Association between soft drink, fruit juice consumption and obesity in Eastern Europe: cross-sectional and longitudinal analysis of the HAPIEE study.

BACKGROUND: Fruit juice and soft drink consumption have been shown to be related to obesity. However, this relationship has not been explored in Eastern Europe. The present study aimed to assess the cross-sectional and longitudinal relationships between fruit juice, soft drink consumption and body mass index (BMI) in Eastern European cohorts. METHODS: Data from the Health, Alcohol and Psychosocial factors in Eastern Europe population-based prospective cohort study, based in Russia, Poland and the Czech Republic, were used. Intakes of sugar-sweetened beverage (SSB), artificially-sweetened beverage (ASB) and fruit juice were estimated from a food frequency questionnaire. Participant BMI values were assessed at baseline (n = 26 634) and after a 3-year follow-up (data available only for Russia, n = 5205). RESULTS: Soft drink consumption was generally low, particularly in Russia. Compared to never drinkers of SSB, participants who drank SSB every day had a significantly higher BMI in the Czech [ß-coefficient = 0.28; 95% confidence interval (CI) = 0.02-0.54], Russian (ß-coefficient = 1.38; 95% CI = 0.62-2.15) and Polish (ß-coefficient = 0.83; 95% CI = 0.29-1.37) cohorts. Occasional or daily ASB consumption was also positively associated with BMI in all three cohorts. Results for daily fruit juice intake were inconsistent, with a positive association amongst Russians (ß-coefficient = 0.75; 95% CI = 0.28-1.21) but a negative trend in the Czech Republic (ß-coefficient = -0.42; 95% CI = -0.86 to 0.02). Russians participants who drank SSB or ASB had an increased BMI after follow-up. CONCLUSIONS: Our findings support previous studies suggesting that soft drink consumption (including SSBs and ASBs) is positively related to BMI, whereas our results for fruit juice were less consistent. Policies regarding these beverages should be considered in Eastern Europe to lower the risk of obesity.

Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project.

BACKGROUND: Hip fractures are associated with diminished quality of life and survival especially amongst the elderly. OBJECTIVE: All-cause mortality after hip fracture was investigated to assess its magnitude. METHODS: A total of 122 808 participants from eight cohorts in Europe and the USA were followed up for a mean of 12.6 years, accumulating 4273 incident hip fractures and 27 999 deaths. Incident hip fractures were assessed through telephone interviews/questionnaires or national inpatient/fracture registries, and causes of death were verified with death certificates. Cox proportional hazards models and the time-dependent variable methodology were used to assess the association between hip fracture and mortality and its magnitude at different time intervals after the injury in each cohort. We obtained the effect estimates through a random-effects meta-analysis. RESULTS: Hip fracture was positively associated with increased all-cause mortality; the hazard ratio (HR) in the fully adjusted model was 2.12, 95% confidence interval (CI) 1.76-2.57, after adjusting for potential confounders. This association was stronger amongst men [HR: 2.39, 95% CI: 1.72-3.31] than amongst women [HR: 1.92, 95% CI: 1.54-2.39], although this difference was not significant. Mortality was higher during the first year after the hip fracture [HR: 2.78, 95% CI: 2.12-3.64], but it remained elevated without major fluctuations after longer time since hip fracture [HR (95% CI): 1.89 (1.50-2.37) after 1-4 years; 2.15 (1.81-2.55) after 4-8 years; 1.79 (1.57-2.05) after 8 or more years]. CONCLUSION: In this large population-based sample of older persons across eight cohorts, hip fracture was associated with excess short- and long-term all-cause mortality in both sexes.

Nobody Is Perfect: Comparison of the Accuracy of PCR-RFLP and KASP™ Method for Genotyping. ADH1B and FTO Polymorphisms as Examples.

DNA genotyping is among the most common analyses currently performed in scientific research. Two high-throughput genotyping techniques are widely used - the "classic" PCR-RFLP and probe-based methods such as TaqMan® PCR assay or KASP™ genotyping. The probe-based techniques are claimed to be more accurate than PCR-RFLP; however, the evidence for this claim is sparse. We have directly compared results of genotyping of two SNPs (rs1229984 and rs17817449) obtained by the PCR-RFLP and KASP™ in 1,502 adult Caucasians. The results were identical in 97.3 % and 95.9 % cases, respectively. Discrepancies (either different results or result obtained with one but not with the other method) were addressed by confirmatory analysis using direct sequencing. The sequencing revealed that both methods can give incorrect results, but the frequency of incorrect genotyping of rs1229984 and rs17817449 was very low for both methods - 0.1 % and 0.5 %, respectively, for PCR-RFLP and 0.1 % and 0.3 %, respectively, for KASP™. These results confirm that the KASP™ technique is slightly more accurate, but it achieves slightly lower call rates than PCR-RFLP. When carefully set up, both PCR-RFLP and KASP™ could have accuracy of 99.5 % or higher.

[Blood Lipid Parameters In Populations of Russia, Poland And Czech Republic: The Hapiee Study].

PURPOSE: to analyze population values of blood lipid parameters in general populations of Russia, Poland and Czech Republic. MATERIALS AND METHODS: In the frame of international project HAPIEE representative samples of general population were examined in Novosibirsk (Russia), Krakow (Poland) and six centers in the Czech Republic. The analysis included data of 25,469 men and women aged 45-69 years old. RESULTS: The average levels of total cholesterol (TC), non-high density lipoprotein cholesterol (non-HDL-C) and low density lipoprotein cholesterol (LDL-C) were found relatively high in all centers, though average levels of blood triglycerides (TG) and high-density lipoprotein (HDL) were within "normal" range. In Novosibirsk mean levels of blood TC and LDL-C in persons of both sexes were obtained the highest among the study participants: 6.3 mmol/ and 4.1 mmol/l, respectively (p < 0.001). But the level of blood triglycerides (1.5 mmol/l) in Novosibirsk was the lowest, and HDL-C (1.5 mmol/l) was the highest among three centres. There were clear trend of increasing concentration of blood TC, non-HDL-C,LDL-C and blood atherogenic indexes with increasing age in both sexes of all participating countries. In Czech Republic levels of blood TC, LDL-C, HDL-C in both sexes were relatively low: 5.7 mmol/l, 3.5 mmol/l, 1.4 mmol/l, respectively, but the level of blood TG were higher, than in other centers (1.9 mmol/l). Women of all centers had more demonstrative age changes of the blood lipid profile, than men. CONCLUSIONS: The average levels of blood TC, non-HDL-C and LDL-C in men and women aged 45-69 years old in Russia (Novosibirsk) were higher and level of blood TG was lower than in Poland and the Czech Republic.

The association between APOA5 haplotypes and plasma lipids is not modified by energy or fat intake: the Czech HAPIEE study.

BACKGROUND AND AIMS: Several smaller studies reported interactions between dietary factors and apolipoprotein A5 (APOA5) gene polymorphisms in determination of plasma lipids. We tested interactions between APOA5 haplotypes and dietary intake in determination of plasma triglycerides (TG) and other lipids. METHODS AND RESULTS: Participants (5487 males and females aged 45-69) were classified according to the number (0, 1, 2+) of minor APOA5 alleles (using T-1131 > C; rs662799 and Ser19 > Trp; rs3135506 polymorphisms) and into three groups of low (bottom 25%), medium (26th-75th percentile) and high (top 25%) of intake of total energy and total, saturated and polyunsaturated fats, assessed by food frequency questionnaire. The age-sex adjusted geometric means of plasma TG increased with the number of minor alleles, from 1.57 (standard error 0.01), to 1.79 (0.02) to 2.29 (0.10) mmol/L (p < 0.00001) but TG did not differ between groups with low, medium and high total energy intake (p = 0.251). TG concentrations were highest in subjects with the combination of 2+ minor alleles and the highest energy intake (mean 2.59 [0.19], compared with 1.62 [0.03] in subjects with lowest energy intake and no minor allele) but the interaction between energy intake and APOA5 haplotypes was not statistically significant (p = 0.186). Analogous analyses with total, saturated and polyunsaturated fat intake yielded similar nonsignificant results. Effects of APOA5 and dietary intakes on total and HDL cholesterol were weaker and no interactions were significant. CONCLUSION: In this Slavic Caucasian population sample, we did not detect the hypothesized interaction between common SNPs within the APOA5 gene and diet in determination of blood lipids.

[Incidence of risk factors of chronic non-infectious diseases including socioeconomic factors in the urban middle age population in the Czech Republic--results of HELEN study]. / Výskyt rizikových faktoru chronických neinfekcnich onemocnëní vcetne faktoru socioekonomických u mestské populace Ceské republiky stredniho veku--výsledky studie HELEN.

BACKGROUND: After 1990, there was a significant decline in total standardized mortality in the Czech Republic. One of the potential causes comprises improved lifestyle. The aim of this report is to present data concerning the lifestyle of the middle-aged urban population and incidence of risk factors of chronic non-infectious diseases associated with lifestyle, including socioeconomic markers as important health determinants. METHODS AND RESULTS: In 1998-2002, a total of 27 cities in the Czech Republic were tested for population health and associated behavioural patterns. In each city 400 male and 400 female subjects aged 45-54 years were randomly selected. Half of this sample was encouraged to undergo medical examination. Resulting data showed that 52.2% of men and 54.6% of women had insufficient physical activity. A total of 43.1% men and 34.9% women were regular smokers and 24.1% men and 21.2% suffered from obesity. Increased risk of cardiovascular disease was detected in 18% of men and 1.2% of women. Gender differences for all of these markers were statistically significant. A statistically significant relationship concerning socio-economic markers and health condition was recorded. CONCLUSIONS: Although relatively well aware of the importance of a healthy lifestyle, the middle-aged urban population showed high incidence of influenceable risk factors for chronic diseases. Men compared to women had higher rates of risk factors and were at higher risk of developing cardiovascular diseases.

The association between psychosocial characteristics at work and problem drinking: a cross-sectional study of men in three Eastern European urban populations.

BACKGROUND: Psychosocial factors at work are thought to influence health partly through health behaviours. AIMS: To examine the association between effort-reward imbalance and job control and several alcohol related measures in three eastern European populations. METHODS: A cross-sectional study was conducted in Novosibirsk (Russia), Krakow (Poland), and Karvina (Czech Republic). The participants completed a questionnaire that included effort-reward at work, job control, and a number of sociodemographic variables. Annual alcohol intake, annual number of drinking sessions, the mean dose of alcohol per drinking session, and binge drinking (> or =80 g of ethanol in one session at least once a week) were based on graduated frequencies in the questionnaire. Data were also available on problem drinking (> or =2 positive answers on CAGE questionnaire) and negative social consequences of drinking. All male participants in full employment (n = 694) were included in the present analyses. RESULTS: After controlling for age and centre, all indices of alcohol consumption and problem drinking were associated with the effort-reward ratio. Adjustment for material deprivation did not change the results but adjustment for depressive symptoms reduced the estimated effects. Job control was not associated with any of the alcohol related outcomes. CONCLUSIONS: The imbalance of effort-reward at work is associated with increased alcohol intake and problem drinking. The association appears to be partly mediated by depressive symptoms, which might be either an antecedent or a consequence of men's drinking behaviour.

Association between fasting plasma triglycerides, all-cause and cardiovascular mortality in Czech population. Results from the HAPIEE study.

Dyslipidemia is the risk factor of cardiovascular disease, but the relationship between the plasma triglyceride (TG) levels and total/cardiovascular mortality has not yet been analyzed in Slavs. The aim of our study was to analyze the association between the fasting TG levels and all-cause/cardiovascular mortality. We have examined 3,143 males and 3,650 females, aged 58.3+/-7.1 years. 729 deaths (274 cardiovascular deaths) have been registered during up to 11.8 years of follow-up. Age-sex adjusted all-cause mortality was higher in individuals with TG values 3.01-4.00 mmol/l (HR 1.37, 95 % CI 1.02-1.83, P=0.035) and over 4.00 mmol/l (HR 1.66, 95 % CI 1.21-2.27, P=0.002) when compared with a reference group (TG 1.41-1.80 mmol/l). Elevated risk remains significant when adjusted for education, marital status and unemployment. When further adjusted for smoking, BMI and dyslipidemia interventions, HR for those in above 4.00 mmol/l group decreased (1.42, P=0.04). The results have been similar when cardiovascular mortality has been examined, however, results reached statistical significance only for the TG over 4.0 mmol/l (P=0.028). Our results confirmed that enhanced plasma levels of plasma triglycerides are dose dependently associated with increased risk of all-cause mortality, however, it seems that individuals with TG values 1.8-3.0 mmol/l are not in higher risk of death.

Contribution of drinking patterns to differences in rates of alcohol related problems between three urban populations.

OBJECTIVES: To examine, on empirical data, whether drinking patterns, in addition to overall alcohol consumption, contribute to differences in rates of alcohol related problems between populations. DESIGN: Cross sectional survey. SETTINGS: One Russian, one Polish, and one Czech city. PARTICIPANTS: 1118 men and 1125 women randomly selected from population registers. MAIN OUTCOME MEASURES: Problem drinking; negative social consequences of drinking; alcohol consumption and drinking pattern. RESULTS: Rates of problem drinking and of negative consequences of drinking were much higher in Russian men (35% and 18%, respectively) than in Czechs (19% and 10%) or Poles (14% and 8%). This contrasts with substantially lower mean annual intake of alcohol reported by Russian men (4.6 litres) than by Czech men (8.5 litres), and with low mean drinking frequency in Russia (67 drinking sessions per year, compared with 179 sessions among Czech men). However, Russians consumed the highest dose of alcohol per drinking session (means 71 g in Russians, 46 g in Czechs, and 45 g in Poles), and had the highest prevalence of binge drinking. In women, the levels of alcohol related problems and of drinking were low in all countries. In ecological and individual level analyses, indicators of binge drinking explained a substantial part of differences in rates of problem drinking and negative consequences of drinking between the three countries. CONCLUSIONS: These empirical data confirm high levels of alcohol related problems in Russia despite low volume of drinking. The binge drinking pattern partly explains this paradoxical finding. Overall alcohol consumption does not suffice as an estimate of alcohol related problems at the population level.

Population-based biomonitoring in the Czech Republic--the system and selected results.

In the framework of the system of monitoring the environmental impact on population health, the concentration of lead, cadmium and selenium in blood and cadmium in urine was measured in adults (n = 670), children (n = 599) and umbilical blood (n = 549) using atomic absorption spectrophotometry. Furthermore, cytogenetic analysis of peripheral lymphocytes in all population groups under study was investigated. The median blood Pb level for the overall group of adults (47.8 micrograms/l, i.e. 0.23 mumol/1) was significantly higher in men (51.5 micrograms/l, i.e. 0.25 mumol/l). Smoking significantly influenced the blood Pb level in women. The 90th percentile in no group exceeded the value of 100 micrograms/l (0.48 mumol/l). The median blood Cd level in adults (0.9 microgram/l, i.e. 0.008 mumol/l) depends on smoking habit (1.25 micrograms/l, i.e. 0.01 mumol/l). The median urine Cd level was 0.585 microgram/g creatinine (0.59 mumol/mole creatinine) in adults and 0.37 microgram/g creatinine (0.37 mumol/mole creatinine) in children. The median blood Se level (53.5 micrograms/l, i.e. 0.68 mumol/l) was found to be higher in the group of non-smokers (57.5 micrograms/l, i.e 0.73 mumol/l). Lead and selenium level were significantly lower in the umbilical blood. Cytogenetic analysis results showed age-dependent average percentages of aberrant cells: 1.1% in umbilical blood, 1.27% in children and 1.71 in adults in line with the reference values for the Czech population.

Determination and multivariate statistical analysis of biochemical responses to environmental contaminants in feral freshwater fish Leuciscus cephalus, L.

Modulations of 11 prospective biochemical markers of impacts of aquatic pollutants in liver tissue of chub (Leuciscus cephalus), caught at several sampling sites of a river with various pollution types and rates, were matched against analytical data of concentrations of organochlorine compounds, polycyclic aromatic hydrocarbons (PAHs), and heavy metals. Multivariate principal component analysis (PCA) of the field data showed general patterns of biochemical responses to different types of pollutants and relationships among the biomarkers. Cytochrome P4501A-dependent 7-ethoxyresorufin O-deethylase (EROD) activity, inducible by 2,3,7,8-tetrachlorodibenzo-p-dioxin and structurally related planar compounds, was strongly enhanced in the more contaminated areas. Compared with polychlorinated aromatic hydrocarbons, PAHs did not contribute so significantly to EROD induction. Testosterone 6 beta- and 16 alpha-hydroxylase activities, as an expression of the cytochrome P4503A27, were slightly increased at several sites but were significantly decreased in samples from some heavily polluted areas. Recently, these activities have been suggested as potential biomarkers of exposure to contaminants that do not induce cytochrome P4501A. In this study, their inhibition or induction was not associated with a specific class of monitored contaminants, and selectivities of these modulations are still to be investigated. Similar modulations of the prospective biochemical indicators of oxidative stress, including microsomal glutathione S-transferase activity, cytosolic glutathione S-transferase with ethacrynic acid, and glutathione reductase, were demonstrated by PCA. The pattern of the modulations of the microsomal nicotinamide adenine dinucleotide phosphate (NADPH)-dependent lipid peroxidation in vitro differed from the responses of the rest of oxidative stress parameters at some sampling sites. Further biochemical markers of oxidative stress under study, including in vivo lipid peroxidation, in vitro production of reactive oxygen species, and the concentration of metallothioneins did not correlate well with the concentrations of the contaminants. Principal component analysis demonstrated that the EROD activity, glutathione-dependent enzymes, and Fe(II)-enhanced lipid peroxidation formed a suitable battery of biomarkers of exposure.

Health risk of urban soils contaminated by heavy metals.

The paper presents the results of geochemical investigations carried out in the city of Prague. Czech Republic, between the years 1994-1997, by the Czech Geological Institute, National Institute of Public Health and Hygiene Stations of Prague. Exposure assessment for children as the most sensitive population, based on soil ingestion pathway, indicates that lead is the major pollutant of concern, especially in the central regions of the city. Direct exposure assessment was done by analyzing blood and urine samples collected from children aged 3-6 years. Blood lead levels were the only biomarker significantly higher as compared to the control group (32.1 +/- 17.4 microg/l, 25.1 +/- 15.4 microg/l). This pilot study supports the establishment of a new sub-system within the already existing System of Monitoring the Environmental Impact on Population Health of the Czech Republic.

Chemoprotective activity of boldine: modulation of drug-metabolizing enzymes.

Possible chemoprotective effects of the naturally occurring alkaloid boldine, a major alkaloid of boldo (Peumus boldus Mol.) leaves and bark, including in vitro modulations of drug-metabolizing enzymes in mouse hepatoma Hepa-1 cell line and mouse hepatic microsomes, were investigated. Boldine manifested inhibition activity on hepatic microsomal CYP1A-dependent 7-ethoxyresorufin O-deethylase and CYP3A-dependent testosterone 6 beta-hydroxylase activities and stimulated glutathione S-transferase activity in Hepa-1 cells. In addition to the known antioxidant activity, boldine could decrease the metabolic activation of other xenobiotics including chemical mutagens.

Five years of the system of monitoring the environmental impact on population health of the Czech Republic.

The data collected in the System of monitoring the environmental impact on population health of the Czech Republic in 1994-1998 were obtained routinely and in a stabilized manner in six subsystems: health consequences and risks related to air pollution, drinking water quality, noise, human dietary exposure, human exposure to toxic pollutants from the environment and monitoring of the health status and evaluation of selected indicators of demographic and health statistics. They represent a useful and comprehensive background for providing objective information on the health status of the Czech population and on pollution of different components of the environment in the Czech Republic. The results obtained in the period 1994-1998 show that no critical situation needing urgent countermeasures to be taken appeared in the localities monitored. However, some results are indicative of the necessity to take certain remedial measures to maintain all population exposure burdens as low as reasonably possible from the economical and social points of view. Generally, the admissible limit values and exposure limits are exceeded only sporadically in some localities while for most contaminants monitored only very low values compared to the limits can be found and such situations are mostly considered as non-systematic changes.

System of monitoring the environmental impact on population health of the Czech Republic.

The data collected in the System of monitoring the environmental impact on population health of the Czech Republic in 1994 and 1995 were obtained routinely and in a stabilized manner in six subsystems: health consequences and risks related to air pollution, drinking water quality, noise, human dietary exposure, human exposure to toxic pollutants from the environment and the monitoring of the health state and evaluation of selected indicators of demographic and health statistics. They represent a useful and comprehensive background for providing objective information on the health status of the Czech population and on pollution of different components of the environment in the Czech Republic to other countries in Europe and worldwide to facilitate their commercial and cultural contacts. The results of the calendar year 1995 show that no critical situation needing urgent countermeasures to be taken appeared in the localities monitored. However, some results are indicative of the necessity to take certain remedial measures to maintain all population exposure burdens as low as reasonably possible from the economical and social points of view. The set of problems was identified as important also in 1994. Generally, the limit values and exposure standards are exceeded only sporadically in some localities while for most contaminants monitored only very low values compared to the admissible limits can be found.

[Health status of the population in six cities in the Czech Republic: prevalence and therapy of various chronic diseases]. / Zdravotní stav obyvatelstva sesti mest Ceské republiky: prevalence a terapie nekterých chronických onemocnení.

BACKGROUND: The aim of the study was to describe health status of the urban middle-age population in six cities of the Czech Republic, which were included into the System of Population Health Survey in Relation to the Environment. METHODS AND RESULTS: From the population of cities Brno, Ceské Budejovice, Hradec Králové, Karviná, Kolín, Ustí nad Labem 400 males and 400 females in the age of 45 to 54 years were included into the study. All respondents filled out a question-form, half of them also underwent a medical check up. Results has shown that 52.8% of males and 51.6% of females had their cholesterol level elevated (> 5.2 mmol/l), 47.3% of males and 38.3% if females had higher blood pressure (SBP > = 140 mmHg and/or DBP > = 90 mmHg) or they were cured of hypertension, 39.4% of males and 22.5% of females were obese. Significant differences were observed in the prevalence of hypercholesterolemia, hypertension and smoking habits among the cities in study. According to the case histories, 55.6% of males and 57.8% of females complained of long-lasting ill-being, 37.0% of males and 45.2% of females were treated for a chronic disease, 13.3% of males and 12.4% of females considered their health during the previous year as bad or very bad. 45.4% of males and 57.9% of females underwent long-term pharmacological treatment, most frequently on a cardiovascular disease. Above described parameters differed significantly among cities in study. CONCLUSION: In the middle-aged population in six Czech cities the high prevalence of chronic diseases, health troubles and risk factors of chronic disease were found. Though the death rate in CR has been declining, chronic diseases have became a serious problem. Since most of these health problems can be improved by correct regimen, high attention should be given to their prevention.

[Antioxidants of biological origin]. / Antioxidanty biogenního puvodu.

Diseases due to free radical are the subject of intensive study. The search aims to find substances preventing the origin of free radicals, substances capable of rendering the developed free radicals harmless, or substances capable of removing the damage of molecules which has already taken place. The present paper briefly surveys the metabolites of biogenic origin, mainly from higher plants, which show in vitro antioxidant activity and are potentially usable in a number of diseases.

[Natural substances as chemoprotective agents]. / Prírodní látky jako chemoprotektiva.

The fate of xenobiotics in the organism and their toxic or therapeutic influence have been under intensive investigation in recent years. The compounds are searched for which affect as preventive agents cancerogenesis and other disorders caused by procancerogens and pro-mutagens from the environment. The main focus is on the compounds able to modulate the activity of enzymes of the Ist and IInd phase of xenobiotic detoxication or compounds with antioxidative activity. In the following review, compounds of natural origin are presented which possess an ability to modulate the processes connected with detoxication of xenobiotics. These compounds could be usable as preventive agents against some diseases or as supportive pharmaceuticals during chemotherapy.

Age at natural menopause in three central and eastern European urban populations: the HAPIEE study.

OBJECTIVES: To investigate the age at menopause in three urban populations in Central and Eastern Europe and to assess whether the (suspected) differences can be explained by a range of socioeconomic, reproductive and behavioural factors. METHODS: The Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) Study examined random samples of populations aged 45-69 years in Novosibirsk (Russia), Krakow (Poland) and six Czech towns. Participants completed a questionnaire and attended an examination in clinic. A total of 12,676 of women were included in these analyses. RESULTS: The median age at menopause was 50 years in Novosibirsk, 51 years in Czech towns and 52 years in Krakow; the Cox regression hazard ratios of menopause, compared with Krakow, were 1.47 (95% CI 1.40-1.55) for Novosibirsk and 1.10 (1.04-1.16) for Czech women. In multivariate analyses, higher education, using vitamin and mineral supplements and ever use of oral contraceptives were associated with later menopause, while smoking, abstaining from alcohol and low physical activity were associated with earlier menopause. These factors, however, did not explain the differences between populations; the multivariate hazard ratios of menopause, compared with Krakow, were 1.48 (1.40-1.57) for Novosibirsk and 1.11 (1.05-1.17) for Czech women. CONCLUSIONS: In this large population based study, differences in age at menopause between Central and Eastern Europe populations were substantial and unexplained by a range of risk factors. Associations of age at menopause with risk factors were largely consistent with studies in other populations.