Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study.

BACKGROUND: Most cardiovascular disease risk prediction equations in use today were derived from cohorts established last century and with participants at higher risk but less socioeconomically and ethnically diverse than patients they are now applied to. We recruited a nationally representative cohort in New Zealand to develop equations relevant to patients in contemporary primary care and compared the performance of these new equations to equations that are recommended in the USA. METHODS: The PREDICT study automatically recruits participants in routine primary care when general practitioners in New Zealand use PREDICT software to assess their patients' risk profiles for cardiovascular disease, which are prospectively linked to national ICD-coded hospitalisation and mortality databases. The study population included male and female patients in primary care who had no prior cardiovascular disease, renal disease, or congestive heart failure. New equations predicting total cardiovascular disease risk were developed using Cox regression models, which included clinical predictors plus an area-based deprivation index and self-identified ethnicity. Calibration and discrimination performance of the equations were assessed and compared with 2013 American College of Cardiology/American Heart Association Pooled Cohort Equations (PCEs). The additional predictors included in new PREDICT equations were also appended to the PCEs to determine whether they were independent predictors in the equations from the USA. FINDINGS: Outcome events were derived for 401 752 people aged 30-74 years at the time of their first PREDICT risk assessment between Aug 27, 2002, and Oct 12, 2015, representing about 90% of the eligible population. The mean follow-up was 4·2 years, and a third of participants were followed for 5 years or more. 15 386 (4%) people had cardiovascular disease events (1507 [10%] were fatal, and 8549 [56%] met the PCEs definition of hard atherosclerotic cardiovascular disease) during 1 685 521 person-years follow-up. The median 5-year risk of total cardiovascular disease events predicted by the new equations was 2·3% in women and 3·2% in men. Multivariable adjusted risk increased by about 10% per quintile of socioeconomic deprivation. Maori, Pacific, and Indian patients were at 13-48% higher risk of cardiovascular disease than Europeans, and Chinese or other Asians were at 25-33% lower risk of cardiovascular disease than Europeans. The PCEs overestimated of hard atherosclerotic cardiovascular disease by about 40% in men and by 60% in women, and the additional predictors in the new equations were also independent predictors in the PCEs. The new equations were significantly better than PCEs on all performance metrics. INTERPRETATION: We constructed a large prospective cohort study representing typical patients in primary care in New Zealand who were recommended for cardiovascular disease risk assessment. Most patients are now at low risk of cardiovascular disease, which explains why the PCEs based mainly on old cohorts substantially overestimate risk. Although the PCEs and many other equations will need to be recalibrated to mitigate overtreatment of the healthy majority, they also need new predictors that include measures of socioeconomic deprivation and multiple ethnicities to identify vulnerable high-risk subpopulations that might otherwise be undertreated. FUNDING: Health Research Council of New Zealand, Heart Foundation of New Zealand, and Healthier Lives National Science Challenge.

Maternal Physiologic Renal Pelvis Dilatation in Pregnancy: Sonographic Reference Data.

OBJECTIVES: The purpose of this study was to produce sonographic reference data for maternal renal pelvis dilatation in asymptomatic pregnant women. METHODS: A prospective cross-sectional study was undertaken on pregnant women presenting for outpatient obstetric imaging. For each side, the renal length and axial anteroposterior diameter of the renal pelvis were measured. Maternal demographics, gravidity and parity, number of fetuses, and estimated fetal weight (when available) were recorded. RESULTS: A total of 700 women enrolled, with 191 excluded. The 509 women analyzed included 465 singleton and 44 twin pregnancies. A total of 815 sonographic investigations were performed: 716 in singleton pregnancies and 99 in twin pregnancies. The gestational age range was 10 to 40 weeks. Charts depicting the anteroposterior renal pelvis diameter versus gestational age were constructed to determine normative sonographic reference data for maternal renal pelvis dilatation in singleton pregnancies. Although the mean renal pelvis diameter increased as pregnancy progressed, measurements of greater than 10 mm remained relatively uncommon, being identified in 9.7% of right and 2.1% of left kidneys in the third trimester. Only 4.1% of right and 0.4% of left third-trimester measurements exceeded 15 mm. Right renal pelvis measurements on average were greater than the left by 1.54 mm (95% confidence interval [CI], 1.20 to 1.87 mm). Twins had significantly larger renal pelvis measurements than singletons on average, measuring 2.11 mm (95% CI, 1.50 to 2.72 mm) larger on the right and 1.69 mm (95% CI, 0.73 to 2.65) on the left. CONCLUSIONS: We present sonographic reference data for asymptomatic pregnancy-related renal pelvis dilatation in singleton pregnancies from a large cohort of women.

Soft X-ray angle-resolved photoemission with micro-positioning techniques for metallic V2O3.

Soft X-ray angle-resolved photoemission has been performed for metallic V2O3. By combining a microfocus beam (40 µm × 65 µm) and micro-positioning techniques with a long-working-distance microscope, it has been possible to observe band dispersions from tiny cleavage surfaces with a typical size of several tens of µm. The photoemission spectra show a clear position dependence, reflecting the morphology of the cleaved sample surface. By selecting high-quality flat regions on the sample surface, it has been possible to perform band mapping using both photon-energy and polar-angle dependences, opening the door to three-dimensional angle-resolved photoemission spectroscopy for typical three-dimensional correlated materials where large cleavage planes are rarely obtained.

Redistribution of heart failure as the cause of death: the Atherosclerosis Risk in Communities Study.

BACKGROUND: Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined. METHODS: We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55 years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records. RESULTS: After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P < 0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study. CONCLUSIONS: Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends.

Respiratory effects of insulin sensitisation with metformin: a prospective observational study.

The mechanism for the association between diabetes mellitus and lung function impairment is unknown, as are any respiratory effects of antidiabetic agents. We aimed to assess whether treatment with metformin, an oral insulin-sensitising agent, improved lung function or symptoms in individuals with COPD and glucose intolerance. A prospective open-label observational study was conducted. Participants with moderate or severe COPD, BMI > 25 kg/m(2), and type 2 diabetes mellitus or impaired glucose tolerance took metformin twice daily for 6 months. Clinical outcomes included St George's Respiratory Questionnaire (SGRQ), transition dyspnoea index, and incremental shuttle walk test. Physiological outcomes including pulmonary function tests, exhaled nitric oxide, respiratory mouth pressures and handgrip strength. In total, 17 participants completed the study. SGRQ score improved by a median of 5 points, and TDI scores improved by 2 points. Inspiratory mouth pressures increased by 7.5 cmH2O. There were trends to improvements in hyperinflation, gas trapping and shuttle walk distance. Spirometry and exhaled nitric oxide were unchanged. In this proof-of-concept study, metformin was associated with improved dyspnoea and health status in COPD, possibly related to increased inspiratory muscle strength. These and other endpoints should be examined in a definitive study.

Chronic obstructive pulmonary disease in non-smokers: a case-comparison study.

BACKGROUND: COPD is often regarded as a smoker's disease. In fact, up to 50% of COPD could be attributable to other causes. Relatively little is known about COPD among nonsmokers, and this group is usually excluded from studies of COPD. METHODS: In this cross-sectional case-comparison study, smokers and nonsmokers aged over 45 with COPD (post-bronchodilator FEV1 ≤ 70% predicted, FEV1/FVC ratio < 0.7) were recruited from specialist outpatient clinics and from primary care. Subjects completed a questionnaire and interview, and underwent spirometry, venesection, exhaled nitric oxide (ENO) measurement, allergen skinprick testing, formal lung function testing and high resolution CT. RESULTS: 48 nonsmokers and 45 smokers participated. Asthma was nearly universal among nonsmokers and was the commonest identifiable cause of COPD in that group. Nonsmokers also exhibited a high prevalence of objective eosinophilic inflammation (raised ENO and eosinophil counts, positive skinprick tests). Smokers had more severe airflow obstruction, but respiratory symptom prevalences were similar between groups. Nonsmokers reported greater lifetime burdens of respiratory disease. Nonsmokers' HRCT results showed functional small airways disease, with no significant emphysema in any subject. Previously undiagnosed bronchiectasis was common in both groups (31% and 42%). CONCLUSIONS: Asthma is a very common cause of COPD among nonsmokers. Radiological bronchiectasis is common in COPD; the clinical significance of this finding is unclear.

Fixed airflow obstruction among nonsmokers with asthma:a case-comparison study.

BACKGROUND: Airflow obstruction in asthma is usually reversible, but fixed obstruction develops in some individuals. Little is known about risk factors for development of fixed airflow obstruction in nonsmokers with asthma. METHODS: This case-comparison study recruited nonsmokers aged over 45 years with physician-diagnosed asthma from specialist outpatient clinics and primary care. Two age-matched groups were recruited on the basis of spirometry: anobstructed group (post-bronchodilator FEV(1) ≤ 70% predicted, FEV1/FVC ratio < lower limit of normal) and a control group with normal lung function. Subjects completed a questionnaire and interview, and underwent spirometry, venesection, exhaled nitric oxide (ENO) measurement, allergen skinprick testing, and formal lung function testing. RESULTS: Thirty-four obstructed subjects and 40 controls participated in the study. Obstructed subjects exhibited greater evidence of systemic inflammation, abnormal glucose homeostasis, and central obesity than controls. Obstructed subjects reported longer duration of asthma, and childhood respiratory infection was commoner in that group. Metabolic syndrome prevalence was similar between groups, but several features of insulin resistance were associated with reduced FEV(1). Cough and sputum were common among controls. CONCLUSIONS: Risk of fixed airflow obstruction may correlate with lifetime asthma duration. Individuals with coexisting asthma and fixed airflow obstruction have heightened systemic inflammation. A variety of chronic respiratory symptoms are common among "healthy" nonsmokers with asthma.

Influence of mediterranean diet on asthma symptoms, lung function, and systemic inflammation: a randomized controlled trial.

OBJECTIVE: The rapidly increasing prevalence of asthma in developed countries suggests an environmental cause. The benefits of Mediterranean diet (MD) in cardiovascular disease have been tentatively attributed to its anti-inflammatory properties. Asthma is an inflammatory disease and MD is associated with reduced asthma risk in epidemiological studies, but there are no reported interventional studies of MD in asthma. METHODS: In this 12-week open-label randomized trial, 38 adults with symptomatic asthma were allocated to high-intervention (HI), low-intervention (LI), and control groups. The first two groups were encouraged to adopt an MD and received multiple consultation sessions with a nutritionist, written advice, and vouchers for the purchase of appropriate foods. Food frequency questionnaires, asthma control questionnaires, asthma-related quality of life questionnaires (AQLQs), and spirometry were completed at the beginning and at the end of the study. RESULTS: The MDt score increased in the HI group (p < .001), indicating successful alteration of dietary behavior. Statistically, nonsignificant improvements were seen in spirometry and several AQLQ subdomains in the two intervention groups. No changes were seen in the asthma control or in inflammatory markers. CONCLUSIONS: The trial intervention has successfully altered the dietary behavior among adults with asthma. Small but consistent improvements were seen in quality of life and spirometry among the intervention group. The use of the MD to treat asthma is feasible and warrants evaluation in a larger study, powered to examine clinical endpoints.

Increased prevalence of albuminuria among non-European peoples with type 2 diabetes.

BACKGROUND: A high incidence of albuminuria, varying by ethnicity, has been found in a number of populations worldwide. There have been few opportunities to explore the prevalence of albuminuria as a marker of chronic kidney disease while adjusting for other risk factors in the different ethnic groups in New Zealand. METHODS: We examined the association between albuminuria and ethnicity using cross-sectional data from a large cohort study of type 2 diabetes conducted in New Zealand. RESULTS: The study population was 65 171 adults in primary care with type 2 diabetes, not on renal replacement therapy; median age was 64.7 years, median diabetes duration 5.1 years and 48.5% were non-European. Microalbuminuria or greater was present in 50% of Maori, 49% of Pacific people, 31% of Indo- and East-Asians and 28% of Europeans. Regression analyses were used to examine the association between ethnicity and albuminuria-measured as albumin:creatinine ratio-after controlling for study site and other known risk variables: age, sex, duration of diabetes, smoking status, socioeconomic status, body mass index, systolic and diastolic blood pressure, triglyceride levels, HbA(1C) and being on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. After controlling for these risk factors and compared with Europeans, odds ratios for 'advanced' albuminuria (≥100 mg/mmol) were 3.9 (95% confidence interval: 3.2-4.6) in Maori, 4.7 (3.6-6.3) in Pacific people, 2.0 (1.5-2.7) in Indo-Asians and 4.1 (3.2-5.1) in East-Asians. CONCLUSION: Non-European ethnicities appear to carry significantly higher risks of albuminuria in type 2 diabetes.

Metabolic syndrome severity score (MetSSS) associates with metabolic health status in multi-ethnic Aotearoa New Zealand cohorts.

AIM: To investigate the relationship of metabolic syndrome severity score (MetSSS) with glucose regulatory and cardiovascular disease (CVD) status in Aotearoa New Zealand. METHODS: MetSSS and MetSSS component coefficients were calculated for participants from the cross-sectional Workforce Diabetes Study (WDS) (n = 5,806) and Diabetes, Heart and Health Survey (DHAH) (n = 4,010) and compared by ethnicity (European, Maori, Pacific and Asian), glucose regulatory status [impaired fasting glucose, impaired glucose tolerance and type 2 diabetes) and history of cardiovascular disease. RESULTS: MetSSS positively associated with impaired glucose regulatory status and history of cardiovascular disease for all ethnic groups. Ethnicity significantly affected different coefficients of the MetSSS components, however all ethnicities had an approximately normal MetSSS distribution, with Maori and Pacific curves being right-shifted compared to European. While the MetSSS thresholds that capture 80% of participant with type 2 diabetes (T2D) were higher for Maori and Pacific, the difference in MetSSS between those participants with and without type 2 diabetes within an ethnicity group was similar across ethnicities. CONCLUSION: MetSSS may have utility as a tool to quantify an individual's cardiometabolic disease risk within the multi-ethnic population of Aotearoa New Zealand, however ethnic-specific categories for disease risk are likely to be required.

Longitudinal associations of blood pressure with aortic stiffness and pulsatility: the Atherosclerosis Risk in Communities Study.

OBJECTIVE: To characterize the longitudinal relationships between blood pressure measured over 24 years and arterial stiffness in late life measured as pulse wave velocity (PWV). METHODS: Carotid--femoral (cf) and femoral--ankle (fa) PWV were measured in 4166 adults at the visit 5 Atherosclerosis Risk in Communities study cohort examination (2011-2013). Participants were categorized into tertiles of PWV measurements. Blood pressure measurements were made at baseline (1987-1989), three subsequent triennial examinations, and visit 5. RESULTS: Partial correlation coefficients between visit 5 cfPWV and SBP ranged from 0.13 for visit 1 SBP to 0.32 for visit 5 SBP. For visit 5 faPWV, correlations were ∼0 for visits 1 to 4 SBP, but was 0.20 for visit 5 SBP. Over 24 years of follow-up, those with higher average SBP were more likely to fall in the middle and upper tertiles of visit 5 cfPWV. Average pulse pressure and mean arterial pressure over 24 years had similar but weaker associations with cfPWV tertiles. DBP had no clear association with cfPWV. Blood pressure measurements were positively associated with faPWV tertiles only cross-sectionally at visit 5. CONCLUSION: Adult life-course measures of SBP, more so than mean arterial and pulse pressure, were associated with later life central arterial stiffness. By contrast, only contemporaneous measures of blood pressure were associated with peripheral arterial stiffness. Although arterial stiffness was only measured at later life, these results are consistent with the notion that elevated blood pressure over time is involved in the pathogenesis of arterial stiffening.

Seasonal variation in the acute presentation of urinary calculi over 8 years in Auckland, New Zealand.

STUDY TYPE: Symptom prevalence (retrospective cohort) Level of Evidence 2b. OBJECTIVE: To determine the incidence of acute presentation of urinary calculi (UC) in Auckland, New Zealand, during the period 1999-2007, and whether there was any significant seasonal variation. PATIENTS AND METHODS: The details of all UC within the population presenting acutely to public hospitals in Auckland between 1999 and 2007 were collected using clinical coding searches International Classification of Disease 10th revision (Australian Modification) N132 and N20. Climatic variables for the Auckland region were obtained from the National Institute of Water and Atmospheric Research, New Zealand. The mean atmospheric temperature, hours of sunshine and humidity data were calculated monthly for this period. RESULTS: During the study there were 7668 acute presentations of UC in the Auckland region. A Poisson regression model showed that the number of presentations was significantly related to temperature (P < 0.001) and hours of sunshine (P = 0.004) but not humidity (P = 0.14). For each degree increase in temperature the number of presentations increased by 2.8% (95% confidence interval 1.3-4.3%). For each 1-h increase in sunshine, the number of presentations increased by 0.2% (0.06-0.33)%. CONCLUSION: The acute presentation of UC in Auckland, New Zealand, varies significantly with temperature and hours of sunshine. Humidity was not a significant factor.

Lymph node examination as a predictor of long-term outcome in Dukes B colon cancer.

BACKGROUND: Mortality from cancer recurrence in Dukes B patients is approximately 25-30%. Outcome in Dukes B patients improves in direct relation to the number of lymph nodes examined. Examining fewer lymph nodes risks understaging and also such patients are less likely to receive chemotherapy. The aim of this study was to assess the impact of the number of lymph nodes examined on recurrence and mortality in Dukes B colon cancers. MATERIALS AND METHODS: A retrospective database was constructed of 328 consecutive patients who underwent resection for Dukes B colorectal cancer between January 1993 and December 2001 at Middlemore Hospital. Patients with incomplete data, previous colorectal cancer, or perioperative deaths were excluded as were cases of rectal cancer. Data for the remaining 216 patients was subjected to multivariate and logistic regression analysis with 'patient death' or 'cancer recurrence' (CRec5) within 5 years as endpoints. A graph was constructed depicting CRec5 as broken down by lymph node strata. Receiver operator characteristic (ROC) curves were constructed for mortality and CRec5. RESULTS: The mean number of lymph nodes examined was 16.0 (median 14; range 2-48). The mean number of lymph nodes examined in those who died within 5 years was 12.8 vs. 17.5 in those who remained alive (p = 0.0027). The mean number of lymph nodes examined in those with evidence of recurrence within 5 years was 11.8 vs. 17.1 in those without recurrence (p = 0.0007). Analysis at various lymph node strata showed a sharp and statistically significant drop in the recurrence rate after the 16th node mark. The ROC curve for CRec5 showed that examination of 12 lymph nodes provided maximum sensitivity (0.60) and specificity (0.64). CONCLUSION: Examination of more than 16 lymph nodes is associated with a significant reduction in cancer recurrence. This supports the current clinical practice of harvesting and analysing as many nodes as possible during surgical resection and pathological analysis.

Dietary intakes of European, Maori, Pacific and Asian adults living in Auckland: the Diabetes, Heart and Health Study.

OBJECTIVE: To compare dietary intakes of European, Maori, Pacific, and Asian men and women living in Auckland. METHODS: Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from participants in a cross-sectional health screening study carried out between 2002 and 2003. Participants were 4,007 Maori, Pacific, Asian and European people (1,915 men, 2,092 women) aged 35 to 74 years. RESULTS: Compared with Europeans, Maori and Pacific men had higher total energy intakes per day, while Asians had lower intakes. A similar pattern was observed for carbohydrate and fat consumption. While protein and cholesterol consumption tended to be lower in Europeans than the other three ethnic groups, alcohol consumption and calcium intakes were highest among Europeans. Many of the differences between ethnic groups were attenuated when nutrient consumption was expressed as their percentage contribution to total energy intake suggesting that total food consumption was the major determinant of ethnic differences in nutrient intakes. CONCLUSIONS: There were substantial differences in dietary habits, food selections and cooking practices between European, Maori, Pacific and Asian participants. However, the observed differences were in the area of serving sizes and frequency of consumption of certain foods than to major differences in the range of foods and nutrients consumed or the percentage contribution of carbohydrate, fat or protein to total energy intake. IMPLICATIONS: The development of strategies to reduce serving sizes and the frequency of consumption of certain foods will be required to help address the major nutrition-related health problems in New Zealand.

HbA1c in relation to incident diabetes and diabetes-related complications in non-diabetic adults at baseline.

AIMS: We compared the utility of glycated hemoglobin (HbA1c) and oral glucose tolerance (oGTT) in non-diabetic patients for identifying incident diabetes; all-cause mortality; cardiovascular disease (CVD) mortality; CVD, coronary heart disease (CHD), and ischemic stroke events; and diabetes microvascular complications. METHODS: Data from a New Zealand community setting were prospectively linked to hospitalization, mortality, pharmaceutical and laboratory test results data. After applying exclusion criteria (prior laboratory diagnosis or history of drug treatment for diabetes or hospitalization for diabetes or CVD event), there were 31,148 adults who had an HbA1c and 2-h 75g oGTT. HbA1c was measured by ion-exchange high-performance liquid chromatography, and glucose using a commercial enzymatic method. We compared glycemic measures and outcomes using multivariable Cox proportional hazards regression. RESULTS: The median follow-up time was 4years (range 0 to 13). The mean age was 57·6years and 53·0% were male. After adjusting for other glycemic measures (fasting glucose, 2-h glucose and/or HbA1c where relevant) in addition to age, sex, ethnicity and smoking habit, the hazard ratios for incident diabetes and diabetes complications of retinopathy and nephropathy were highest for 2-h glucose levels, followed by HbA1c and lastly by fasting glucose. However, all-cause mortality and CHD were significantly associated with HbA1c concentrations only, and ischemic stroke and CVD events with 2-h glucose only. Circulatory complications showed a stronger association with HbA1c. CONCLUSION: Apart from neuropathy, HbA1c showed stronger associations with outcomes compared to fasting glucose and provides a convenient alternative to an oGTT.

Seasonality of nutrient intake - An analysis including over 44,000 participants in 4 countries.

BACKGROUND AND AIMS: Dietary intake is believed to follow a seasonal pattern, so adjusting for seasonality in nutritional epidemiology is usually requested. The aim of this study was to assess the seasonality of energy and macronutrients intake (expressed as % of total caloric intake) using a large set of population-based studies. METHODS: Cross-sectional data from 9 population-based studies from 4 countries (3 in the Northern Hemisphere and 1 in Southern Hemisphere), with a total sample size of 44,611 subjects. Data were derived from FFQ or repeated 24 h-recalls. Dietary markers included total energy intake, protein, carbohydrates, fat, alcohol, sugars and fatty acids (saturated, mono and poly-unsaturated). Seasonality was assessed using the cosinor method stratifying on hemisphere and gender. RESULTS: Most nutrients did not show a significant seasonal variation. When individual studies were considered, the number of nutrients showing significant seasonal variations varied from 5 to none in men and from 6 to none in women. Jointly, in the Northern hemisphere, significant seasonal variations were found for sugar intake in both genders and for alcohol consumption in men only; in the Southern Hemisphere, significant seasonal variations were found for fat and monounsaturated fatty acids in women. Analysis of the three consecutive periods of the Bus Santé study in Switzerland showed that the number of significant seasonal variations decreased from 5 in 1993-1999 to 1 in 2006-2012 in men, and from 6 in 1993-1999 to none in 2006-2012 in women. Seasonal variation decreased over time for most nutrients, with the exception of monounsaturated fatty acids in men. CONCLUSIONS: Seasonality of energy and macronutrients intake varies considerably according to study, with no common pattern and small magnitude of variation. Its amplitude appears to be declining over time. Systematic adjustment for season might not be necessary when assessing the effects of total energy and macronutrient intake on disease.

Do triglycerides explain the U-shaped relation between alcohol and diabetes risk? Results from a cross-sectional survey of alcohol and plasma glucose.

The association between alcohol and blood glucose levels, and whether it is modified by other variables, was examined in a cross-sectional survey of 5518 staff aged 40-65 years at worksites in Auckland and Tokoroa, New Zealand. Diabetes was determined by oral glucose-tolerance tests using 1999 WHO criteria. Usual alcohol intake in the previous 3 months, measured by food frequency questionnaire, was related positively with fasting triglycerides and high-density-lipoprotein (HDL)-cholesterol, and unrelated with fasting glucose, but had an approximate U-shaped relationship with 2-h glucose, which varied from an adjusted mean (S.E.) of 5.62 (0.08) mmol/l in non-drinkers, down to 5.34 (0.08) mmol/l in light alcohol drinkers (alcohol <5 g per day), and back up to 5.52 (0.09) mmol/l in heavy drinkers (> or =20 g per day). Adjusting further for triglycerides increased the mean difference in 2-h glucose for all drinking categories compared with non-drinkers, particularly for heavy drinkers (> or =20 g per day), from -0.22 (S.E. = 0.10) to -0.37 (0.10) mmol/l. The confounding effect of triglycerides suggests alcohol may affect the diabetes risk by a mechanism related to the triglyceride metabolism, which in heavy drinkers may counteract the protective effect of improved insulin sensitivity, resulting in the U-shaped relationship between alcohol and diabetes described in previous studies.

Long-term effects of a reduced fat diet intervention on cardiovascular disease risk factors in individuals with glucose intolerance.

The long-term effects on cardiovascular disease risk factors of a reduced fat (RF), ad libitum diet were compared with usual diet (control, CD) in glucose intolerance individuals. Participants were 136 adults aged > or =40 years with 'glucose intolerance' (2h blood glucose 7-11.0 mmol/l) detected at a Diabetes Survey who completed at 1 year intervention study of reduced fat, ad libitum diet versus usual diet. They were re-assessed at 2, 3 and 5 years. Main outcome measures were blood pressure, serum concentrations of total cholesterol, HDL and LDL cholesterol, total cholesterol:HDL ratio, triglycerides and body weight. The reduced fat diet lowered total cholesterol (P<0.01), LDL cholesterol (P< or =0.05), total cholesterol:HDL ratio (P< or =0.05), body weight (P<0.01) and systolic blood pressure (P< or =0.05) initially and diastolic blood pressure (P<0.01) long-term. No significant changes occurred in HDL cholesterol or triglycerides. In the more compliant 50% of the intervention group, systolic and diastolic blood pressure levels and body weight were lower at 1, 2 and 3 years (P<0.05). It was concluded that a reduced fat ad libitum diet has short-term benefits for cholesterol, body weight and systolic blood pressure and long-term benefits for diastolic blood pressure without significantly effecting HDL cholesterol and triglycerides despite participants regaining their lost weight.

Fat content of chips, quality of frying fat and deep-frying practices in New Zealand fast food outlets.

OBJECTIVES: To collect baseline data on the fat content of hot chips, quality (degradation) of cooking fat, deep-frying practices and related attitudes in fast food outlets in New Zealand. To identify the key determinants of the fat content of chips and quality of cooking fat. METHODS: A nationally representative sample of fast food outlets (n=150, response rate 80%) was surveyed between September 1998 and March 1999. Data collected included a questionnaire, observation of cooking practices and analysis of cooked chips and frying fat. RESULTS: Only 8% of independent operators had formal training in deep frying practices compared with 93% of chain operators. There was a wide range of fat content of chips (5%-20%, mean 11.5%). The use of thinner chips, crinkle cut chips and lower fryer fat temperature were associated with higher chip fat content. Eighty-nine per cent of chain outlets used 6-10 mm chips compared with 83% of independent outlets that used chips > or = 12 mm. A wide range of frying temperatures was recorded (136-233 degrees C) with 58% of outlets frying outside the reference range (175-190 degrees C). As indices of fat degradation, fat acid and polar compound values above the recommended levels occurred in 54% and 5% of outlets respectively. Operators seemed willing to learn more about best practice techniques, with lack of knowledge being the main barrier to change. CONCLUSIONS AND IMPLICATIONS: Deep frying practices could be improved through operator training and certification options. Even a small decrease in the mean fat content of chips would reduce the obesogenic impact of this popular food.

The effects of social networks on disability in older Australians.

OBJECTIVE: To investigate the effects of total social networks and specific social networks with children, relatives, friends, and confidants on disability in mobility and Nagi functional tasks. METHODS: Six waves of data from the Australian Longitudinal Study of Ageing were used. Data came from 1,477 participants aged 70 years or older. The effects of total social networks and those with children, relatives, friends, and confidants on transitions in disability status were analyzed using binary and multinomial logistic regression. RESULTS: After controlling for a range of health, environmental, and personal factors, social networks with relatives were protective against developing mobility disability (OR = 0.89; 95% CI = 0.79 to 1.00) and Nagi disability (OR = 0.85; 95% CI = 0.74 to 0.96). Other social subnetworks did not have a consistent effect on the development of disability. DISCUSSION: The effects of social relationships extend beyond disability in activities of daily living. Networks with relatives protect against disability in mobility and Nagi tasks.