Heart Rate-Corrected QT and JT Intervals in Electrocardiograms in Physically Fit Students and Student Athletes.

In literature, data on the prevalence of prolonged and shortened corrected QT (QTc) have shown considerable variability. The aim of the study was to compare QTc and JTc intervals of competitive student athletes and noncompetitive sport participants to QTc cutoff points used in athletes. A group of 485 physically fit candidates for the study of kinesiology (139 female and 346 male candidates) aged 18-20 participated in the study. Basic anthropometry, field fitness test, cardiovascular, electrocardiograms measurements, and blood sampling for lipid profile were conducted. The prolonged QTc according to European Society of Cardiology criteria was found in 2.9% of female and 4.3% of male students. When the "Seattle criteria" were used, the proportion of prolonged QTc was 1.44% in female and 0.29% in male students. The shortened QTc according to the Seattle cutoff points was presented in 0.7% of female and 2.0% of male students. The JTc over 400 ms was found in 0.72% of female and 0.29% of male students. The JTc shorter than 320 ms was presented in 0.7% of female and 1.1% of male students. No significant differences were found between students involved in competitive sport and those involved in recreational sporting activities. Female students had lower body mass index and blood pressure values, better blood lipid profile, and lower uric acid concentrations. In conclusion, the Seattle criteria markedly decreased the proportion of prolonged QTc in student athletes, particularly in male students. It seems that the JTc interval could be a better parameter than the QTc interval for the estimation of specific repolarization time in physically fit university students.

Smoking habits according to metabolic traits in an island population of the eastern Adriatic Coast.

The study deals with the connection between metabolic syndrome (MS) and smoking habits of 1602 males and 828 females aged 18-97 years from the island of Hvar, Croatia. The age-adjusted prevalence of MS was higher in males (18.1-31.2%) than females (9.7-24.2%) by all five criteria that were defined, except the one by AHA/NHLBI. The overall prevalence of MS reached 12.9% by WHO using body mass index (BMI), 13.1% by EGIR, 14.5% by WHO using waist to hip ratio (WHR), 18.2% by NCEP/ATP III, 18.9% by AHA/NHLBI, and 26.7% by IDF criteria. The prevalence of smoking habits was similar in males (24.7%) and females (23.8%). The frequency of mild, moderate and heavy smoking was higher in males than females, 35.8:26.6%, 31.0:27.0%, and 35.9:7.7%, respectively. Age and sex had significant influence on BMI and WHR, both being highest in male former smokers (28.15 kg/m2 and 0.973, respectively) and in female non-smokers (27.18 kg/m2 and 0.869, respectively). The appearance of arterial hypertension (HTN) differed according to frequency of smoking; males had higher prevalence than females using WHO and EGIR criteria of blood pressure > or = 140/90 mmHg, even after age adjustment. In males and females respectively, systolic HTN in non-smokers was 20.7:15.1%, in former smokers 17.9:15.2% and in current smokers 16.9:13.0%; diastolic HTN in non-smokers was 19.8:12.7%, in former smokers 22.4:10.5%, and in current smokers 11.3:9.1%. By NCEP, AHA, IDF criteria of blood pressure > or = 130/85 mmHg, arterial HTN was also more prevalent in males than females; systolic HTN in non-smokers being 31.4:19.8%, in former smokers 29.9:12.7%, and in current smokers 25.4:11.1%; and diastolic HTN in non-smokers was 20.5:11.5%, in former smokers 24.8:11.3%, and in current smokers 14.7:9.4%. According to AHA/NHLBI and IDF criteria of high plasma glucose as > or = 5.6 mmoL/L, both males and females in all the three categories of smokers had glucose levels above the normal range (5.80-6.31 mmol/L in males and 5.80-5.91 mmol/L in females), except female current smokers (5.51 mmol/L). By WHO, EGIR and NCEP/ATP III criteria of high plasma glucose as > or = 6.1 mmol/L, only male non-smokers (6.31 mmol/L) and former smokers (6.24 mmol/L) had elevated levels. Considering normal HDL-cholesterol as > 1.0 mmol/L in males and > 1.2 mmol/L in females, both males and females in all the three smoker's categories had HDL within normal range; females having higher HDL levels (1.52 mmol/L) than males (1.30 mmol/L). Considering normal value for triglycerides as < 1.7 mmol/L, male former smokers (1.76 mmol/L) and current smokers (1.81 mmol/L) had higher levels; and as a whole group triglycerides were higher in males than females, 1.66:1.37 mmol/L respectively. The prevalence of MS differed between males and females using various MS criteria. Both males and females had the highest prevalence of MS by IDF criteria; male former smokers 60.5%, female non-smokers 51.4%, male non-smokers 53.8%, female former smokers 38.2%, and lowest in both male and female current smokers 39.8 and 33.0% respectively. In males, the lowest prevalence of MS was observed in non-smokers by AHA criteria (30.5%), in former smokers by WHO criteria (35.7%), and in current smokers using EGIR criteria (18.1%). Females in all the three smoker's categories had the lowest prevalence of MS using EGIR and WHO criteria. MS were less prevalent in current smokers than in non-smokers and former smokers.

Dietary patterns in adults from an Adriatic Island of Croatia and their associations with metabolic syndrome and its components.

Adriatic islanders have a high prevalence of metabolic syndrome (MetS) although they have traditionally practiced an active lifestyle and adhered to a Mediterranean diet. We performed a cross-sectional study to identify dietary patterns in a sample of 1442 adults from the island of Hvar, and determined whether MetS and its components: waist-circumference, serum triglycerides, fasting plasma glucose, HDL-cholesterol, and blood pressure, were related to an altered pattern of the traditional Mediterranean diet. Dietary intake was assessed by a food frequency questionnaire. MetS was defined using the International Diabetes Federation criteria. Our study showed that dietary patterns in this population have diversified from the traditional diet. Principal component analysis identified three major patterns. The meat, alcohol, and fish pattern (MAFp), sweets, grains, and fats pattern (SGFp), and an olive-oil, vegetables, and fruits pattern (OVFp) explained 30.6% of total dietary variance. The MAFp associated significantly with MetS (p = 0.027) and high plasma glucose (p = 0.006).

Genome-wide association of serum uric acid concentration: replication of sequence variants in an island population of the Adriatic coast of Croatia.

A genome-wide association study of serum uric acid (SUA) laevels was performed in a relatively isolated population of European descent from an island of the Adriatic coast of Croatia. The study sample included 532 unrelated and 768 related individuals from 235 pedigrees. Inflation due to relatedness was controlled by using genomic control. Genetic association was assessed with 2,241,249 single nucleotide polymorphisms (SNPs) in 1300 samples after adjusting for age and gender. Our study replicated four previously reported SUA loci (SLC2A9, ABCG2, RREB1, and SLC22A12). The strongest association was found with a SNP in SLC2A9 (rs13129697, P=2.33×10(-19)), which exhibited significant gender-specific effects, 35.76 µmol/L (P=2.11×10(-19)) in females and 19.58 µmol/L (P=5.40×10(-5)) in males. Within this region of high linkage disequilibrium, we also detected a strong association with a nonsynonymous SNP, rs16890979 (P=2.24×10(-17)), a putative causal variant for SUA variation. In addition, we identified several novel loci suggestive of association with uric acid levels (SEMA5A, TMEM18, SLC28A2, and ODZ2), although the P-values (P<5×10(-6)) did not reach the threshold of genome-wide significance. Together, these findings provide further confirmation of previously reported uric-acid-related genetic variants and highlight suggestive new loci for additional investigation.

Unexpected sudden death due to recreational swimming and diving in men in Croatia in a 14-year period.

The article deals with 17 sudden deaths which occurred during recreational swimming and diving in men in Croatia in a 14-year period: from January 1, 1998 to December 31, 2011. The sample is taken out from the total number of 61 sudden deaths in men during or immediately after sport or recreational exercise. Included are also sudden deaths of 8 foreigners spending holidays at the Croatian Adriatic Coast. In all of them forensic medicine autopsy was done. Thirteen males from Croatia died during recreational swimming. Three of them were aged 15-29 yrs: one had signs of hypertrophic cardiomyopathy, the second suffered from chronic myopericarditis with left ventricular aneurysm, and the third had cardiomegaly and blood alcohol level of 1.7 per thousand. Five were aged 30-64 yrs: four of them have suffered from coronary atherosclerosis and left ventricular hypertrophy of 15-18-18-22 mm, and one with left ventricular hypertrophy drowned suddenly, probably because of malignant ventricular arrhythmia. The fifth suffered stroke and drowned. Five elderly men, aged 65-85 yrs, have suffered from coronary atherosclerosis, myocardial fibrosis or myocardial scars, and three of them had left ventricular hypertrophy of 19 mm. Four males died during recreational diving. One aged 26yrs drowned, at autopsy he had left ventricular hypertrophy of 17 mm. Three males were middle-aged: two had coronary atherosclerosis, two of them had a severe degree of coronary atherosclerosis and one had coronary atherosclerosis of medium degree but with myocardial fibrosis and left ventricular hypertrophy of 18 mm. Seven male foreigners died, five of them during swimming: two aged 30-64 and two aged 65-85. They all have had coronary atherosclerosis: one of them had an acute myocardial infarction of the posterior wall, and one hypertrophic cardiomyopathy as well. One middle-aged and one elderly man died during diving, and both had an acute myocardial infarction of the posterior wall. One elderly foreign woman died during swimming, she had coronary atherosclerosis and a myocardial scar. In Croatia, death rate during both swimming and diving in men aged 15-29 years amounted to 0.63/1,000.000 (p=1.0000); in those aged 30-64 it reached 0.56/1,000.000 (p=0.3698), and in those aged 65-85 it was 1.41/1,000.000 (p=0.1849). The death rate during swimming in men aged 15-29 amounted to 1.47/1,000.000 (p=0.9864), in men aged 30-64 it reached 0.35/1,000.000 (p=0.2245), and in those aged 65-85 it was 1.41/1,000.000 (the difference is significant, p=0.0472). The death rate during diving in men aged 15-29 was 0.16/1,000.000, and in men aged 30-64 the observed rate was 0.21/1,000.000 (p=1.0000).

Hypertrophic cardiomyopathy and sudden cardiac death due to physical exercise in Croatia in a 27-year period.

The paper deals with the sudden cardiac death during physical exercise in males in Croatia. The data are a part of a retrospective study dealing with 69 sudden death due to physical activity in men in Croatia during 27 years: from January 1, 1984 to December 31, 2010. Three of them suddenly died during training and two of them died during recreational physical exercise, probably because of malignant ventricular arrhythmia due to hyperthrophic cardiomyopathy. One had an obstructive form of hypertrophic cardiomyopathy with i.v. septum of 40 mm and four had a non-obstructive forms of hyperthrophic cardiomyopathy with left ventricular wall of 18-20-22-25 mm. First athlete was a short trails runner, aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second athlete was a soccer player aged 18, with no any previous physical discomfort, who suddenly collapsed and died during training. The third aged 15, was a school boy, basketball player, with no any previous physical discomfort, who collapsed and died during training. Two aged 25 and 34, were with no physical discomfort during exercise and died suddenly during recreational soccer games. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of hyperthropic cardiomyopathy reached 0.06/100 000 yearly (p = 0.00000) in 27 years, in teenagers 0.26/100 000 (p = 0.00226), in teenagers suffered of hypertrophic cardiomyopathy reached 0.10/100 000 (p = 0.00000), in all young athletes suffered of other heart diseases reached 0.19/100 000 (p = 0.00005), and in the total male population aged 15 or more, engaged in sports and recreational physical exercise: 0.71/100.0000 (p = 0.00001).

Arrhythmogenic right ventricular dysplasia and sudden cardiac death in Croatians' young athletes in 25 years.

The paper deals with the sudden cardiac death during training in male athletes in Croatia. The data are a part of a retrospective study dealing with 67 sudden death due to physical activity in men in Croatia during 25 years: from January 1, 1986 to December 31, 2010. Two of them suddenly died during training due to malignant ventricular arrhythmia because of the arrhythmogenic right ventricular dysplasia. First was a short trails runner aged 24, with no any previous physical discomforts, who suddenly collapsed and died during training. The second was a soccer player aged 13, with no any previous physical discomfort, who suddenly collapsed and died during training. A sudden cardiac death due to physical exercise in young athletes in Croatia suffered of arrhythmogenic right ventricular dysplasia reached 0.07/ 100.000 yearly (p = 0.00000), in all young athletes suffered of heart diseases reached 0.19/100 000 (p = 0.00005), and in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.71/100.0000 (p = 0.00001).

Physical activity and sudden cardiac death in elders--a Croatian study.

The paper deals with the sudden cardiac death in elders due to physical activity in Croatia and to compare it to other population groups who practice physical activity. The data are a part of a retrospective study dealing with 59 sudden death due to physical activity in men in Croatia: from January 1, 1988 to December 31, 2008. Fifteen aged 65 to 82 years were recreationally engaged in physical activity: six in swimming, four in tennis, one in driving a bicycle, one in jogging, two in bowling and one died during sexual act. Only one had symptoms of pectoral angina, two suffered from arterial hypertension, and two had congestive heart failure. Eleven were without symptoms before exercise. At forensic autopsy, fourteen had coronary heart disease, seven had critical coronary artery stenosis, three had occluded left descendens anterior coronary artery and four critical coronary stenosis, four had a recent myocardial infarctions, and eleven had myocardial scars due to previous myocardial infarctions. Twelve of them had left ventricular hypertrophy: 15-25 mm. In Croatia, about 7per cent of the entire male population undertake recreational physical activity, while 13 per cent of them are elders. A sudden cardiac death due to recreational physical activity in elders reached 1.71/100 000 yearly, in the entire male population engaged in recreational physical exercise: 0.75/100 000 (p = 0.05730), in the total male population aged 15-40 engaged in sports and recreational physical exercise: 0.57/100.0000 (p = 0.00387), in young athletes: 0.15/100 000 (p = 0.00000). Medical examination of all elderly persons has to be done before starting of recreational physical activity: by clinical examination, searching for risk factors for atherosclerosis, performing ECG at rest, stress ECG, and echocardiography and to repeat the medical examination at least once a year Physical activity should start with a warm-up period and with a gradually increasing load, and usually not to exceed 6-7 metabolic equivalents (METs).

[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.

Suppurative tonsillitis and sudden cardiac death due to physical training in a young soccer player.

A teenager aged 17 was a professional soccer player, and was without symptoms. He died suddenly during physical exercise at the field. All reanimation efforts were unsuccessfull. At the forensic autopsy he had suppurative bacterial tonsillitis, subacute diffuse myopericarditis and narrowing of the ascending aorta of 10 mm. In Croatia the death rate among athletes reached 0.15/100,000, in athletes suffered of acute respiratory tract infections 0.34/100,000, in males who practice exercise recreatively 0.75/100,000 (p = 0.0014), in school children 1.0/100,000 (p = 0.0010). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after suppurative-bacterial tonsillitis depends on disappearing of clinical signs, normalization of erythrocite sedimentation rate; of white cell count and serum level of C-reactive protein. Physical exercise is contraindicated in patients suffering of myopericarditis for at least 6 months. When to start exercise depends on disappearing of subjective symptoms and normalization of clinical and laboratory findings.