Average intake of anti-oxidant (pro)vitamins and subsequent cancer mortality in the 16 cohorts of the Seven Countries Study

This ecologic study aimed to investigate whether differences in population mortality from lung, stomach and colorectal cancer among the 16 cohorts of the Seven Countries Study could be explained by differences in the average intake of anti-oxidant (pro)vitamins. In the 1960s, detailed dietary information was collected in small sub-samples of the cohorts by the dietary record method. In 1987, food-equivalent composites representing the average food intake of each cohort at baseline were collected locally and analyzed in a central laboratory. The vital status of all participants was verified after 25 years of follow-up. The average intake of vitamin C was strongly inversely related to the 25-year stomach-cancer mortality (r = -0.66, p = 0.01), also after adjustment for smoking and intake of salt or nitrate. The average intake of alpha-carotene, beta-carotene, and alpha-tocopherol were not independently related to mortality from lung, stomach or colorectal cancer, nor was vitamin C related to lung and colorectal cancer.

Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study

BACKGROUND

In the Seven Countries Study associations between intake of individual fatty acids and dietary cholesterol were studied in relation to serum cholesterol and 25-year mortality from coronary heart disease. All analyses concern only intercohort comparisons.

METHODS

In the baseline surveys carried out between 1958 and 1964, risk factors for coronary heart disease were measured among 12,763 middle-aged men constituting 16 cohorts in seven countries. In 1987 and 1988 equivalent food composites representing the average food intake of each cohort at baseline were collected locally and analyzed in a central laboratory. The vital status of all participants was verified at regular intervals during 25 years of follow-up.

RESULTS

Of the individual saturated fatty acids, the average population intake of lauric and myristic acid was most strongly related to the average serum cholesterol level (r > 0.8, P < 0.001). Strong positive associations were observed between 25-year death rates from coronary heart disease and average intake of the four major saturated fatty acids, lauric, myristic, palmitic, and stearic acid (r > 0.8, P < 0.001); the trans fatty acid elaidic acid (r = 0.78, P < 0.001); and dietary cholesterol (r = 0.55, P < 0.05).

CONCLUSIONS

Interpreted in the light of experimental and clinical studies, the results of these cross-cultural analyses suggest that dietary saturated and trans fatty acids and dietary cholesterol are important determinants of differences in population rates of coronary heart disease death.

A self-administered semiquantitative food-frequency questionnaire with optical reading and its concurrent validation

An improved semiquantitative self-administered food frequency questionnaire has been designed in order to investigate possible associations between diet and health, to plan nutrition education programmes, and to examine dietary compliance. The questionnaire consists of 16 printed forms and 16 pages with coloured photos of the most common foods and courses from the Italian diet. Instructions and other questions are included. The questionnaire uses optical reading from a scanner connected to a personal computer. The questionnaire was validated by comparing it with the seven-day weighed record method using 46 healthy adult volunteers. Significant correlations were found for all nutrients tested (Spearman rank correlation procedure), r ranging from 0.33 for ascorbic acid to 0.84 for alcohol. The two methods gave comparable results (Wilcoxon matched-pairs signed rank test) for all nutrients except riboflavin and alcohol. Similarity of the two methods in classifying relative intakes was examined by determining the frequency of similar classification into tertiles. Half of the subjects were correctly classified for most nutrients and for frequency of consumption of 18 food groups.

Flavonoid intake and long-term risk of coronary heart disease and cancer in the seven countries study

OBJECTIVE

To determine whether flavonoid intake explains differences in mortality rates from chronic diseases between populations.

DESIGN

Cross-cultural correlation study.

SETTING/PARTICIPANTS

Sixteen cohorts of the Seven Countries Study in whom flavonoid intake at baseline around 1960 was estimated by flavonoid analysis of equivalent food composites that represented the average diet in the cohorts.

MAIN OUTCOME MEASURES

Mortality from coronary heart disease, cancer (various sites), and all causes in the 16 cohorts after 25 years of follow-up.

RESULTS

Average intake of antioxidant flavonoids was inversely associated with mortality from coronary heart disease and explained about 25% of the variance in coronary heart disease rates in the 16 cohorts. In multivariate analysis, intake of saturated fat (73%; P = 0.0001), flavonoid intake (8%, P = .01), and percentage of smokers per cohort (9%; P = .03) explained together, independent of intake of alcohol and antioxidant vitamins, 90% of the variance in coronary heart disease rates. Flavonoid intake was not independently associated with mortality from other causes.

CONCLUSIONS

Average flavonoid intake may partly contribute to differences in coronary heart disease mortality across populations, but it does not seem to be an important determinant of cancer mortality.

Dietary studies on two rural Italian population groups of the Seven Countries Study. 1. Food and nutrient intake at the thirty-first year follow-up in 1991

The food and nutrient intake at the thirty-first follow-up in 1991 of 16 surviving elderly from Crevalcore and Montegiorgio, two Italian rural ares of the Seven Countries Study, are reported. For dietary appraisal the individual weighed record method for 3 and 9 days in three seasons was used. In autumn the dietary history method was also used. Because the number of survivors was small, 15 additional elderly subjects in both areas were surveyed. Then, to detect any change related to age in food intake, 41 younger subjects were assessed with the dietary history method. The results in both areas showed in general a high intra-individual variability and no statistically significant difference in food group and nutrient intake between seasons. Between the two methods for dietary survey no statistically significant difference, in general, was observed (P > 0.05 only for a few items). The diet of the subjects of Crevalcore was characterized by a rather high intake of milk and meat and a low intake of fish and legumes. In Montegiorgio the picture was similar to that of Crevalcore, but at a lower level of intake. In both areas, but particularly in Montegiorgio, these subjects have been abandoning the traditional Mediterranean diet.

Dietary studies on two rural Italian population groups of the Seven Countries Study. 2. Concurrent validation of protein, fat and carbohydrate intake

On 18 subjects from two rural areas in Italy which were part of the Seven Countries Study (Crevalcore and Montegiorgio), we carried out the concurrent validation of protein, fat, fatty acid and carbohydrate intake in the diet at the thirty-first year follow-up in 1991. The values of the above nutrients obtained using food composition tables from the weighted record method for dietary surveys were compared with the values from chemical analysis of food composites. In both areas for protein, fat and carbohydrate intake the inter-individual variation was large. For protein intake the mean difference was statistically significant but not for fat intake. From 1960 to 1991 protein and fat intake tended to decrease and for protein the means of differences between analysis and calculation were, in general, statistically different. For dietary saturated and polyunsaturated fatty acids, the means of differences were statistically significant in Crevalcore, but this was not the case in Montegiorgio for polyunsaturated fatty acids. The intake of trans fatty acids in both areas was rather low. Available and unavailable carbohydrate intake of both areas showed no statistically significant difference. The mean differences between analysis and calculation for both areas were statistically significant with the exception of cellulose in Crevalcore and sugars in Montegiorgio.

Is diet an independent risk factor for mortality? 20 year mortality in the Italian rural cohorts of the Seven Countries Study

The relation of diet to mortality is examined using the data of the Italian rural cohorts of the Seven Countries Study, a prospective investigation of factors related to cardiovascular disease. The present analysis includes 1536 men aged 45-64 years, whose dietary habits and food consumption, including alcoholic beverages, were measured in 1965. Of the 1536, 668 (43.5%) died during a follow-up period of 20 years. Large differences in survival probabilities were observed for different dietary patterns (i.e. for different intakes of energy and nutrients). The dietary pattern that corresponded to the lowest mortality rate (27% after 20 years) was: more than 2800 kcal/d (11.7 MJ/d), with more than 41% of the calories coming from carbohydrates, more than 9% from proteins, between 16% and 23% from unsaturated lipids, and between 13% and 19% from alcohol. As the number of disagreements from the previous conditions increases, the mortality rate increases to reach 69% in 20 years in the worst case. Differences in mortality persisted after adjustment for confounders and some major established mortality risk factors.

Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the seven countries study

Sixteen cohorts of men aged 40-59 years at entry were examined with the measurement of some risk factors and then followed-up for mortality and causes of death for 25 years. These cohorts were located in the USA (1 cohort), Finland (2), the Netherlands (1), Italy (3), the former Yugoslavia (5), Greece (2), and Japan (2), and included a total of 12,763 subjects. Large differences in age-adjusted coronary heart disease (CHD) death rates were found, with extremes of 45 per 1000 in 25 years in Tanushimaru, Japan, to 288 per 1000 in 25 years in East Finland. In general, higher rates were found in the US and Northern European cohorts as compared to the Southern European and Japanese cohorts. However, during the last 10 years of follow-up large increases of CHD death rates were found in some Yugoslavian areas. Out of 5 measured entry characteristics treated as age-adjusted levels (serum cholesterol, systolic blood pressure, cigarette smoking, body mass index and physical activity at work), only serum cholesterol was significant in explaining cohort differences in CHD death rates. Over 50% of the variance in CHD death rates in 25 years was accounted for by the difference in mean serum cholesterol. This association tended to decline with increasing length of follow-up, but this was due to the great changes in mean serum cholesterol in the two Yugoslavian cohorts of Velika Krsna and Zrenjanin. When these two cohorts were excluded the association increased with time. Changes in mean serum cholesterol between year 0 and 10 helped in explaining differences in CHD death rates from year 10 onward. It can be concluded that this study suggests that mean serum cholesterol is the major risk factor in explaining cross-cultural differences in CHD.

[Anticholinergics and cytoprotectants in gastroduodenal ulcer]

The authors evaluate the present curative indications of anticholinergic and cytoprotector drugs in the treatment of ulcer disease. They conclude that the therapeutic relevance of mucosal protective agents is limited in comparison with the major gastroactive medications especially in the treatment of peptic ulcer disease.

Inter- and intra-individual variability in food intake of elderly people in Perugia (Italy)

It has been shown that each individual has a considerable day-to-day variation (intra-individual variation) in his or her level of food consumption. A large intra-individual variation has adverse effects on the reliability of research studies. The effect of the intra-individual variation can be minimized by taking food intake records over several days. An increase in the number of days entails higher costs, and this could limit the practicability of the study. In the recent literature on the methodology of dietary surveys, there is a growing interest in the estimation of the number of days required to conduct a reliable dietary survey. Recent developments in statistical theory allow the problem of large intra-individual variability to be overcome. These new statistical techniques require knowledge of the intra- and inter-individual variability and the appropriate adjustment of the statistical results. The aim of the present study was to evaluate the number of days of recorded intake required to obtain an estimate of the components of variance (the inter-individual and the intra-individual variability) focusing on foods rather than nutrients.

[Omeprazole and misoprostol in acute gastroduodenal pathology. Physiopathological and therapeutic considerations in a surgical study]

In a clinical study on acute gastroduodenal pathology, the authors checked the therapeutical efficacy of Omeprazole and Misoprostol in comparison with H2-Antagonists. The study shows how Omeprazole could reduce to a half the treatment period necessary for H2-Antagonists to determine duodenal ulcer healing. Compared with these drugs, Omeprazole represents a real therapeutical progress. However, Omeprazole did not change the actual indications for surgical treatment in gastroduodenal ulcer. In drug-induced erosive gastritis treatment, Misoprostol proved to be unable to replace H2-Antagonists advantageously.

Alcohol and mortality in the Italian rural cohorts of the Seven Countries Study

The relation of alcohol consumption to mortality is examined using the data of the Italian rural cohorts of the Seven Countries Study, a prospective investigation of factors related to cardiovascular disease (CVD). The present analysis includes 1536 men aged 45-64, whose dietary habits and food consumption, including alcoholic beverages, were measured in 1965. Of them, 463 men died in a follow-up period of 15 years. The analysis shows a J-shaped relationship between alcohol consumption, expressed as percentage of total daily energy intake, and both overall mortality and cardiovascular mortality; this J-shaped relationship is evident even after adjusting for age, cigarette smoking and occupation. The inverse relationship for consumption of small quantities of alcohol, which is represented by the left side of the J-curve, is no longer significant when all men with previous cardiovascular manifestations are excluded from the analysis, yet it is never completely eliminated.

All cause mortality and its determinants in middle aged men in Finland, The Netherlands, and Italy in a 25 year follow up

STUDY OBJECTIVE

The aims were (1) to compare all cause mortality in population samples of different cultures; and (2) to cross predict fatal event by risk functions involving risk factors usually measured in cardiovascular epidemiology.

DESIGN

The study was a 25 year prospective cohort study. The prediction of all cause mortality was made using the multiple logistic equation as a function of 12 risk factors; the prediction of months lived after entry examination was made by the multiple linear regression using the same factors. POPULATION SAMPLES: There were five cohorts of men aged 40-59 years, from Finland (two cohorts, 1677 men), from The Netherlands (one cohort, 878 men), and from Italy (two cohorts, 1712 men).

SETTING

The Finnish cohorts came from geographically defined rural areas, the Dutch cohort from a small town in central Holland, and the Italian cohorts from rural villages in northern and central Italy.

MEASUREMENTS AND MAIN RESULTS

All cause mortality was highest in Finland (557 per 1000), and lower in The Netherlands (477) and in Italy (475). The solutions of the multiple logistic function showed the significant and almost universal predictive role of certain factors, with rare exceptions. These were age, blood pressure, cigarette smoking, and arm circumference (the latter with a negative relationship). Similar results were obtained when solving a multiple linear regression equation predicting the number of months lived after entry examination as a function of the same factors. The prediction of fatal events in each country, using the risk functions of the others, produced limited errors, the smallest one being -2% and the largest +11%. When solving the logistic model in the pool of all the cohorts with the addition of dummy variables for the identification of nationality, it also appeared that only a small part of the mortality differences between countries is not explained by 12 available risk factors.

CONCLUSIONS

A small set of risk factors seems to explain the intercohort differences of 25 year all cause mortality in population samples of three rather different cultures.

Twenty-year stroke mortality and prediction in twelve cohorts of the Seven Countries Study

Twelve cohorts of men aged 40-59 for a total of 8287 individuals in six countries (Finland, the Netherlands, Italy, Yugoslavia, Greece and Japan) were examined in the late 1950s or early 1960s for the measurement of some risk factors and then followed up for mortality and causes of death through 20 years. Large differences in 20-year death rates from stroke were recorded among cohorts, with the highest levels in the pool of the Yugoslavia (67 per 1000) and Japanese cohorts (62 per 1000) and the lowest in the Dutch cohort (22 per 1000). The simple linear correlation (among cohorts) of stroke mortality on mean levels at entry of some factors showed inverse significant coefficients for systolic (-0.63) diastolic (-0.51) and mean blood pressure (-0.72), and for serum cholesterol (-0.72), whereas no significant coefficients were found for mean body mass index, mean cigarette consumption and mean physical activity. The Cox model solved for six national pools of cohorts showed that only age and mean blood pressure carry significant positive coefficients, whereas all the other available factors (cigarette consumption, serum cholesterol, body mass index, physical activity) did not approach significant levels except the negative coefficients of smoking habits in Greece.

Twenty-five-year mortality from coronary heart disease and its prediction in five cohorts of middle-aged men in Finland, The Netherlands, and Italy

Five cohorts of men ages 40-59 (Finland: 2 cohorts of 1,677 men; Netherlands: 1 cohort of 878 men; Italy: 2 cohorts of 1,712 men) were examined and evaluated for cardiovascular risk factors in 1959-1960 and subsequently followed-up for mortality over the next 25 years. Age-adjusted death rates from coronary heart disease were highest in Finland (244 per 1,000), intermediate in The Netherlands (195 per 1,000), and lowest in Italy (122 per 1,000) with a twofold range between the extremes. The Cox proportional hazards model was used for single cohorts and for the pools of national cohorts with coronary heart disease deaths as endpoints and 12 risk factors as covariates. It showed the significant and almost universal predictive value of these factors (with some rare exceptions). The most highly predictive values were age, blood pressure, total serum cholesterol, cigarette smoking, and physical activity (negative relationship). The prediction of events within each country using the risk function of the others produced errors ranging from -19% to +51%. The largest errors were those involving the Italian cohorts whose experience tended to underpredict coronary heart disease mortality elsewhere and to be overpredicted by the risk functions of the other countries. Solving a Cox model which included all the cohorts, and adding dummy variables for the identification of nationality, it appears that the relative risk, everything else being equal, is 1.49 and 1.34 for a Finnish man, compared with Italian and Dutch men, respectively.

[Total parenteral nutrition in patients undergoing total gastrectomy in cancer of the stomach. A clinical study]

Total gastrectomy is the elective therapy for gastric cancer, but anastomotic dehiscences often improve the results of this surgery, performed in patients with malnutrition due to the neoplasy. The authors present a group of 27 patients treated with total gastrectomy and a routine postoperative TPN; the incidence of dehiscences and postoperative complications is very low. The preoperative evaluation of surgical risk and the choice of pre- and/or postoperative, parenteral and/or enteral nutritional therapy, are discussed.

Diet and 20-y mortality in two rural population groups of middle-aged men in Italy

The relationships between individual diet, measured in 1965 on the two Italian rural cohorts of the Seven Countries Study on Cardiovascular Disease, and subsequent mortality from all and specific causes of death in 20 y are studied. The analysis covers 1536 men aged 45-64 y at entry to the study. By using a cluster analysis technique, individuals are aggregated into four groups so that the elements within a group have a higher degree of similarity in dietary nutrients than between groups. Impressive differences in death rates between groups are found especially at the 10- and 15-y anniversaries. The relative risk between the least and the most favored group in 15-y mortality from coronary heart disease is 4.7; in 10 y the relative risk for cancer mortality is 2.9 and for liver cirrhosis approximately 4.

Seven Countries Study. First 20-year mortality data in 12 cohorts of six countries

Out of the original 16 cohorts in the Seven Countries Study on Cardiovascular Diseases, 12 population samples in six countries have reached the 20 year follow-up deadline. Data on mortality became fully available for a total of 8287 men aged 40-59 at entry examination (two cohorts in Finland, one in the Netherlands, three in Italy, two in Yugoslavia, two in Greece, and two in Japan). Death rates from CHD as well as from all causes follow the traditional falling north to south trend (18 fold between the extremes for CHD; 2.7 fold for total mortality). The differences in all causes mortality are, however, largely accounted for by the variation in CHD mortality. The mean entry levels of serum cholesterol and representative levels of the consumption of saturated fats, mono-unsaturated fats, poly-unsaturated fats and carbohydrates explain a large proportion of inter-cohort difference in CHD mortality (81% for saturated fats). By applying the proportional hazards model to the pools of national cohorts, with CHD deaths as end-point and five risk factors as covariates, only age and mean blood pressure are universally significant predictors of fatal events. Cholesterol, smoking habits, body mass index and physical activity play some part but not in all the pools. Age and mean blood pressure are also the only universal risk factors for all causes of death.

Food consumption patterns in the 1960s in seven countries

At the end of the 1950s the Seven Countries Study was designed to investigate the relations between diet and cardiovascular diseases. Sixteen cohorts were selected in Finland, Greece, Italy, Japan, The Netherlands, United States, and Yugoslavia. During the 1960s food consumption data were collected from random samples of these cohorts by use of the record method. In Finland the intake of milk, potatoes, edible fats, and sugar products was very high. A similar but lower intake pattern was observed in The Netherlands. Fruit, meat, and pastry consumption was high in the United States; cereal and alcoholic drink consumption was high in Italy; and bread consumption high in Yugoslavians except for those in Belgrade. In Greece the intake of olive oil and fruit was high and the Japanese cohorts were characterized by a high consumption of fish, rice, and soy products. These differences in food consumption patterns have lessened during the past 25 y.

Plasma vitamin E, apolipoprotein B and HDL-cholesterol in middle-aged men from southern Italy

Plasma vitamin E, HDL-cholesterol, apolipoprotein B and triglycerides were measured in an apparently healthy, male, random population sample (n = 74) from Southern Italy. Plasma vitamin E concentration was positively correlated to that of serum cholesterol, non-HDL cholesterol, triglycerides and apolipoprotein B (all P less than 0.001). The results of partial correlation analysis showed that apo B, the apolipoprotein constituent of LDL, was related to vitamin E independently of serum triglycerides, a fairly accurate marker of VLDL. On the other hand, triglycerides were related to vitamin E independently of apo B. Both correlations were much weaker if an adjustment was performed for non-HDL-cholesterol. No independent relationship was demonstrated between plasma vitamin E and HDL-cholesterol.

[Anastomotic dehiscence in colorectal surgery and the total parenteral nutrition. A clinical study]

After analysing previous investigations into the incidence of anastomotic dehiscence in colorectal surgery, the paper reports experience with a group of 27 patients treated by a "routine"-TPN after major surgery. In addition, a second group of 67 patients, treated by TPN alone after a postoperative complication, was included in this study. The results show the utility of TPN in the prevention or faster healing of anastomotic dehiscences.

Adipose tissue fatty acids and blood pressure in middle-aged men from southern Italy

Adipose tissue (AT) biopsies were performed in a random population sample of 74 clinically healthy middle-aged men (40-49 years) from southern Italy. The percentage of saturated fatty acids (FA) in AT was directly correlated with systolic (SBP) and diastolic (DBP) blood pressure (p less than 0.01). This relationship was independent of smoking habit and body weight. AT of men in the upper DBP quintile (range 90-102 mmHg) was significantly richer in palmitic acid (p less than 0.01) compared to that of men in the lowest DBP quintile. Dietary history demonstrated that the overall intake of saturated fat (% energy) was similar in the two extreme DBP quintiles. There was a relatively higher consumption of fish by those in the lowest DBP quintile (p less than 0.05). The amount of monounsaturated fat consumed (% energy) was also higher (p less than 0.05) in men with low blood pressure. Men in the upper quintile of DBP consumed more eggs (p less than 0.05).

The diet and 15-year death rate in the seven countries study

In 15 cohorts of the Seven Countries Study, comprising 11,579 men aged 40-59 years and "healthy" at entry, 2,288 died in 15 years. Death rates differed among cohorts. Differences in mean age, blood pressure, serum cholesterol, and smoking habits "explained" 46% of variance in death rate from all causes, 80% from coronary heart disease, 35% from cancer, and 45% from stroke. Death rate differences were unrelated to cohort differences in mean relative body weight, fatness, and physical activity. The cohorts differed in average diets. Death rates were related positively to average percentage of dietary energy from saturated fatty acids, negatively to dietary energy percentage from monounsaturated fatty acids, and were unrelated to dietary energy percentage from polyunsaturated fatty acids, proteins, carbohydrates, and alcohol. All death rates were negatively related to the ratio of monounsaturated to saturated fatty acids. Inclusion of that ratio with age, blood pressure, serum cholesterol, and smoking habits as independent variables accounted for 85% of variance in rates of deaths from all causes, 96% coronary heart disease, 55% cancer, and 66% stroke. Oleic acid accounted for almost all differences in monounsaturates among cohorts. All-cause and coronary heart disease death rates were low in cohorts with olive oil as the main fat. Causal relationships are not claimed but consideration of characteristics of populations as well as of individuals within populations is urged in evaluating risks.

Serum cholesterol and cancer mortality in the Seven Countries Study

In the Seven Countries Study, carried out in Finland, Greece, Italy, Japan, The Netherlands, the United States, and Yugoslavia, among 11,325 "healthy" men aged 40-59 years in 15 years, there were 594 cancer deaths. Among 477 cancer deaths five years after cholesterol measurement, there was a significant excess of lung cancer deaths in the bottom 20% of the cholesterol distributions in the populations. Age, blood pressure, smoking habits, occupation, and relative body weight did not help explain this. A U-shaped relationship between cancer and cholesterol was not seen in any population. Trend analysis with various cutting points indicated increasing risk of lung cancer death at cholesterol levels under 170 mg/dl. The 45 men dead from cancer in the first two years had lower cholesterol levels than their compatriots who died from cancer later but they did not differ in relative weight or fatness. In contrast to relationships for individuals within populations, the highest cancer death rates were in northern Europe, where the general level of cholesterol was also highest. Other characteristics of the populations--age, relative weight, smoking habits, blood pressure, physical activity, and vitamin A and ascorbic acid in the diet--did not help in the attempt to understand the regional differences in cancer mortality. There is no evidence that any of the observed cancer-serum cholesterol relationships among or within the populations involve an effect of serum cholesterol concentration on oncogenesis or cancer mortality but the possibility of such an effect cannot be denied.

[Plasma values of vitamin A and its binding proteins (retinol binding proteins and prealbumin), carotene, total cholesterol and HDL-cholesterol in subjects with breast carcinoma]

In this study plasma levels of vitamin A, carotenoids, retinol binding protein (RBP), prealbumin (PA), HDL-and total cholesterol were determined in 33 subjects with breast cancer and compared to those of a group of healthy subjects previously described. Plasma levels of vitamin A and carotene were determined by a spectrophotometric method using trifluoroacetic acid, plasma RBP and PA by single radial immunodiffusion, and HDL-and total cholesterol by enzymatic colorimetry. Mean plasma values of vitamin A, carotene and HDL-cholesterol were lower (P less than 0.01) than in the control group, the same applies to the RBP and PA mean levels (P less than 0.05). On the contrary, the mean value of total cholesterol was higher (P less than 0.01) in the patients than in the control group. Vitamin A plasma levels were significantly related to RBP and PA. No significant statistical correlation was found between clinical stage and vitamin A plasma levels.

[Plasma levels of vitamin A and its protein vectors (RBP and PA), carotene, total cholesterol and HDL-cholesterol in patients with carcinoma of the cervix]

In this study plasma levels of vitamin A, carotenoids, retinol binding protein (RBP), prealbumin (PA), HDL-and total cholesterol of 40 subjects with carcinoma of cervix uteri were determined and compared to those of the healthy female subjects described in our previous research. Plasma levels of vitamin A and carotene were determined by a spectrophotometric method using trifluoroacetic acid, plasma RBP and PA by single radial immunodiffusion, and HDL-and total cholesterol by enzymatic colorimetry. Plasma mean values of carotene, vitamin A, RBP and HDL-cholesterol were lower (P less than 0.01) than in the control group, and the same applies to the PA mean plasma level (P less than 0.05). On the contrary, total cholesterol mean value of the patients resulted to be higher (P less than 0.01) than in the control group. Vitamin A plasma levels were significantly related (P less than 0.01) to RBP and PA. No significant statistical correlation was found between the clinical stage and the histological grading and vitamin A plasma levels.

[Plasma levels of vitamin A and its protein vectors (RBP and PA), carotene, total cholesterol and cholesterol-HDL in patients with dysplasia of the uterine cervix]

In this study plasma levels of vitamin A, carotenoids, retinol binding protein (RBP), prealbumin (PA), HDL-and total cholesterol were determined in 19 female subjects with cervical dysplasia and compared to those of the healthy female subjects described in our previous research. Plasma levels of vitamin A and carotene were determined by a spectrophotometric method using trifluoroacetic acid, plasma RBP and PA by single radial immunodiffusion and HDL- and total cholesterol by enzymatic colorimetry. Plasma mean values of vitamin A and HDL-cholesterol were lower (P less than 0.05 and P less than 0.01, respectively) than in the control group. On the contrary total cholesterol was higher (P less than 0.01) in the patients than in the control group. Vitamin A plasma levels were significantly related (P less than 0.01) to RBP and PA. No significant statistical correlation was found between the severity of the dysplasia and vitamin A plasma levels.

[Plasma levels of vitamin A and its protein vectors (RBP and PA), carotene, total cholesterol and HDL-cholesterol in healthy adults of the female sex]

Plasma vitamin A, carotenoids, retinol binding protein (RBP), prealbumin (PA), HDL-and total cholesterol were examined in healthy adult females. Plasma levels of vitamin A and carotene were determined by a spectrophotometric method using trifluoroacetic acid, plasma RBP and PA by single radial immunodiffusion, and HDL-and total cholesterol by enzymatic colorimetry. Vitamin A and carotene mean values resulted as 43.0 +/- 8.2 micrograms/100 ml and 231.9 +/- 69.0 micrograms/100 ml, respectively. RBP and PA values averaged as 4.2 +/- 1.1 mg/100 ml and 29.4 +/- 6.1 mg/100 ml, respectively; whereas HDL-and total cholesterol were 179 +/- 16 mg/100 ml and 57 +/- 8 mg/100 ml. Vitamin A plasma levels were shown to be significantly related (P less than 0.01) to RBP and PA, but not to the other parameters examined (carotene, HDL-and total cholesterol).

HDL serum cholesterol and 24-year mortality of men in Finland

Examinations of 'healthy' men in Helsinki and in rural west and east Finland in 1956 included estimation of total cholesterol and that in the HDL and beta fractions separated by electrophoresis. Vital status to the end of 1980 has been ascertained for all but eight of the 526 men aged 35-61 and for all but two of 261 men aged 30-34 at entry. Among the men aged 35-61, in 24 years 155 died, 63 from coronary heart disease; among the men aged 30-34, 36 died, 16 from coronary heart disease. All causes and coronary death rates were highest in east Finland where HDL cholesterol was also highest. Coronary death rates were not related to HDL cholesterol in east or west Finland but 16 men dead from coronary heart disease in Helsinki tended to have low HDL values. Consideration of five other entry characteristics did not change the picture with regard to HDL-mortality relationships. Solution of the multiple logistic equation using all those variables found the probability of 24-year coronary death was not significantly related to HDL but was significantly related, positively, to the non-HDL cholesterol concentration. HDL and total cholesterol mean values for men of the same age in the same area of Finland, with lipoprotein separation by the new recommended methods, agree closely with the means recorded in 1956. These 24-year findings are not necessarily in conflict with reports in the literature on an inverse relationship between coronary heart disease incidence and HDL cholesterol based on much shorter periods of follow-up and few data on mortality.

The seven countries study: 2,289 deaths in 15 years

Among 11,579 men ages 40-59 without evidence of cardiovascular disease, 2,289 died in 15 years, 618 from coronary heart disease. The 15 cohorts in seven countries (four regions) differed in all-causes death rate, mainly reflecting great differences in coronary mortality. Among characteristics of entry, only mean blood pressure helped to explain cohort differences in all-causes death rate. Three-quarters of the variance in coronary death rate was accounted for by differences in mean serum cholesterol and blood pressure of the cohorts. The mortality risk for individuals was examined in each of the regions. For coronary death, age, serum cholesterol, blood pressure, and smoking were highly significant in all regions except Japan, where coronary deaths were too few for evaluation. Relative weight was not significant anywhere. Physical activity was significant only in southern Europe, where differences are associated with socioeconomic status. For all-causes death, age and blood pressure were highly significant risk factors in all regions as was smoking habit, except in Japan. Relative body weight tended to be a negative risk factor everywhere, significantly so in southern Europe. Expectations for coronary death from the experience in the United States and northern Europe greatly exceeded observed deaths in southern Europe for men of their age, serum cholesterol, blood pressure, smoking habits, physical activity, and relative weight. The reverse, prediction of coronary deaths in America and in northern Europe from the southern European experience, greatly underestimated the deaths observed. Similar cross-predictions between the United States and northern Europe were good for all-causes deaths, excellent for coronary deaths. Analysis of time trends in relationships of mortality to entry characteristics showed continued importance of age, blood pressure, and smoking and a tendency for the importance of cholesterol to fall in the last 5 years of follow-up.

Evaluation of the hypocholesterolemic effect of vegetable proteins

The hypocholesterolemic effect of dietary vegetable proteins was studied by comparing egg-white protein and fava bean protein concentrate in one normal and seven hypercholesterolemic (six type II A, one II B) persons; five completed the crossover design. To maintain stable body weight, subjects were kept on an isocaloric diet (20% protein, 48% carbohydrate (CH), 32% fat, P/S = 2) for 1 month and then hospitalized for two consecutive 18-day periods while receiving an isocaloric diet of different composition (15% protein, 50% CH, 26% fat, P/S = 2). Women were provided 50 g and men 70 g daily of egg-white or fava bean protein concentrate during the two crossover periods. Hematocrit and fasting plasma or serum were analyzed every 3 days for glucose, insulin, uric acid, creatinine, total and low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) cholesterols, and for total and VLDL triglyceride. Dietary adequacy of both proteins was evaluated by measuring plasma concentration of prealbumin, transferrin, and retinol-binding globulin. Insulin and hematocrit did not show any change, nor did any other biochemical variables show significant differences when results were compared at the end of each crossover period. Compared with baseline, fasting plasma glucose significantly decreased on the fava bean diet. Serum total and LDL cholesterol decreased during both diets but were statistically significant only on the egg-white diet. Serum HDL cholesterol significantly decreased only on the fava bean diet. Serum total and VLDL triglyceride did not show any significant change. Labile plasma protein concentration was significantly reduced only on the fava bean diet. In conclusion, the fava bean diet did not show a significant effect on lowering serum total and LDL cholesterol. Such an effect was mild but significant on the egg-white diet, compared with baseline.

Changing patterns of food consumption in Italy

Italy is perhaps unique in that data spanning more than a century are available on food consumption. During that period, the country was unified and evolved from an agricultural economy to one of an industrial society. Analysis shows that the greatest changes have occurred within the last twenty years. Excesses of fat and energy have shown up. Whereas the nutrient levels of the Italian population were formerly only borderline, today they are substantialy above energy recomendations, but fat and sugar account for much of the increase. Protein intake has remained substantially stable. Food expenditures represent more than 40 per cent of total income. Positive aspects of the Italian diet remain its richness in complex carbohydrates, fresh fruits, vegetables, olive and seed oils, with relatively low saturated fat and cholesterol. Significant North-South differences persist.

[Anthropometric nutritional status and food habits of students of the secondary schools of Umbertide (author's transl)]

A survey has been carried out on anthropometric nutritional status and food habits of students of the secondary schools of a little town of Umbria that is now in an economic development. The anthropometric data (body weight and height, skinfolds, diameters, muscle and fat areas and body mass index) show that in the girls the body fat mass is higher than in boys and american girls of the same age. The boys of professional men are fatter than the boys of workmen. The survey of food habits (using the method of frequency of occurrence for three days) shows that milk, eggs, legumes and cheese are not frequently consumed, while meat (particularly beef and veal), alcoholic beverages, animal fats and sucrose occur rather frequently in the diet. The excess of body fat mass and the biological and economic errors in the diet of these children need to be corrected with a nutrition education program. It is well recognized that both diet and physical activity play an important role in the prevention of metabolic degenerative disease and this prevention has to be started as early as possible.

[Food protein quality. III Enzymatic ultrafiltrate digest (EUD) aminoacid index (author's transl)]

An aminoacid index for protein quality evaluation is presented, using a new model of enzymatic digestion of proteins in vitro. The EUD index is obtained determining on the ultrafiltrate the available aminoacids after digestion with pepsin, trypsin, pancretin and erepsin in an Amicon ultrafiltration cell. A very high correlation is obtained between EUD index and the biological values of 10 protein or food protein samples. The experimental validity of this in vitro method allow his utilization for direct evaluation of protein quality instead of the more complicated and time consuming biological tests.

Food and nutrient consumption of two rural population groups of Italy followed for ten years

Two groups of men, 40 through 59 years old, from two rural areas of Italy (one in the north and one in the centre) were subjects of dietary surveys on three occasions over 10 years, using the individual weighing technique. Over the 10 years, changes in the consumption of some foods were observed; these were most striking in respect to cereals and legumes, which decreased, and to animal protein and fats, which increased. The decrease of energy was much greater than expected (partly explained by the current mechanization in agriculture in Italy). In one area a low intake of riboflavin was observed, but otherwise the diets could be considered to be nutritionally good. There was no correlation between some dietary variables and anthropometric and blood lipid data, as observed previously. This was probably because the population groups examined were practically homogeneous in regard to habits.