P13
Teaching of cardiovascular prevention and rehabilitation in European medical schools 2009: results of a first institutional survey
P Marques-Vidal1, H Saner2
1
University Hospital Center Vaudois, Lausanne, Switzerland, 2Bern University Hospital, Cardiovascular Prevention and Rehabilitation, Bern, Switzerland
Topic: Health services research
Background: Little is known regarding the teaching of cardiovascular prevention and rehabilitation (CVP&R) in Europe.
Design: cross-sectional institutional survey.
Methods: A questionnaire was sent to 376 European medical schools, 44 National Cardiology Societies, 31 Heart Foundations and 32 National Medical Associations.
Results: One hundred and twenty medical schools (32% response rate) answered. Forty-three postgraduate courses on CVP&R were provided in 32 (27%) schools. the median number of students was 25 (range: 4 – 140) and the median number of teaching hours was 72 (range: 3-518). the topics most frequently taught were cardiovascular risk factors (86%), physical activity (81%), global risk estimation and smoking cessation (both 74%). For the 26 countries for which data was available, 14 (54%) had postgraduate teaching on CVP&R but only three (12%) provided continuous medical education on the topic. Teaching was aimed essentially at cardiologists; in two countries, internists, neurologists and other health professionals (nurses, paramedics) could also attend CVP&R postgraduate courses.
Conclusion: teaching of CVP&R is low in European medical schools, and the courses provided differ considerably between countries and schools. there is a great need to provide a minimal educational framework to ensure adequate training in CVP&R throughout Europe.
P326
Cardiovascular prevention in Russia: primary care physicians knowledge seems to be an obstacle
N Pogosova, RG Oganov, IY Koltunov, VA Vigodin, OY Sokolova
National Center for Preventive Medicine, Moscow, Russian Federation
Topic: Health services research
Aim: To assess primary care physicians beliefs and knowledge concerning secondary prevention in patients with arterial hypertension (AH) and coronary heart disease (CHD) in the Russian Federation.
Materials and methods: A multicenter study RELIF (REgularnoe Lechenie I proFilaktika) has been performed in 20 big cities of Russia: in each city were randomly selected 5 polyclinics, in each policlinic 5 general practitioners (GPs). All GPs (N=512) filled out questionnaire containing questions on their demographic data, employment, postgraduate medical education, access to professional information, awareness of National and European guidelines on AH and CHD treatment, knowledge on cardiovascular risk factors (RF) and their goals.
Results: the average age of participating GPs was 44.2+10.4 years, average work experience 16.7+10.6 years, 89.64% were female. 89% of GPs have completed postgraduate training programs as required by National authorities. 85.4% of GP s reported to be trained in prevention counseling. In previous 5 years they attended 7.2+6.9 scientific congresses and received 9.4+10.3 medical journals, newspapers, print materials on treatment and prevention of cardiovascular diseases. 85% of GPs reported that they have read the National guidelines and 67.8% of GPs guidelines of the European Society of Cardiology on AH and CHD treatment. While answering opened questions on the RF of CHD, 74.68% of physicians named smoking, 70.17% obesity, 53.0% dyslipidemia, 44.42% low physical activity, 40.13% family history of premature CHD, 38.84% stress, 30.26% diabetes, 25.54% – age, 19.31% AH, and only 12.45% – male sex. 70.9% of GPs exactly mentioned the BP cut points for AH I, II and III degrees. 27.8% were aware of target levels for total cholesterol, 11.5% for LDL cholesterol, 51.9% for HDL cholesterol in CHD patients. 72.8% of GPs knew normal ranges of body mass index, but only 40% were familiar with limits of waist circumference. 60.9% of GPs were mistaken while estimating the recommended salt intake for AH patients, at the same time 66.9% knew the proper duration of daily aerobic activity.
Conclusion: Present study has shown a low level of GPs knowledge on cardiovascular RF and their secondary prevention goals which can indicate a poor efficacy of current postgraduate training programs and guideline implementation strategies.
P327
HAPIEE study: Dietary patterns and their association with socio-demographic factors in Lithuanian urban population
DI Luksiene, M Baceviciene, A Tamosiunas, R Radisauskas, R Reklaitiene, E Daugeliene
Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania
Topic: Nutrition
Traditionally nutritional research has focused primarily on single nutrients or food, interest is growing in dietary patterns that consider the complexity of the overall diet. the aim of the study was to identify the main dietary patterns in Lithuanian urban population and to determine their association with socio-demographic factors.
Material and methods: Data from the survey performed in the framework of the international HAPIEE (Health, Alcohol, and Psychosocial factors in Eastern Europe) study are presented. A random sample of Kaunas men and women aged 45–72 years, stratified by gender and age was randomly selected from Lithuanian population register. 7087 individuals were screened. Response rate was 60.5%. Factor analysis was performed in order to reduce the number of food items. A five-factor solution which accounted 47.8% of the total variance was indicated. the association between dietary patterns and socio-demographic factors was analyzed by logistic regression.
Results: the first “fresh vegetables, fruit” factor and the second “sweets” factor were inversely associated with age: older people consumed less frequent than average of particular food groups (p<0.001). Conversely, third factor “porridge, cereals” was directly associated with age: older people favored this diet (p<0.001). the fourth factor “potatoes, meat, boiled vegetables, eggs” was directly associated with age only in women group (p<0.01). the fifth factor “chicken, fish” was not associated with age. Men and women with university education were more likely to follow the “fresh vegetables, fruit” and “porridge, cereals” patterns and less likely “potatoes, meat, boiled vegetables, eggs” pattern than people with secondary education: in men – odds ratio (OR)-1.51; OR-1.33 and OR-0.74 respectively (p<0.01); in women – OR-1.72; OR-1.42 and OR-0.69 respectively (p<0.01). Married men and women were more likely to follow “fresh vegetables, fruit” and “potatoes, meat, boiled vegetables, eggs” patterns than single people (p<0.001); also married women favored the “chicken, fish” diet than single women (p<0.05). Men and women who self-rated health as poor were less likely to follow the “fresh vegetables, fruit” and “sweets” patterns than people with good health: in men – OR-0.62 and OR-0.73 respectively (p<0.05); in women – OR-0.55 and OR-0.79 respectively (p<0.05).
Conclusion: this study identified five main dietary patterns in Lithuanian urban population. Dietary patterns of people with university education, married and good self-rated health are healthier than among people with lower education, single and poorer health.
P328
Adherence to the Mediterranean dietary pattern is inversely associated with small dense low-density lipoprotein (sdLDL) phenotype B: the ATTICA Study
CM Kastorini1, DB Panagiotakos1, C Chrysohoou2, C Pitsavos2, J Skoumas2, S Vellas2, M Kambaxis2, C Stefanadi2
1
Harokopio University, Athens, Greece,2Hippokration Hospital, 1st Department of Cardiology of the University of Athens, Athens, Greece
Topic: Nutrition
Objective: Lipoprotein phenotype B is characterized by a predominance of small dense LDL particles and is associated with increased risk for developing coronary heart disease. the aim of the present work is to examine the relationship between adherence to the Mediterranean dietary pattern and the level of small dense LDL-cholesterol.
Methods: the ATTICA study is a population-based cohort that has randomly enrolled 1528 men and 1514 women (aged > 18 years old), stratified by age gender, from the greater area of Athens, during 2001–2002. Adherence to Mediterranean diet was assessed through the Med-DietScore (theoretical range 0–55). the LDL-cholesterol/LDL-apo-B ratio was calculated using the formula (0.94chol0.94HDL0.19TG)/(apo B0.09chol+0.09HDL0.08TG). Lower levels of this ratio indicate the presence of small dense LDL.
Results: After controlling for several potential confounding factors, participants in the lowest tertile and in the second tertile of the MedDietScore (i.e., <, lower adherence to the Mediterranean diet), had lower LDL-cholesterol/LDL-apo B ratio, compared with those in the highest tertile (B=-0.063, p=0.012 and B=–0.049, p=0.009, respectively). In addition multiple logistic regression analysis, showed that participants following very closely the Mediterranean dietary pattern have 36% (95% CI: 0.42–0.96) lower likelihood of having levels of the LDL-cholesterol/LDL-apo B ratio below the median, i.e., 1.35, compared with those who follow a more western diet.
Conclusions: Adherence to the Mediterranean dietary pattern has a protective effect regarding the presence of the more atherogenic small dense LDL particles that are considered a major risk factor for cardiovascular disease.
P329
Effects of nuts on coronary heart disease risk factors in type 2 diabetes
C Kendall, A Esfahani, S Mitchell, T Parker, M Banach, JA DavidJenkins
University of Toronto, Toronto, Canada
Topic: Nutrition
Background: Diabetes is associated with a significant increase risk in the development of cardiovascular disease (CVD). While recent studies indicate that nut consumption can improve CVD risk factors in hyperlipidemic subjects, few studies have investigated their effect in type 2 diabetes.
Objective: To determine if consumption of nuts improves CVD risk factors and glycemic control in type 2 diabetes.
Methods: 117 subjects with type 2 diabetes were randomized to a 3-month parallel design study. Subjects were randomized to one of three treatments: 1) Test (Full Dose Nut Diet): 75g/d for 2,000kcal/d; 2) Test (Half Dose Nut Diet): half-dose of nuts and half-dose of control muffin; and 3) Control: whole wheat muffins matched with energy content of nut supplements. Fasting blood samples were collected at baseline and weeks 2, 4, 8, 10 and 12 for markers of glycemic control and CVD risk factors.
Results: Compared to the control, the full dose nut supplement significantly lowered HbA1c (P=0.039), total-C (P=0.002), LDL-C (P=0.007), total-C:HDL-C (P=0.015), and LDL-C:HDL-C (P=0.028). the half-dose of nuts did not result in any significant improvements in blood lipids or glycemic control.
Conclusions: the addition of nuts to the diet improves reduces blood lipid CVD risk factors and glycemic control in type 2 diabetes.
P330
Long-term plant and animal protein consumption are associated with likelihood of developing left ventricular systolic dysfunction, in acute coronary syndrome patients
CM Kastorini1, C Chrysohoou2, DB Panagiotakos1, P Aggelopoulos2, C Pitsavos2, C Stefanadis2
1
Harokopio University, Athens, Greece, 2Hippokration Hospital, 1st Department of Cardiology of the University of Athens, Athens, Greece
Topic: Nutrition
Background and Aims: the aim of the present work was to evaluate the association between plant and animal protein consumption and the development of left ventricular systolic dysfunction (LVSD) in patients who have had an acute coronary syndrome (ACS).
Methods: During 2006–2009, 1000 consecutive ACS patients were included in the study; 459 patients who developed LVSD, 367 males (64±14 years) and 92 females (71±12 years) and 541 patients with preserved systolic function, 421 males (62±12 years) and 120 females (67±12 years). Detailed information regarding their medical records, anthropometric data, physical activity and smoking habits were recorded. Nutritional habits were assessed using a semi-quantitative food-frequency questionnaire and macronutrient consumption was evaluated.
Results: Multi-adjusted analysis after adjustment for various confounding factors revealed that in patients with first coronary event, plant protein intake at the third quartile of consumption was associated with 60% (95% CI:0.17–0.95) lower likelihood of developing LVSD, compared to the first. Furthermore in patients with previous coronary heart disease history, animal protein intake at the highest quartile of consumption, was associated with 211% greater likelihood of developing LVSD (95% CI:1.08–8.98), compared to the first.
Conclusions: Plant protein consumption seems to be beneficial, while animal protein consumption detrimental, against the development of LVSD in post-ACS patients.
P331
Dietary intake of vitamin B6, B12 and folate and their association with homocysteine in adult Polish population
A Waskiewicz, E Sygnowska, G Broda, W Drygas
National Institute of Cardiology, Warsaw, Poland
Topic: Nutrition
WOBASZ investigators
Purpose: To assess vitamin B6, B12 and folate intake and describe the relationship of these vitamins with homocysteine (Hcy) level in the Polish population.
Methods: Within the frame of the National Multicenter Health Survey (WOBASZ), a representative sample of whole Polish population aged 20–74 was screened in years 2003–2005. In each province of Poland 6 communities were randomly selected and in each of them a sample of 100 men and 100 women from personal identification number (PESEL) database was randomly selected. In 50% of subjects sample (3004 men and 3401 women) Hcy level and nutrients were performed according to study protocol.
Results: Average intake of vitamin B6 ranged from 2,26 in men to 2,03 mg/day in women, of vitamin B12 from 5,85 to 3,69 çg/day and folate from 258 to 211 çg/day respectively. the recommended levels of intake were not achieved by 16% of men and 36% of women for vitamin B6, by 32% and 51% for vitamin B12 and by 78 % and 90% for folate respectively. Hcy level (after adiustment for age, smoking, coffee and alcohol consumption) and prevalence of hiperHcy (Hcy =12 çmol/l) was falling with an increase of number of quartiles vitamins B6, B12 in both genders and folate in men. In multivariable linear regression model an inverse association between Hcy level and intake of vitamin B6 and folate in both genders and vitamin B12 in men was confirmed.
Conclusions: In Polish population insufficient folate intake was common (deficiency was noted in nearly 80–90% of population) and despite correct average, high share of subjects were not fulfilling B6 and B12 intake recommendations; the inverse association between vitamin B6, B12 and folate consumption and Hcy concentration and prevalence of hiperHcy were observed.
P332
Moderate coffee consumption lowers the likelihood of developing left ventricular systolic dysfunction in post-acute coronary syndrome normotensive patients
CM Kastorini1, C Chrysohoou2, D B Demosthenes B Panagiotakos1, P Aggelopoulos2, C Liontou2, C Pitsavos2, C Stefanadis2
1
Harokopio University, Athens, Greece, 2Hippokration Hospital, 1st Department of Cardiology of the University of Athens, Athens, Greece
Topic: Nutrition
Background & Aims: the aim of the present work was to evaluate the association between coffee consumption and the development of left ventricular systolic dysfunction (LVSD) in patients who had had an acute coronary syndrome.
Methods: During 20062007, 144 male (65±14 years) and 50 female (71±12 years) post-acute coronary syndrome patients who developed LVSD (ejection fraction >40%) after the cardiac event and 129 male (64±12 years) and 51 female (67±10 years) post-acute coronary syndrome patients without LVSD (ejection fraction >50%) were included in the study. Detailed information regarding their medical records, sociodemographic and anthropometric data, and various psychological and lifestyle characteristics (physical activity, smoking habits, etc.) were recorded. In particular, nutritional habits, including coffee consumption, were evaluated using a semiquantitative food-frequency questionnaire.
Results: Multiadjusted analysis revealed that in normotensive patients coffee consumption of 12 cups/day was associated with 88% (95% confidence interval, 0.020.84) lower likelihood of developing LVSD and consumption of >3 cups/day with 90% (95% confidence interval, 0.010.88) lower likelihood for LVSD, compared with no history of consumption of coffee and after adjusting for various confounders. In contrast, in hypertensive patients coffee consumption of >3 cups/day was associated with 4.5-fold higher likelihood for developing LVSD (95% confidence interval, 0.8922.58) as compared with no history of coffee consumption.
Conclusions: Coffee consumption has opposite effects on the likelihood of developing LVSD in post-acute coronary syndrome patients depending on their blood pressure levels.
P333
Time to update recommendations on the Mediterranean eating style
S Giampaoli1, L Palmieri1, C Donfrancecso1, C Lo Noce1, F Dima1, J Stamler2
1
Istituto Superiore di Sanita, Rome, Italy, 2Northwestern University, Feinberg School of Medicine, Chicago, United States of America
Topic: Nutrition
In 1975 Ancel and Margaret Keys described the Mediterranean eating style in their book, How to Eat Well and Stay Well the Mediterranean Way: “the ordinary food of the common Neapolitans – home made minestrone (vegetable soup); pasta in endless variety, always freshly cooked, served with tomato sauce and a sprinkle of cheese, only occasionally enriched with some bits of meat, or served with a local sea food without any cheese; beans and short lengths of macaroni; lots of bread never served with any kind of spread; great quantities of fresh vegetables; a modest portion of meat or fish twice a week; wine; always fresh fruits for dessert” Today this eating style is still the keystone of the Mediterranean way. the Keys book also briefly mentioned potential problems: already in 1975, weight gain – and the issue of energy intake, including from foods high in favorable fats; excess wine intake by men; high salt; increasing intakes of meats, sweets. Since 1975 changes have occurred in Mediterranean countries: industrialization with migration from rural to urban areas; more sedentary work, little physical exercise during leisure; expanded food supply with modifications in diet composition – increased proportions of proteins and fats of animal origin compared to those of vegetable origin; more sugars (e.g. from soft drinks), more salt (from processed foods), less fiber, vitamins, minerals; caloric imbalance from energy-dense foods and reduced caloric expenditure, responsible for epidemic obesity and aggravating risks of major cardiovascular diseases and cancers. there is need to reverse these departures from the Mediterranean eating style, and also to note and overcome its weak points. this is important for a Mediterranean country like Italy, where stroke death rates are twice those of the USA (despite lower CHD rates). thus, need for dietary sodium intake is 10–20 mmol/day, i.e. 0.5–1.0 gr of NaCl/day. Results of the DASH-Sodium feeding trial are relevant: limited sodium consumption (1.5 gr/day equivalent to 67 mmol/l) along with high intake of fruits and vegetables, whole grains, legumes, low fat and fat free dairy products, fish, poultry; limited in red meat, visible fats, eggs, sweets – effective for reduction of blood pressure and serum lipids in the general population. this is a food pattern like the Mediterranean eating style.
P334
Selenium deficiency is associated with adverse vascular function in patients with high risk for vascular events
YH Chan1, CW Siu1, KH Yiu2, HT Chan1, SW Li3, CP Lau1, th Lam1, HF Tse1
1
the University of Hong Kong, Hong Kong, People's Republic of China, 2Queen Mary Hospital, Department of Medicine, Hong Kong, Hong Kong SAR, People's Republic of China 3Tung Wah Hospital, Hong Kong, People's Republic of China
Topic: Nutrition
Background: Experimental studies have shown that selenium is involved in the synthesis of selenoproteins relevant to the protection against cardiovascular disease. However, the relationship between selenium deficiency and vascular function in clinical context remains unknown.
Methods: We studied 306 consecutive patients with high risk for vascular events (coronary artery disease 35%, acute/recurrent ischemic stroke 40%, diabetes 58%). Non-invasive brachial-ankle pulse wave velocity (baPWV) was measured using vascular profiling system (VP-2000). Long-term intake of selenium was determined by a validated food frequency questionnaire.
Results: Mean daily selenium intake was 59.4 ± 52.1 mcg/day. Mean baPWV was 1782.4 ± 418.4 m/s indicating increased arterial stiffness overall. Patients with selenium intake <10th percentile had significantly higher baPWV as compared to patients with intake ? 10th percentile (1994.4 ± 662.6 m/s versus 1761.0 ± 380.8 m/s, P=0.005). After adjusting for potential confounders including age, gender, history of hypertension, hyperlipidemia, diabetes and cardiovascular disease, smoking status, use of cardiovascular medications, waist-hip ratio, education/financial status, physical activity, calorie intake and intake of antioxidant vitamins, deficient selenium intake <10th percentile remained independently predictive of increased baPWV by 768.5 m/s [95% CI: 1345.0–192.0 m/s, P=0.010].
Conclusion: Selenium deficiency is associated with worsening arterial stiffness in patients with high risk for vascular events.
P335
Rural to urban migration in India increases obesity and diabetes risk
S B J Ebrahim1, S Kinra1, L Bowen1, L Andersen1, Y Ben-Shlomo2, T Lyngdoh3, D Prabhakaran4, K, S Reddy3
1
London School of Hygiene and Tropical Medicine, London, United Kingdom, 2University of Bristol, Bristol, United Kingdom, 3Public Health Foundation of India, New Delhi, India, 4Centre for Chronic Disease Control, New Delhi, India
Topic: Obesity
Indian Migration Study
Background: Effects of migration on risk of obesity and diabetes cannot be reliably assessed from simple rural urban comparisons. We hypothesised that rural to urban migrants would be at higher risk of obesity and diabetes than rural non-migrants and that migrants would have an intermediate risk of obesity and diabetes compared with life-long urban and rural dwellers using a sib-pair design.
Methods: the place of origin of people working in factories in north, central and south India was identified. Migrants of rural origin, their rural dwelling sibs, those of urban origin and their urban dwelling sibs were assessed by interview, examination and fasting blood samples. Obesity, diabetes and other cardiovascular risk factors were compared.
Results: A total of 6,510 participants (42% women) were recruited. Among urban, migrant and rural men the age and factory adjusted percentages classified as obese (BMI 25+kg/m2) were 41.9%, 37.8%, and 19.0% respectively and diabetic were 13.5%, 14.3%, and 6.2% respectively. Findings for women showed similar patterns, but prevalence of obesity was higher and of diabetes was slightly lower than in men. Rural men had lower blood pressure, lipids and fasting blood glucose than urban and migrant men, whereas no differences were seen in women.
Conclusion: Migration is associated with increases in obesity which drive other risk factor changes. Migrants are at higher risk of obesity and diabetes than rural dwellers, but have adopted lifestyles putting them at similar risk to the urban population. Gender differences in some risk factors by place of origin are unexpected and require further exploration.
Odds ratios (95% CI) for the risk of disease in a sibling compared to a rural sibling, adjusted for age group and factory.
P336
12-month weight loss and triglyceride changes with PHEN/TPM in overweight and obese subjects with hypertriglyceridemia
K Gadde1, C Peterson2, B Troupin2, WW Day2
1
Duke University Medical Center, Durham, United States of America, 2VIVUS, Inc, Mountain View, United States of America
Topic: Obesity
the CONQUER Study Team
Background: PHEN/TPM is a low-dose, controlled-release combination of phentermine (PHEN) and topiramate (TPM) for once-daily oral dosing. this phase 3 study evaluated weight loss over a 56 week period in overweight and obese subjects with two or more comorbidities.
Methods: In this double-blind, placebo-controlled trial, 2487 subjects were randomly assigned to one of 2 dose levels of PHEN/TPM (15/92 and 7.5/46 mg) or placebo. All subjects were managed to standard of care for their dyslipidemia, received lifestyle and exercise guidance, and were instructed on a 500 kcal/day deficit diet. Subjects were seen at monthly clinic visits, and had periodic fasting laboratory assessments.
Results: the majority of the 2487 subjects randomized to study treatment were female (70%) and Caucasian (86%). Subjects averaged 51 years of age, with a baseline mean weight of 103.1 kg, mean BMI of 36.6 kg/m2, and mean fasting triglycerides of 162.5 mg/dL (1.84 mmol/L). 36% of enrolled subjects were considered hypertriglyceridemic. Mean weight loss at 56 weeks was 1.8%, 8.4%, and 10.4% (ITT-LOCF); and in subjects completing the entire 56 weeks of treatment on study drug, mean weight loss at Week 56 was 2.4%, 10.5%, and 13.2% for the placebo, 7.5/46 mg, and 15/92 mg groups, respectively (p<0.0001). Subjects with hypertriglyceridemia showed comparable weight loss at Week 56. the mean percent change in fasting triglycerides from baseline at Week 56 for the entire study population was a decrease of 11.3 to 13.3% compared to a 1.8% increase in placebo (p<0.001 for PHEN/TPM and 0.005 for placebo). For subjects with hypertriglyceridemia (baseline TG 233 mg/dL, 2.63 mmol/L), the mean percent change in fasting triglycerides at Week 56 with LOCF was –9.4% with placebo, –23.7% with PHEN/TPM 7.5/46 mg, and –25.2% with PHEN/TPM 15/92 mg treatment. Additional lipid parameters will be discussed during the session.
Conclusions: In this large, randomized, controlled clinical trial, significant weight loss and clinically meaningful improvements in lipid parameters were seen over 56 weeks of treatment with both doses of PHEN/TPM compared to placebo. Well-tolerated medical treatments that effect significant weight reduction and can address common obesity-related co-morbidities may have significant benefits in terms of preventing future weight-related morbidity and mortality.
P337
Prevalence of metabolically healthy obesity in a Swiss population-based cohort
S Velho1, P Marques-Vidal1, F Paccaud1, G Waeber2, P Vollenweider2
1
University Institute of Social and Preventive Medicine Lausanne (IUMSP), Lausanne, Switzerland, 2University Hospital Center Vaudois, Lausanne, Switzerland
Topic: Obesity
Objective: To assess the prevalence of metabolically healthy obesity (MHO) in the Swiss population according to different definitions.
Methods: population-based sample of 2803 women and 2557 men. Metabolic abnormalities were defined using two sets of criteria: elevated blood pressure, triglycerides, fasting glucose, high-sensitivity C-reactive protein and homeostasis model assessment (HOMA), and low high density lipoprotein (HDL) cholesterol (set 1); elevated total cholesterol, low density lipoprotein cholesterol and HOMA index, and low HDL cholesterol (set 2). For each set, prevalence of MHO was assessed for three obesity markers (body mass index, waist circumference or body fat).
Results: Among obese (BMI=30 kg/m2) participants, prevalence of MHO was 18.8% and 7.3% using sets 1 and 2, respectively (3.1% and 1.2% in the general population). Conversely, the prevalences of MHO using sets 1 and 2 were 27.2% and 9.6% when using waist, and 19.6% and 6.4% when using body fat. Prevalence of MHO was higher in women than in men (21.8% vs. 15.8%, for BMI and set 1). After multivariate adjustment, a lower odds of presenting with MHO was found in men: OR=0.59, 95% confidence interval (0.49–0.70); with increasing age: OR=0.59 (0.47–0.73), 0.31 (0.25–0.39) and 0.24 (0.19–0.31) relative to age group 35–44 for age groups 45–54, 55–64 and 65–74 years, respectively; and smoking status: OR=0.83 (0.69–1.00) and 0.80 (0.65–0.98) for former and current smokers, respectively. Conversely, higher odds of MHO were found for moderate alcohol consumption: OR=1.32 (1.07–1.61), 1.35 (1.06–1.71) and 0.98 (0.75–1.26) relative to nondrinkers, for 1–6, 7–13 and >13 drinks/week, respectively; and leisure-time physical activity, OR=1.51 (1.29–1.77). Finally, obese women presented with significantly higher hs-CRP levels and with lower hypertension, hypertriglyceridaemia and hyperglycaemia prevalence than obese men.
Conclusion: the prevalence of MHO varies considerably according to the definition used. Between-gender differences in the prevalence of the metabolic abnormalities, suggest the need for gender-specific, standardized, agreed upon, MHO criteria.
P338
Effects of an in-patient lifestyle programme for overweight and obese children
M Rank1, M Siegrist1, H Langhof2, B Wolfarth1, W Koenig3, M Halle1
1
Technical University of Munich, Munich, Germany, 2Clinic Schoensicht, Berchtesgaden, Germany, 3University of Ulm, Ulm, Germany
Topic: Obesity
Purpose: Plasma concentration of leptin, an adipokine secreted by adipocytes, is increased in overweight and obese children. It acts as a satiety hormone and links fat mass to food intake and energy expenditure. Furthermore obesity is characterized by a state of low-grade inflammation at all ages. Little is known on the effects of short-term therapy programmes on the relationship between changes in body composition and plasma concentrations of leptin and inflammatory markers in overweight and obese children additionally focusing on changes in exercise capacity.
Methods: Between 2006 and 2008 we examined 498 overweight and obese children and adolescents (301 girls, 211 boys, age 8–18 years) before and after a 4 week in-patient treatment programme including nutritional counseling, increase in physical activity and behavioral intervention. During the pre- and post-intervention examinations, anthropometric data, plasma concentration of leptin, IL-6 and TNF-α were assessed. the cardiovascular fitness was determined by a cardiopulmonary maximal bicycle-ergometer stress test.
Results: Over the 4 week intervention we found a significant reduction in body weight from 91.0±23.1 kg to 84.0±21.4 kg (p<0.001). Leptin levels decreased significantly from 39.5 ± 24.5 ng/dl to 18.6±14.4 ng/dl (p<0.001). In addition, we found an increase in relative exercise capacity from 1.66±0.40 to 2.04±0.48 W/kg (p<0.001). Concentrations of IL-6 and TNF-α remained unchanged. Correlation analyses between reduction in body weight and the reduction in leptin concentrations were significant (p < 0.001), whereas the increase of relative exercise capacity was not associated with changes in leptin (p = 0.428).
Conclusion: A life-style programme significantly improves body weight as well as exercise capacity and induces a reduction in plasma leptin concentration in overweight and obese children. the changes in leptin are dependent on changes in body weight but not on changes in physical exercise capacity. Leptin therefore seems to be independent of exercise capacity.
P339
Trends in overweight and diet among Russian adolescent population
D Denisova, L Zavyalova, M Voevoda
Institute of Internal Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation
Topic: Obesity
Rising of children and adolescent obesity in recent decades was well documented worldwide, but there is a lack of information about Russian young population.
Objective: Using international references the trends of overweight and nutrition in adolescent population aged 14–17 y during 1989–2009 in Russia were examined.
Design: Five cross-sectional surveys of representative samples of school children aged 14–17 in 1989, 1994, 1999, 2003 and 2009 were carried out. Total sample was 3060 (45% males). To define overweight the sex- and age-specific body mass index (BMI) cutoffs recommended by the International Obesity Task Force were used. Diet was estimated using 24-hour dietary recall. the questionnaire for parents with the informationonself-reported height and weight was used.
Results: the prevalence of overweight significantly decreased from 12% in boys and from 14% in girls in 1989 to 4% in 1999 for both gender groups. Since 2003 slight increasing of overweight was observed among both genders particularly in boys. During the same period (1989–1999) significant decreasing of total energy intake (from 3021 to 2342 kcal in boys and from 2300 to 1644 kcal in girls) and of basic nutrient intakes (proteins, fats, carbohydrates) was registered. From 2003 to 2009 there was moderate rising of nutrient intakes among adolescents. In spite of concordant trends of overweight and energy consumption there were not associations between BMI and dietary factors in observed population. Associations of parents and children's BMI levels were revealed. Parents of overweight adolescents had BMI higher than parents of adolescents with normal BMI.
Conclusion: Revealed decreasing of overweight rates among Russian adolescent population during the period of socioeconomic crisis following by changes in diet indicate on significant influences of reforms on life style and some health parameters in children.
P340
Supervised exercise training benefit on physical fitness in young metabolic syndrome patients
C Avram1, M Oravitan1, LD Hoble1, E Bota1, S Voicu1, D Gaita2
1
West University Timisoara, Timisoara, Romania, 2Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Topic: Obesity
Metabolic syndrome (MS) consists of multiple, interrelated risk factors of metabolic origin that appear to directly promote the development of atherosclerotic cardiovascular disease or diabetes mellitus. An important role in MS treatment is played by the lifestyle management including increase in physical fitness.
Purpose: To evaluate the exercise training benefit in young metabolic syndrome patients.
Methods: We conduct a randomized prospective study of 6 months on 94 voluntary students, previously diagnosed with MS using National Cholesterol Education Program Adult Treatment Panel III criteria. the patients were divided in 2 groups: Group S (43 patients) benefit from an intensive exercise training programme supervised and guided by a personal trainer; Group C: 51 patients had the same exercise training recommendations but were unsupervised. All patients were evaluate through a cardiopulmonary exercise testing (CPET) at inclusion and after 6 months. the CPET results were used to prescribe the optimal effort intensity of the exercise training programme in order to improve endurance and increase the VO2peak. Exercise recommendation consisted in 3 times per week of 60 minutes at extensive and intensive endurance training zone (in the range of anaerobic threshold), completed by 1 minute interval in the range between anaerobic threshold (AT) and respiratory compensation point (RCP), for every 5 minutes of training.
Results: the 6 months follow-up of the Group S showed a significant improvement in physical fitness: Oxygen uptake (VO2) at AT increased from 1.19 to 1.55 L/min, P<0.0001; VO2 at RCP increased from 1.66 to 1.96 L/min, P=0.0003 and VO2peak increased from 1.9 to 2.13 L/min, P<0.0001. We also noticed an increase of the oxygen pulse (VO2/HR an important indices of cardiac performance in exercise) from 10.3 to 11.7 mL, P<0.0001. Even there were no significant differences between groups at baseline, the comparison at the end of the study showed the additional benefit of the Group S patients, which was intensively supervised.
Conclusions: Six months supervised exercise training programme improves physical fitness in young metabolic syndrome patients. the study is a clear demonstration that using sports technology and close supervision of the exercise programme, we can obtain an additional benefit on physical fitness than recommendations alone. this particular intensive intervention is recommended at least in the beginning of a lifestyle changing programme.
P341
Metabolic syndrome is associated with a higher prevalence of nonalcoholic fatty liver disease
Y Cavusoglu, A Cavusoglu, I Unluoglu, M Unalacak, M Tek, C Demirustu, F Yuksel, N Ata
Eskisehir Osmangazi University, Eskisehir, Turkey
Topic: Obesity
Purpose: the metabolic syndrome (MS) in adults is associated with an increased risk for development of type 2 diabetes and cardiovascular disease. Obesity and elevated fasting triglyceride levels, which are the components of MS, have also been shown to be more tightly correlated with nonalcoholic fatty liver disease (NAFLD). However, the frequency of NAFLD in MS is not clear. therefore, the aim of this study was to determine whether evidence of NAFLD were more common in patients with MS than in those without MS.
Methods: A total of 251 consecutive subjects were enrolled in the study. A blood sample was obtained for fasting glucose, lipid panel as well as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) to determine the presence of markers for NAFLD. Additional liver ultrasound (US) was performed to evaluate the presence of fatty liver. MS was defined by ATP III criteria (3 or more of the following abnormalities): waist circumference > 102 cm in men and >88 cm in women; triglycerides (TG) >150 mg/dl; high-density lipoprotein cholesterol (HDL-C) < 40 mg/dl in men and <50 mg/dl in women; blood pressure >130/85 mmHg; or fasting glucose level >100 mg/dl. Patients with any etiology for abnormal liver function tests such as chronic hepatic or renal disease, alcohol use, hepatotoxic drug use, hepatitis B or C positivity, connective tissue diseases were excluded from the study.
Results: In the study population 67 subjects had 3 or more MS criteria (MS group) and the remaining 184 did not (control group). Mean age was not different between groups with and without MS (46±8 vs 47±9 years, p=ns). As has been expected, waist circumference (103±8 vs 95±10 cm, p<0.001), TG (217±86 vs 123±61 mg/dl, p<0.001), fasting glucose (104±36 vs 85±12 mg/dl, p<0.001) were higher and HDL-C (41±10 vs 52±12 mg/dl, p<0.001) was lower in MS group compared with the control group. Mean ALT (31.0±23.0 vs 22.6±15.2 IU/L, p=0.001), AST (23.4±10.3 vs 20.9±7.6 IU/L, p=0.038) and GGT (32.3±23.6 vs 23.7±19.0 IU/L, p=0.004) levels were found to be significantly higher in MS group than in control group. the proportion of subjects with transaminase levels more than the upper limit of normal was also higher in MS group as compared to control group (%20.9 vs %8.6, p=0.01 for ALT, %10.4 vs %3.8, p=0.047 for AST, %20.9 vs %5.4, p=0.001 for GGT). Liver US showed steatosis in 78.5% of subjects with elevated ALT and AST or GGT.
Conclusions: this study suggest that the presence of MS was associated with a significantly higher prevelance of markers for NAFLD and an increase in fatty liver on US.
P342
Physical and psychological aspects of obesity in Lithuanian urban population of Kaunas city
M Baceviciene, D Luksiene, A Tamosiunas, R Reklaitiene, E Daugeliene, R Radisauskas
Institute of Cardiology, Kaunas, Lithuania
Topic: Obesity
Purpose: the aim of the study was to evaluate physical and psychological aspects of obesity in urban Lithuanian population of Kaunas city.
Methods: Random sample of 7115 men and women, aged 45–72, stratified by age and sex was selected from the population register of Kaunas city. Response rate was 60.5%. Health examination as a part of international HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study was carried out in 2006–2008. Examination included physical measurements and information on risk factors related to lifestyle. 1193 respondents were randomly selected to fill in the WHOQOL-100 questionnaire. the relationship between body mass index (BMI) and life-style related risk factors, objective measurements, overall quality of life (QOL), aspects of energy and fatigue, body image and appearance, mobility, daily activities and dependence on medication were analyzed using age-adjusted general linear models.
Results: 78% of men and 81% of women had excess body weight. Mean systolic and diastolic blood pressure was found to be higher in obese respondents group as compared to the group of fit weight (p<0.01). Obese people had higher levels of fasting blood glucose, triglycerides and low density lipoproteins; whereas high density lipoprotein cholesterol level was lower among obese respondents (p<0.001). Obese women consumed less amounts of alcohol (p<0.05) whereas smoking was more prevalent among obese men (p<0.01) as compared to the groups of normal body mass. Mean amount of hours that were spent for physical activity a week was higher in women with BMI<25.0 kg/m2 as compared to obese women (22.0 and 18.2, p<0.05). Conversely, obese people were tended to follow healthier diet of higher amounts of fresh fruit and vegetables and lower amounts of sweets (p<0.05). When controlling effect of age, mean scores of energy and fatigue, daily activity, dependence on medication, mobility facets and overall QOL were lower in obese respondents as compared to the ones with normal body mass (p<0.05). Obese men and women were less satisfied with their body appearance as compared to the ones with fit body weight (men 67.1 and 69.6, women 58.0 and 68.2 respectively, p<0.05). Obese and overweight women more often rated their health as bad or very bad as compared to women with BMI<25.0 kg/m2 (p<0.05).
In conclusion, high prevalence of obesity in Lithuanian urban population should receive more attention of health policy as a factor predicting poor subjective status and related to large number of conditions linked to reduced objective physical statement.
P343
Effects of physical training on cardiac modulation in normal weight, overweight, and obese individuals: a comparative study
H C Hugo CelsoDutra De Souza, thR Di Sacco, IC Cozza, KD Maida
University of Sao Paulo, Ribeirao Preto, Brazil
Topic: Obesity
Purpose: Our study has assessed the effect of aerobic physical training on the heart rate variability (HRV) on sedentary women with different body mass indices (BMI; weight/height).
Methods: Forty-eight volunteers were divided into three groups according to their BMI as follows: NW group (normal weight), 18.0–24.9; OW group (overweight), 25.0–29.9; and OB group (obese), 30.0–39.9. All the subjects were submitted to aerobic physical training protocol during 12 weeks. HRV was assessed with the subjects at rest and during tilt test by means of spectral analysis.
Results: Prior to aerobic physical training, OW and OB groups exhibited decrease in low frequencies (LF, 0.40.15 Hz) and high frequencies (HF, 0.15–0.5 Hz). After APT, NW, OW, and OB groups had similar HF oscillations, with only OB group exhibiting increase in LF oscillations. the HRV responses to tilt test obtained before and after aerobic physical training showed that NW group had no differences in LF (34 ± 6% vs. 36 ± 8%) and HF (–65 ± 6% vs. –60 ± 7%) oscillations. However, OW group had an increase in LF (46 ± 6% vs. 86 ± 14%) and HF (–44 ± 7% vs. –61 ± 7%) oscillations, whereas OB group had a decrease in LF (288 ± 25% vs. 159 ± 16%) and HF (–83 ± 5 vs. –70 ± 4%) oscillations.
Conclusion: Our results suggest that regular physical activity has a beneficial effect on the autonomic nervous system, thus being a relevant predictor of cardiovascular morbidity and mortality, and that physical training can attenuate the negative effect of obesity.
P344
Nutrient intake in relation to central and overall obesity status among elderly people living in mediterranean islands: the MEDIS study
S Tyrovolas1, T Psaltopoulou2, G Pounis1, N Papairakleous1, V Bountziouka1, A Zeimbekis3, E Gotsis1, M Antonopoulou4, G Metallinos1, E Polychronopoulos1, C Lionis1, DB Panagiotakos1
1
Harokopio University, Athens, Greece, 2Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, University of Athen, Athens, Greece, 3Health Center of Kalloni, General Hospital of Mitilini, Mitilini, Greece, 4University of Crete, Medical School, Clinic of Social and Family Medicine, Heraklion, Greece
Topic: Obesity
Background: Obesity becomes a global epidemic throughout the developed world. the aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders.
Methods: During 2005–2007, 553 elderly men and 637 elderly women (mean age 74±7 years) from eight Mediterranean Islands in Greece and Cyprus, were enrolled. the retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern.
Results: the prevalence of obesity was 27% in males and 39% in females (p<0.001), while 73% of males and 87% of females had central obesity. the obese elderly presented higher consumption of carbohydrates (p<0.001) and lower consumption of fat (p=0.006) After adjusting for various confounders, one percent increase in carbohydrate consumption was associated with 12% (95% CI 0.78–0.99) lower likelihood of having central obesity, while one percent increase in carbohydrate and protein consumption was associated with 14% (95% CI 0.78–0.95) and 16% (95% CI 0.72–0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with 15% (95% CI 0.77–0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90–0.98) lower likelihood of having central obesity.
Conclusions: the presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with lower likelihood of being obese and may help the elderly persons to preserve normal weight.
P345
the healthy knowledge of obese persons, do they know more about cardiovascular diseases prevention? Results of WOBASZ Study
A Piwonska, E Sygnowska, W Drygas
Institute of Cardiology, Warsaw, Poland
Topic: Obesity
WOBASZ group
Purpose: Obesity is one of main risk factors (RF) of CVD morbidity and mortality, because many proven CVD risk factors, like f. e. hypertension, lipid disturbances, diabetes, are strongly associated with obesity. It is also a huge healthy problem in many populations. To have an effective prevention programs one should know the healthy knowledge of population. We want to evaluate the healthy knowledge [on own RF, complications of untreated hypertension (cHT) and prevention methods (PM)] of obese persons and we want to know if it is greater than the knowledge of the rest of population.
Methods: Data came from representative Polish population sample – 6392 men and 7153 women, aged 20–74, examined in 2003–2005 in the frame of Polish National Health Survey (WOBASZ). Data on socio-demographic factors, healthy knowledge were assessed using questionnaire and collected together with data from biochemistry and physical examination. We analyzed the frequency of persons that know their body mass (BM), can correctly classified it to the group of overweight or obesity, know their blood pressure (BP), cHT and MP.
Results: 1313 men – M (21%) and 1612 women – W (22%) were obese. Obese persons were older and independently of age had higher levels of RF. Out of obese persons, 8% of men and 18% of women did not know their own BM, and 30% of men and 25% of women did know their own BP. About 50% both obese, as well as not obese men, could give their BM exactly to the 2 kg, but obese women rarely than the others knew their BM. Obese persons more often than not obese correctly classified their BM. Persons with obesity had significantly better knowledge on own BP and on classification of BP to normal/low or high group. Moreover obese persons (especially men) better knew cHT. About 30% of obese men and women (less than in population with normal weight) did not know any cHT. the knowledge on PM was worse among obese persons or did not differ significantly In comparison to the rest of population. More than 30% of obese persons did not know any PM.
Conclusions: Obese persons were characterized by better, than the rest of population, knowledge on own risk factors or complications of untreated hypertension, but worse knowledge on prevention methods.
