers in both men and women, while smoking cessation has beneficial aspect on the quality of the diet. Current smoking appears to have an even stronger effect on the diet of women than on the diet of men.

A Swiss population-based assessment of dietary habits before and after the March 1996 'mad cow disease' crisis.

OBJECTIVE: To assess differences in dietary habits in the general population of Geneva, Switzerland, after the 1996 (BSE) crisis. DESIGN: Repeated population-based survey during 1993, 1994, 1995 and 1996. SETTING: The Bus Santé 2000 epidemiological observatory of Geneva, Switzerland. SUBJECTS: A representative sample of 1190 men and 1154 women. MAIN OUTCOME MEASURE: Dietary habits assessed by a semi-quantitative food frequency questionnaire. RESULTS: The proportion of women who reported not having eaten beef was 7.7% in 1993-1995 and went up to 14.6% in 1996 (age-adjusted difference +6.4%, 95% CI +2.4 to +10.4). Among men, the proportion of non-beef-eaters remained constant (5%). There was a sharp increase of women who did not eat liver (+14.7%, +9.1 to +20.3) but less so in men (+2 5.1%, -0.7 to +10.8). Among women who ate meat, the amount of beef intake decreased by 120 g/month (95% CI -208 to -36). While chicken intake increased (+44 g/month, -2 to 88), overall intake of meat (including poultry but not fish) declined by 204 g/month (or 2.7 kg per year). In men the decrease in beef intake was not statistically significant (-48 g/month, -172 to 80), but consumption of chicken increased (+2 56g/month, +8 to +104). Fish intake was stable in both genders. The reduction in intake of animal protein (-3.5 g/day) in women and of retinol intake in both sexes (women -77 micrograms/day; men -56 micrograms/day) was statistically significant. CONCLUSIONS: The BSE crisis coincided with spontaneous differences in food habits, especially in women, that may have nutritional consequences at the population level.

Cytokines in metal fume fever.

Metal fume fever is a flulike illness caused by zinc oxide inhalation and accompanied by an impressive pulmonary cellular response. We hypothesized that the syndrome is mediated by cytokines released in the lung after exposure to zinc oxide fume. We carried out 26 experimental welding exposures in 23 volunteer subjects, performing postexposure bronchoalveolar lavage (BAL) 3 h (n = 6), 8 h (n = 11), or 22 h (n = 9) after exposure. We detected tumor necrosis factor (TNF), interleukin-6 (IL-6), and interleukin-8 (IL-8) varying in a time- and exposure-related manner. The concentration of TNF in the BAL fluid supernatant was significantly greater at 3 h than at 8 h or 22 h after exposure (p < 0.05), exhibiting a statistically significant exposure-response relationship to airborne zinc at each follow-up time period (p < 0.05). TNF concentrations were statistically correlated with those of IL-6 in BAL supernatant obtained at 22 h (r = 0.78, p = 0.01) and with concentrations of IL-8 in BAL 8 h after exposure (r = 0.85, p = 0.001). IL-6 displayed a significant exposure-response relationship to zinc (p < 0.05) at 22 h. IL-8 exhibited a significant exposure-response relationship to zinc (p < 0.05) at 8 h after exposure, a time at which IL-8 correlated with marked increases in BAL fluid polymorphonuclear leukocytes (PMN) (r = 0.7, p = 0.01). Although we also detected interleukin-1 (IL-1) in BAL samples, this cytokine did not demonstrate a statistically significant exposure response. TNF, IL-6, and IL-8 in BAL fluid supernatant concentrations increased in a time and exposure-dependent fashion after zinc oxide welding fume exposure. The time course of increased cytokines, their correlations with one another and with PMN in the BAL fluid, and the consistency of our findings with the known kinetics and actions of these cytokines support the hypothesis that a network of cytokines is involved in the pathogenesis of metal fume fever.

Interleukin-8 is a major neutrophil chemotactic factor in pleural liquid of patients with empyema.

Interleukin-8 (IL-8), a potent neutrophil chemotactic peptide, has been found in association with human disease, but its contribution to chemotactic activity in humans is not yet known. We asked whether IL-8 is present in inflammatory human pleural effusions, and to what extent it contributes to pleural liquid neutrophil chemotactic activity. Because tumor necrosis factor alpha (TNF-alpha) is a strong inducer of IL-8, we also asked whether TNF-alpha was present. For this prospective study, we collected pleural liquid from 51 patients (empyema, 14; parapneumonic, four; tuberculous, eight; malignant, nine; miscellaneous exudative, seven; and transudative, nine), counted pleural neutrophils, and measured IL-8 and TNF-alpha concentrations in the supernatant. To determine the contribution of IL-8 to chemotactic activity in empyema, we measured the neutrophil migration induced by empyemic liquids before and after addition of anti-IL-8 F(ab')2 antibody fragments or control anti-IL-6 F(ab')2. We found that IL-8 concentrations were higher in empyema (61.3 +/- 21.0 ng/ml [SEM]) than in all other effusions (1.1 +/- 0.5 ng/ml) (p = 0.0001). All empyema liquids had IL-8 concentrations above 2.5 ng/ml, which was true for only three of the other 37 effusions (two parapneumonic, one tuberculous). IL-8 levels correlated with the pleural neutrophil count (r = 0.46; p = 0.007) and the neutrophil chemotactic activity of pleural liquid (r = 0.43; p = 0.008). Anti-IL-8 antibodies decreased chemotactic activity in empyema liquids by 65 +/- 5%, whereas the control antibody had no effect (0 +/- 5% decrease) (p = 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Activation of human monocyte--derived macrophages with lipopolysaccharide decreases human immunodeficiency virus replication in vitro at the level of gene expression.

Activation of T lymphocytes infected with the human immunodeficiency virus-1 (HIV-1) results in enhancement of viral replication mediated in part by activation of cellular NF kappa B capable of binding directly to sequences in the viral long terminal repeat, or LTR. Together with CD4+ T cells, macrophages constitute a major target for infection by HIV-1. Unlike lymphocytes, however, stimulation of mononuclear phagocytes is not associated with cell division and proliferation. Human monocyte-derived macrophages transfected with HIV-LTR-CAT constructs demonstrated down-regulation of CAT activity after stimulation with bacterial lipopolysaccharide (LPS) that mapped to a region distinct from NF kappa B binding sites. In contrast, fresh monocytes and the promonocytic U937 cell line both demonstrated up-regulation of HIV-LTR-CAT expression by LPS. Differentiation of U937 by PMA to establish a nondividing phenotype resulted in down-regulation of transfected HIV-LTR-CAT activity by LPS similar to that in mature macrophages. Human monocyte-derived macrophages infected with HIV-1 in vitro demonstrated a decrease in viral p24 release after incubation in LPS that was comparable to the negative regulation that occurred in the transient transfection assays. Factors controlling HIV replication may differ in dividing and nondividing hematopoietic cells and may contribute to restricted viral expression in nondividing cells.

Pregnancy complicated by collagen vascular disease.

Pregnancies complicated by collagen vascular diseases present a challenge to the obstetrician, internist, and other consulting physicians caring for the patient. Although most pregnancies complicated by these disorders result in satisfactory outcomes, a significant number develop manifestations sufficiently serious to require admission to an intensive care unit. Such manifestations include lupus nephritis, CNS lupus, ARDS, massive alveolar hemorrhage, scleroderma renal crisis, pulmonary hypertension, severe myositis, and diffuse vasculitis. Of the numerous therapeutic options available, many may be used to optimize maternal and perinatal outcome.