Chronic obstructive pulmonary disease: the Disability Adjusted Life Years in northern Italy.

AIM: The DALY measure represents a new tool for improving the capacity of local health unit to assess population health needs and priorities. Our study aimed to increase the validity of the Disability Adjusted Life Years (DALY), by incorporating local estimates of the disease incidence and applying population-specific disability weights. METHODS: This is a prospective cohort study enrolling subjects aged 45+ years, first-time admitted to the hospital with principal diagnosis of 490-492, 496 ICD IX-CM codes and followed for one year to evaluate the vital status. A subset was administered the Saint George Respiratory Questionnaire to estimate the distribution of the chronic obstructive pulmonary disease (COPD)-related disability. RESULTS: Estimates of total DALY (per 1000) for COPD varied between 2.1 to 3.4 years among men and between 1.0 to 2.3 years among women; percentages of years of life lost due to a premature mortality were between 60 and 70%. CONCLUSION: The DALY represents a new tool for improving the capacity to assess population health needs and priorities. Policy makers owning such a further element of evaluation may be better oriented in allocating resources for COPD among the different health care chapters: prevention, emergency, chronicity and rehabilitation.

Ten-year trends in vitamin intake in free-living healthy elderly people: the risk of subclinical malnutrition.

OBJECTIVE: To explore the trends of vitamin intake over a 10-year follow-up in a group of successfully aging elderly people. DESIGN: Longitudinal study. SETTING: City of Padua, Italy. PARTICIPANTS: 78 (34M/44F) free-living and still well-functioning survivors among the Italian participants in the SENECA multicenter project, aged 70-75 y at the baseline. MEASUREMENTS: data were collected by means of a modified validated dietary history, both at baseline and then 10 y later. The dietary intake of vitamins B1, B2, A and C were considered, calculating the percentages of individuals with an intake below the lowest European Recommended Dietary Intake (RDI). RESULTS: mean energy and macronutrient intake were consistent with dietary guidelines at both time points. There was no decline in total energy intake after a decade. At baseline, the intake of all vitamins exceeded the Lowest European RDI, with the exception of vitamin B1, for which 44% of the men and 60% of the women were already deficient. After a decade, the prevalence of vitamin B2 and vitamin A deficiencies rose to 50% of the sample. Vitamin C deficiencies rose in a decade from 3% to 6% in men and from 2.3% to 4.5% in women and it was the least prevalent. CONCLUSION: despite an adequate nutritional/functional status and a total energy intake that could be expected to cover the recommendations for micronutrients too, a considerable proportion of our successfully aging elderly were already deficient in, or at high risk of becoming deficient in several essential vitamins. Multivitamin supplementation may be necessary, even in healthy individuals, to ensure an adequate micronutrient intake in the elderly.

Ten-year trends in dietary intake, health status and mortality rates in free-living elderly people.

OBJECTIVE: To explore the trends of food preferences and nutrient intake over a 10-year follow-up in a group of successfully aging elderly. DESIGN: Longitudinal study. SETTING: City of Padua, Italy. PARTICIPANTS: Randomly stratified sample of 97 men and 94 women born between 1913 and 1918. MEASUREMENTS: The study involved a dietary assessment conducted in 1988/89 and repeated in 1999. Data were collected by means of a modified validated dietary history. RESULTS: Nutrient and energy intake remained fairly stable over a decade, despite changes in eating habits, with a higher intake of sweets and a lower consumption of soft drinks in both genders. All individuals significantly increased their daily intake of water. CONCLUSION: Despite changes in eating habits, no significant decline in total energy and macronutrient intake was recorded in a decade in our elderly. The increased daily consumption of water and decreased use of soft drinks would suggest that these people were still receptive to nutritional advice even in very old age, while the increase in their sweet-eating might be because aging itself increases a person's sweet tooth, and this could be regarded as an age-related effect on dietary habits.