Distinctiveness of the Roma population within CYP2B6 worldwide variation.

AIM: To determine variation of CYP2B6 gene within the genetically specific Croatian Roma (Gypsy) population originating from India and to examine it in the worldwide perspective. MATERIALS & METHODS: Seven SNP loci (rs12721655, rs2279343, rs28399499, rs34097093, rs3745274, rs7260329 and rs8192709) were genotyped in 439 subjects using Kompetitive Allele Specific PCR (KASP) method. RESULTS: The Croatian Roma took an outlying position in CYP2B6 variation from the worldwide perspective mainly due to their exceptionally high minor allele frequency (MAF) for rs8192709 (12.8%), and lower for rs2279343 (21.1%) compared with south Asian populations. CONCLUSION: This study provides the first data of several CYP2B6 polymorphisms in Roma population and indicates the need for systematic investigation of the most important pharmacogenes' variants in this large, transnationally isolated population worldwide.

Psychogeriatric Diagnoses in Old People's Homes and Negative Health Behavior.

BACKGROUND: The study was designed as a gerontologic-public health analysis of the relationship between the leading and accompanying psychogeriatric diagnoses and negative health behaviors recorded in the old people's home users, with the aim to evaluate and redefine gerontologic-public health priorities and geroprophylactic measures, with special reference to persons suffering from Alzheimer's disease and other dementias. SUBJECT AND METHODS: Gerontologic-public health indicators obtained by monitoring health care needs of the elderly in specific institutional primary health care at 10 old people's homes (N=1185) in Croatia in 2013 were analyzed using the professional methodology developed at Department of Health Gerontology, Andrija Stampar Teaching Institute of Public Health (Registry List 1 that refers to monitoring specific primary health care needs of elderly at old people's homes). RESULTS: Study results revealed that essential arterial hypertension was the principal (leading) principal diagnosis in the old people's home users as of 2013, accounting for 13% of all leading diagnoses recorded in the elderly in institutional health care. In the study population, psychogeriatric diagnoses were recorded among the first five accompanying and leading diagnoses. Refusal of occupational therapy was the most common unfavorable health behavior recorded in the old people's home users, accounting for 22%, followed by poor personal and environmental hygiene (19%), physical inactivity (18%), mental inactivity (15%), obesity (13%) and smoking (5%) of 861 unfavorable behaviour characteristics recorded in study subjects. Study results showed the leading diagnoses in the old people's home users (such as circulatory system diseases, hip fracture, non-insulin dependent diabetes mellitus) to be associated with negative health behaviors that can be considered as risk factors for the development or progression of the disease, in psychogeriatric patients in particular. CONCLUSIONS: The results obtained by gerontological-public health indicator analysis indicate that programs of geroprophylaxis, gerontologic and psychogeriatric measures should be implemented in old people's homes as a priority, with day centers for Alzheimer's disease patients. It is necessary to identify and evaluate risk factors for the occurrence of preventable diseases, change the negative health behaviors in the elderly, and apply the nutritional-gerontologic dietary standards at old people's homes including follow up of dietary intake of nutrients such as vitamins and mineral, with special reference to psychogeriatric patients.

Novel locus for fibrinogen in 3' region of LEPR gene in island population of Vis (Croatia).

Leptin, a possible mediator between energy homeostasis, inflammation and cardiovascular disease (CVD), acts via leptin receptors. We investigated association of single-nucleotide polymorphisms (SNPs) and haplotypes of the leptin receptor gene (LEPR) with several CVD risk factors: body mass index, waist circumference (WC), serum lipids, fibrinogen and C-reactive protein levels. Thirty-one SNPs in and near LEPR gene were analyzed in 986 inhabitants of the island of Vis, Croatia and 29 SNPs in the inland sample (N=499). We assessed linkage disequilibrium (LD), SNP and haplotype associations with the selected phenotypes. rs4291477 significantly associated with fibrinogen (P=0.003) and rs7539471 marginally significantly with high-density lipoprotein (P=0.004), but only in the Vis sample, while rs10493384 marginally significantly associated with triglyceride levels (P=0.006) in the inland sample. SNPs were grouped into eight LD blocks in Vis and in seven blocks in the inland population. Haplotype A-C-A-A-G-A in block 5 in Vis (rs1782754, rs1171269, rs1022981, rs6673324, rs3790426, rs10493380) and haplotype A-A-A-A in block 4 in the inland data (rs1782754, rs1022981, rs6673324, rs1137100) were nominally associated with WC, P=7.085 × 10(-22) (adjusted P=0.0979) and P=5.496 × 10(-144) (adjusted P=0.1062), respectively.

Are the physically active adolescents belonging to the "at risk of overweight" BMI category really fat?

The adolescence is recognized as one of the critical periods for the development of obesity. Children and adolescents who practice sports regularly have higher muscle mass and lower percentage of body fat than their peers who are physically less active. Since body mass index (BMI) is a widely used indicator of overweight/obesity in spite of the fact that it directly measures excess in weight but not in fat, it often misclassifies athletic populations, both children and adults. The specific aim of this study was to evaluate whether BMI adequately assesses fatness in adolescents, especially physically active ones. The analysis was performed on anthropometric data from two surveys (1997 and 2009/2010) of Zagreb secondary school adolescents, 1315 girls and 1034 boys, aged 15-19 years. The group defined as "physically active" consisted of adolescents who practice organized sports (36.2% girls, 44.6% boys), while the "physically inactive" group was made of their peers who practice sport only as a part of physical education in schools. The standardized values, calculated within each sex by survey, were used for comparison of adolescents with different levels of physical activity. Physically active adolescents of both sexes had lower sum of skinfolds mean Z-valutes (Pgirls<0.05, Pboys<0.001); additionally, boys had higher Z-values for body weight (p<0.05) and triceps/subscaputar ratio (indicating peripheral distribution of body fat) (p<0.05) than their less active peers. In order to evaluate whether BMI was adequate indicator for body composition during adolescence, we estimated the concordance of above-median category defined by BMI and the other body fat indicators. The largest discrepancy was found for sum of skinfolds in both sexes and was more pronounced in physically active adolescents. This finding was further confirmed in more extreme BMI category (85th - 95th percentile) which indicated that adolescents categorized as "at risk of overweight" were predominantly characterized by larger lean body mass and not by increased fatness.

Age trends in prevalence of cardiovascular risk factors in Roma minority population of Croatia.

The Roma (Gypsy) are the largest European minority population characterized by poverty, social exclusion as well as by numerous life-style and cultural specificities, which all could have an adverse impact on their cardiovascular health. This study assesses the prevalence of cardiovascular diseases (CVD) risk factors in community-based sample of 430 adult Roma, living in rural area of Croatia, by providing the actual and age-adjusted estimates using the European standard population. The most prominent classical CVD risk phenotypes (blood pressure, obesity, smoking, glucose and lipid profile) were selected, and the standard risk cut-offs were applied. The study has shown that compared to general population of Croatia, the Roma population bears a high CVD risk factors load related to smoking and high glucose level. The CVD risk factors prevalence in Roma also showed important sex and age patterns, the most imposing of which are the findings of higher prevalence of CVD risks in women (especially obesity and triglyceride levels) and the trend of higher body mass index (BMI) level in younger age group (18-34 years) which both stand in contrast to the trends characterizing the general population of Croatia. These findings are complemented by the trend of decreased risk in the oldest age group (65+ years) for all investigated CVD risk factors (with exception of triglycerides level) compared to the 50-64 age group. We conclude that the age and sex CVD risks pattern point to the health transition of this rural Roma population. As we expect the proportion of CVD in the Roma minority of Croatia to increase in the future along with further modernization of their lifestyle, the CVD prevention measures in this population are urgent and should be primarily targeted at women and at the younger segment of this population.

A detection of microevolutionary changes by the analysis of qualitative dermatoglyphic traits: an example of Albanians from Kosovo.

In this study we analyzed the qualitative dermatoglyphic traits in the Albanians from three Kosovo distinct regions. We aimed to detect possible microevolutionary changes, which could have happened as a consequence of geographical and cultural isolation. The dermatoglyphic traits were analyzed for total 641 Albanians of both sexes. The analysis included 4 variables on fingers, 8 on palms and terminations of A, B, C, D and T main-lines. The differences in patterns incidence were tested using the chi-square test. The frequencies of several pattern types varied to a great extent between distinct groups with statistically significant difference in most of the cases. Our results indicated that the Albanians from South Morava valley and from Kosovo plain were genetically close, and the population from Dukagjini valley is less close to any of them. The analysis of qualitative dermatoglyphic patterns may be utilized effectively to track the microevolutionary changes. This is especially useful in a developing country like Kosovo, since it is an inexpensive and effective tool for screening and studying the patterns influenced by the divergence of population.

[Croatian guidelines for nutrition in the elderly, part I]. / Hrvatske smjernice za prehranu osoba starije dobi, dio I.

Aging produces numerous physical and physiologic changes, which in turn alter nutritional requirements and affect nutritional status. The presence of chronic disease, and/or medications can enhance potential disparities between nutrient needs and dietary intake, leading to malnutrition. Indeed, research suggests that malnutrition is a common condition among the elderly. Therefore, regular nutritional assessment should be done as an integral part of healthcare for elderly. Also, it is important to take in consideration all determinants of geroanthropometry. The physiologic changes associated with aging affect requirement for several essential nutrients. In general, the requirement for many nutrients decreases, concomitant with the decrease in energy needs. However, some nutrients are needed in higher amounts. Additionally, various psychosocial and socioeconomic changes that often attend aging may also alter dietary intake. Dietary planning is important part of nutritional care in the elderly. Also, some elderly persons can benefit with dietary supplements and oral nutritional supplements (enteral formulas) which can be prescribed by diagnosed or threatening malnutrition. Croatian guidelines for nutrition in the elderly have been developed by interdisciplinary expert group of Croatian clinicians, gerontologists, anthropologists, nutritionists and other professionals involved with care for elderly population. The guidelines are based on evidence from relevant medical literature and clinical experience of working group.

Comparative analysis of qualitative dermatoglyphic traits of Albanian and Turkish populations living in the area of Dukagjin Valley in Kosovo.

Dermatoglyphic prints were collected from 800 inhabitants of Dukagjin valley in Kosovo. The sample consisted of two ethnically different sub-populations who refer themselves as Albanians (N = 400) and Turks (N = 400). Qualitative analysis of prints concerned the frequency of the patterns on fingers (arch, ulnar and radial loop, whorl, accidental whorl) and on palms (Thenar and I, II, III, and IV interdigital area and the hypothenar, main line index, and the axial "t" triradius position). As was expected due to previous study of quantitative dermatoglyphic traits, in the same population the Alba-nians and Turks showed to be significantly different in most explored qualitative dermatoglyphic variables. Found differences indicated that the reproductive isolation between the Albanian and Turkish population in Kosovo is substantial, despite the fact that those two ethnic sub-populations live in the close vicinity through several centuries.

E2 allele of the apolipoprotein E gene polymorphism is predictive for obesity status in Roma minority population of Croatia.

BACKGROUND AND AIMS: The Roma (Gypsies) are a transnational minority, founder population characterized by unique genetic background modeled by culturally determined endogamy. The present study explores whether the widely found cardiovascular diseases (CVD) risk effects of ACE I/D, APOE (ε2, ε3, ε4), eNOS-VNTR and LEP G2548A polymorphisms can be replicated in this specific population. METHODS AND RESULTS: The community-based study was carried on 208 adult Bayash Roma living in rural settlements of eastern and northern Croatia. Risk effect of four CVD candidate polymorphisms are related to the most prominent classical CVD risk phenotypes: obesity indicators (body mass index and waist circumference), hypertension and hyperlipidemia (triglycerides, HDL and LDL cholesterol). For all of them the standard risk cut-offs were applied. The extent to which the phenotypic status is related to genotype was assessed by logistic regression analysis. The strongest associations were found for ε2 allele of the APOE as a predictor of waist circumference (OR 3.301; 95%CI 1.254-8.688; p = 0.016) as well as for BMI (OR 3.547; 95%CI 1.471-8.557; p = 0.005). It is notable that ε3 allele of APOE gene turned out to be a protective genetic factor determining low lipid levels. CONCLUSION: The strength of the relation and the similarity of the results obtained for both tested indicators of obesity provide firm evidence that APOE plays an important role in obesity development in the Roma population.

Replication of genetic variants from genome-wide association studies with metabolic traits in an island population of the Adriatic coast of Croatia.

Twenty-two single-nucleotide polymorphisms (SNPs) in 10 gene regions previously identified in obesity and type 2 diabetes (T2D) genome-wide association studies (GWAS) were evaluated for association with metabolic traits in a sample from an island population of European descent. We performed a population-based study using 18 anthropometric and biochemical traits considered as continuous variables in a sample of 843 unrelated subjects (360 men and 483 women) aged 18-80 years old from the island of Hvar on the eastern Adriatic coast of Croatia. All eight GWAS SNPs in FTO were significantly associated with weight, body mass index, waist circumference and hip circumference; 20 of the 32 nominal P-values remained significant after permutation testing for multiple corrections. The strongest associations were found between the two TCF7L2 GWAS SNPs with fasting plasma glucose and HbA1c levels, all four P-values remained significant after permutation tests. Nominally significant associations were found between several SNPs and other metabolic traits; however, the significance did not hold after permutation tests. Although the sample size was modest, our study strongly replicated the association of FTO variants with obesity-related measures and TCF7L2 variants with T2D-related traits. The estimated effect sizes of these variants were larger or comparable to published studies. This is likely attributable to the homogenous genetic background of the relatively isolated study population.

Functional ability of the elderly in institutional and non-institutional care in Croatia.

Gerontology-public health indicators of functional ability of the elderly in institutional and non-institutional health care in Croatia were determined by use of expert methodology developed at Department of Gerontology, Dr. Andrija Stampar Institute of Public Health in Zagreb, with the aim to upgrade the Program of Health Care Measures and Procedures in Health Care of the Elderly. Comparison of functional ability between the users of selected Old People's Homes (institutional care; N = 5030) and Gerontology Centers (non-institutional care; N = 2112) yielded highest between-group difference in the proportion of "fully movable" and "fully independent" categories in favor of the latter, thus steering the program of health care for the elderly accordingly. In addition, study results showed greater difference in the proportion of categories describing mental status of institutional and non-institutional care users as compared with the categories describing their physical status, suggesting that mental status plays a more important role than physical status in the geriatric user's stay in non-institutional care versus institutional care. This issue requires additional studies. The results obtained by this indicator analysis pointed to the preventive and geroprophylactic measures to ensure efficient health care for the elderly and to develop the program of mental health promotion and preservation. According to 2007 estimate, there were 759,318 (16.9%) persons aged > or = 65 in Croatia. Data collected at gerontology database kept at Department of Gerontology, Dr. Andrija Stampar Institute of Public Health (September 2008) showed 2% of the elderly (N = 14807) to be accommodated at Old People's Homes, which is below the European average of 4%.

Common SNPs in FTO gene are associated with obesity related anthropometric traits in an island population from the eastern Adriatic coast of Croatia.

BACKGROUND: Multiple studies have provided compelling evidence that the FTO gene variants are associated with obesity measures. The objective of the study was to investigate whether FTO variants are associated with a broad range of obesity related anthropometric traits in an island population. METHODOLOGY/PRINCIPAL FINDINGS: We examined genetic association between 29 FTO SNPs and a comprehensive set of anthropometric traits in 843 unrelated individuals from an island population in the eastern Adriatic coast of Croatia. The traits include 11 anthropometrics (height, weight, waist circumference, hip circumference, bicondilar upper arm width, upper arm circumference, and biceps, triceps, subscapular, suprailiac and abdominal skin-fold thicknesses) and two derived measures (BMI and WHR). Using single locus score tests, 15 common SNPs were found to be significantly associated with "body fatness" measures such as weight, BMI, hip and waist circumferences with P-values ranging from 0.0004 to 0.01. Similar but less significant associations were also observed between these markers and bicondilar upper arm width and upper arm circumference. Most of these significant findings could be explained by a mediating effect of "body fatness". However, one unique association signal between upper arm width and rs16952517 (P-value = 0.00156) could not be explained by this mediating effect. In addition, using a principle component analysis and conditional association tests adjusted for "body fatness", two novel association signals were identified between upper arm circumference and rs11075986 (P-value = 0.00211) and rs16945088 (P-value = 0.00203). CONCLUSIONS/SIGNIFICANCE: The current study confirmed the association of common variants of FTO gene with "body fatness" measures in an isolated island population. We also observed evidence of pleiotropic effects of FTO gene on fat-free mass, such as frame size and muscle mass assessed by bicondilar upper arm width and upper arm circumference respectively and these pleiotropic effects might be influenced by variants that are different from the ones associated with "body fatness".

A quantitative trait locus for SBP maps near KCNB1 and PTGIS in a population isolate.

BACKGROUND: Population isolates are characterized by simplified genetic background and as such present promising opportunities for studying complex diseases. We performed a genome-wide linkage analysis for systolic (SBP) and diastolic blood pressure (DBP) followed up by the association analysis in the Croatian isolated island of Vis, where a very high prevalence of hypertension was reported (75%). METHODS: Variance-components linkage analysis was used to map quantitative trait loci (QTL) for SBP and DBP in 125 families with 1,389 members. Follow-up association analysis was performed in a sample of 421 subjects from the island of Vis. The 15 top-ranking single nucleotide polymorphisms (SNPs) were selected and tested for the association by in silico replication in the British 1958 Birth Cohort DNA Collection. RESULTS: Linkage results showed evidence for a QTL influencing DBP (lod = 1.89) on chromosome 7p14.2 and two QTL influencing SBP (lod = 2.03 on chromosome 1p36 and lod = 1.75 on chromosome 20q13). For the association results, the replication was observed for the rs237484 polymorphism on chromosome 20 that was associated with SBP with the effect size beta = -5.2 (P = 0.001; per A allele) in Vis population and beta = -1.1 (P = 0.04) in the British 1958 Birth Cohort. rs237484 is in proximity to the potassium voltage gate channel gene (KCNB1) and close to the prostaglandin I2 (prostacyclin) synthase gene (PTGIS). CONCLUSIONS: These results provide evidence of a QTL influencing blood pressure (BP) variability in this region and support the notion that the isolated population of the island of Vis is a suitable population for conducting linkage and association analyses of cardiovascular-related phenotypes.

Traditional CVD risk factors and socio-economic deprivation in Roma minority population of Croatia.

Researches into health inequalities consistently show disadvantages in health status, morbidity and mortality for various ethnic minority groups. Current knowledge about prevention of cardiovascular diseases (CVD) mainly derives from studies carried out in populations of European origin while the evidences involving Roma population are scarce. Roma, an ethnic minority of northern Indian origin, live in many countries throughout the world and are well known for preserved traditions and resistance to assimilation. They are most often marginalized economically, spatially, politically and in terms of culture. In order to assess the health status and health-related lifestyle attributes, a multidisciplinary anthropological and epidemiological community-based study was carried out including a total of 423 members of the Bayash Roma minority population living in two regions of Croatia (144 men and 279 women, aged 18-84 yrs). Hypertension (HT) was found in 24.8% Bayash Roma (21.5% men and 26.5% women) using standard diagnostic criteria (i.e. BP > or = 140/90 mm Hg or taking antihypertensive therapy). The prevalence increases from 5.9% in the age group 18-34 yrs; 35.0% in the age group 35-64 yrs, and 51.4% in the age group 65+ yrs. The prevalence of hypertension in the Bayash Roma is almost half of the magnitude of what is usually reported for the general population of Croatia. It is also lower when compared with other European populations and this finding is not due to comparatively younger average age of the Bayash sample. The significant association of hypertension with age and BMI was confirmed in this study and the importance of non-traditional SES-related CVD risk factors was highlighted. Smoking is a part of traditional Roma life-style and with 70% of smokers almost the entire population is equally exposed to this risk factor in their family environment. Since homogenously distributed, this risk factor did not show to be a significant predictor of hypertension. The extent to which hypertension is influenced by traditional CVD risk factors as well as by some SES indicators was also assessed using a forward stepwise method of the multivariate logistic analysis. Each risk factor was explored as quantitative variable as well as qualitative one using various cut-offs. The best model showed to be the one having age and BMI presented as quantitative variables and sex, region, smoking status, income and schooling years as categorical ones; with cut-off 3 for number of income sources and 8 for the number of schooling years. In spite of the low prevalence of hypertension, the presented results are showing that Bayash Roma are bearing a high CVD risk factors load. We expect that with westernization of their life-style and along with increase of the economic power, the proportion of CVD in population of Bayash Roma will also increase. Therefore, it is important to recognize the need for early cardiovascular disease risk factors prevention in this minority population.

Metabolic syndrome in an island population of the eastern Adriatic coast of Croatia.

The metabolic syndrome, an assemblage of risk factors, viz., obesity, dyslipidemia, carbohydrate intolerance, and hypertension, associated with development of cardiovascular diseases and Type 2 diabetes, has become a major public health problem in the developed countries. However, data on its prevalence in worldwide populations, particularly in non-industrialized societies is sparse. We report the prevalence of metabolic syndrome in an island population of the eastern Adriatic coast of Croatia, a distinctly homogenous population living in relative isolation with a traditional way of life style pattern. The participants consist of 381 unrelated individuals (136 males, 245 females) from the island of Hvar, age 19 and above. Hvar is among the most populated Croatian islands with a total population of 11,459 individuals according to the 1991 census. Metabolic syndrome was assessed following the National Cholesterol Education Program (NCEP) criteria, with the exception of using body mass index and waist hip ratio as the predictors of obesity. Overall age-adjusted prevalence of metabolic syndrome is 26% (32% in males and 24% in females) with body mass index, and 42% (57% in males and 36% in females) with waist hip ratio as the measures of obesity. Pairwise correlations of the age and sex-adjusted individual components show that with the exception of fasting plasma glucose, the other components of metabolic syndrome are significantly associated with each other, suggesting their co-morbidity. In spite of adherence to a relatively traditional life-style pattern together with a "Mediterranean diet" and rural habitat, the prevalence of metabolic syndrome is substantially high in the population of Hvar. It is likely that factors other than nutritional practices, that might include genetic susceptibility, could potentially be important in predisposition to metabolic syndrome.

Effects of isolation and inbreeding on human quantitative traits: an example of biochemical markers of hemostasis and inflammation.

Isolation is a known force in evolutionary biology and one of the main factors in speciation. One of the main consequences of severe isolation is reduced mate choice, which results in the occurrence of inbreeding as a result of isolation. We investigated the effects of individual genome-wide heterozygosity measured as the multilocus heterozygosity (MLH) on biochemical markers of hemostasis and inflammation in 1,041 individuals from the island of Vis, Croatia, where inbreeding is prevalent and a wide range of variation in the genome-wide heterozygosity is expected. Assessment of individual genome-wide heterozygosity was based on genome-wide scans using 800 microsatellite (STR) and 317,503 single nucleotide (SNP) polymorphic markers in each examinee. In addition, for each examinee we defined a personal genetic history (PGH) based on genealogical records. The association between PGH and MLH and fibrinogen, D-dimer (Dd), von Willebrand factor (vWF), tissue plasminogen activator (tPA), and C-reactive protein (CRP) was performed with a mixed model, controlling for possible confounding effects. PGH was a significant predictor only for tPA (P < 0.001), whereas neither of the two MLH measures exhibited significant association with any of the investigated traits. The effects of individual genome-wide heterozygosity are most likely expressed in highly polygenically determined traits or in traits that are mediated by rare and recessive genetic variants. Weak associations between PGH and MLH and markers of hemostasis and inflammation suggest that their genetic control may not be highly polygenic and that they could be promising targets for genetic association studies.

Trapped between tradition and transition--anthropological and epidemiological cross-sectional study of Bayash Roma in Croatia.

AIM: To assess the key characteristics related to living conditions and health in the Bayash Roma population in Baranja and Medimurje regions of Croatia and identify possible demographic and socio-economic sources of variance in self-reported health and reproductive profile. METHODS: The study comprised a total of 266 adult Bayash individuals from Baranja and 164 from Medimurje (aged 41.3+/-15.1 years). Data on ethno-historical and demographic background, self-identity, life and hygiene conditions, education, employment, health insurance, and health (dietary and smoking habits, reproductive characteristics, diagnosed and undiagnosed health problems, use of medications). were obtained through interviews. Bivariate and multivariate methods were used in statistical analyses. RESULTS: The reported migratory pattern demonstrated that 88.8% of the examinees were born in the region of residence, which showed that the Bayash population was autochthonous and sedentary one. Financially, the Bayash primarily relayed on social welfare support allowance (84%) and child allowance (47%), while merely 2% were permanently and 23% occasionally employed. The proportion of the Bayash who had never attended school amounted to 33.3% (19.3% men and 40.6% women). The access to public water supply system was available to 52.5% of examinees, whereas only 1.7% had public sewage system, and 23.4% had private septic tanks. The most commonly reported health burden were frequent headaches (20.3%), stomach pain (16.3%), anxiety or insomnia (13.1%), hypertension (9.3%), and chronic obstructive pulmonary disease (COPD) (8.6%). The logistic regression identified level of education (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.63-0.94) and access to health insurance (OR, 4.32; 95% CI, 1.46-12.77) as socio-economic/life-style factors playing a significant role in the occurrence of COPD. CONCLUSION: Our results indicate poor inclusion of the Bayash in the essential social service sectors such as health care, education, and employment, as well as substandard living conditions and unfavorable health-related behavior. Since education and health insurance were found to have significant effects on the observed reproductive status and self-reported health, they should be targeted in planning public health actions for socially marginalized and economically deprived groups.

Gene polymorphisms of the renin-angiotensin system and early development of hypertension.

BACKGROUND: A case-control association study was conducted to investigate a possible involvement of polymorphisms of three renin-angiotensin system genes: ACE (I/D and T-3892C), AGT (M235T and T174M), and AT1R (A1166C) in the early development of hypertension. METHODS: One hundred nineteen hypertensive and 125 normotensive participants aged 18 to 40 years were selected from a broader sample representative of the general population of Croatia. The selection criteria for hypertensive cases were systolic blood pressure (BP) higher than 140 mm Hg or diastolic BP higher than 90 mm Hg and a history of hypertension according to patient interview. RESULTS: Among the polymorphisms investigated, only those located on the ACE gene were associated with hypertension. For ACE I/D, the odds ratio for hypertension of DD versus II homozygote individuals was 2.50 (95% confidence interval [CI] 1.19-5.25) and for ACE T-3892C, the odds ratio of CC versus TT individuals was 2.32 (95% CI 1.05-5.10). Both polymorphisms of the ACE gene were in tight linkage disequilibrium. Of the investigated risk factors for hypertension, only body mass index (BMI) showed an influence on the early development of hypertension, acting independently of the ACE polymorphism. Their additive effect gives rise to 86% of hypertensives in subjects having both the DD genotype and BMI >or=30 kg/m(2). CONCLUSIONS: The present study provides evidence of the association of the ACE gene polymorphisms and premature hypertension. In addition, BMI proved to be another important predictor of the disorder acting independently of the ACE gene.

Calcaneous ultrasonographic assessment of bone mineral density in the Roma minority population of Croatia--preliminary report.

A multidisciplinary anthropological and epidemiological pilot field study of the Bayash population living in 6 villages of the eastern Croatian region of Baranya has been performed in 2005/06. The Bayash (or Boyash) belong to the Roma minority population speaking a distinct archaic dialect of the Romanian language. Since the bone mineral density values in the Roma have not been explored so far and the prevalence of osteoporosis is unknown for this ethnic minority group a screening by means of the Sahara Hologic clinical bone sonometer has been performed on 232 voluntary participants (73 males and 159 females). The prevalence of osteoporosis (T-score <-2.5) in the Bayash aged 50 and older is found to be 9.1% in males and 34.4% in females, which is substantially higher than in the general population of Croatia. The prevalence of T-values ranging from -1 to -2.5 indicating osteopenia is found to be 63.6% in males and 45.3% in females, while T-values within the normal range are found only in 27.3% males and 20.3% females. In addition to the low bone mass in older subjects, the mean estimated bone mineral density in all age groups of Bayash men and women was lower in comparison to the manufacturer's reference ranges for European population of the same age. Since body size effects could not be declined, the reference values that would be appropriate for the Roma population should be further explored. The high estimated prevalence of developed osteoporosis calls for attention and the survey should also be extended to exploring the association of low bone mineral density with particular life style and reproductive factors present in this semi-sedentary Roma population.

Body mass index and nutritional status of the Bayash Roma from eastern Croatia.

This study examines anthropometrically assessed nutritional status of the Bayash, the Roma population from the eastern Croatian region of Baranya, and compares it to the non-Roma general population of eastern Croatia. The analysis of nutritional status and diets is a segment of multidisciplinary anthropological and epidemiological survey of the Roma minority population in Croatia began in 2005. The Bayash are an ethnic group that arrived to Croatia from Romania most likely in the 19th century and speaks a distinct archaic dialect of the Romanian language. The Roma population of Baranya approximates 1,000 according to the 2001 census. The Bayash sample comprised 227 adults aged 18-65yrs. The women fall below the Croatian 10th percentile for stature and men track about the 10th percentile. Both sexes approximate the 25th percentile for body weight. Despite their diminutive size, the Bayash appear to have adequate nutritional status until the age of 35yrs after which their average BMI exceeds the value of 25 kg/m(2) and falls in the overweight category. However, 8% of Bayash are underweight (BMI<18.5) in contrast to 1% of the majority population in the region. Underweight rates are especially high in women (11%) compared to men (4%). The prevalence of overweight (BMI 25.0 to 29.9) of 30% is considerably lower than in the majority population (42%) while the prevalence of obesity (BMI>or=30.0) of 23% is approximately equal. Overall unsatisfactory nutritional status of the Bayash merits attention. It appears to be the product of unhealthy dietary habits and their socio-economic deprivation that resulted from their poor education and extremely high unemployment.