Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries.

BACKGROUND: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. METHODS: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. FINDINGS: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14µg, 95% CI 12, 16) in higher educated individuals. INTERPRETATION: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

The type 2 diabetes-associated variant in TCF7L2 is associated with latent autoimmune diabetes in adult Europeans and the gene effect is modified by obesity: a meta-analysis and an individual study.

AIMS/HYPOTHESIS: The variants of transcription factor 7-like 2 (TCF7L2) gene have been proposed to be associated with latent autoimmune diabetes in adults (LADA). We sought to confirm the possible association in Europeans and to examine the interaction between one gene variant and clinical data. METHODS: The TCF7L2 rs7903146 C-to-T polymorphism was genotyped in 211 LADA, 1,297 type 2 diabetic, 545 type 1 diabetic and 1,497 control individuals from Hungary. A meta-analysis of our and previously published studies was performed to evaluate the size and the heterogeneity of the gene effect. RESULTS: The meta-analysis yielded a significant effect of TCF7L2 T allele (OR 1.28; p < 0.0001) on LADA risk without heterogeneity among Europeans. The T allele conferred equally strong susceptibility to LADA and type 2 diabetes. In the Hungarian dataset, the T allele was associated with LADA and type 2 diabetes, but not with type 1 diabetes. T allele carriers had significantly lower BMI than patients with the CC genotype in the LADA and type 2 diabetes groups (p = 0.0021 and p = 0.0013, respectively). In both diseases, the diabetes risk was significantly higher in the non-overweight than in the overweight BMI category (p = 0.0013 and p < 0.0001, respectively); susceptibility to LADA was increased by 2.84-fold in non-overweight individuals compared with overweight ones. CONCLUSIONS/INTERPRETATION: The meta-analysis demonstrates that TCF7L2 rs7903146 polymorphism is a population-independent susceptibility locus for LADA in Europeans. The effect size is similar for LADA and type 2 diabetes. The gene effect on diabetes risk may be modulated by BMI, such that the lower the BMI, the higher the gene effect.

[Spatial differences in mortality and morbidity from cancer of the lip, oral cavity and pharynx in Hungary] / Az ajak, szájüreg és garat rosszindulatú daganatos betegsége miatti halálozás valamint a morbiditás területi különbségei Magyarországon.

In evaluating the health state of the population one of the most reliable parameter is mortality. The development of statistical and spatial analytical methods gave a tool for evaluating mortality and morbidity in small areas. GIS mapping helps in the assessment of health state of small areas, to investigate causal relationship and create plans of intervention. Within the frames of the National Environmental Health Action Programme (NEHAP, 1996) a spatial statistical information system was elaborated. By the help of this system, mortality from cancer of the lip, oral cavity and pharynx (ICD-X.: C00-C14) was analysed for 1986-1997 and morbidity for 1997-1999 by computing standardised mortality and morbidity ratio. Regions with unfavourable mortality and morbidity were defined, statistical significance was tested. After age and gender stratification, a cluster analysis was also carried out. An international comparison of mortality was done as well. According to our data, mortality - most frequent in both sexes according to the international comparison - as well as morbidity showed a typical spatial distribution. An excess in mortality and morbidity is observable in the central part of the country, as well as in the Northern part and in traditional wine producing areas. The spatial accumulation of mortality is very similar to that of mortality from chronic liver diseases (ICD-X.: K70). In the primary prevention of oral cancer smoking cessation and the decrease of alcohol consumption is of great importance. Screening activity of GPs and dental doctors is of major importance in secondary prevention.