Diet and Health Implications for Reducing Chronic Disease Risk (1989) / Chapter Skim
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Extent and Distribution of Chronic Disease: An Overview
Extent and Distribution of Chronic Disease: An Overview
Pages 99-136
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From page 99... ...
It is characterized by the average and the distribution of nutrients and foods consumed by an individual or by a defined group. The committee gave special attention to major diet-related chronic diseases and conditions of adulthood, including atherosclerotic cardiovascular diseases (i.e., coronary heart disease, stroke, and peripheral arterial diseases)
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From page 100... ...
The highest reported CHD death rates occurred in Finland and the English-speaking countries, including the (not shown' were highest in Northem Ireland, Scotland, and the United States and lowest in Japan (Inter-Society Commission for Heart Disease Resources, 1984~. These large geographic differences in CHD death rates were confirmed by studies comparing geographic differences in CHD incidence rates, such as the Seven Countries Stucly, in which the lO-year incidence rate among men 40 to 59 years old at the beginning of the study was about 200 per thousand in Finland as compared to about 40 per thousand in Japan and the Greek Islands (Keys, 1980~.
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From page 101... ...
In addition, the decline in CHD deaths was generally accompanied by, and probably preceded by, decreased CHD incidence and by lowered average levels of factors associated with increased CHD risk in the population (e.g., cigarette smoking, hypertension, and high serum cholesterol levels) (Inter-Society Commission for Heart Disease Resources, 1984; ,
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From page 102... ...
Associations Between Risk Factors in ~v~duais and CHD Age CHD prevalence, incidence, and mortality rates rise steeply with age, approximately doubling in each 5-year age class past age 24. The decline in age-specific CHD death rates between 1968 and 1978 in the United States occurred across all age groups; it was 40 to 50% for those in the 35- tO 44-year-old age group and 15 tO 20% among those over age 70 (DHHS, 1987~.
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From page 103... ...
Generally, better educated people are nonsmokers and have healthier patterns of eating, lower serum cholesterol levels, leaner body mass index, and greater physical activity. Numerous studies have indicated slight to moderately strong associations between CHD risk and other psychosocial and behavioral characteristics, but the existence of coronaryprone behavior and personality has been increasingly questioned because few of those studies controlled for social networks, physical activity, diet, and alcohol intake (Inter-Society Commission for Heart Disease Resources, 1984; Jenkins, 1983~.
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From page 104... ...
. Associations Between Risk Factors in In~v~duais and Stroke Age Stroke deaths and incidence rates are very low until age 45.
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From page 105... ...
This differential applied to both sexes and was independent of the associated risk factors: 105 blood pressure, serum cholesterol, cigarette smoking, and electrocardiographic findings. Cigarette smoking was positively and independently associated with cerebral infarction in men below age 65 In the Honolulu and Framingham studies (Abbott et al., 1986; Kanne!
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From page 106... ...
Other Risk Factors Clinical observations suggest a strong concentration of PAD risk among people with Diabetes (Schadt et al., 1961~. This was confirmed by the greater annual incidence of intermittent cIaudication in diabetic men and women in the Framingham Study.
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From page 107... ...
Serum total cholesterol and relative weight were only weakly significant risk factors. Clustering of intermittent cIaudication with other atherosclerotic and cardiovascular diseases was also pronounced in the Framingham Study.
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From page 108... ...
The risk of hypertension varies markedly with age, sex, race, and the total burden imposed by associated risk factors, including socioeconomic status, occupation, obesity, family history, psychosocial stresses, and other factors (as discussed below)
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From page 109... ...
Interaction of hypertension with other risk factors may alter their risk as much as sixfold. A striking feature of the epidemiology of hypertension is the remarkable decrease in hypertension~related deaths, i.e., from all cardiovascular disease, cerebrovascular disease, renal disease, hypertensive heart disease, and CHD (DHHS, 19871.
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From page 110... ...
Cohort data show systolic pressure starting lower in women, but rising to meet that of men by age 60, after which systolic pressure rises in men and women at the same rate. With respect to diastolic blood pressure, the cross-sectional data show a higher level in men than in women in their early decades and the reverse during the middle 50s when levels decrease in men and further increase in women.
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From page 111... ...
, blacks also had a higher prevalence of hypertension-related complications (such as cerebrovascular, cardiovascular, and renal events) than whites at all blood pressure levels (HDFP, 1979~.
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From page 112... ...
The absolute effect was somewhat greater among blacks, but the gradient of relative risk was somewhat steeper among whites. Associations of Blood Pressure and Hypertension with AtheroscJero~c Cardiovascular Diseases and Death Blood pressure is a strong and independent risk predictor for CHD-a relationship that was thoroughly reviewed in the report of Inter-Society Commission for Heart Disease Resources (1984~.
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From page 113... ...
These relationships are consistent and widely confirmed (Inter-Society Commission for Heart Disease Resources, 1984~. Despite the strong individual correlations between blood pressure level and CHD risk within populations, the frequency of hypertension does not account for much of the variation of CHD incidence between populations.
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From page 114... ...
in addition to definitions of total body fat, considerable evidence suggests that regional fat distribution influences the risk of mortality from atherosclerotic cardiovascular diseases and diabetes mellitus. The most widely used techniques for assessing regional fat distribution involve determining the ratio of abdominal (waist)
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From page 115... ...
yond age 54, the percentage of overweight men and women decreased. Associaf:'ons Between Risk Factors Individuals and]
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Thus, no psychological risk factors for the development of obesity have been identified (Wadder and Stunkard, 1985~. Familial and Genetic Factors There is a high familial association with obesity.
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From page 117... ...
This may be due to the strong association of obesity with risk of hypenension, diabetes mellitus, and lowered levels of HDL cholesterol, which are in themselves important risk factors for atherosclerotic cardiovascular diseases (Manson et al., 1987~. Diabetes mellitus is the disease most strongly associated with obesity.
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From page 118... ...
Colorectal cancers tend to be more common in countries where breast cancer is common and relatively rare in countries where breast cancer is also relatively rare (Waterhouse et al., 1982~. There is also a strong international association between colorectal cancer rates and rates for endometrial, ovarian, and to a lesser extent prostate cancer.
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From page 119... ...
For females, however, rates are continuing to increase, and deaths from lung cancer currently surpass deaths from breast cancer in many states. If present trends continue, there will be a 1-to-!
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From page 120... ...
A particularly dramatic example of the latter occurred during the 1970s: After breast cancer was diagnosed in the wives of the President and VicePresident of the United States, reported incidence rates in the United States rose by more than 10% in a single year and then subsided, without a detectable effect on mortality rates. This reflects an increased awareness by women, their subsequent visits to physicians for breast examinations, and the diagnosis of very early lesions with good prognosis.
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From page 121... ...
Thus, the proportion of individuals predisposed to fractures of the hip, femur, forearm, or vertebrae is expected to increase. 121 Associations Between Risk Factors in Individuals and Osteoporosis The demographic characteristics associated with osteoporosis and osteoporosis-related fractures are age over 40, female sex, and Caucasian race.
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From page 122... ...
It can be diagnosed by the presence of classical signs and symptoms, including elevated blood glucose levels, by a fasting plasma glucose '140 mg/41, or by an abnormal coral Pluco.~e tolerance test (Harris, 1985~. Two distinct pri' mary forms of diabetes mellitus are Type I, or insulin-dependent (IDDM)
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From page 123... ...
However, adiposity, a risk factor for NIDDM, appears to be at least partly detennined by genetic predisposition. Other Risk Factors Adiposity is the major risk factor for NIDDM.
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From page 124... ...
and cirrhosis occur less frequently than fatty liver among chronic alcoholics, but they are more advanced stages of liver disease. Alcoholic hepatitis, a lifethreatening complication of heavy chronic alcohol consumption, may be a precursor to alcoholic cirrhosis (Rubin and Lieber, 1974~.
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From page 125... ...
The rates of few other chronic diseases in the technologically developed West 125 em countries vary as. widely from country to country as do rates of alcoholic cirrhosis of the liver.
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From page 126... ...
Associations Between Risk Factors In Individuals and Alcoholic Cirrhosis Alcoholic cirrhosis has consistently been correlated predominantly with the per-capita consumption of alcohol on a national basis (Gordis et al., 1983~. In tum, alcohol consumption and alcoholic cirrhosis have been correlated positively with the availability and the ease of access to alcohol as stated above, and inversely with cost (ferris, 1967)
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From page 127... ...
are indices of the cumulative effect of dental caries over the life of the dentition. Thus, for the primary rendition in 6-year-olds, the exposure period was approximately 4 to 5 years; for permanent teeth in the 12-year-olds, the period was 4 to 6 years for the molars and anterior teeth.
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From page 128... ...
1913. Coronary Risk Handbook: Estimating Risk of Coronary Heart Disease in Daily Practice.
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From page 129... ...
1976. Prevalence of ischaemic heart disease, arterial hypertension and intermittent claudication, and distribution of nsk factors among middle-aged men in Moscow and Berlin.
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From page 130... ...
1986. The pateem of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study.
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From page 131... ...
1976. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of stroke.
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From page 132... ...
1972. Coronary heart disease: overweight and obesity as risk factors.
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From page 133... ...
1975. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and Califomia: prevalence of coronary and hypertensive heart disease and associated risk factors.
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From page 134... ...
1977. Epidemiologic studies of coronary heart disease and snoke in Japanese men living in Japan, Hawaii and Glifomia: incidence of myocardial infarction and death from coronary heart disease.
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From page 135... ...
1984. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and Califomia: incidence of stroke in Kaplan and Hawaii.
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