Consumption of whole grains, fruit and vegetables is not associated with indices of renal function in the population-based longitudinal Doetinchem study.

Emerging evidence suggests that diet and renal function are related. Little is known, however, about the association of consumption of whole grains, fruit and vegetables with urinary albumin:creatinine ratio (ACR) and changes in estimated glomerular filtration rate (eGFR). We investigated this in a population-based cohort aged 26-65 years. Data were from 3787 participants from the Doetinchem cohort study, who were examined ≥3 times, 5 years apart. Consumption of food groups was assessed at each round with a validated FFQ. GFR was estimated at each round from routinely measured cystatin C and creatinine using the Chronic Kidney Disease-Epidemiology (CKD-EPI) equation. ACR was measured at the last round. Generalised estimated equation models were performed to examine associations with changes in eGFR. Linear regression was used to examine associations with ACR. Adjustments were made for covariates related to lifestyle, biological factors and diet. Mean baseline eGFR was 104·5 (sd 13·7) and mean annual decline was -0·95 (sd 0·67) ml/min per 1·73 m2 over a 15-year follow-up. A trend was observed towards slightly less annual decline in eGFR among those with higher consumption of whole grains (P=0·06). This association, however, was attenuated and no longer significant in multivariate models (P=0·29). Consumption of fruit and vegetables was not associated with changes in eGFR and urinary ACR. In conclusion, consumption of whole grains, fruit and vegetables is not associated with changes in eGFR and mean ACR. As this was the first longitudinal study into this association in the general population, and as results are only partially in line with related studies, further research is recommended.

Association of dietary protein and dairy intakes and change in renal function: results from the population-based longitudinal Doetinchem cohort study.

BACKGROUND: Evidence has suggested that protein from dairy may be less detrimental to renal health than protein from nondairy products. However, to our knowledge, no previous studies have used cystatin C-based measures of the estimated glomerular filtration rate (eGFR). OBJECTIVE: We investigated the associations of sources of protein and dairy with the change in the eGFR in persons with a normal or mildly decreased eGFR. DESIGN: We included 3798 participants, aged 26-65 y, from the Doetinchem Cohort study who were examined ≥3 times 5 y apart. Intakes of protein and dairy and subtypes of protein and dairy were assessed at each round. With the use of the Chronic Kidney Disease Epidemiology Collaboration equation, the eGFR was estimated from cystatin C with all available samples per participant examined in one assay run. Generalized estimating equation models, which were adjusted for lifestyle, biological, and other dietary factors (monounsaturated fat, polyunsaturated fat, phosphorus, magnesium, calcium, and vitamin D) were performed. RESULTS: The mean baseline eGFR in the total cohort and in subjects with a mildly decreased eGFR (≥1 eGFR of 60-90 mL · min-1 · 1.73 m-2 during follow-up; n = 1326) was 108.6 and 95.2 mL · min-1 · 1.73 m-2, and the mean annual decline in both groups was 1.01 and 1.34 mL · min-1 · 1.73 m-2, respectively. Intakes of total, vegetable, animal, and nondairy protein, dairy protein, cheese, total dairy, high-fat dairy, and fermented dairy were not associated with eGFR changes. In individuals with a mildly decreased eGFR, higher consumption of milk, milk products, and low-fat dairy was associated with less annual decline in the eGFR (P-trend = 0.003). These associations were partially explained by dietary components of dairy (monounsaturated fat, polyunsaturated fat, phosphorus, magnesium, calcium, and vitamin D; P-trend < 0.04). CONCLUSIONS: Higher low-fat dairy consumption, but not sources of protein, is associated with less annual decline in the eGFR, particularly in individuals with a mildly decreased eGFR. These associations are partly attributable to other major components of dairy. Confirmation of these results will improve our ability to understand the role of dairy consumption in the prevention of renal dysfunction.

Obesity and Age-Related Changes in Markers of Oxidative Stress and Inflammation Across Four Generations.

OBJECTIVE: The prevalence of obesity increases with age and is higher in each younger generation (unfavorable generation shift). This may influence patterns of oxidative stress and inflammation. Age-related changes and generation shifts in markers of oxidative stress and inflammation were investigated, specifically addressing the role of body mass index (BMI). METHODS: Four generations (aged 26-35, 36-45, 46-55, and 56-65 at baseline) (N = 5,155) were examined every 5 years for 15 years between 1993 and 2012. Random coefficient analyses were used to study age-related changes and generation shifts in BMI, γ-glutamyltransferase (GGT), uric acid (UA), and C-reactive protein (CRP). RESULTS: Levels of BMI, UA, and CRP increased in all generations up to age 75, whereas GGT increased up to age 55. No consistent generation shifts were observed for GGT, UA, and CRP (P ≥ 0.05). Participants with a stable BMI (change ≤1 kg/m(2) /15 years) had either no or small increases with age in GGT, UA, and CRP, whereas participants with increasing BMI (increase >1 kg/m(2) /15 years) had much larger increases (P < 0.01). CONCLUSIONS: The unfavorable age-related changes in obesity-related biochemical markers, particularly among individuals with increasing BMI, show the importance of maintaining a healthy weight to improve population levels of oxidative stress and inflammation.

Coffee and tea consumption in relation to estimated glomerular filtration rate: results from the population-based longitudinal Doetinchem Cohort Study.

BACKGROUND: Although coffee consumption and tea consumption have been linked to diabetes, the relation with kidney function is less clear and is underresearched. OBJECTIVE: We investigated the prospective associations of coffee and tea consumption with estimated glomerular filtration rate (eGFR). DESIGN: We included 4722 participants aged 26-65 y from the Doetinchem Cohort Study who were examined every 5 y for 15 y. Coffee and tea consumption (in cups/d) were assessed at each round. eGFR was assessed by using the Chronic Kidney Disease Epidemiology Collaboration equation based on both plasma creatinine and cystatin C. We determined the association between categories of coffee and tea intake and 1) eGFR and 2) subsequent annual changes in eGFR by using generalized estimating equation analyses. RESULTS: Baseline mean ± SD eGFR was 108.0 ± 14.7 mL · min(-1) · 1.73 m(-2) Tea consumption was not associated with eGFR. Those individuals who drank >6 cups coffee/d had a 1.33 (95% CI: 0.24, 2.43) mL · min(-1) · 1.73 m(-2) higher eGFR than those who drank <1 cup/d (P-trend = 0.02). This association was most apparent among those with a median age of ≥46 y at baseline, with eGFR being 2.47 (95% CI: 0.42, 4.51) mL · min(-1) · 1.73 m(-2) higher in participants drinking >6 cups/d compared with <1 cup/d (P-trend = 0.02). Adjustment for biological risk factors and coffee constituents did not attenuate the associations. Neither coffee nor tea consumption was associated with changes in eGFR. CONCLUSIONS: Coffee consumption was associated with a slightly higher eGFR, particularly in those aged ≥46 y. The absence of an association with eGFR changes suggests that the higher eGFR among coffee consumers is unlikely to be a result of glomerular hyperfiltration. Therefore, low to moderate coffee consumption is not expected to be a concern for kidney health in the general population.

Physical Activity Is not Associated with Estimated Glomerular Filtration Rate among Young and Middle-Aged Adults: Results from the Population-Based Longitudinal Doetinchem Study.

There is debate as to whether physical inactivity is associated with reduced kidney function. We studied the prospective association of (changes in) physical activity with estimated glomerular filtration rate (eGFR) in adult men and women. We included 3,935 participants aged 26 to 65 years from the Doetinchem Cohort study, examined every 5 years for 15 years. Physical activity was assessed at each round using the Cambridge Physical Activity Index. Using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation, GFR was estimated from routinely measured cystatin C concentrations, examining all available samples per participant in one assay run. We determined the association between 1) physical activity and eGFR and 2) 5-year changes in physical activity (becoming inactive, staying inactive, staying active, becoming active) and eGFR, using time-lagged generalized estimating equation analyses. At baseline, 3.6% of the participants were inactive, 18.5% moderately inactive, 26.0% moderately active, and 51.9% active. The mean (± SD) eGFR was 107.9 (± 14.5) mL/min per 1.73 m2. Neither physical activity nor 5-year changes in physical activity were associated with eGFR at the subsequent round. The multivariate adjusted ßeGFR was 0.57 mL/min per 1.73 m2 (95% Confidence Interval (CI) -1.70, 0.56) for inactive compared to active participants. Studying changes in physical activity between rounds, the adjusted ßeGFR was -1.10 mL/min per 1.73 m2 (95% CI -4.50, 2.30) for those who stayed inactive compared with participants who became active. Physical activity was not associated with eGFR in this population-based study of adults.

Changes in the Relationships Between Body Mass Index and Health Outcomes Across Middle Age and Older Adulthood.

OBJECTIVE: To examine patterns of the incidence of diabetes, hypertension, and mortality by single units of body mass index (BMI) and 5-year age groups using longitudinal data from middle-aged and older women. PATIENTS AND METHODS: Middle-aged (born between 1946 and 1951; N = 13,715) and older (born between 1921 and 1926; N = 12,432) participants in the Australian Longitudinal Study on Women's Health completed surveys in 1996 and at approximately 3-year intervals thereafter until 2011. Proportions of women with diabetes, hypertension, and mortality over 3-year intervals were estimated for each unit of BMI and 5-year age group (45 to < 50, 50 to < 55, 55 to < 60, 70 to < 75, 75 to < 80, and 80 to < 85 years) using generalized additive modeling with adjustment for time-varying covariates. RESULTS: Three-year incidence of diabetes (1.2%-3.6%), hypertension (5.2%-17.8%), and death (0.4%-9.5%) increased with age. For both diabetes and hypertension, the associations with BMI were curvilinear in middle-aged women and became almost linear in older women. With increasing age, the slope became steeper, and the increase started at lower BMI values. For hypertension, there was a marked increase in intercept from 75 years onward. In contrast, mortality risks were highest for low BMI (≤ 20) in all age groups. A clear U-shaped curve was observed only in the oldest age group. CONCLUSION: The shapes of the relationships between BMI and incidence of diabetes, hypertension, and mortality change with age, suggesting that weight management interventions should be tailored for different age groups.

Early severe vasomotor menopausal symptoms are associated with diabetes.

OBJECTIVE: The purpose of this study was to investigate associations between profiles of vasomotor menopausal symptoms (VMS) during the menopausal transition with the prevalence of diabetes. METHODS: VMS and diabetes were measured at baseline and 3-year intervals for 15 years in 4,895 women in the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years at baseline in 1996. Latent class analysis and generalized estimating equation models for binary repeated measures were performed. The VMS profiles were labeled as mild, moderate, early severe, and late severe. RESULTS: The prevalence of diabetes in the total group was 9.0%. Compared with mild VMS, the odds of diabetes were higher in those with a late severe profile (though not statistically significant; adjusted odds ratio, 1.28; 95% CI, 0.97-1.68) and in those with an early severe profile (adjusted odds ratio, 1.67; 95% CI, 1.20-2.32). Adjustment for body mass index attenuated this association, but the odds of diabetes were still significantly higher in women with an early severe profile than in women with mild VMS (odds ratio, 1.55; 95% CI, 1.11-2.17). The moderate profile was not associated with diabetes. CONCLUSIONS: Women with an early severe VMS profile are more likely to have diabetes across a period of 15 years. This association is not explained by body mass index or other potential confounders. Our findings imply that the predictive value of VMS for diabetes may vary with the timing of VMS relative to menopause.

Vasomotor menopausal symptoms are not associated with incidence of breast cancer in a population-based cohort of mid-aged women.

BACKGROUND: Recently, two case-control studies showed that vasomotor menopausal symptoms (VMS), i.e. hot flushes (HF) and night sweats (NS), are associated with a decreased risk of breast cancer. Until now, however, no prior studies have prospectively examined the association between VMS and breast cancer incidence. We investigated this in a population-based cohort of mid-aged women in Australia. METHODS: We included 11,297 women without a history of breast cancer aged 47-52 years from the Australian Longitudinal Study on Women's Health, surveyed every 3 years from 1998 to 2010. Information regarding first invasive breast cancer events and date of diagnosis was obtained from cancer registries. We determined the association between HF and NS and breast cancer occurrence before the subsequent survey, using time-dependent cox regression analysis, adjusting for time-varying lifestyle factors. RESULTS: At baseline 33.1% of the women reported experiencing HF and 24.6% reported NS. During a mean follow-up of 13.7 years, 348 cases of breast cancer occurred. VMS were not associated with breast cancer; adjusted hazard ratios were 1.09; 95% confidence interval (CI) 0.87-1.35 for HF and 1.06; 95% CI 0.84-1.33 for NS. No significant interactions were found between each of body mass index, alcohol use, current hormone therapy use, menopausal status and VMS and breast cancer (p-values>0.05). CONCLUSIONS: We did not find an association between VMS and breast cancer incidence. Research in this area is scarce and additional large prospective population-based studies are required to confirm or refute these findings.

Self-reported sitting time is not associated with incidence of cardiovascular disease in a population-based cohort of mid-aged women.

BACKGROUND: In Westernised societies adults are increasingly spending many hours each day in sedentary, low energy expenditure activities such as sitting. Although there is growing evidence on the relationship between television/screen time and increased cardiovascular disease mortality, very little is known about the association between total sitting time (in different domains) and cardiovascular disease incidence. We investigated this in a population-based cohort of mid-aged women in Australia. FINDINGS: Data were from 6154 participants in the 1946-51 birth cohort of the Australian Longitudinal Study on Women's Health who were free of cardiovascular disease at baseline. Survival analysis was used to determine the association between self-reported sitting time and cardiovascular disease incidence, determined through hospital diagnoses and cause of death data. During a mean (± SD) follow-up time of 9.9 ± 1.2 years, 177 cases of cardiovascular disease occurred. Mean sitting time (± SD) was 5.4 ± 2.6 hours a day. Sitting time was not associated with incident cardiovascular disease (adjusted hazard ratio 0.97, 95% CI 0.92 to 1.03). We found no interaction between physical activity and sitting time and cardiovascular disease. CONCLUSIONS: In mid-aged women sitting time does not appear to be associated with cardiovascular disease incidence. These findings are contrary to expectations, given the growing evidence of a relationship between sitting time and cardiovascular disease mortality. Research in this area is scarce and additional studies are needed to confirm or refute these findings.

More vasomotor symptoms in menopause among women with a history of hypertensive pregnancy diseases compared with women with normotensive pregnancies.

OBJECTIVE: Cardiovascular disease is the major cause of mortality in women worldwide. In recent years, several female-specific cardiovascular risk factors, such as hypertensive pregnancy diseases (HPDs) and vasomotor menopausal symptoms (VMS), have been identified. In this study, we evaluated the association between a history of HPD and the presence of VMS. METHODS: We consecutively included 853 women (mean age, 55.5 y) who visited the outpatient cardiovascular clinic for women in Kampen between 2003 and 2010. The visit included a questionnaire on history of HPD, demographic characteristics, and VMS; physical examination; and blood sampling. Logistic regression analysis was used to analyze the data. RESULTS: A history of HPD was reported by 274 women (32%), and VMS were reported by 83% of women with a history of HPD and by 75% of women without a history of HPD. In adjusted models, VMS were more often present (odds ratio [OR], 1.62; 95% CI, 1.00-2.63) and more frequently persisted for longer than 1 year (OR, 2.05; 95% CI, 1.08-3.89) among women with a history of HPD than among women with normotensive pregnancies. VMS were more often severe in women with a history of HPD, but this did not reach significance (adjusted OR, 1.28; 95% CI, 0.92-1.80). The frequency and intensity of VMS did not differ between both groups. CONCLUSIONS: In our "Kampen women cardiology clinic" cohort, women with a history of HPD report VMS during the menopausal transition significantly more often than women with normotensive pregnancies.

Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study.

BACKGROUND: Diet has been suggested to be a potential risk factor for vasomotor menopausal symptoms (VMSs), ie, hot flushes and night sweats. OBJECTIVE: We investigated the associations between dietary patterns and risk of VMSs by using data from middle-aged women born between 1946 and 1951 in the Australian Longitudinal Study on Women's Health. DESIGN: A prospective cohort study of 6040 women with a natural menopause were followed up at 3-y intervals over 9 y. Dietary intake was assessed at baseline in 2001, and the presence of VMSs was assessed at baseline and follow-up. Factor analysis and generalized estimating equation models for binary repeated measures were performed. RESULTS: Six dietary patterns were identified from factor analysis: cooked vegetables, fruit, Mediterranean style, meat and processed meat, dairy, and high fat and sugar. A higher consumption of the fruit or Mediterranean-style diet was inversely associated with VMSs in a comparison of the top with the bottom quintile, with adjusted ORs of 0.81 (95% CI: 0.71, 0.93; P-trend = 0.0009) and 0.80 (95% CI: 0.69, 0.92; P-trend = 0.0004), respectively. The high-fat and -sugar pattern increased the risk of VMSs in a comparison of the top with the bottom quintile, with an adjusted OR of 1.23 (95% CI: 1.05, 1.44; P-trend = 0.02). CONCLUSIONS: Consumption of a fruit or Mediterranean-style diet decreased the risk of reporting VMSs, whereas consumption of a high-fat and -sugar diet increased the risk of VMSs. These results may eventually lead to a basis for the development of dietary preventive measures for VMSs.

Risk factors for night sweats and hot flushes in midlife: results from a prospective cohort study.

OBJECTIVE: This study aims to identify social, lifestyle, and reproductive history risk factors for night sweats (NS) only, hot flushes (HF) only, and both NS and HF. METHODS: Risk factors and symptoms among 10,454 participants of the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years in 1996 were measured at baseline and 3-year intervals (surveys 2-6) for 15 years. Multinomial logistic regression analyses were performed. RESULTS: Compared with neither symptom, both symptoms together were reported less often by highly educated women (odds ratio, 0.61; 99.9% CI, 0.50-0.74), but more often by women who were heavier (odds ratio, 1.23; 99.9% CI, 1.08-1.40), were current smokers (odds ratio, 1.31; 99.9% CI, 1.09-1.56), were high-risk drinkers (odds ratio, 1.44; 99.9% CI, 1.10-1.89), were perimenopausal (odds ratio, 6.57; 99.9% CI, 5.52-7.82) or postmenopausal (odds ratio, 4.74; 99.9% CI, 4.00-5.63), had gained weight (odds ratio, 1.15; 99.9% CI, 1.01-1.31), or had premenstrual tension (odds ratio, 1.86; 99.9% CI, 1.48-2.34), than by women without these characteristics. HF only was reported less often by highly educated women (odds ratio, 0.73; 99.9% CI, 0.59-0.90), but more often by perimenopausal (odds ratio, 3.58; 99.9% CI, 2.95-4.35) or postmenopausal (odds ratio, 2.97; 99.9% CI, 2.47-3.57) women and by those with premenstrual tension (odds ratio, 1.60; 99.9% CI, 1.25-2.04). Finally, NS only was reported more often among current smokers (odds ratio, 1.55; 99.9% CI, 1.11-2.19), high-risk drinkers (odds ratio, 1.76; 99.9% CI, 1.04-2.97), perimenopausal women (odds ratio, 1.53; 99.9% CI, 1.14-2.06), those with diabetes (odds ratio, 1.91; 99.9% CI, 1.08-3.35), those with premenstrual tension (odds ratio, 1.67; 99.9% CI, 1.09-2.56), or those of early age at first pregnancy (odds ratio, 1.45; 99.9% CI, 1.05-1.99). CONCLUSIONS: The presence of both symptoms is associated with social, behavioral, and menstrual factors. Some differences in risk factors among women who report only one symptom or both symptoms are observed, suggesting a slightly different etiology for each.

Five-year changes in biologic risk factors and risk of type 2 diabetes: are attained but not initial risk factor levels of importance?

Independent effects of changes in biologic risk factors on type 2 diabetes incidence remain unclear. The authors examined whether associations between changes in biologic risk factors and diabetes risk are driven by initial or attained risk factor levels. Biologic risk factors were measured at baseline and at each 5-year interval follow-up (rounds 2, 3, and 4) among 4,204 initially healthy men and women, aged 20-59 years, participating in the Dutch Doetinchem Cohort Study (1987-2007). Time-dependent Cox regression analyses were used to analyze associations between changes in waist circumference, blood pressure, and high density lipoprotein cholesterol (HDL cholesterol) and incident diabetes, adjusted for initial or attained levels; 130 diabetes cases occurred during 9 years of follow-up. Five-year increases in waist circumference and blood pressure and decreases in HDL cholesterol were positively associated with risk of diabetes after adjustment for initial levels but no longer after adjustment for attained levels: waist circumference (hazard ratio (HR) = 0.86, 95% confidence interval (CI): 0.69, 1.07), systolic blood pressure (HR = 0.96, 95% CI: 0.84, 1.10), diastolic blood pressure (HR = 0.96, 95% CI: 0.87, 1.06), and HDL cholesterol (HR = 0.91, 95% CI: 0.81, 1.01). In conclusion, the associations between changes in biologic risk factors and risk of diabetes are mainly driven by the attained levels. Hence, not the prior changes, but the attained levels seem to be of importance with regard to diabetes risk.

Hormone therapy and coronary heart disease risk by vasomotor menopausal symptoms.

OBJECTIVES: We examined whether the association between hormone therapy (HT) use and coronary heart disease (CHD) risk differed between women with and without vasomotor symptoms (VMS). STUDY DESIGN: We used data from a Dutch (EPOS) and Swedish (WHILA) population-based sample of 8865 women, aged 46-64 years, and free of CHD, stroke, venous thrombosis/pulmonary embolism or cancer at baseline. Data on HT use, VMS and potential confounders were collected by questionnaires. MAIN OUTCOME MEASURES: CHD endpoints, obtained via registries. RESULTS: 252 CHD cases occurred during 10.3 years of follow-up. Neither for women with nor for women without flushing or (night) sweats ever HT use was associated with CHD risk, compared with never HT use. Among women with intense VMS, ever HT use borderline significantly decreased CHD risk compared with never HT use (HR 0.48 [95% CI 0.20-1.03]). Among women without intense VMS, ever HT use was associated with a borderline significant increased CHD risk (HR 1.28 [95% CI 0.96-1.70]; P for interaction=0.02). However, after multivariate adjustment, as compared to never HT use, ever HT use was not associated with risk of CHD among women with or without intense VMS. CONCLUSIONS: In both groups of women with and without VMS, HT use does not seem to be associated with the risk of CHD. Hence, our findings do not support the view that HT use increases the CHD risk among women with an indication, i.e. VMS, but this needs to be confirmed in specifically designed studies.

Vasomotor menopausal symptoms are associated with increased risk of coronary heart disease.

OBJECTIVE: Emerging evidence suggests that women with vasomotor menopausal symptoms (VMS) may have an adverse cardiovascular disease (CVD) risk profile. We investigated whether VMS are related to an increased risk of future coronary heart disease (CHD) and whether possible associations can be explained by CVD risk factors. METHODS: Data used were from a Dutch and Swedish population-based sample of 10,787 women enrolled between 1995 and 2000, aged 46 to 64 years, and free of CVD at baseline. Data on VMS were collected by questionnaires. Body mass index and blood pressure were measured in all women, and total cholesterol levels were measured in a subgroup of the population. Multivariable Cox regression models were used to analyze the data. RESULTS: After a mean ± SD follow-up period of 10.3 ± 2.1 years, 303 women were diagnosed with CHD. Symptoms of flushing were not associated with risk of CHD. However, the presence of night sweats was associated with a significantly modest increased risk of CHD, with a multivariable-adjusted hazard ratio of 1.33 (95% CI, 1.05-1.69). This association was attenuated but not eliminated after correction for body mass index, blood pressure, and total cholesterol (hazard ratio, 1.25; 95% CI, 0.99-1.58). CONCLUSIONS: Women with menopausal symptoms of night sweats have a significantly moderately increased risk of CHD, which cannot be totally explained by the levels of CVD risk factors.

Menstrual cycle characteristics and risk of coronary heart disease and type 2 diabetes.

In a prospective cohort study, we observed that women with a history of irregular cycles have a 28% increased coronary heart disease risk and tended to have a higher type 2 diabetes risk as compared with women who had a regular cycle length of 27 to 29 days. This association could not be explained by metabolic risk factors or altered hormone levels.

Vasomotor symptoms, estradiol levels and cardiovascular risk profile in women.

OBJECTIVES: We investigated whether menopausal vasomotor symptoms (VMS) are related to an adverse cardiovascular risk profile. Furthermore, we examined the association between estradiol levels and VMS, and whether an association between VMS and cardiovascular risk factors can be explained by estradiol levels. STUDY DESIGN: We used data from a Swedish population-based sample of 5857 women, aged 50-64 years. Data on VMS and potential confounders were collected by questionnaires. MAIN OUTCOME MEASURES: Body mass index (BMI), waist hip ratio (WHR), glucose, blood pressure, lipid profile and estradiol levels were measured. RESULTS: Symptoms of flushing/sweats were reported by 55% and sweats by 31% of all women. Estradiol concentrations were significantly lower in women with VMS. After multivariate adjustment, women with symptoms of sweats had a statistically significantly higher BMI, waist hip ratio, total cholesterol level, LDL level, triglycerides level, glucose level, systolic and diastolic blood pressure. These patterns did not change after correction for estradiol. The associations between flushing/sweats combined and cardiovascular risk factors were less pronounced. CONCLUSIONS: Women with VMS have a less favorable cardiovascular risk profile. Although estradiol levels were significantly lower among women with VMS, the increased cardiovascular risk profile cannot be explained by circulating estradiol levels.

Gender differences in risk factors for coronary heart disease.

Coronary heart disease (CHD), traditionally considered a male disease, is also a major threat to women. This review article addresses independent risk factors for CHD that are specific for women as well as non-gender-specific risk factors and how their effects differ between men and women. Although polycystic ovary syndrome (PCOS) in women is associated with an adverse metabolic risk profile, current evidence regarding future risk of CHD is conflicting. Preeclampsia is consistently associated with higher risk of CHD later in life. Menopause is associated with an increased risk of CHD, and the earlier the onset of menopause, the larger the risk. Existing data on postmenopausal hormone therapy (HT) was inconclusive with regard to possible protection when HT is initiated close to menopause in young peri- or postmenopausal women. Evidence on use of low-dose oral contraceptives strongly suggests no increased risk of CHD. Although levels of physical inactivity are similar for men and women, the higher prevalences of hypertension, diabetes, and obesity in older women portends a greater risk in women than in men. Additionally, risk factors like smoking, hypertriglyceridemia and low high-density lipoprotein cholesterol levels have greater impact in women than in men. This review indicates that acknowledgement of non-gender-specific risk factors in addition to those that are unique to women would help optimize diagnosis, treatment and earlier prevention of CHD in women. Further research is needed to ascertain if incorporating these gender-specific risks into a clinically used risk stratification model would change outcome in women.

Vasomotor symptoms are associated with a lower bone mineral density.

OBJECTIVE: The severity of vasomotor symptoms has been hypothesized to be linked to a lower bone mineral density (BMD). We examined whether women with vasomotor symptoms are different from women without symptoms with regard to BMD. METHODS: We used data from a population-based sample of 5,600 women, aged 46 to 57 years and free from bone diseases, who participated in the first cross-sectional part of the Eindhoven Perimenopausal Osteoporosis Study between 1994 and 1995. Questionnaires at baseline were used to collect data on vasomotor symptoms and potential confounders. At baseline, BMD of the lumbar spine was measured using dual energy x-ray absorptiometry. Linear regression analysis was used to analyze the data. RESULTS: Flushing was reported by 39% of all women, and night sweats, by 38% of all women. The average BMD was 1.01 +/- 0.14 g/cm and decreased with increasing frequency of flushing (P for trend < 0.0001) and night sweats (P for trend = 0.03). After multivariate adjustments for age, body mass index, menopause status, smoking, education, exercise, and hormone use, women with the highest frequency of symptoms had a 0.022 g/cm (95% CI, -0.03 to -0.01) lower BMD compared with asymptomatic women. Women who reported having the highest frequency of night sweats had a 0.011 g/cm (95% CI, -0.02 to -0.001) lower BMD compared with women with no symptoms of night sweats. CONCLUSIONS: Our findings show that vasomotor symptoms are associated with reduced bone density. It could be hypothesized that women with vasomotor symptoms might be more susceptible to the beneficial effects of estrogens, possibly by neutralizing the effect of estrogen fluctuations. Further research is needed to extend these findings to other estrogen-sensitive end organs.

Do differences in childhood diet explain the reduced overweight risk in breastfed children?

Breastfeeding has been associated with a reduced risk of overweight later in life. This study investigates whether differences in diet and lifestyle at 7 years of age between breastfed and formula-fed children can explain the difference in overweight prevalence at 8 years of age. We studied 2,043 Dutch children born in 1996-1997 who participated in the Prevention and Incidence of Asthma and Mite Allergy birth cohort study. Data on breastfeeding duration and diet and lifestyle factors at 7 years were collected using questionnaires. Weight and height were measured at 8 years. Overweight was defined according to international gender- and age-specific standards. Compared to nonbreastfed children (15.5%, n = 316), children breastfed for >16 weeks (38.0%, n = 776) consumed fruit and vegetables significantly more often and meat, white bread, carbonated soft drinks, chocolate bars, and fried snacks less often. Overall, breastfed children were less likely to have an unhealthy diet (adjusted prevalence ratio: 0.77, 95% confidence interval: 0.61-0.98). The associations could only partly be explained by maternal education, maternal overweight, and smoking during pregnancy. At 8 years, 14.5% (n = 297) of the children were overweight. Breastfeeding for >16 weeks was significantly associated with a lower overweight risk at 8 years (adjusted odds ratio: 0.67, 95% confidence interval: 0.47-0.97), and the association hardly changed after adjustment for diet (adjusted odds ratio: 0.71, 95% confidence interval: 0.49-1.03). Breastfed children had a healthier diet at 7 years compared to nonbreastfed children, but this difference could not explain the lower overweight risk at 8 years in breastfed children.