Indices of relative weight and obesity.

Analyses are reported on the correlation with height and with subcutaneous fat thickness of relative weight expressed as per cent of average weight at given height, and of the ratios weight/height, weight/height squared, and the ponderal index (cube root of weight divided by height) in 7424 'healthy' men in 12 cohorts in five countries. Analyses are also reported on the relationship of those indicators of relative weight to body density in 180 young men and in 248 men aged 49­59. Judged by the criteria of correlation with height (lowest is best) and to measures of body fatness (highest is best), the ponderal index is the poorest of the relative weight indices studied. The ratio of weight to height squared, here termed the body mass index, is slightly better in these respects than the simple ratio of weight to height. The body mass index seems preferable over other indices of relative weight on these grounds as well as on the simplicity of the calculation and, in contrast to percentage of average weight, the applicability to all populations at all times.

Cardiovascular risk factors predict survival in middle-aged men during 50 years.

OBJECTIVES: We aimed at studying the expectancy of life in middle-aged men as a function of several personal characteristics and risk factors. MATERIAL AND METHODS: A sample of 1712 Italian men aged 40-59, first examined in 1960, was followed-up for mortality for 50 years. The length of survival was estimated as a function of 48 personal characteristics and risk factors using the multiple linear regression. RESULTS: In 50 years 1672 men died (97.7%) and 40 survived (2.3%). Twenty risk factors, most of which were never measured in previous studies of such duration, proved to be significant, for the estimation of survival with an overall adjusted R(2) of 0.3236. They were: age, 4 anthropometric measurements (body mass index, and its squared term, laterality-linearity index, shoulder/pelvis shape), mean blood pressure, father and mother history of premature (<65-year) death, marital status, arm circumference, 2 respiratory measurements (vital capacity and forced expiratory volume), serum cholesterol, corneal arcus, xantelasma, cancer, cardiovascular diseases, diabetes and chronic bronchitis. Coefficients of 5 suitable risk factors became definitely larger after adjustment for regression dilution bias with 5 year data. All 40 cases of survival were located in the higher 5 deciles of estimated survival and 25 (62.5%) were in the upper decile. CONCLUSION: A small number of risk factors and personal characteristics, mainly known as cardiovascular risk factors and measured once in middle-aged men, are strongly associated with the length of survival in a 50-year follow-up.

Factor analysis in the identification of dietary patterns and their predictive role in morbid and fatal events.

OBJECTIVE: The purpose was to examine the role of dietary patterns derived from factor analysis and their association with health and disease. DESIGN: Longitudinal population study, with measurement of diet (dietary history method), cardiovascular risk factors and a follow-up of 20 years for CHD incidence and 40 years for mortality. SETTING: Two population samples in rural villages in northern and central Italy. SUBJECTS: Men (n 1221) aged 45-64 years were examined and followed up. RESULTS: One of the factors identified with factor analysis, run on seventeen food groups, was converted into a factor score (Factor 2 score) and used as a possible predictor of morbid and fatal events. High values of Factor 2 score were characterized by higher consumption of bread, cereals (pasta), potatoes, vegetables, fish and oil and by lower consumption of milk, sugar, fruit and alcoholic beverages. In multivariate analysis, Factor 2 score (mean 0·0061; sd 1·3750) was inversely and significantly associated (hazard ratio for a 1 sd increase; 95% CI) with 20-year CHD incidence (0·88; 0·73, 0·96) and 40-year mortality from CHD (0·79; 0·66, 0·95), CVD (0·87; 0·78, 0·96), cancer (0·84; 0·74, 0·96) and all causes (0·89; 0·83, 0·96), after adjustment for five other risk factors. Men in quintile 5 of Factor 2 score had a 4·1 years longer life expectancy compared with men in quintile 1. CONCLUSIONS: A dietary pattern derived from factor analysis, and resembling the characteristics of the Mediterranean diet, was protective for the occurrence of various morbid and fatal events during 40 years of follow-up.

The Mediterranean Adequacy Index: further confirming results of validity.

BACKGROUND AND AIMS: Since dietary patterns can influence levels of major risk factors for chronic disease, various indexes or scores of overall diet quality have been proposed and related to risk factors for disease. The Mediterranean Adequacy Index (MAI) was developed to simply assess how close a diet is to the Healthy Reference National Mediterranean Diet (HRNMD), a healthful diet in which Mediterranean food patterns are inversely correlated with prevalence of risk factors for chronic disease. This report describes further evidence of MAI values for diets of population groups from different countries. METHODS AND RESULTS: MAI is obtained by dividing the food group intakes typical of a healthy reference Mediterranean diet, expressed in g/day, by the food group intakes not characteristic of a healthy Mediterranean diet. In this paper, the MAI was computed based on the diets of 23 population groups from Italy, Greece, U.S.A., Costa Rica, Chile, Spain, and Germany. High MAI values were recorded among working class men from southern Italy, and Seven Countries Study (SCS) men from the Greek islands, and the lowest among U.S.A. men and a control group of German women; surprisingly low values were recorded among Madrid men and women and participants from Spanish-speaking Latin American countries. The inversely significant correlation between the 16 SCS cohort diet MAI values and the 25-year coronary heart disease death rate previously observed was stable when an appropriate statistical analysis was used. Furthermore, MAI values of diets in elderly participants from 10 European countries followed for 10 years were inversely associated with total mortality. CONCLUSIONS: The above results further confirm the validity of MAI, indicating that it is as good as the most utilised indexes or scores proposed for adults in Europe.

Mediterranean Adequacy Index of Italian diets.

OBJECTIVE: To assess, particularly in longitudinal studies, how close or far the food intakes of population groups are from a reference dietary pattern. DESIGN: Computation of an index, called the Mediterranean Adequacy Index (MAI), by dividing the sum of the percentage of total energy from typical Mediterranean food groups by the sum of the percentage of total energy from non-typical Mediterranean food groups. The reference Italian-Mediterranean diet utilised was that of subjects from Nicotera in 1960. SETTING: Different areas in Italy. SUBJECTS: Men aged 45-65 years at the start of the study from rural areas of Italy in the Seven Countries Study followed for 26 years (Crevalcore and Montegiorgio), elderly men and women from Perugia followed for 11 years, men and women from Pollica (Salerno) followed for 32 years, and families from Rofrano (Salerno) followed for 41 years. RESULTS: The median value of MAI among 40-59-year-old men from Nicotera in 1960 was 7.2; in Crevalcore it was 2.9 in 1965 and 2.2 in 1991; and in Montegiorgio, 5.6 in 1965 and 3.9 in 1991. In Pollica, the values in men ranged from 5.6 to 6.3 in 1967 and from 2.4 to 4.5 in 1999; for women, the corresponding ranges were 4.2-7.2 and 2.7-4.1. In elderly men of Perugia, median MAI value was 4.9 in 1976 and 3.2 in 1987; for women, the corresponding values were 3.1 and 2.6. CONCLUSIONS: The diet of these Italian population groups has changed over the last four decades, progressively abandoning the nutritional characteristics of the reference Italian-Mediterranean diet. The MAI proposed is simple to compute; it has satisfactory discriminating power particularly for longitudinal dietary data with only a few limitations.

Vegetable intake and long-term survival among middle-aged men in Italy.

PURPOSE: To examine prospectively the relationship between vegetable consumption and long-term survival. METHODS: In 1965, a total of 1536 Italian males from two Italian rural cohorts of the Seven Countries Study, aged 45-65 years, were examined. Information on lifestyle and food consumption collected at this visit, and total and cause-specific mortality data collected in 30 years of follow-up were analyzed for the present study. RESULTS: During a period of 30 years, 1096 deaths occurred (308 from coronary heart disease, 325 from cancer, 158 from cerebrovascular disease and 305 from all other causes). The age-adjusted life expectancy for men consuming more than 60 g/day of vegetables was nearly 2 years longer than for men consuming less than 20 g/day. This increase in survival was more striking in smokers than nonsmokers (2.1 vs. a 1 year gain). The association also held for both geographic cohorts, although the pattern of vegetable consumption was very different in the two villages. CONCLUSIONS: The results suggest a positive association between vegetable intake and life expectancy. Vegetable intake may be especially protective for smokers although the biological explanation for such an effect is unclear.