ABSTRACT
Potential upstream determinants of coronary heart disease (CHD) include life-course socioeconomic position (e.g., childhood socioeconomic circumstances, own education and occupation); however, several plausible biological mechanisms by which socioeconomic position (SEP) may influence CHD are poorly understood. Several CHD risk factors appear to be more strongly associated with SEP in women than in men; little is known as to whether any CHD risk factors may be more strongly associated with SEP in men. Objectives were to evaluate whether cumulative life-course SEP is associated with a measurement of subclinical atherosclerosis, the ankle-brachial index (ABI), in men and women. This study was a prospective analysis of 1,454 participants from the Framingham Heart Study Offspring Cohort (mean age 57 years, 53.8% women). Cumulative SEP was calculated by summing tertile scores for father's education, own education, and own occupation. ABI was dichotomized as low (≤1.1) and normal (>1.1 to 1.4). After adjustment for age and CHD risk factors cumulative life-course SEP was associated with low ABI in men (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.22 to 3.42, for low vs high cumulative SEP score) but not in women (OR 0.86, 95% CI 0.56 to 1.33). Associations with low ABI in men were substantially driven by their own education (OR 4.13, 95% CI 1.86 to 9.16, for lower vs higher than high school education). In conclusion, cumulative life-course SEP was associated with low ABI in men but not in women.
Subject(s)
Ankle Brachial Index/economics , Atherosclerosis/physiopathology , Blood Pressure/physiology , Coronary Disease/physiopathology , Social Class , Adult , Atherosclerosis/economics , Atherosclerosis/epidemiology , Coronary Disease/economics , Coronary Disease/epidemiology , Europe/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morbidity/trends , Prognosis , Retrospective Studies , Socioeconomic Factors , Survival Rate/trends , United States/epidemiologyABSTRACT
BACKGROUND: Low fruit and vegetable consumption is an important risk factor for chronic diseases, but for many (mainly developing) countries, no prevalence data have ever been published. This study presents data on the prevalence of low fruit and vegetable intake for 52 countries and for various sociodemographic groups and settings across these countries. METHODS: Data from 196,373 adult participants from 52 countries taking part in the World Health Survey (2002-2003) were analyzed in the summer of 2008. Low fruit and vegetable consumption was defined according to the WHO guidelines of a minimum of five servings of fruits and/or vegetables daily. RESULTS: Low fruit and vegetable consumption prevalence ranged from 36.6% (Ghana) to 99.2% (Pakistan) for men and from 38.0% (Ghana) to 99.3% (Pakistan) for women. Significant differences in the likelihood of low fruit and vegetable intake between men and women were found in 15 countries. The prevalence of low fruit and vegetable consumption tended to increase with age and decrease with income. Although urbanicity was not associated overall with low fruit and vegetable consumption, urban and rural differences were significant for 11 countries. CONCLUSIONS: Overall, 77.6% of men and 78.4% of women from the 52 mainly low- and middle-income countries consumed less than the minimum recommended five daily servings of fruits and vegetables. Baseline global information on low fruit and vegetable consumption obtained in this study can help policymakers worldwide establish interventions for addressing the global chronic disease epidemic.