Does educational level influence lung function decline (Doetinchem Cohort Study)?

Low socioeconomic status is associated with reduced lung function in adults. In addition, there are indications that lung function decline with age is accelerated in low socioeconomic groups, but, to date, findings have been inconclusive. In order to investigate the relation between educational level, forced expiratory volume in 1 s (FEV1) and decline in FEV1 over time, linear mixed-effects models were fitted to baseline and 10-yr-follow-up data from the Doetinchem Cohort Study. The study population (26-66 yrs at baseline) consisted of 2,679 males and 3,026 females with an FEV1 measurement in at least one of the three rounds of follow-up and information on relevant covariables. High educational level was used as the reference class. Low educational level was associated with a higher prevalence of smoking and with a lower smoking-adjusted FEV1 at baseline (-148 mL in males and -47 mL in females). In females, low educational level was associated with a faster FEV1 decline (3.4 mL x yr(-1), age- and height-adjusted), which was not explained by smoking. In males, no differences in rates of decline between educational levels were observed. FEV1 decline was faster in less-educated females, independent of smoking. In males, FEV1 decline did not differ between educational levels.

Diet and asthma in Dutch school children (ISAAC-2).

BACKGROUND: The rise in the prevalence of asthma in western societies may be related to changed dietary habits. Epidemiological studies in children have shown inverse associations of asthma related outcomes with intake of fruits, vegetables, dairy and whole grain products, and fish. In contrast to most previous studies, we used both questionnaire and clinical data to define asthma. METHODS: Intake of the abovementioned foods was studied in relation to asthma in 598 Dutch children aged 8-13 years. Dietary intake was estimated using a parent completed semi-quantitative food frequency questionnaire. Current wheeze and current asthma were defined based on questionnaire data. More complex end points were defined using information on bronchial hyperresponsiveness (BHR) and atopic sensitisation as well. Linear associations were studied using logistic regression analysis and odds ratios presented for the highest versus the lowest tertile of intake. In the final models, adjustments were made for maternal educational level, foreign descent, and total energy intake. RESULTS: The intake of whole grain products and of fish was inversely associated with asthma. Adjusted odds ratios for the independent associations with whole grains and fish were 0.46 (95% CI 0.19 to 1.10) and 0.34 (95% CI 0.13 to 0.85) for current asthma and 0.28 (95% CI 0.08 to 0.99) and 0.12 (95% CI 0.02 to 0.66) for atopic asthma with BHR. Similar results were observed for current wheeze and atopic wheeze with BHR. Intake of (citrus) fruits, vegetables, and dairy products showed no clear associations with asthma end points. CONCLUSIONS: Our findings suggest that a high intake of whole grain products and fish may have a protective effect against asthma in children.

Nutrition and respiratory health in children in six Central and Eastern European countries.

BACKGROUND: The results of studies on the effect of nutrition on respiratory diseases are inconsistent. The role of nutrition in children's respiratory health was therefore analysed within the cross sectional Central European Study on Air Pollution and Respiratory Health (CESAR). METHOD: A total of 20 271 children aged 7-11 were surveyed in six European countries. Respiratory health and food intake were assessed using questionnaires. Associations between four symptoms and nutritional factors were evaluated using logistic regression, controlling for area plus other potential confounders. RESULTS: All symptoms showed initial associations with nutritional factors. Low consumption of fish and of summer and winter fruit were the most consistent predictors. In a fully adjusted model low fish intake remained a significant independent predictor of persistent cough (OR=1.18; 95% CI 1.04 to 1.34), wheeze ever (OR=1.14; 95% CI 1.03 to 1.25) and current wheeze (OR=1.21; 95% CI 1.06 to 1.39) and a weaker predictor of winter cough (OR=1.10; 95% CI 0.99 to 1.23). Low summer fruit intake was a predictor of winter cough (OR=1.40; 95% CI 1.10 to 1.79) and persistent cough (OR=1.35; 95% CI 1.01 to 1.82). Low winter fruit intake was associated with winter cough (OR=1.28; 95% CI 1.09 to 1.51). Associations between symptoms and vegetable intake were inconsistent. Low summer intake was significantly associated with winter cough (OR=1.23; 95% CI 1.03 to 1.47) but, overall, winter intake had inverse associations with both coughs. Associations between winter vegetable intake and wheeze varied considerably between countries. CONCLUSION: A number of associations were found between respiratory symptoms and low intake of fish, fruit and vegetables in children. Low fish intake was the most consistent predictor of poor respiratory health. Fruit and vegetable intake showed stronger associations with cough than with wheeze.

Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three European countries.

OBJECTIVE: To investigate the relation of baseline antioxidant, fruit, vegetable and fish intake with 20 y chronic obstructive pulmonary disease (COPD) mortality in middle-aged men from three European countries. DESIGN: Prospective study (1970-1990). SETTING: Five population-based cohorts of middle-aged men from Finland, Italy and The Netherlands. SUBJECTS: A total of 2917 men aged 50-69 y at baseline. METHODS: Baseline information on diet was collected using the cross-check dietary history method. After 20 y of follow-up the underlying cause of death of those who died was established centrally. Survival analyses were performed using the Cox Proportional Hazards Model. RESULTS: After adjustment for age, smoking and country, we observed an inverse trend (P-trend <0.05) of 20 y COPD mortality across tertiles of fruit and vitamin E intake. No trend was observed for vegetables, fish, vitamin C and beta-carotene. When modelled continuously, a 100 g increase in fruit intake was associated with a 24% lower COPD mortality risk (RR=0.76, 95% CI=0.60-0.92). For vitamin E intake (per 5 mg) the RR was 0.77 (95% CI=0.55-1.06), after adjustment for age, smoking and country. Additional adjustment for body mass index, total energy intake and alcohol consumption reduced the RR to 0.86 (95% CI=0.69-1.07, P=0.12) for fruit and 0.93 (95% CI=0.65-1.33) for vitamin E. CONCLUSIONS: Our results suggest a protective effect of fruit and possibly vitamin E intake against COPD. No effect was observed for intake of vitamin C, beta-carotene, vegetables and fish.

Chronic obstructive pulmonary disease and intake of catechins, flavonols, and flavones: the MORGEN Study.

Flavonoids have been suggested to protect against chronic lung disease. We studied intake of catechins, flavonols, and flavones in relation to pulmonary function and COPD symptoms in 13,651 adults from three Dutch cities examined from 1994 to 1997. Dietary intake was estimated using a food frequency questionnaire, and flavonoid intake was calculated using specific food composition tables. Pulmonary function (FEV1) was determined by spirometry and COPD symptoms by questionnaire. Associations were presented for the fifth versus the first quintile of intake (Q5-Q1), adjusted for age, height (for FEV1 only), sex, smoking, BMI, and energy intake. Smoking was strongly associated with COPD, independent of dietary effects. Average catechin, flavonol, and flavone intake was 58 mg/d (SD = 46) with tea and apples as main sources. Total catechin, flavonol, and flavone intake was positively associated with FEV1 (beta(Q5-Q1) = 44 ml, 95% CI = 18-69) and inversely associated with chronic cough (OR(Q5-Q1) = 0.80, 95% CI = 0.66-0.97) and breathlessness (OR(Q5-Q1) = 0.74, 95% CI = 0.58- 0.94), but not chronic phlegm. Catechin intake was independently associated with FEV1 (beta(Q5-Q1) = 130 ml, 95% CI = 101-159) and all three COPD symptoms (OR(Q5-Q1) = 0.60-0.72, p < 0.001). Flavonol and flavone intake was independently associated with chronic cough only. Solid fruit, but not tea, intake was beneficially associated with COPD. Our results suggest a beneficial effect of a high intake of catechins and solid fruits against COPD.

Diet and chronic obstructive pulmonary disease: independent beneficial effects of fruits, whole grains, and alcohol (the MORGEN study).

BACKGROUND: In recent years antioxidants, foods rich in antioxidants (e.g. fruits, vegetables) and fish have been suggested to protect against chronic obstructive pulmonary disease (COPD). There are also indications for a protective effect of whole grain intake and of consuming moderate amounts of alcohol. It is, however, not clear whether the effects of the different dietary factors on COPD are independent of each other and if so, whether their effects are additive. OBJECTIVE: To gain more insight into the potential protective effect of diet on COPD, we studied fruit, vegetable, fish, alcohol and whole grain consumption simultaneously in relation to pulmonary function and COPD symptoms. METHODS: Analysed were cross-sectional data collected in 13 651 men and women aged 20-59 years participating between 1994 and 1997 in the MORGEN study (monitoring project on risk factors and health in The Netherlands). Regression models were adjusted for age, gender, height (for pulmonary function only), smoking, BMI and energy intake. RESULTS: Fruit and whole grain intake showed independent beneficial associations with COPD (P-trend < 0.001). Furthermore, in subjects with low alcohol consumption (1-30 g/day) the forced expiratory volume in 1 s (FEV1) was higher and the prevalence of COPD symptoms lower than in non-drinkers (P < 0.001). The effects of a favourable intake of fruits (> 180 g/day), whole grains (> 45 g/day) and alcohol (1-30 g/day) were largely additive. In the 2998 subjects with a favourable intake of the three foods, the FEV1 was 139 mL higher and the prevalence of COPD symptoms lower (odds ratio (OR) = 0.44) than in subjects (n = 1406) with unfavourable intakes of fruits, whole grains and alcohol (P < 0.001). A similar effect was observed in those who had never smoked. Fish and vegetable intake did not show independent beneficial associations with COPD. CONCLUSIONS: Our results suggest independent beneficial effects of fruits, whole grains and alcohol on COPD that are largely additive and cannot be explained by smoking habits.

Alcohol consumption in relation to 20-year COPD mortality and pulmonary function in middle-aged men from three European countries.

Alcohol consumption shows a U-shaped relation with all-cause and cardiovascular mortality. To determine whether a similar relation exists between alcohol and chronic obstructive pulmonary disease mortality, we analyzed data on alcohol consumption in 1970 and 20-year mortality from chronic obstructive pulmonary disease among 2,953 middle-aged men from Finland, Italy, and the Netherlands. We also studied alcohol consumption in relation to pulmonary function (FEV1 or FEV0.75) at baseline. We used regression models adjusted for age, height (for pulmonary function only), body mass index, smoking habits, energy intake, and country. A smoothed spline-plot showed a U-shaped relation between alcohol and chronic obstructive pulmonary disease mortality. Compared with non-drinkers and occasional drinkers, the relative risk of chronic obstructive pulmonary disease mortality was 0.60 (95% CI = 0.33-1.09) in light drinkers (> 1 drink per week, < or = 3 drinks per day) and 1.25 (95% CI = 0.47-3.31) in moderate-to-heavy drinkers. Pulmonary function was lower in non-drinkers compared with occasional and light drinkers in Finland (75 ml, 95% CI = -2 to 151) and the Netherlands (93 ml, 95% CI = 0-186) and lower in very heavy (> 12 drinks per day) compared with moderate-to-heavy drinkers in Italy (99 ml, 95% CI = 9-189). In conclusion, we observed a U-shaped curve between alcohol consumption and 20-year chronic obstructive pulmonary disease mortality in middle-aged men that was supported by cross-sectional data on alcohol and pulmonary function.

[Bronchial symptoms and obstruction: recent prevalence and short-term trends (1993-1997) in adults in the Netherlands]. / Luchtwegsymptomen en -obstructie: recente prevalenties en kortetermijntrends (1993-1997) bij volwassenen in Nederland.

OBJECTIVE: To determine recent prevalences of, and short-term trends in, characteristics of chronic pulmonary disease amongst adults in the Netherlands. DESIGN: Long-term cross-sectional study. METHOD: An analysis was carried out on data collected from the 'Monitoring of risk factors and health in the Netherlands' study (Dutch acronym: MORGEN) in the period 1993-1997. The study involved 9791 men and 11,712 (non-pregnant) women aged 20-59 years from three Dutch cities, Amsterdam, Doetinchem and Maastricht. A written questionnaire was used to collect data on items such as respiratory symptoms, age, educational level and smoking habits. The presence of asthma symptoms was defined as: wheezing without a cold, nocturnal attacks of breathlessness or 'had ever suffered from asthma'. The presence of chronic obstructive pulmonary disease (COPD) symptoms was defined as: chronic cough, chronic phlegm or breathlessness when walking with people of the same age. Pulmonary function (FEV1) was measured only in 1994-1997 (n = 12,347). Bronchial obstruction was defined as FEV1 < 80% of predicted. Age standardisation was performed using the age distribution of the Dutch population in 1995 as standard. Changes over time were studied using linear regression analysis. RESULTS: The age-standardised prevalence of asthma symptoms (circa 14%), COPD symptoms (circa 14%) and obstruction (circa 8%) were comparable in men and women. The prevalence of respiratory symptoms and obstruction was clearly higher in subjects with a low versus a high educational level and this trend was also observed amongst those who had never smoked. After adjustment for age, education and city, the prevalence of respiratory symptoms increased during the study period in women (beta = 0.79% per year (95%-CI: 0.27-1.32)), but not in men. The strongest increase was observed in women aged 40-49 years and in those women with a low educational level. In both men and women no increase in the prevalence of bronchial obstruction was observed.

Dietary factors and pulmonary function: a cross sectional study in middle aged men from three European countries.

BACKGROUND: Results of epidemiological studies relating individual dietary factors to chronic obstructive pulmonary disease (COPD) are inconsistent. To evaluate the cross sectional association of dietary factors with pulmonary function, data were collected from middle aged men in three European countries. METHODS: The data were collected in the 1960s in Finland (n = 1248), Italy (n = 1386), and the Netherlands (n = 691). Dietary intake was estimated using the cross-check dietary history method. Forced expiratory volume (FEV(0.75) or FEV(1), here called FEV) was measured by spirometry. Associations were adjusted for age, height, smoking, body mass index (BMI), alcohol consumption, and energy intake. RESULTS: FEV was positively associated with intake of vitamin E in Finland, with intake of fruit in Italy, and with intake of beta-carotene in the Netherlands. In all three countries men with intakes of both fruit and vegetables above the median had a higher FEV than those with a low intake of both foods. The difference in FEV ranged from 110 to 169 ml before and from 53 to 118 ml after energy adjustment. Differences in FEV for intake of three antioxidants (vitamins C and E and beta-carotene) above versus below the median ranged from 61 to 181 ml before and from -35 to 58 ml after energy adjustment. Intake of fish was not associated with FEV. CONCLUSIONS: In three European countries a high intake of fruit and vegetables was positively associated with pulmonary function. A high intake of all three antioxidants tended to be positively associated with pulmonary function before, but not after, adjustment for energy intake. Associations of individual antioxidants with pulmonary function were not consistent across countries.

Dietary influences on chronic obstructive lung disease and asthma: a review of the epidemiological evidence.

The epidemiological evidence for a relationship between diet and indicators of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The review focuses on the intake of Na, n-3 fatty acids, and antioxidant vitamins as well as fruit and vegetables. Experimental studies suggest that a high-Na diet has a small adverse effect on airway reactivity in asthma patients. However, observational studies provide no clear evidence that high Na intake has adverse effects on airway reactivity or asthma symptoms in open populations. n-3 Polyunsaturated fatty acids, which are present in fish oils, are metabolized into less broncho-constricting and inflammatory mediators than n-6 polyunsaturated fatty acids. Studies in the general adult population suggest that a high fish intake has a beneficial effect on lung function, but the relationship with respiratory symptoms and clinically-manifest asthma or COPD is less evident. Also, experimental studies in asthma patients have not demonstrated an improvement in asthma severity after supplementations with fish oil. Several studies showed a beneficial association between fruit and vegetable intake and lung function, but the relationship with respiratory symptoms and the clinically-manifest disease was less convincing. A similar pattern was found for vitamin C in relation to indicators of asthma and COPD, but there are still conflicting results with respect to vitamin E and beta-carotene. In conclusion, the epidemiological evidence for a beneficial effect on indicators of asthma and COPD of eating fish, fruit and vegetables is increasing. However, the effectiveness of dietary supplementation in open-population samples is often not demonstrated. Several unresolved questions are raised, which should be addressed in future studies on the relationship between diet and respiratory disease.

Fruit and fish consumption: a possible explanation for population differences in COPD mortality (The Seven Countries Study).

OBJECTIVE: To investigate whether average intake of antioxidants, fruits, vegetables and fish may help to explain international differences in chronic obstructive pulmonary disease (COPD) mortality. DESIGN: Ecological analysis using information on baseline diet and the 25-year COPD mortality rate in the 16 cohorts of the Seven Countries Study. SETTING: Population-based cohorts. SUBJECTS: Men aged 40-59 years at baseline. METHODS: Dietary information was collected at baseline in small random samples of each cohort. In 1987 the reported foods were bought locally and analysed chemically. After 25 years of follow-up the underlying cause of death of those who died was established centrally. COPD mortality rate ratios were calculated, for a change equivalent to 10% of the overall mean consumption of a dietary factor. RESULTS: We observed independent inverse associations between 25-year COPD mortality and baseline consumption of fruits (rate ratio 0.49; 95% confidence interval 0.36-0.67) and fish (rate ratio, 0.97; 95% confidence interval 0.93-1.00), after adjustment for potential confounders. COPD mortality showed no statistically significant association with intake of antioxidants or vegetables. Fruit and fish consumption together explained about 67% of the variance in the COPD mortality rates of the cohorts. CONCLUSIONS: Fruit and fish consumption may partly explain population differences in COPD mortality. This is in accordance with suggestions for a relationship between fruit and fish consumption and COPD observed in studies in individuals.

Primary sternal closure and mediastinal decompression by inlay autologous rib grafts.

Hemodynamic instability and arrhythmia after cardiopulmonary bypass occasionally requires delayed sternal closure or placement of a stenting device. A primary sternal closure with autologous inlay rib grafts can ensure a secure, stable sternal repair and avoids prolonged ventilator support and the concerns, risks, and expense associated with a secondary sternotomy repair.

Aortopulmonary window and aortic isthmic hypoplasia. Operative management in newborn infants.

Aortopulmonary window with aortic isthmic hypoplasia is an unusual combination of congenital heart lesions that usually causes severe heart failure, poor systemic perfusion, and death shortly after birth. In 21 previously reported cases, survival beyond infancy was uncommon, yet only one neonate survived operation. This report describes three cases of aortopulmonary window and aortic isthmic hypoplasia and a two-stage operative approach that proved successful in both infants in which it was tried. During the first step the isthmic obstruction is relieved, the ductus is ligated, and the aortopulmonary window is plicated via a left thoracotomy. The second stage consists of definitive closure of the aortopulmonary window using the technique of deep perfusion hypothermia.

Glucagon enhancement of cholangiography. A preliminary report.

Fourteen patients having cholecystectomies under general anesthesia were divided into two groups in a double-blind study. All had intraoperative cholangiograms, before which half had glucagon hydrochloride given intravenously in a dose of 1 mg; the others received only normal saline solution. There was a consistently superior visualization of the biliary tree in those given glucagon, and the difference was statistically significant. No significant changes in blood glucose level, heart rate, or ECG patterns were noted in either group. One patient with preoperative hypertension had a brief rise in BP after the glucagon was given. This study confirms previous anecdotal reports suggesting that glucagon in low dose enhances the quality of cholangiography without producing side effects.

Upper gastrointestinal hemorrhage in cirrhosis: timing and indications for active intervention.

The medical treatment of upper gastrointestinal hemorrhage was assessed in 101 patients with alcoholic liver disease. Mortality was proportional to the number of blood transfusions required, regardless of the severity of liver disease. Overall mortality was 73% when transfusion requirements exceeded four units, compared with 19% when less than this amount was required (p less than 0.05). A more direct approach to the control of variceal hemorrhage is indicated when blood loss reaches 21.

Clinical significance of erosive gastritis in patients with alcoholic liver disease and upper gastrointestinal hemorrhage.

Since, in many patients with alcoholic liver disease and upper gastrointestinal hemorrhage, varices and erosive gastritis frequently coexist, the purpose of this study was to assess the severity of hemorrhage, rebleeding and mortality rates when these lesions are present singly or concomitantly. In 104 patients not operated upon, 31 had both lesions present on endoscopic examination, and their clinical courses paralleled the severity of 29 patients who had bleeding varices as the sole finding. In 13 patients with alcoholic liver disease and upper gastrointestinal hemorrhage who were found to have erosive gastritis as the sole lesion, the clinical course was as benign as in 31 patients with ethanol-induced gastritis without liver disease, and their blood loss, rebleeding and mortality rates were significantly less than in patients with both varices and gastritis. It is concluded that the course and prognosis of upper gastrointestinal hemorrhage in patients with alcoholic liver disease and erosive gastritis is dependent upon the presence or absence of gastroesophageal varices.

Erythrocyte survival following extracorporeal circulation. A question of membrane versus bubble oxygenator.

Five groups of seven dogs were studied. Each animal had 250 ml of blood withdrawn and tagged with Cr51. Group I (control) samples were combined with 500 ml of lactated Ringer's solution and reinfused into the respective animals after 3 hours of incubation at 37 degrees C. Group II samples were pumped in a closed-circuit bubble oxygenator with 500 ml of lactated Ringer's prime for 2 hours before reinfusion into the animals. Group III samples were pumped in a bubble oxygenator for 3 hours before reinfusion. Group IV samples were pumped in a closed-circuit membrane oxygenator for 2 hours, and Group V samples were pumped in a membrane circuit for 3 hours. All extracorporeal pump runs were performed at 37 degrees C. Blood samples were drawn from the dogs at regular intervals after bypass for 30 days. Erythrocyte survival was determined by Cr51 activity recorded by a gamma counter. The red cell half-life was determined for each dog. The control half-life was 24.1 +/- 2.03 days; Group II, 19.88 +/- 1.69 (p < 0.05); Group III, 9.63 +/- 1.4 (p < 0.001); Group IV, 19.4 +/- 1.65 (p < 0.05); and Group V, 9.13 +/- 1.45 (p < 0.001). These data indicate that serious red cell injury does occur with extracorporeal circulation but that the injury is a function of pump time, rather than of the type of oxygenator.