[Participation in the Dutch national screening programme for uterine cervic cancer higher after invitation by a general practitioner, especially in groups with a traditional low level of attendance]. / Opkomst bij bevolkingsonderzoek naar baarmoederhalskanker hoger na uitnodiging door de huisarts, in het bijzonder voor groepen met doorgaans lage participatiegraad.

OBJECTIVE: To gain insight into the differences in participation in the screening programme for uterine cervix cancer between women invited by a general practitioner (GP) and women invited by the local health authority (GGD). Specific attention was given to those groups whose participation is generally below average. DESIGN: Descriptive epidemiological study. METHOD: In the period 2000-2003, 237,719 women (30-60 years of age) were invited to participate in the national uterine cervix cancer screening programme in the Southwest of the Netherlands; 37.1% of the women were invited by the GP and 62.9% by the GGD. Data were obtained from the Cervix Information System of the GGDs. Differences in attendance between those invited by the GP and those invited by the GGD were tested by linear regression. Participation was defined as the number of women for whom the result of a cervical smear was known, divided by the number invited. RESULTS: Invitation by a GP led to a 7.9% (95% CI: 7.5-8.3) higher attendance rate than invitation by a GGD. This difference in attendance was higher for women born in Morocco, Turkey, Surinam and the Netherlands Antilles/Aruba (17.2%; 95% CI: 15.2-I9.2), young women (11.9%; 95% CI: 10.8-13.0), women with a low socio-economic status (11.6%; 95% CI: 10.4-12.7), and women who lived in highly urban areas (13.0%; 95% CI: 12.3-13.6). The differences were the greatest among non-western women who were also part of another low-attendance group: 19.0% (95% CI: 16.7-21.2) for women who lived in highly urban areas and 20.8% (95% CI: 16.8-24.9) for those in the youngest age group.

Effect of glutathione S-transferase M1 genotype on progression of atherosclerosis in lifelong male smokers.

We hypothesize that smokers with the null genotype for GSTM1 (GSTM1-0), who thus lack the detoxification enzyme glutathione S-transferase mu-1, develop atherosclerosis at an increased rate compared to smokers with the positive genotype (GSTM1-1). We used data from a 2-year randomized placebo-controlled trial on the effect of vitamin E on atherosclerosis among 189 male smokers. Progression of atherosclerosis was measured by 2-year change of the common carotid intima media thickness (CCA-IMT) as measured by B-mode ultrasonography. The frequency of GSTM1-0 genotype was 0.5 in both the placebo and the vitamin E group. Smokers with GSTM1-0 genotype had a tendency to higher baseline CCA-IMT values than those with GSTM1-1 (0.97 versus 0.92 mm, P=0.09). Within the placebo group, more CCA-IMT progression was found for smokers with the GSTM1-0 than for smokers with the GSTM1-1 genotype after adjustment for baseline IMT and major CVD risk factors (0.050 versus -0.002 mm, P=0.046). In the vitamin E group no effect of GSTM1 genotype on atherosclerosis progression was found. Overall, smokers with GSTM1-0 genotype had a higher mean 2-year progression compared to those with GSTM1-1 as shown by a difference in increase of 0.042 mm (95% CI 0.006; 0.078, P=0.02). In conclusion, our data suggest that smokers lacking the detoxifying enzyme GST mu-1 develop progression of atherosclerosis at an increased rate.

Serum carotenoids, alpha-tocopherol and mortality risk in a prospective study among Dutch elderly.

BACKGROUND: Although beta-carotene has shown inverse associations with chronic diseases involving free radical damage in observational epidemiological studies less attention has been paid to five other major carotenoids also showing antioxidant activity in vitro. METHODS: We studied the associations between 7.2-year mortality and serum levels of six carotenoids, and alpha-tocopherol, measured in stored serum, sampled in 1991/1992 during a health survey among 638 independently living elderly subjects aged 65-85 years. Proportional hazards regression was used to estimate hazard ratios of all-cause mortality for the lowest tertiles of serum vitamins with the highest tertiles, adjusting for possible confounding effects. RESULTS: During a follow-up period of 7.2 years 171 elderly died. The adjusted hazard ratios for all-cause mortality for the lowest tertiles of vitamins compared with the highest tertiles were between 1.02 and 1.73. The strongest increase in mortality risk was seen for beta-cryptoxanthin (1.52, 95% CI : 1.00, 2.32), lutein (1.56, 95% CI : 1.05, 2.31) and zeaxanthin (1.32, 95% CI : 0.89, 1.97) and their sum (oxygenated carotenoids: 1.73, 95% CI : 1.12, 2.67). Tests for trend were significant (P < 0.05) for all-cause mortality risk and serum levels of total carotenoids, oxygenated carotenoids and beta-cryptoxanthin. CONCLUSIONS: Our findings suggest that serum levels of individual carotenoids, particularly the oxygenated species are inversely associated with all-cause mortality and should be considered as candidates for further investigations.

Smoking characteristics, antioxidant vitamins, and carotid artery wall thickness among life-long smokers.

We studied the associations between the common carotid-intima-media thickness (IMT), as a marker of atherosclerosis, and smoking characteristics and antioxidant vitamins among 158 male life-long cardiovascular disease (CVD)-free smokers. An "increased" carotid IMT was defined as the upper 25%. The prevalence of increased IMT was 2.5 times (odds ratio (OR) = 2.5; 95% CI: 1.1, 5.6) higher among smokers inhaling smoke deeply into the lungs than among moderate and non-inhalers. This association decreased when adjusted for other CVD risk factors. Smokers with an increased carotid IMT did not differ significantly in mean antioxidant vitamin intake and status with the remaining group. However, classical CVD risk factors contributed importantly to increased carotid IMT. In our study, depth of inhalation was the only smoking characteristic associated with carotid IMT although attenuated after adjustment for traditional risk factors for CVD. Furthermore, in these life-long smokers not using any vitamin supplements, no associations were found for antioxidant vitamins.

Serum carotenoids, alpha-tocopherol, and lung function among Dutch elderly.

Antioxidant vitamins (provitamins) may protect against loss of lung function over time. We studied the association between serum carotenoids (alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, zeaxanthin, and lutein), alpha-tocopherol, and lung function among noninstitutionalized Dutch elderly age 65 to 85 yr (n = 528). Multiple linear regression analysis was performed with FEV(1) or FVC as dependent variables and serum levels of antioxidants in quintiles as independent variables. We adjusted for age, gender, height, and pack-years of smoking. Subjects in the fifth quintile of serum beta-carotene had a 195 ml (95% confidence interval [95% CI]: 40 to 351 ml) higher and those in the fifth quintile of alpha-carotene had a 257 ml (95% CI: 99 to 414 ml) higher FEV(1) compared with subjects in the first quintile of these carotenoids. Significant (p < 0.05) positive trends were observed between alpha-carotene, beta-carotene, lycopene, and FEV(1) and between alpha-carotene, beta-carotene, and FVC. Subjects in the highest quintile of the other carotenoids or alpha-tocopherol did not have significantly higher FEV(1) or FVC compared with subjects in the first quintile of these antioxidants. In conclusion, this study shows that from the six major serum carotenoids and alpha-tocopherol studied, particularly alpha-carotene, beta-carotene, and lycopene were positively associated with lung function in the elderly and may be considered as candidates for further investigations.

Effect of 50- and 100-mg vitamin E supplements on cellular immune function in noninstitutionalized elderly persons.

BACKGROUND: It has been suggested that vitamin E can counteract the age-associated decline in cellular immune responsiveness (CIR). Particularly, T helper cell type 1 (Th1) activity, ie, interferon (IFN) gamma-producing Th1 activity and, hence, delayed-type hypersensitivity (DTH) would be enhanced by vitamin E supplementation. OBJECTIVE: Our aim was to study the effects of 6 mo supplementation with 50 and 100 mg vitamin E on CIR in the elderly. DESIGN: A double-blind, placebo-controlled trial was conducted in 161 healthy elderly subjects aged 65-80 y. CIR was measured in vivo by means of DTH skin tests and in vitro by assessing the production of interleukin (IL) 2, IFN-gamma (a typical Th1 cytokine), and IL-4 (a typical Th2 cytokine) by peripheral blood mononuclear cells after stimulation with phytohemagglutinin. RESULTS: Both DTH and IL-2 production showed a trend toward increased responsiveness with increasing dose of vitamin E. However, IFN-gamma production decreased whereas IL-4 production increased in the groups receiving vitamin E. Only the change in the number of positive DTH reactions was borderline significantly larger in the 100-mg vitamin E group than in the placebo group (P = 0.06, Bonferroni adjusted). Subjects receiving 100 mg vitamin E with low baseline DTH reactivity or who were physically less active had a significantly larger increase in the cumulative diameter of the skin induration resulting from the DTH test than did the placebo group (P = 0.03), although this difference was not significant after Bonferroni correction (P = 0.07). CONCLUSION: Possible beneficial effects of 100-mg vitamin E supplementation may be more pronounced in particular subgroups of elderly subjects.

Effect of 3 months vitamin E supplementation on indices of the cellular and humoral immune response in elderly subjects.

It has been suggested that decreased immune responsiveness in the elderly may be counteracted by the antioxidant vitamin E. In a 3-month double-blind placebo-controlled intervention trial among elderly subjects aged 65 years and over we studied the effects of a daily dose of 100 mg dl-alpha-tocopheryl acetate on the cellular immune responsiveness (n 52) measured by the in vitro response of peripheral blood mononuclear cells (PBMC) to the mitogens concanavalin A (ConA) and phytohaemagglutinin (PHA). Also effects on the humoral immune responsiveness (n 74) were investigated by measuring immunoglobulin (Ig)G, IgG4 and IgA antibody concentrations against various common antigens. In the vitamin E group plasma alpha-tocopherol increased by 51% (P = 0.0001) during intervention whereas no significant changes were observed in the control group. Initial proliferative PBMC responses differed between the vitamin E group and the control group whereas all other baseline characteristics were comparable. No significant changes were observed in cellular immune responsiveness when adjusted for initial values in either the control group or the vitamin E group and, after the trial period, responses in the two groups were not significantly different. Similarly, in the vitamin E group no significant changes were found in levels of IgG and IgA raised against Penicillium or IgG4 raised against egg, milk, or wheat proteins. In the control group small but significant increases in IgG anti-Penicillium (P < 0.05) and decreases in IgG4 against milk proteins (P < 0.05) were observed. Thus, the results of this study performed with the relatively low dose of 100 mg dl-alpha-tocopheryl acetate do not support the claims of a beneficial effect of vitamin E intake on the overall immune responsiveness of elderly subjects.

Vitamin E supplementation in elderly lowers the oxidation rate of linoleic acid in LDL.

Oxidation of LDL-linoleic acid (LDL-LA), a major substrate for lipid peroxidation, may be counteracted by the antioxidant vitamin E. In a 3-month randomized double-blind placebo-controlled trial in 83 apparently healthy Dutch elderly, aged 67-85 years, the direct protective effect of 100 IU vitamin E on the rate of oxidized LDL-LA was studied. The oxidation of LDL-LA was measured by its disappearance after a 5-h in vitro Cu-oxidation of LDL isolated from 1 ml plasma. In the vitamin E group, the decrease in oxidized LDL LA of 10.4, (p < 0.05) was significantly different (p < 0.05) from the smaller 4.6% p< 0.01) decrease in the control group. Moreover, within the vitamin E group the decrease was even more marked over tertiles of alpha-tocopherol to LDL-LA ratio with a significant difference in decrease (p < 0.05) from the lowest compared to the highest tertile of, respectively, 18.4% [-24; -2%] (median and range) and 2.0% [-16: 34%]. In conclusion, supplementation with 100 IU vitamin E in elderly is beneficial in lowering the rate of oxidation of LDL LA. The protective effect of vitamin E might best be monitored by using the ratio of alpha-tocopherol to LDL-LA as this reflects the degree of alpha-tocopherol available to protect the amount of LDL-LA present.

Comparison of body composition assessments by bioelectrical impedance and by anthropometry in premenopausal Chinese women.

Fat-free mass (FFM) was estimated in forty-seven premenopausal Chinese women, aged 18-43 years, from anthropometric data (skinfolds, body mass index (weight/height2; BMI)) or bioelectrical impedance, using several prediction formulas for body composition from the literature, and values compared with the mean of these three individual methods used as a frame of reference. In thirty-six women these values could be compared with FFM calculated from total body water (TBW) determined by D2O dilution. The prediction formulas used were developed from studies on Caucasian adults and their validity will have to be shown in populations with different ethnic backgrounds. The mean difference between FFM predicted from BMI and the frame of reference was 0.1 kg (95% confidence interval (CI) -0.1, 0.4), from bioelectrical impedance it was 0.5 kg (95% CI 0.3, 0.7), and from skinfolds it was -0.6 kg (95% CI -0.9, -0.4). The mean difference between FFM calculated from TBW and the frame of reference was higher (2.2 kg, 95% CI 1.2, 3.3). The results of the present study indicate that the three methods may be valid for predicting body composition in adult Chinese females, but further research is needed on development and cross-validation of prediction equations for body composition for Chinese.

Cross-sectional study on the iron and vitamin A status of pregnant women in West Java, Indonesia.

A cross-sectional study of the prevalence of iron and vitamin A deficiency in normal pregnant women in West Java, Indonesia, was carried out. Of the 318 women studied, 49.4% were anemic and, according to multiple criteria, 43.5% had iron-deficiency anemia, 22.3% had iron-deficient erythropoiesis, and 6.6% had iron depletion. Serum retinol values revealed that 2.5% of the pregnant women were vitamin A deficient and 31% had marginal vitamin A status. The relative dose-response test carried out on 45 women showed that 4 (8.9%) had deficient vitamin A liver stores. After gestational stage, parity, and subdistrict were adjusted for, serum retinol concentrations were significantly positively associated (P < 0.01) with hemoglobin concentrations, hematocrit, and serum iron concentrations. The suboptimal vitamin A status associated with nutritional-deficiency anemia suggests that pregnant women in the area should be supplemented not only with iron but also with vitamin A. This proposal should be tested in an intervention study.