Non-alcoholic fatty liver disease independently predicts prediabetes during a 7-year prospective follow-up.

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) is suspected to confer an increased risk for developing type 2 diabetes (DM). However, only a few prospective studies evaluated NAFLD as a predictor for DM, most did not adjust for the full range of potential cofounders and none used an objectively quantified degree of steatosis. Our aim was to evaluate the independent role of NAFLD in predicting the development of pre-DM in a 7-year prospective follow-up of healthy volunteers. METHODS: A prospective cohort of a subsample of the Israeli National Health Survey evaluated at baseline and after 7 years by identical protocols. Metabolic parameters and ultrasonographic evidence of NAFLD were evaluated in 213 subjects, without known liver disease or history of alcohol abuse. Exclusion criteria were pre-DM at the baseline survey. Steatosis was quantified by ultrasound with the hepato-renal ultrasound index (HRI). RESULTS: The study included 141 volunteers (mean age 48.78 ± 9.68, 24.82% with NAFLD) without pre-DM/DM at baseline. Both NAFLD on regular US (OR=2.93, 1.02-8.41 95%CI) and HRI (OR=7.87, 1.83-33.82) were independent predictors for the development of pre-DM, adjusting for age, gender, BMI, family history of DM, baseline insulin, adiponectin and glucose. Further adjustment for physical activity and dietary intake did not weaken the association. Furthermore, NAFLD was a stronger predictor for pre-DM than the metabolic syndrome. Subjects with both NAFLD and glucose ≥89 had 93.3% incidence rate of pre-DM. CONCLUSION: Non-alcoholic fatty liver disease is a strong and independent risk factor for pre-DM in the general adult population; thus, NAFLD patients should be classified as a population at risk.

Predictors for incidence and remission of NAFLD in the general population during a seven-year prospective follow-up.

BACKGROUND & AIMS: Data on the incidence and remission rates of non-alcoholic fatty liver disease (NAFLD) as well as predictive factors are scant. This study aims at evaluating NAFLD's epidemiology in prospective follow-up of individuals sampled from the general population. METHODS: Evaluation of metabolic parameters and ultrasonographic evidence of NAFLD was performed in 213 subjects, with no known liver disease or history of alcohol abuse. The evaluation was performed at baseline and after a 7-year period by identical protocols. RESULTS: Of the 147 patients who did not have NAFLD at baseline, 28 (19%) were found to have NAFLD at a 7-year follow-up. Baseline BMI, HOMA score, blood cholesterol, triglycerides, leptin levels, and weight gain (5.8±6.1 vs. 1.4±5.5kg, p<0.001) were significantly higher and adiponectin was lower among those who developed NAFLD at 7-year follow-up, compared with those who remained NAFLD-free. However, only weight gain and baseline HOMA were independent predictors for the development of NAFLD. Of the 66 patients who were found to have NAFLD at baseline, as many as 24 patients (36.4%) had no evidence of NAFLD at 7years. Weight loss of 2.7±5.0kg was significantly associated with NAFLD remission. Moreover, there was a 75% remission rate among NAFLD patients who lost 5% or more from their baseline weight. CONCLUSIONS: Among the general population, weight gain, and baseline insulin resistance are predictors for NAFLD incidence. One third of NAFLD patients may have remission of disease within a 7-year follow-up, mostly depending on modest weight reduction.

Role of leisure-time physical activity in nonalcoholic fatty liver disease: a population-based study.

UNLABELLED: Physical activity (PA) is commonly recommended for nonalchoholic fatty liver disease (NAFLD) patients. However, there is limited evidence on the independent role of PA in NAFLD. The aim of this study was to examine the association between PA and NAFLD. We conducted a cross-sectional study of a subsample (n = 375) of the Israeli National Health and Nutrition Survey. Exclusion criteria were any known etiology for liver disease. Participants underwent an abdominal ultrasound examination; biochemical tests, including leptin, adiponectin, and resistin; and the noninvasive biomarker SteatoTest and anthropometric evaluations. A semiquantitative food frequency questionnaire and a detailed PA questionnaire were administered. Three hundred forty-nine patients (52.7% men, 30.9% primary NAFLD) were included. The NAFLD group engaged in less aerobic, resistance, or other kinds of PA (P

Prevalence and determinants of physical activity and lifestyle in relation to obesity among schoolchildren in Israel.

OBJECTIVE: To describe the relationships between physical activity, lifestyle determinants and obesity in adolescent Israeli schoolchildren.Design and settingCross-sectional survey. SUBJECTS: The MABAT Youth Survey was a nationally representative, school-based study of youth in grades 7 to 12 (ages 11-19 years). METHODS: Self-administered questionnaires assessed health behaviours and anthropometric indices were measured. Logistic regression analysis was used to examine the associations between obesity, physical activity, socio-economic status and other lifestyle habits. One-way ANOVA was used to determine mean physical activity levels (MET values) by BMI categories. RESULTS: The prevalence of overweight was 13-15 % and of obesity 4-9 % depending on gender and ethnicity, and was higher among the non-Jewish sectors. Thirty-six per cent and 57 % of Jewish girls and boys, and 40 % and 58 % of non-Jewish girls and boys, respectively, were optimally active. Boys from low socio-economic schools and those who slept for less than 6 h at night were less active. Girls from middle school were found to be 53 % more optimally physically active among Jews, and 89 % more among non-Jews, compared with girls from high school (P = 0.001); girls with less educated parents were also less physically active. No clear relationship was found between the level of obesity and physical activity. CONCLUSIONS: Physical inactivity was strongly related to gender, age, social status, sleeping habits, hookah smoking, and parental educational status. Education and intervention programmes should focus on these risk factors.

Obese children and adolescents: a risk group for low vitamin B12 concentration.

OBJECTIVE: To assess whether overweight children and adolescents are at an increased risk for vitamin B(12) deficiency. DESIGN: Prospective descriptive study. SETTING: Two pediatric endocrine centers in Israel. PARTICIPANTS: Three hundred ninety-two children and adolescents were divided into 2 groups as follows: the normal-weight group had body mass indexes, calculated as weight in kilograms divided by height in meters squared, under the 95th percentile (<1.645 standard deviation scores; n = 228); the obese group had body mass indexes equal to or above the 95th percentile (>/=1.645 standard deviation scores; n = 164). INTERVENTION: We measured vitamin B(12) concentrations. Low serum B(12) was defined as a B(12) concentration less than 246 pg/mL, and vitamin B(12) deficiency was defined as a concentration below 211 pg/mL. MAIN OUTCOME MEASURE: Vitamin B(12) concentrations corrected for body mass index standard deviation scores, age, and sex. RESULTS: Median concentration of serum B(12) in normal- weight children was 530 pg/mL and in obese children, 400 pg/mL (P<.001). Low B(12) concentrations were noted in 10.4% of the obese children compared with only 2.2% of the normal weight group (P<.001). Vitamin B(12) deficiency was noted in 12 children, 8 (4.9%) of the obese subjects and 4 (1.8%) of the normal weight group (P = .08). After we adjusted for age and sex, obesity was associated with a 4.3-fold risk for low serum B(12), and each unit increase in body mass index standard deviation score resulted in an increased risk of 1.24 (95% confidence interval, 0.99-1.56). CONCLUSIONS: Obesity in children and adolescents was associated with an increased risk of low vitamin B(12) concentration. We recommend that dietary assessment of obese children should include an estimation of vitamin B(12) intake. The possibility of vitamin B(12) deficiency in addition to other micronutrient deficiencies should be considered in obese children.

[Human immunodeficiency virus in newborn of infected mothers: pregnancy, breast feeding and prevention].

The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, especially in developing countries, where the estimated rate of vertical transmission is 15%-40%, compared with 15%-25% in developed countries. To date, a total number of 90 children younger than 12 years of age are infected with the virus in Israel, and during the years 2001-2003, an average of 29 mothers living with AIDS gave birth annually. Mother-to-child transmission (MTCT) of HIV can occur during pregnancy, in the intrapartum period or postnatally, through breastfeeding. One third of all the breastfed newborn acquire the infection postnatally. HIV can penetrate through the damaged gastrointestinal mucosa into the newborn blood system. Risk increases during gastrointestinal infections and oral skin lesions. MTCT rate is 3.2 to 100 child years, especially if the mother is infected just before or after labor. Antiretroviral therapy during pregnancy and labor, and throughout the first 6 weeks of life in newborn may reduce MTCT by 3-folds. Further avoidance of breastfeeding lowers MTCT to 1%-2%. Most HIV infected women who gave birth in Israel originated from endemic countries. As breastfeeding is the preferred option in traditional cultures, early waning and alternative strategy of supplying substitutes is unique. This recommendation should be combined with medical follow-up for both the mother and her offspring, as well as psychosocial intervention, if needed.

Overweight and obesity prevalence in Israel: findings of the first national health and nutrition survey (MABAT).

BACKGROUND: The prevalence of obesity has increased considerably in many countries in recent decades. OBJECTIVE: To describe the prevalence of overweight and obesity in the Israeli population, based on findings of the first national health and nutrition survey (MABAT). METHODS: This cross-sectional survey was carried out during 1999-2000. MABAT is based on a representative sample (n = 3,246) of the general Israeli population aged 25-64 years. The current study population comprised those with complete data on measured weight and height (n = 2,781). Participants were interviewed in person and had their weight and height measured by the interviewer. RESULTS: Over 50% of the study participants were women (n = 1,410); 76% were Jews and 24% Arabs. Most participants had an education of at least 12 years (72%). Body mass index > or = 30.0 was more prevalent in women compared to men (P < 0.001) in both population groups (Jews and Arabs). Obesity rates increased with age and reached 22.4% for men and 40.4% for women aged 55-64 years. Lower education was associated with higher obesity rates, with lowest rates observed for Jewish women with an academic education (13.6%) and highest rates observed for Arab women with a basic education (57.3%). Multiple logistic regression analyses showed age to be a significant risk factor in men. Age, education and origin (Arab, and the former Soviet Union for Jews) were significant risk factors for obesity in women. CONCLUSIONS: Obesity rates in Israel are high and comparable to those in the United States. Of special concern is the subgroup of older Arab women (55-64 years), whose obesity rates reached 70%.

Ukraine: health system review.

This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population's health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3 % in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conflict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system.

Bovine spongiform encephalopathy in Israel: implications for human health.

Only one case of a cow infected with bovine spongiform encephalopathy has been reported in Israel. Its publication, in 2002, caused both public and professional concern. The inevitable health policy question raised was whether or not to recommend against consuming beef and what public health measures should be taken. In this article we describe the prion diseases among animals and humans, their interaction and the precautionary procedures that were carried out by the state Veterinary Services and the Ministry of Health since 1988. The BSE case (a 10 year old dairy cow) is believed to be the result of local consumption of infected mammalian meat and bone meal more than a decade earlier. The risk assessment took into consideration that no cases of vCJD (a new variant of Creutzfeldt-Jacob disease) have ever been diagnosed in Israel, as well as the low risk of contamination of the meat due to the religious method of slaughtering performed in the country. The policy decision was to implement a contingency plan prepared in advance. Israel was reclassified from the level II category of geographic risk where BSE is unlikely but not excluded in the herds, to level III where BSE is likely but not confirmed, or confirmed at a lower level. No undue damage to the meat industry has occurred. By the end of 2002, despite the examination of more than 3,800 brains from slaughtered cows older than 3 years, no other cases of BSE have been detected.

[Soy and phytoestrogens consumption and health policy hesitation or certitude].

Soy and phytoestrogens are controversial as to their beneficial effects on health and the prevention of disease. To date, dietary recommendations in Israel do not specify a diet rich in soy and phytoestrogens. In order to establish a policy on this issue, we carried out a comprehensive, updated review of the relevant scientific literature. Data on the role of these substances in the primary and secondary prevention of cancer are limited. As yet, there is no conclusive evidence on the efficacy of phytoestrogens and soy in the prevention of osteoporosis. Their effect on fertility in animals and humans is still unclear. There are no data on the long-term risks or benefits of using soy-based formulae in infancy. Therefore, for those who cannot be breast-fed, cow-milk based formulae are recommended. Currently, the most supportive evidence for health benefits of soy can be found in studies on the prevention of cardiovascular diseases.

Increasing lung cancer incidence among Israeli Arab men reflects a change in the earlier paradox of low incidence and high smoking prevalence.

Lung cancer in Israel has previously appeared to be less common than expected, relative to the prevalence of smoking. The objective is to examine trends in lung cancer rates and smoking prevalence in Israeli Arab and Jewish men compared with the United States. Age-adjusted lung cancer incidence and mortality rates in Israel were calculated for 1980-2004 using the National Cancer Registry, and compared with the United States' rates, on the basis of the Surveillance Epidemiology and End Results program. Smoking rates were obtained from national surveys carried out during the years 1970-2004. During the period 1980-2004, among Israeli Arab men, there was an increase in lung cancer incidence rates, particularly during 1990-2004, when they increased by 17.8%. During the latter period, the incidence of lung cancer among Israeli Jewish men and men in the United States declined by 5.2 and 22.8%, respectively. In 2003-2004, the age-adjusted smoking rates were 41.3 and 31.6% among Israeli Arab and Jewish men, respectively, and past smoking habits reflect higher rates among Arab men over the past three decades. The marked increase in the incidence of lung cancer among Israeli Arab men during the last decade, without any evidence of increased smoking prevalence, might reflect a gradual loss of some apparent protection in this subpopulation. The possible explanations are changes in lifestyle, particularly in dietary habits.

NAFLD and hyperinsulinemia are major determinants of serum ferritin levels.

BACKGROUND/AIMS: There is an increasing body of evidence that serum ferritin is associated with the metabolic syndrome. However, no study has tested for NAFLD. The aim was to test the assumption that the association between serum ferritin and the metabolic syndrome is mediated by NAFLD. METHODS: A cross-sectional study of a sub-sample of the first Israeli national health survey. Exclusion criteria were any known etiology for secondary NAFLD. Participants underwent an abdominal ultrasound (US), biochemical tests, and dietary and anthropometric evaluations. RESULTS: Three hundred and forty-nine subjects were included in the analysis. Serum ferritin was higher in the NAFLD group (92.4+/-63.1 vs. 65.1+/-58.0, P<0.001). After adjusting for age and gender, the following variables were significantly associated with increased ferritin levels: abdominal obesity, hyperglycemia, hyperinsulinemia, HOMA, hypertriglyceridemia and the metabolic syndrome itself. After further adjusting for NAFLD, only abdominal obesity [2.1 (1.1-3.9)] and hyperinsulinemia [2.3 (1.3-4.2)] were still significantly associated with ferritin. In a multivariate analysis the interaction between NAFLD and hyperinsulinemia was the second strongest predictor of serum ferritin (P=0.005). CONCLUSIONS: The association between serum ferritin and the metabolic syndrome is mediated by undiagnosed NAFLD. The interaction between NAFLD and hyperinsulinemia is a major determinant of serum ferritin levels at the population level.

Long term nutritional intake and the risk for non-alcoholic fatty liver disease (NAFLD): a population based study.

BACKGROUND/AIMS: Weight loss is considered therapeutic for patients with NAFLD. However, there is no epidemiological evidence that dietary habits are associated with NAFLD. Dietary patterns associated with primary NAFLD were investigated. METHODS: A cross-sectional study of a sub-sample (n=375) of the Israeli National Health and Nutrition Survey. Exclusion criteria were any known etiology for secondary NAFLD. Participants underwent an abdominal ultrasound, biochemical tests, dietary and anthropometric evaluations. A semi-quantitative food-frequency questionnaire was administered. RESULTS: After exclusion, 349 volunteers (52.7% male, mean age 50.7+/-10.4, 30.9% primary NAFLD) were included. The NAFLD group consumed almost twice the amount of soft drinks (P=0.03) and 27% more meat (P<0.001). In contrast, the NAFLD group consumed somewhat less fish rich in omega-3 (P=0.056). Adjusting for age, gender, BMI and total calories, intake of soft drinks and meat was significantly associated with an increased risk for NAFLD (OR=1.45, 1.13-1.85 95% CI and OR=1.37, 1.04-1.83 95% CI, respectively). CONCLUSIONS: NAFLD patients have a higher intake of soft drinks and meat and a tendency towards a lower intake of fish rich in omega-3. Moreover, a higher intake of soft drinks and meat is associated with an increased risk of NAFLD, independently of age, gender, BMI and total calories.

Prevalence of primary non-alcoholic fatty liver disease in a population-based study and its association with biochemical and anthropometric measures.

BACKGROUND/AIMS: Only a few studies have assessed the epidemiology of non-alcoholic fatty liver disease (NAFLD). The aim was to evaluate the prevalence of primary NAFLD in a population-based study in Israel and to determine independent risk factors. METHODS: A cross-sectional study of a subsample of the Israeli national health survey (n=352). Individuals with a known etiology for secondary NAFLD were excluded. Each participant underwent an abdominal ultrasound, biochemical tests and an anthropometric evaluation. RESULTS: Three hundred and twenty-six subjects (53.4% male, mean age 50.5+/-10.3 standard deviaton [SD]) met the inclusion criteria. The prevalence of primary NAFLD was 30% (25-35% 95% confidence intervals [CI]). NAFLD was more prevalent in men than women (38% vs. 21%; P=0.001). Compared with ultrasonography, the sensitivity of serum alanine transaminase (ALT) for the diagnosis of primary NAFLD was 8.2%. Risk factors independently associated with NAFLD included male gender (odds ratios (OR)=2.8, 95% CI 1.5-5.3), abdominal obesity (OR=2.9, 95% CI 1.3-6.4), homeostasis model assessment (OR=5.8, 95% CI 2.0-17.2), hyperinsulinemia (OR=2.3, 95% CI 1.2-4.3, P=0.01) and hypertriglyceridemia (OR=2.4, 95% CI 1.3-4.5). CONCLUSIONS: NAFLD is prevalent in the general Israeli population and closely related to the metabolic syndrome. The use of ALT as a marker for NAFLD seriously underestimates its prevalence.

Outbreak of life-threatening thiamine deficiency in infants in Israel caused by a defective soy-based formula.

OBJECTIVE: Between October and November 2003, several infants with encephalopathy were hospitalized in pediatric intensive care units in Israel. Two died of cardiomyopathy. Analysis of the accumulated data showed that all had been fed the same brand of soy-based formula (Remedia Super Soya 1), specifically manufactured for the Israeli market. The source was identified on November 6, 2003, when a 5.5-month-old infant was admitted to Sourasky Medical Center with upbeat nystagmus, ophthalmoplegia, and vomiting. Wernicke's encephalopathy was suspected, and treatment with supplementary thiamine was started. His condition improved within hours. Detailed history revealed that the infant was being fed the same formula, raising suspicions that it was deficient in thiamine. The formula was tested by the Israeli public health authorities, and the thiamine level was found to be undetectable (<0.5 microg/g). The product was pulled from the shelves, and the public was alerted. Thiamine deficiency in infants is very rare in developed countries. The aim of this study was to report the epidemiology of the outbreak and to describe the diagnosis, clinical course, and outcome of 9 affected infants in our care. METHODS: After the index case, an additional 8 infants were identified in our centers by medical history, physical examination, and laboratory testing. The group consisted of 6 male and 3 female infants aged 2 to 12 months. All were assessed with the erythrocyte transketolase activity assay, wherein the extent of thiamine deficiency is expressed in percentage stimulation compared with baseline (thiamine pyrophosphate effect [TPPE]). Normal values range from 0% to 15%; a value of 15% to 25% indicates thiamine deficiency, and >25% indicates severe deficiency. Blood lactate levels (normal: 0.5-2 mmol/L) were measured in 6 infants, cerebrospinal fluid lactate in 2 (normal: 0.5-2 mmol/L), and blood pyruvate in 4 (normal: 0.03-0.08 mmol/L). The diagnostic criteria for thiamine deficiency were abnormal transketolase activity and/or unexplained lactic acidosis. Treatment consisted of intramuscular thiamine 50 mg/day for 14 days combined with a switch to another infant formula. RESULTS: Early symptoms were nonspecific and included mainly vomiting (n = 8), lethargy (n = 7), irritability (n = 5), abdominal distension (n = 4), diarrhea (n = 4), respiratory symptoms (n = 4), developmental delay (n = 3), and failure to thrive (n = 2). Infection was found in all cases. Six infants were admitted with fever. One patient had clinical dysentery and group C Salmonella sepsis; the others had mild infection: acute gastroenteritis (n = 2); upper respiratory infection (n = 2); and bronchopneumonia, acute bronchitis, and viral infection (n = 1 each). Two infants were treated with antibiotics. Three infants had neurologic symptoms of ophthalmoplegia with bilateral abduction deficit with or without upbeat nystagmus. All 3 had blood lactic acidosis, and 2 had high cerebrospinal fluid lactate levels. Patient 1, our index case, was hospitalized for upbeat nystagmus and ophthalmoplegia, in addition to daily vomiting episodes since 4 months of age and weight loss of 0.5 kg. Findings on brain computed tomography were normal. Blood lactate levels were high, and TPPE was 37.8%. Brain magnetic resonance imaging (MRI) revealed no abnormalities. Patient 2, who presented at 5 months with lethargy, vomiting, grunting, and abdominal tenderness, was found to have intussusception on abdominal ultrasound and underwent 2 attempts at reduction with air enema several hours apart. However, the lethargy failed to resolve and ophthalmoplegia appeared the next day, leading to suspicions of Wernicke's encephalopathy. Laboratory tests showed severe thiamine deficiency (TPPE 31.2%). In patients 1 and 2, treatment led to complete resolution of symptoms. The third infant, a 5-month-old girl, was admitted on October 10, 2003, well before the outbreak was recognized, with vomiting, fever, and ophthalmoplegia. Her condition deteriorated to seizures, apnea, and coma. Brain MRI showed a bilateral symmetrical hyperintense signal in the basal ganglia, mamillary bodies, and periaqueductal gray matter. Suspecting a metabolic disease, vitamins were added to the intravenous solution, including thiamine 250 mg twice a day. Clinical improvement was noted 1 day later. TPPE assay performed after treatment with thiamine was started was still abnormal (17.6%). Her formula was substituted after 4 weeks, after the announcement about the thiamine deficiency. Although the MRI findings improved 5 weeks later, the infant had sequelae of ophthalmoplegia and motor abnormalities and is currently receiving physiotherapy. All 3 patients with neurologic manifestations were fed exclusively with the soy-based formula for 2 to 3.5 months, whereas the others had received solid food supplements. Longer administration of the formula (ie, chronic thiamine deficiency) was associated with failure to thrive. For example, one 12-month-old girl who received the defective formula for 8 months presented with refusal to eat, vomiting, failure to thrive (75th to <5th percentile), hypotonia, weakness, and motor delay. Extensive workup was negative for malabsorption and immunodeficiency. On admission, the patient had Salmonella gastroenteritis and sepsis and was treated with antibiotics. After thiamine deficiency was diagnosed, she received large doses of thiamine (50 mg/day) for 2 weeks. Like the other 5 infants without neurologic involvement, her clinical signs and symptoms disappeared completely within 2 to 3 weeks of treatment, and TPPE levels normalized within 1 to 7 days. There were no side effects. As part of its investigation, the Israel Ministry of Health screened 156 infants who were fed the soy-based formula for thiamine deficiency. However, by that time, most were already being fed alternative formulas and had begun oral thiamine treatment. Abnormal TPPE results (>15%) were noted in 8 infants, 3 male and 5 female, all >1 year old, who were receiving solid food supplements. Although their parents failed to notice any symptoms, irritability, lethargy, vomiting, anorexia, failure to thrive, and developmental delay were documented by the examining physicians. None had signs of neurologic involvement. Treatment consisted of oral thiamine supplements for 2 weeks. CONCLUSIONS: Clinician awareness of the possibility of thiamine deficiency even in well-nourished infants is important for early recognition and prevention of irreversible brain damage. Therapy with large doses of thiamine should be initiated at the earliest suspicion of vitamin depletion, even before laboratory evidence is available and before neurologic or cardiologic symptoms appear.

Correlates of osteoporosis among Jewish and Arab women aged 45-74 in Israel: national women's health interview survey.

OBJECTIVE: To determine the prevalence and correlates of osteoporosis among middle-aged and elderly Jewish and Arab women in Israel. DESIGN: A cross-sectional study on a random sample of Israeli women, carried out through telephone interviews. Questions included physician-diagnosed osteoporosis, demographic and lifestyle variables, medical conditions, and present and past use of estrogen-containing medications. Body mass index (BMI) was calculated from reported height and weight. SETTING: A national population-based survey conducted from March through August 1998. PARTICIPANTS: A national random sample of 888 women aged 45-74. MAIN RESULTS: The overall prevalence of self-reported osteoporosis was estimated at 13.7%. The rates increased abruptly from about 5.8% at ages 45-59 to 19.6% at ages 60-64, and reached 27.7% at ages 70-74. Between ages 45-59, the rates were higher among Arab women, whereas in the older group they were higher among Jewish women. There was a marked increase following menopause. After adjustment for potential confounders, at ages 45-59, osteoporosis was positively associated with menopause and BMI, whereas at ages 60-74, it was positively associated with age and family history of osteoporosis, and negatively associated with BMI. CONCLUSIONS: The prevalence of physician-diagnosed osteoporosis in Israel among women aged 45-74 is estimated to be 13.7%, which is similar to that for the United States. The association of osteoporosis with risk factors is age-dependent, and in particular, age-BMI interaction on osteoporosis requires further investigation.

Multiethnic differences in smoking in Israel: pooled analysis from three national surveys.

BACKGROUND: Smoking is a major public health risk and information regarding high-risk groups is needed to plan, implement and evaluate interventions aimed at lowering the number of smokers. METHODS: During the years 1999-2001 data was collected regarding the smoking behaviour of the Israeli population in three national surveys. All three surveys included ages 25-64 and two included also ages 21-25 and over 64. RESULTS: Smoking was associated with age, sex, ethnicity, education and religiosity after adjusting for the various demographic characteristics of the survey population. The prevalence of smoking among Arab and immigrant men from the former Soviet Union is higher than among Jewish men. Among women the opposite association exists. The older, religious and more educated reported smoking less frequently. In the Jewish population respondents, defining themselves as secular, reported higher rates of smoking. Only in women was marital status associated with smoking. A few specific high-risk groups for smoking can be identified such as young, less educated men, Arab men, single Jewish women and young immigrant men and women. CONCLUSIONS: The three ethnic groups residing in Israel differ in the prevalence of smoking; each has a distinct pattern of smoking, positioning them at different stages within the conceptual framework of the larger smoking pandemic. Ethnicity, religiosity, age and education are associated with smoking in both sexes. This calls for specific tailored interventions aimed at younger men with less education, Arab men, and young immigrants.