Usability and outcomes of self-monitored surgical wound healing using a smartphone-based application by patients following neurosurgery.

BACKGROUND: The Radboudumc developed a smartphone application (WondGezond) to collect surgical wound-healing information provided by the patient. AIM: To evaluate usability and outcomes to assess its potential for early surgical site infection (SSI) detection. METHODS: Patients surgically treated for degenerative spinal disorders or carpal tunnel syndrome between August 2020 and February 2023 were enrolled one day post surgery and asked to download the app via a quick-response (QR) code. Participants uploaded a photo and answered four questions about their wound daily, for 14 days. Afterwards, participants indicated whether they received treatment for a suspected SSI (participant-reported outcome). Two neurosurgeons independently assessed photos and questionnaire answers for suspected SSIs (physician-assessed outcome). The association between both outcomes was determined by calculating sensitivity, specificity, and positive and negative predictive value (PPV/NPV). FINDINGS: After 2009 surgeries, 1695 QR-codes were distributed and 412 (21%) were activated. In all, 232 (56%) participants completed the 14-day period of whom 22 (10%) reported SSI treatment. Physician assessment identified 15 (7%) SSIs. Concordance was reached in 88% of cases. Among 27 discordant cases were 17 false-positives and 10 false-negatives, resulting in low sensitivity (33%) and PPV (23%), but high NPV (95%). CONCLUSION: WondGezond provides clinicians with information regarding wound healing and SSIs to follow-up on patients at risk, while possibly also reducing antibiotic (over)treatment and unnecessary visits for patients without issues in wound healing. However, the low participation and false-positive results render the app in its current form unsuitable for surveillance purposes. Further validation of WondGezond is required.

Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries.

BACKGROUND: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. METHODS: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. FINDINGS: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14µg, 95% CI 12, 16) in higher educated individuals. INTERPRETATION: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

Traditional methods v. new technologies - dilemmas for dietary assessment in large-scale nutrition surveys and studies: a report following an international panel discussion at the 9th International Conference on Diet and Activity Methods (ICDAM9), Brisbane, 3 September 2015.

The aim of the present paper is to summarise current and future applications of dietary assessment technologies in nutrition surveys in developed countries. It includes the discussion of key points and highlights of subsequent developments from a panel discussion to address strengths and weaknesses of traditional dietary assessment methods (food records, FFQ, 24 h recalls, diet history with interviewer-assisted data collection) v. new technology-based dietary assessment methods (web-based and mobile device applications). The panel discussion 'Traditional methods v. new technologies: dilemmas for dietary assessment in population surveys', was held at the 9th International Conference on Diet and Activity Methods (ICDAM9), Brisbane, September 2015. Despite respondent and researcher burden, traditional methods have been most commonly used in nutrition surveys. However, dietary assessment technologies offer potential advantages including faster data processing and better data quality. This is a fast-moving field and there is evidence of increasing demand for the use of new technologies amongst the general public and researchers. There is a need for research and investment to support efforts being made to facilitate the inclusion of new technologies for rapid, accurate and representative data.

Preparation of Dutch food consumption data for risk assessment.

The availability of detailed and high-quality food consumption data collected at an individual level is essential for assessing the exposure to potential risks in the food chain. During the years 2012-2016, the Dutch National Food Consumption Survey was conducted in the Netherlands as part of the EU Menu survey, following the EFSA 2009 guidance on 'General principles for the collection of national food consumption data in the view of a pan-European dietary survey'. Complete results were obtained for 4,313 persons aged 1-79 years (response rate 65%). The work programme proposed to the European Food Risk Assessment (EU-FORA) Fellow included FoodEx2 mapping of the Dutch food consumption data and preparing the final scientific report for EFSA as well as analysing habitual intake of nutrients using the SPADE programme. Further activities were added, such as performing a literature search as to the validity and usability of mobile applications for collecting food consumption data and exploring methods for estimating added-sugar/free-sugar intake.

The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring.

BACKGROUND/OBJECTIVES: The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies. SUBJECTS/METHODS: Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc 'EPIC-Soft specifications questionnaire' sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs. RESULTS: A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts. CONCLUSIONS: EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.

Epirubicin and paclitaxel with G-CSF support in first line metastatic breast cancer: a randomized phase II study of dose-dense and dose-escalated chemotherapy.

An increased dose-intensity can be achieved by either higher dose of chemotherapy per cycle (dose-escalation) or by shortening the interval between cycles (dose-dense). This multicenter randomized phase II study assessed the efficacy and safety of two different approaches: epirubicin 110 mg/m(2) combined with paclitaxel 200 mg/m(2) every 21 days and epirubicin 75 mg/m(2) combined with paclitaxel 175 mg/m(2) every 10 days, both supported with G-CSF. Patients with advanced breast cancer and without prior palliative chemotherapy were scheduled for 6 cycles. Evaluable for response were 101 patients and for toxicity 106 patients. Grade ≥ 3 toxicities occurred in 39% of patients in the dose-escalated arm and in 29% of the dose-dense arm, mainly febrile neutropenia, thrombocytopenia, neurotoxicity and (asymptomatic) cardiotoxicity. The median delivered cumulative doses for epirubicin/paclitaxel were 656/1194 and 448/1045 mg/m(2), treatment durations were 126 and 61 days, and delivered dose intensities were 36/67 and 51/120 mg/m(2)/week for the dose-escalated and dose-dense arm, respectively. Response rates were 75 and 70%, the progression-free survival 6 and 7 months, respectively. Dose-dense chemotherapy with a lower cumulative dose, a halved treatment time, but a higher dose-intensity may be as effective and safe as dose-escalated chemotherapy. The value of dose-densification over standard scheduled chemotherapy regimes yet needs to be determined.

Polymorphisms in the NPY and AGRP genes and body fatness in Dutch adults.

OBJECTIVE: To investigate the association between DNA polymorphisms in the NPY and AGRP genes and body fatness. DESIGN AND METHODS: The association between the AGRP Ala67Thr or the NPY Leu7Pro polymorphisms and indicators of body fatness (baseline leptin levels, body mass index (BMI) values and prevalence of overweight) are investigated in 582 participants of two large cohorts in The Netherlands (total 18 500 adult men and women), aged 20-40 years whose weight remained relatively constant or whose weight increased substantially (range 5.5-47 kg) during a mean follow-up of 7 years. RESULTS: No consistent associations were found for the indicators of body fatness for men and women. Among women, BMI values, leptin levels and prevalence of overweight were not statistically different for carriers of the mutant alleles compared to that of the non-carriers. Among men, carriers of the Thr67-allele of the AGRP gene had similar leptin levels, but higher BMI values compared to those with the genotyping Ala67/Ala67: mean adjusted BMI 25.6 kg/m2 (95% CI 24.3-27.0) vs 23.9 kg/m2 (23.6-24.3). Also, the risk of being overweight at baseline tended to be higher for male carriers of the Thr67-allele of the AGRP gene (OR 2.52; 95% CI 0.86-7.4). Furthermore, male carriers of the Pro7-allele of the NPY gene had on average higher leptin levels and BMI values vs non-carriers of this allele: 4.7 microg/l (95% CI 3.7-6.0) and 25.7 kg/m2 (95% CI 24.4-27.0) vs 3.1 microg/l (95% CI 2.9-3.4) and 23.9 kg/m2 (95% CI 23.5-24.3), respectively. These male carriers had also a higher risk on being overweight at baseline (OR 3.3 (95% CI 1.2-8.9)) compared to non-carriers of the Pro7-allele. CONCLUSION: The consistent findings among men suggest that the NPY Leu7Pro polymorphism (or another linked marker) might be involved in the development of obesity at younger ages. The findings for the AGRP Ala67Thr were less consistent and need further investigation. Among women, these polymorphisms do not play an important role.

Fasting leptin and appetite responses induced by a 4-day 65%-energy-restricted diet.

OBJECTIVE: Animal studies show that the leptin decline after acute severe caloric restriction is a peripheral signal to increase food intake. However, most human studies have failed to observe such a relationship. We studied the acute effects of severe caloric restriction on the association between serum leptin concentrations and subjective appetite. SUBJECTS: A total of 44 healthy adult men (aged: 43 +/- 5 years; BMI: 27.3 +/- 3.2 kg/m(2)). MEASUREMENTS: Fasting serum leptin concentrations and self-perceived appetite levels were measured during a 4-day diet containing 36% of the estimated energy requirements. Appetite levels were assessed with a 10-point Likert scale, reflecting hunger, fullness, desire to eat, prospective consumption and total appetite. RESULTS: After the 4-day energy deficit, fasting leptin concentrations decreased by 39.4% (95% CI: -43.6; -34.9%). This decline was associated with an increase in fasting hunger (r = -0.42; P < 0.01), desire to eat (r = -0.39; P < 0.05) and total appetite (r = -0.38; P < 0.05). Furthermore, the association between fasting leptin concentrations and fasting appetite levels became stronger during the energy restriction period (for total appetite: day 0 r = -0.15, P = 0.32; day 2 r = -0.31, P =< 0.05; day 4 r = -0.41, P < 0.01). CONCLUSIONS: The acute proportional reduction in fasting leptin after 4-day energy restriction is associated with an increase in self-perceived appetite. Additionally, the inverse association between proportional fasting leptin concentrations and self-perceived appetite response becomes stronger as energy restriction is prolonged. These findings suggest that leptin has an instrumental role in restoring energy balance in humans through the expression of appetite.

Functional constipation in infants: a follow-up study.

Our objective of this study was to describe the clinical course of severe functional constipation in early childhood. Eligible patients were 47 children (60% boys; median age, 3.5 months) who had constipation in their first year of life. Follow-up data were obtained through a standardized questionnaire. Success was defined as a period of at least 4 weeks with > or =3 painless bowel movements per week. Six months after initial evaluation, 69% of the children were recovered. After initial success, a relapse occurred in 15% of the children within 3 years. A duration of symptoms <3 months before referral correlated significantly with better outcome. We conclude that most infants with severe constipation evaluated at a tertiary center are recovered after 6 months. Early therapeutic intervention may beneficially contribute to the resolution of constipation.

Influence of beta(2)-adrenoceptor gene polymorphisms on diet-induced thermogenesis.

The sympathetic nervous system is involved in the control of energy metabolism and expenditure. Diet-induced thermogenesis is mediated partly by the ss-adrenergic component of this system. The aim of the present study was to investigate the role of genetic variation in the beta(2)-adrenoceptor in diet-induced thermogenesis. Data from twenty-four subjects (fourteen men and ten women; BMI 26.7(sem 0.8) kg/m(2); age 45.2(sem1.4) years) with different polymorphisms of the beta(2)-adrenoceptor at codon 16 (Gly16Gly, Gly16Arg or Arg16Arg) were recruited for this study. Subjects were given a high-carbohydrate liquid meal, and the energy expenditure, respiratory exchange ratio, and plasma concentrations of NEFA, glycerol, glucose, insulin and catecholamines were measured before and over 4 h after the meal. The AUC of energy expenditure (diet-induced thermogenesis) was not significantly different between polymorphism groups, nor was the response of any of the other measured variables to the meal. In a multiple regression model, the only variable that explained a significant proportion (32 %) of the variation in diet-induced thermogenesis was the increase in plasma adrenaline in response to the meal (P<0.05). The beta(2)-adrenoceptor codon16 polymorphisms did not contribute significantly. In conclusion, an independent contribution of the codon 16 polymorphism of the beta(2)-adrenoceptor gene to the variation in thermogenic response to a high-carbohydrate meal could not be demonstrated. The interindividual variation in thermogenic response to the meal was correlated with variations in the plasma adrenaline response to the meal.

beta2-adrenergic receptor polymorphisms and salbutamol-stimulated energy expenditure.

The beta-adrenergic system is involved in the control of energy metabolism and expenditure. The beta2-adrenergic receptor (beta2-AR) gene shows polymorphisms that have been associated with obesity in several studies. In vitro and in vivo studies suggest differences in beta2-AR-mediated function between these polymorphisms. The aim of this study was to investigate the influence of genetic variation in codon 16 of the beta2-AR gene on energy metabolism in humans. Thirty-four subjects were recruited [Gly16Gly (n = 13), Gly16Arg (n = 16), or Arg16Arg (n = 5)]. The beta2-AR was stimulated with two doses of salbutamol (50 and 100 ng/kg fat-free mass per minute) after blockade of the beta1-adrenergic receptors with atenolol. Energy expenditure and plasma substrate and hormone concentrations were measured. The increase in energy expenditure (DeltaEE) was significantly different among groups in which the Arg16Arg group showed the lowest increase (P < 0.05 vs. Gly carriers). In a multiple regression model, variations in the increase in nonesterified fatty acid concentration during salbutamol infusion (partial r = 0.51) and the polymorphism contributed significantly to the variation in DeltaEE. Thirty-five percent of the variation in DeltaEE was explained by these two factors. We conclude that subjects with the Arg16Arg polymorphism of the beta2-AR gene have a reduced thermogenic response to beta2-adrenergic stimulation. Although this relatively small study needs confirmation, the findings support a role for this polymorphism in the development and maintenance of overweight and obesity.

[Nutrition and health--safety of new types of food]. / Voeding en gezondheid--veiligheid van nieuwe voedingsmiddelen.

In Europe it is currently a statutory requirement that all novel foods must first be tested before they can be put on the market to establish that they pose no hazard to consumers. A novel food is a food or food ingredient which was not used to a significant degree on the European market prior to 1997 and which falls within one of the categories described in a specific European regulation. The procedure used to establish the safety of such a novel food involves a request for authorization. The company compiles a safety dossier containing a comprehensive report on the characteristics of the substance, details of toxicological studies and any other relevant information. The company submits the dossier to the relevant authority in one of the European member states. In the Netherlands, this is the Ministry of Health, Welfare and Sport. The Ministry then arranges for an initial assessment to be carried out. In the Netherlands the Committee on Safety Assessment of Novel Foods (Dutch acronym: VNV), part of the Health Council, conducts the assessment. Following the completion of the assessment, other member states may carry out their own assessments. Finally, the member states make a collective decision on whether or not to authorise the marketing of the product. The VNV assessment takes a case-by-case and step-by-step approach. Each request for authorization is individually examined to determine the types of research data that will be needed to reach a verdict. A short-track procedure or 'notification' is available for products that are substantially equivalent to existing foods. The VNV Committee operates as transparently as possible. All dossiers are available for inspection. The Committee's advisory reports are available to the public and committee members provide details of their personal interests.

Leptin and insulin responses to a four-day energy-deficient diet in men with different weight history.

OBJECTIVE: To assess the leptin responses to a 4-day energy-restricted diet in men with different weight history; high retrospective weight gain was expected to be associated with a small decline in leptin. DESIGN: Changes in fasting leptin and insulin were measured during a 4-day controlled intervention, in which men with high retrospective weight gain and men who had stable weight consumed 35% of their estimated energy needs. SUBJECTS: A total of 44 healthy men (age: 31-52 y, BMI: 22.7-39.8 kg/m(2)) were recruited from a cohort study: 22 men who had gained weight (weight change >1 kg/y) and 22 men whose weight had remained stable (weight change +/-0.3 kg/y) between the first (1987-1991) and the second measurement (1993-1997) of the cohort study. The intervention study was carried out in 2001. RESULTS: After intervention, changes in fasting leptin levels were similar for both groups of retrospective weight gain: -2.2 microlU/ml (95% CI: -2.8; -1.7) and -2.4 microlU/ml (95% CI: -3.2; -1.7) respectively (P=0.69). Proportional changes in fasting leptin levels were different: -43.3% (95% CI: -47.8; -38.4) in the participants whose weight had remained stable (n=22) and -35.2% (95% CI: -42.4; -27.1) in those who had gained weight (n=22)(P<0.05). Analyses in a subgroup of men (n=18), in which the contrast in weight history was more pronounced than in the total group, did not show this difference. A higher proportional decrease in insulin levels was seen in men whose weight remained stable than in those who had gained weight: -35.4% (95% CI: -46.9; -21.3) and -12.8% (95% CI: -28.1; 5.7), respectively. The proportional decrease in leptin was positively associated with the proportional decrease in insulin (r=0.52; P<0.05). The decrease in leptin was positively associated with preintervention body weight (r=0.36; P<0.05), BMI (r=0.44; P<0.05), and waist-circumference (r=0.46; P<0.05). CONCLUSION: Although we found that the 4-day energy restriction had a smaller effect on the decrease in leptin in men with retrospective weight gain, our study does not show convincing evidence that men who gained weight are less leptin responsive to changes in energy balance than those who were weight stable.

Echocardiographic diagnosis in carcinoid heart disease.

In this case report the typical echocardiographic features of carcinoid heart disease are presented. Newer treatments such as the use of a somatostatin analogue, interferon and hepatic de-arterialisation have improved the prognosis in patients with carcinoid syndrome. Nevertheless this syndrome portends a poor prognosis in patients with cardiac involvement. Cardiac lesions are mainly located in the right side of the heart. Regurgitation and stenosis of the tricuspid and pulmonary valve, leading to right heart failure, are the most common cardiac manifestations of the disease. Elevated levels of serotonin are probably responsible for the development of these cardiac lesions. Despite treatment resulting in significant reductions of urinary levels of 5-HIAA, regression of the cardiac manifestations in carcinoid syndrome has not been observed. Two-dimensional and Doppler echocardiography are the main tools to establish the diagnosis and severity of carcinoid heart disease. Cardiac surgery for carcinoid heart disease might improve symptoms and longevity, but the scarce data report on early mortality of over 35%.

Genetic factors as predictors of weight gain in young adult Dutch men and women.

OBJECTIVE: To investigate the association between DNA polymorphisms in several candidate genes for obesity and weight gain. Polymorphisms in these genes may contribute to weight gain through effects on energy intake, energy expenditure or adipogenesis. DESIGN AND METHODS: From two large cohorts in The Netherlands (total 17,500 adult men and women), we compared 286 subjects aged 20-40 y who gained an average of 12.8 kg (range 5.5-47 kg) during a mean follow-up of 6.8 y with 296 subjects who remained relatively constant over the same period with respect to occurrence of several polymorphisms in candidate genes of obesity and some lifestyle factors. Subjects who were dieting, were high alcohol consumers, were pregnant, changed their smoking status recently, or those who suffered from serious illnesses were excluded. Polymorphisms were determined in the LEPR-gene (LEPR Lys109Arg, LEPR Gln223Arg, LEPR Lys656Asn), in the UCP1 gene (A-G mutation at position-3826 5' region), in the UCP2 gene (Ala55Val, 45 bp Ins/Del), in the PPARG2 gene (Pro12Ala) and in the ADRB2 gene (Gly16Arg and Gln27Glu). RESULTS: With the exception of the Gly16Arg polymorphism in the ADRB2 gene in men (P = 0.04) and women (P = 0.05), and the Lys109Arg polymorphism in the LEPR gene in women, no statistically significant differences in the genotype and allele frequencies were observed between weight gainers and non-weight gainers. Weight gainers differed in some aspects of dietary habits and physical activity patterns: weight gainers consumed relatively more savory snacks and were less active during leisure time compared with non-weight gainers. CONCLUSION: Only variations in the ADRB2 gene and LEPR gene, may contribute to susceptibility to weight gain. None of the other studied genetic markers were clearly associated with weight gain. Further research is necessary to establish the role of lifestyle factors, or interactions between genes or between genes and lifestyle factors on weight gain with age.

Seasonal variation in cause-specific mortality: are there high-risk groups? 25-year follow-up of civil servants from the first Whitehall study.

OBJECTIVES: To determine the seasonal effect on all-cause and cause-specific mortality and to identify high-risk groups. METHODS: A 25-year follow-up of 19,019 male civil servants aged 40-69 years. RESULTS: All-cause mortality was seasonal (ratio of highest mortality rate during winter versus lowest rate during summer 1.22, 95% CI : 1.1-1.3), largely due to the seasonal nature of ischaemic heart disease. Participants at high risk based on age, employment grade, blood pressure, cholesterol, forced expiratory volume, smoking and diabetes did not have higher seasonal mortality, although participants with ischaemic heart disease at baseline did have a higher seasonality effect (1.38, 95% CI : 1.2-1.6) than those without (1.18, 95% CI : 1.1-1.3) (P = 0.03). CONCLUSIONS: Seasonal mortality differences were greater among those with prevalent ischaemic heart disease and at older ages, but were not greater in individuals of lower socioeconomic status or with a high multivariate risk score. Since seasonal differences showed no evidence of declining over time, elucidating their causes and preventive strategies remains a public health challenge.

Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study.

STUDY OBJECTIVE: To test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men. DESIGN: 25 year follow up of mortality in relation to employment grade. SETTING: The first Whitehall study. PARTICIPANTS: 18,001 male civil servants aged 40-69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years. MAIN OUTCOME MEASURE: Specific causes of death. RESULTS: After more than 25 years of follow up of civil servants, aged 40-69 years at entry to the study, employment grade differences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the differentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases. CONCLUSIONS: Differentials in mortality persist at older ages for almost all causes of death.

Prevalence, treatment, and control of hypertension by sociodemographic factors among the Dutch elderly.

The study objective was to assess the prevalence, level of treatment, and control of hypertension in a general elderly population according to age and sociodemographic factors. We conducted a cross-sectional analysis of 7983 participants of the Rotterdam Study who were >/=55 years old and living in a district of Rotterdam. The prevalence of hypertension was based on blood pressure levels (>/=160/95 mm Hg) and the use of blood pressure-lowering medication for the indication of hypertension, type of treatment, and control of hypertension. Systolic blood pressure rises with age, whereas diastolic blood pressure declines. The prevalence of hypertension increases with age and was higher among women (39%) than among men (31%). About 80% of the hypertensives were aware of having hypertension, and 82% of the 80% were treated. For 70% of them, treatment was adequate with reference to conservative criteria. Hypertension was more prevalent among persons not living in a home for the elderly, for more-educated men, and for less-educated women. Persons without a partner and men living in a home for the elderly had a higher risk of being unaware of or of not being treated for existing hypertension. Treatment was more often successful among those living in a home for the elderly. The prevalence of hypertension was higher among older women and increased with age in both genders. A large proportion of hypertensive elderly persons were aware and were successfully treated for hypertension. The degree of awareness and control appeared to be affected by sociodemographic factors. More importantly, the majority of hypertensives did not have their hypertension well controlled. This group requires more attention by medical practitioners to reduce the burden of cardiovascular diseases in elderly persons.

Education and nutrient intake in Dutch elderly people. The Rotterdam Study.

OBJECTIVE: Unfavourable dietary habits might explain a part of the increased cardiovascular morbidity and mortality among the lower socioeconomic groups. The aim of the study was to describe differences in dietary intake in older subjects by socioeconomic status, as indicated by educational level. DESIGN: A cross-sectional analysis of socioeconomic status in relation to dietary intake. SETTING: The Rotterdam Study. SUBJECTS: 2213 men and 3193 women, aged 55 y and over living between 1990 and 1993 in a district of Rotterdam, The Netherlands. METHODS: Dietary data were assessed with a semiquantitative food frequency questionnaire, containing 170 food items in 13 food groups. RESULTS: In general, the dietary differences between socioeconomic groups were small. Lower educated subjects had a higher intake of almost all macronutrients compared with higher educated subjects. The total energy intake of men/women with the lowest educational level differed from those with the highest education in the following respect: 9.60/7.54 vs 8.94/7.17 MJ/day. Furthermore, fat composition was more adverse in the lower educated strata; in lower educated subjects, relatively more energy was derived from saturated fat (14.5/14.6 vs 13.8/13.8 energy%), the ratio of polyunsaturated saturated fat was lower (for men: 0.50 vs 0. 55) and the intake of cholesterol higher (271/220 vs 240/204 mg/day). These differences could be explained by a higher intake of visible fat (46/37 vs 44/34 g/day) and more meat consumption (130/100 vs 116/86 g/day). In addition, the composition of these products differed: the higher educated used relatively more lean meat and low-fat milk products. Furthermore, the intake of fibre was lower among the lower educated (1.88/2.17 vs 2.03/2.29 g/MJ). Among lower educated groups there were more abstainers (15.5/31.5 vs 12.3/26.9%) and the type of alcoholic beverages also differed between the groups. Intake of antioxidant vitamins from food alone did not differ between educational groups. CONCLUSIONS: In Dutch elderly people, there are socioeconomic differences in dietary intake. Although these differences are small, these findings support the role of diet in the explanation of socioeconomic inequalities in cardiovascular health. SPONSORSHIP: Erasmus Centre for Research on Aging, Erasmus University Rotterdam. European Journal of Clinical Nutrition (2000) 54, 159-165