Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women's Heart and Health Study

AIMS/HYPOTHESIS

The aim of this study was to assess the associations of lung function with insulin resistance and Type 2 diabetes.

METHODS

We did a cross-sectional study of 3911 women who were 60 to 79 years old from 23 British towns, assessing the association of measures of lung function with insulin resistance (based on fasting insulin and glucose concentrations) and Type 2 diabetes (World Health Organisation diagnostic criteria).

RESULTS

Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were inversely associated with insulin resistance and prevalence of Type 2 diabetes. In age-adjusted analyses, the homeostasis model assessment (HOMA) score (insulin resistance) decreased by 5% (95% CI: 2-7%) for a one standard deviation increase in log FEV1 and by 8% (95% CI: 6-10%) for a one standard deviation increase in log FVC. With additional adjustment for height, smoking, BMI, waist-to-hip ratio, physical activity, white cell count, adult social class, childhood social class and respiratory medication, these associations attenuated to 3% (95% CI: 1 to 5%) and 5% (95% CI: 3 to 8%). The fully adjusted odds ratio for diabetes prevalence was 0.85 (95% CI: 0.74-0.98) for a one standard deviation increase in log FEV1 and 0.80 (95% CI: 0.70-0.92) for a one standard deviation increase in log FVC. Forced expiratory flow in the central period of FVC was not associated with insulin resistance or diabetes.

CONCLUSIONS/INTERPRETATION

Lung function measures which predominantly reflect lung volume are inversely associated with insulin resistance and Type 2 diabetes. These associations could reflect childhood exposures which affect lung growth and also programme insulin resistance.

Dietary restraint and the mis-reporting of anthropometric measures by middle-aged adults

OBJECTIVE

To assess whether levels of dietary restraint are associated with mis-reporting measures of adiposity by middle-aged adults.

DESIGN

Cross-sectional study of middle-aged men and women, the parents of a group of young adults followed up since birth.

METHODS

In all, 631 couples were mailed questionnaires and asked to record their height, weight and waist circumference. A paper tape measure with instructions for use was attached. Couples also completed the dietary restraint section of the Dutch Eating Behaviour Questionnaire, and provided information on employment and lifestyle habits. A subsample of participants was then invited to attend a clinic where detailed anthropometric measures were taken.

RESULTS

In all, 435 women (69%) and 332 men (55%) completed the questionnaire; of those invited, 182 (85%) women and 102 (61%) men attended a clinic session. Regression analyses showed that the dietary restraint score was associated with the mis-reporting of BMI by women (P<0.01), but not men (test for interaction with gender, P=0.11). In women, the difference between the measured and reported BMI increased by 0.36 kg/m(2) (0.11-0.61) per unit increase in restraint score. This association was independent of age, smoking, social class, slimming, exercise frequency or television viewing time, but was attenuated in models controlling for measured BMI. The dietary restraint score was not associated with mis-reporting of waist circumference in men or women.

CONCLUSIONS

Dietary restraint score may be a useful tool for identifying individuals more likely to mis-report anthropometric measurements, although associations may vary by gender.

Blood pressure and site-specific cancer mortality: evidence from the original Whitehall study

Studies relating blood pressure to cancer risk have some shortcomings and have revealed inconsistent findings. In 17 498 middle-aged London-based government employees we related systolic and diastolic blood pressure recorded at baseline examination (1967–1970) to the risk of cancer mortality risk at 13 anatomical sites 25 years later. Following adjustment for potential confounding and mediating factors, inverse associations between blood pressure and mortality due to leukaemia and cancer of the pancreas (diastolic only) were seen. Blood pressure was also positively related to cancer of the liver and rectum (diastolic only). The statistically significant blood pressure–cancer associations seen in this large-scale prospective investigation offering high power were scarce and of sufficiently small magnitude as to be attributable to chance or confounding.

Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study

AIMS

To investigate socio-economic inequalities in diabetes complications, and to examine factors that may explain these differences.

METHODS

Cross-sectional questionnaire survey of 770 individuals with diabetes among 40 general practices in Avon and Somerset. General practice, optometrist and eye hospital records over time (median 7 years) were analysed. Slope indices of inequality, odds ratios and incidence rate ratios were calculated to estimate the magnitude of inequality between the most and least educated, and the highest and lowest earning patients, adjusted for age, sex and type of diabetes, and clustering of outcomes within practices.

RESULTS

The least educated patients were more likely than the most educated patients to have diabetic retinopathy [adjusted odds ratio (OR) 4.3; 95% confidence interval 0.8, 23.7] and heart disease (adjusted OR 3.6; 1.1, 11.8), had higher HbA1c levels (adjusted slope index of inequality 0.9; 0.3, 1.5), felt that diabetes more adversely affected their social and personal lives (adjusted slope index of inequality 0.8; 0.5, 1.1 Diabetes Care Profile units), were more likely to be recorded as non-compliant by their health professionals, and had lower rates of hospital attendance (adjusted rate ratio 0.43; 0.26, 0.71). However, they did not see themselves as less compliant, and had higher general practice attendance rates (adjusted rate ratio 1.5; 1.1, 2.2).

CONCLUSIONS

Less educated and lower earning individuals with diabetes bear a larger burden of morbidity but use hospital care less. Health service resource allocation should reflect the distribution of chronic illness.

Body mass index in early and mid-adulthood, and subsequent mortality: a historical cohort study

BACKGROUND

The aim of this study was to investigate the associations between body mass index (BMI) in early and mid-adulthood, and BMI change between these ages, and mortality.

METHODS

Historical cohort study of 629 men, who had height and weight measured at the Student Health Service of the University of Glasgow in 1948-1949 (median age 22 y) and who reported their weight in a postal questionnaire in 1963-1966 (median age 38 y). The participants were followed up until April 2002 (mean follow-up: 35 y). During this time, 124 men died, 68 of cardiovascular disease (CVD) and 33 of cancer.

FINDINGS

Mean BMI increased from 21.4 kg/m(2) (standard deviation (s.d.): 2.2 kg/m(2)) in early adulthood to 24.2 kg/m(2) (s.d.: 3.0 kg/m(2)) in mid-adulthood. All-cause mortality was associated with being overweight (BMI> or =25 kg/m(2)) at age 22 but not at age 38, adjusted hazard ratio (HR): 1.85 (95% confidence interval (CI) 1.09-3.13) and 1.05 (95% CI: 0.73-1.52), respectively. BMI at age 22 y was more strongly associated with CVD mortality than was BMI at age 38 y, adjusted HR(22 y): 2.41 (95% CI: 1.26-4.60) and HR(38 y): 1.33 (95% CI: 0.82-2.16). There was no clear relationship between cancer mortality and BMI at either age: HR(22 y): 0.68 (95% CI: 0.16-2.91), HR(38 y): 0.90 (95% CI: 0.44-1.84), although relatively few men died of cancer in the follow-up period. Similar patterns were seen for obesity (BMI> or =30 kg/m(2)) as for being overweight. Analyses of weight patterns indicated particularly detrimental effects of overweight persisting from early to mid-adulthood.

CONCLUSIONS

BMI in early adulthood is positively related to CVD mortality in later life in men. The risk associated with early adulthood adiposity appeared to be greater than that in mid-adulthood. We did not demonstrate an association between weight gain and later mortality. These results reinforce the need to stem the obesity epidemic in children and young adults.

Effects of income and wealth on GHQ depression and poor self rated health in white collar women and men in the Whitehall II study

STUDY OBJECTIVE

To determine whether measures of income and wealth are associated with poor self rated health and GHQ depression.

DESIGN

Whitehall II study of London based civil servants re-interviewed between 1997-1999; 7162 participants.

MAIN RESULTS

A twofold age adjusted difference in morbidity was observed between the top and bottom of the personal income hierarchy for both sexes. For household income and particularly for wealth these associations are stronger. After adjusting for health at baseline the associations between personal income and both health outcomes are reduced by about 40%-60%. For household income the attenuation is somewhat smaller and for wealth is about 30%. Adjusting for other sociodemographic factors leads to further attenuation of the effects.

CONCLUSIONS

The associations between income, particularly personal income, and morbidity can be largely accounted for by pre-existing health and other measures of social position. The strong independent association between household wealth-a measure of income earned over decades and across generations-and morbidity are likely to be related to a set of early and current material and psychosocial benefits.

An investigation of fetal, postnatal and childhood growth with insulin-like growth factor I and binding protein 3 in adulthood

OBJECTIVE

Weight at birth and adult height are positively associated with cancer risk. These patterns may be mediated by the insulin-like growth factor (IGF) axis. We have examined whether pre- and postnatal growth patterns have a long-term influence on adult IGF-I and IGFBP-3 levels.

DESIGN

A follow-up study of a randomized controlled trial of milk supplementation in pregnancy and childhood.

SUBJECTS

A total of 951 individuals took part in a study of diet and growth in South Wales between 1972 and 1974 followed up from birth until their mid-20s.

MEASUREMENTS

Anthopometric measures at birth, postnatally up to 5 years of age and in adulthood, and serum measures of IGF-I and IGF-I to IGFBP-3 ratio at mean age of 25 years.

RESULTS

A total of 63 subjects (70%) provided blood for analysis. We found no association between birth dimensions and adult IGF-I. Subjects who exhibited 'catch-down growth' had lower IGF-I levels (P-value for trend 0.02). Adult height was positively related to IGF-I, for every one standard deviation increase in adult height, IGF-I increased by 3.75 ng/dl (95% CI 0.46-7.08, P = 0.03). Adiposity was inversely associated with the IGF-I and IGF-I to IGFBP-3 ratio and positively associated with IGFBP-3. The strength of the associations increased with age. Downward centile crossing at any time in childhood was associated with lower IGF-I whilst the highest levels were observed in subjects who were tall throughout their early life course. Adult height remained a significant predictor of IGF-I even after adjustment for earlier growth.

CONCLUSIONS

Our results indicate that IGF-I levels in early adulthood are associated with patterns of childhood growth as well as adult stature and adiposity. These associations suggest the IGFs may contribute to anthropometric associations with cancer risk.

Assessing health impact assessment: multidisciplinary and international perspectives

Health impact assessment (HIA) seeks to expand evaluation of policy and programmes in all sectors, both private and public, to include their impact on population health. While the idea that the public's health is affected by a broad array of social and economic policies is not new and dates back well over two centuries, what is new is the notion-increasingly adopted by major health institutions, such as the World Health Organisation (WHO) and the United Kingdom National Health Services (NHS)-that health should be an explicit consideration when evaluating all public policies. In this article, it is argued that while HIA has the potential to enhance recognition of societal determinants of health and of intersectoral responsibility for health, its pitfalls warrant critical attention. Greater clarity is required regarding criteria for initiating, conducting, and completing HIA, including rules pertaining to decision making, enforcement, compliance, plus paying for their conduct. Critical debate over the promise, process, and pitfalls of HIA needs to be informed by multiple disciplines and perspectives from diverse people and regions of the world.

Is maternal transmission of coronary heart disease risk stronger than paternal transmission?

OBJECTIVE

To test whether intergenerational transmission of coronary heart disease (CHD) to offspring is greater from the mother than from the father, the association between parental history of CHD and coronary mortality in male offspring was examined.

DESIGN

Prospective cohort study with 43 years of follow up.

SETTING

University of Glasgow.

PARTICIPANTS

Male students (n = 8402) aged 16-30 years when examined in 1948 to 1968.

MAIN OUTCOME MEASURE

Fatal CHD.

MAIN RESULTS

Of the 8402 men studied, 615 (7.3%) reported a history of CHD in at least one of the parents: 479 (5.8%) for fathers only, 124 (1.6%) for mothers only, and a further 12 (0.2%) for both their parents. During follow up, 373 (4.4%) men died of CHD. Parental history of disease was associated with fatal CHD and controlling for personal risk factors such as cigarette smoking, body mass index, systolic blood pressure, and father's social class did not attenuate this relation. The fully adjusted hazard ratios were 1.53 (95% confidence interval (CI) 1.08 to 2.18), 1.19 (95% CI 0.61 to 2.32), and 8.65 (95% CI 2.65 to 28.31) for father only, mother only, and both parents with CHD, respectively, compared with men whose parents did not have CHD. There was some evidence for interaction between parental histories (p = 0.049), with particularly high risk if both parents reported a history of CHD.

CONCLUSIONS

This study found no differential transmission of CHD. Paternal history of CHD was at least as important as maternal history. Data from other comparable cohorts provide no consistent evidence of differential transmission. Intergenerational transmission of CHD does not appear to have differential effects between mothers and fathers.

Breast density: agreement of measures from film and digital image

Mammographic density, in particular density from digital images, is increasingly used in breast cancer research. We investigated the concordance between density assigned by the same radiologist to a mammogram film and a digital image of the same mammogram. Two density measures were investigated, Wolfe parenchymal patterns and a six category classification (SCC) system of density. Included in the study were 78 women, 528 mammograms. Crude and weighted Kappa statistics were used to estimate agreement between the density assigned from the film and the image. Kappa for Wolfe measures was 71%, p<0.001 and for SCC measures was 54%, p<0.001. Weighted Kappa values were 79%, p<0.001 and 77%, p<0.001, respectively. There was some evidence to suggest that the digitized image may be assigned a higher Wolfe but not numerical category than the original film, and the magnitude of these differences was small. Neither age nor mammogram view (craniocaudal or mediolateral oblique) were related to the likelihood of agreement of the two density measurements. This evidence justifies the use of digital images in the visual assessment of breast density in research studies.

Psychosocial factors and public health: a suitable case for treatment?

Adverse psychosocial exposure or "misery" is associated with physical disease. This association may not be causal. Rather it may reflect issues of reverse causation, reporting bias, and confounding by aspects of the material environment typically associated with misery. A non-causal relation will not form the basis of effective public health interventions. This may be why psychosocial interventions have, so far, showed little effect on objective physical health outcomes. This paper reviews evidence for the "psychosocial hypothesis" and suggests strategies for clarifying these issues. It concludes that, although misery is clearly a bad thing as it erodes people's quality of life, there is little evidence that psychosocial factors cause physical disease. In the absence of better evidence, suggestions that psychosocial interventions are needed to improve population physical health, in both absolute and relative terms, seem premature.

Associations of adult measures of childhood growth with breast cancer: findings from the British Women's Heart and Health Study

Since the two components of adult height - leg length and trunk length - are poorly correlated with each other and appear to be influenced by different early life factors, examining their separate influence on breast cancer may provide additional insights into the mechanisms responsible for the positive association between adult height and breast cancer. In a cross-sectional study of 4286 women aged 60-79 years, in whom there were 170 cases of breast cancer, we found total height, leg length and trunk length were all modestly positively and linearly associated with breast cancer. The magnitudes of the associations of leg and trunk length were similar: fully adjusted odds ratio (95% confidence interval) of breast cancer for a one standard deviation (s.d.) increase in leg length 1.17 (0.98, 1.39) and for a 1 s.d. increase in trunk length 1.19 (0.99, 1.41). Self-reported birth weight (available on 33% of the sample) was positively and linearly associated with breast cancer: fully adjusted odds ratio of breast cancer for a 1 s.d. increase in birth weight 1.30 (0.93, 1.80). These associations were all independent of each other and other potential confounding factors and are likely to reflect different mechanisms by which factors operating prenatally and prepubertally influence breast cancer risk.

Synchrotron-based Biological Microspectroscopy: From the Mid-Infrared through the Far-Infrared Regimes

Infrared radiation from synchrotron storagerings serves as a high-brightness source fordiffraction-limited microspectroscopy inboth the mid- and far-infrared spectralranges. Mid-infrared absorption, due to localvibrational modes within complex molecules,is shown to be sensitive to small chemicalchanges associated with certain diseases.Farinfrared modes are believed to result from thefolding or twisting of larger, morecomplex molecules. The ability for thesynchrotron source to perform microscopy ata frequency of 1 THz is demonstrated.

Relation between number of siblings and adult mortality and stroke risk: 25 year follow up of men in the Collaborative study

STUDY OBJECTIVE

To investigate the relation between number of siblings, mortality risk, and stroke risk.

DESIGN

Prospective cohort study.

SETTING

27 workplaces in Scotland.

PARTICIPANTS

5765 employed men aged 35-64 from a variety of different workplaces, screened between 1970 and 1973.

MAIN RESULTS

There were strong relationships between number of siblings and socioeconomic variables and also with adult behavioural measures. Men with greater numbers of siblings had an increased risk of dying of all causes, coronary heart disease, lung cancer, stomach cancer, and respiratory disease over a 25 year follow up period. Adjustment for risk factors could explain these associations, excepting stomach cancer mortality. With the definition of stroke as either a hospital admission for stroke or death from stroke, there was a strong relation between number of siblings and haemorrhagic stroke, but not ischaemic stroke.

CONCLUSIONS

Number of siblings is strongly related to mortality risk, but as it is also related to many risk factors, adjustment for these can generally explain the relation with mortality. The exceptions are stomach cancer mortality and haemorrhagic stroke, which are known to be related to deprivation in childhood, and, in the case of stomach cancer to childhood infection.

The Scottish mental survey 1932 linked to the Midspan studies: a prospective investigation of childhood intelligence and future health

The Scottish mental survey of 1932 (SMS1932) recorded mental ability test scores for nearly all children born in 1921 and at school in Scotland on 1 June 1932. The Collaborative and Renfrew/Paisley studies, two of the Midspan studies, obtained health and social data by questionnaire and a physical examination in the 1970s. Some Midspan participants were born in 1921 and may also have taken part in the SMS1932, so there was a possibility that their mental ability data from childhood would be available. The 1921 born Midspan participants were matched with the computerized SMS1932 database, and in total, 1032 of 1251 people (82.5%) were matched successfully. Of those matched, 938 (90.9%) had a mental ability test score recorded. The mean score of the matched sample was 37.2 (standard deviation (SD) 13.9) out of a possible score of 76. The mean (SD) for the boys and girls was 38.3 (14.2) and 35.7 (13.9), respectively. This compared with 38.6 (15.7) and 37.2 (14.3) for boys and girls in all of Scotland. Graded relationships were found between mental ability in childhood, and social class and deprivation category of residence in adulthood. Being in a higher social class or in a more affluent deprivation category was associated with higher childhood mental ability scores, and the scores reduced with increasing deprivation. Future plans for the matched data include examining associations between childhood mental ability and other childhood and adult risk factors for disease in adulthood, and modelling childhood mental ability, alongside other factors available in the Midspan database, as a risk factor for specific illnesses, admission to hospital and mortality.

Observer variability in the Goseki grouping of gastric adenocarcinoma in resection and biopsy specimens

AIMS

The Goseki grouping of gastric adenocarcinoma has been suggested as a possible prognostic factor. In those centres where it is used, it may be valuable to assess the Goseki grouping of a tumour on the initial diagnostic biopsy as well as on the resection specimen since it may in theory influence management. We examined the robustness of Goseki grouping of gastric adenocarcinoma in representative sections from resection and biopsy specimens in order to assess the consistency of agreement among a group of pathologists.

METHODS

A single representative block from 100 gastric resection specimens was studied using a haematoxylin and eosin and mucin (alcian blue/periodic acid-Schiff) stain. These were circulated in batches to members of a group of 12 pathologists who each completed a simple proforma confirming the presence of carcinoma and assigning a Goseki group. In a second circulation the diagnostic biopsy specimen taken prior to resection was examined in the same way. This allowed comparison of the Goseki group of the biopsy and resection specimens.

RESULTS

In both studies kappa statistics showed good agreement on tubular differentiation of the carcinoma, but only moderate agreement for the intracellular mucin production, resulting in moderate agreement for the final Goseki group. Correlation between the Goseki group assigned on the biopsy and resected specimens was seen in 62% of the cases. However, the reproducibility was low (kappa 0.375).

CONCLUSIONS

The Goseki grouping of resected gastric adenocarcinoma is reproducible and can be used in prognostication. Goseki grouping of biopsy specimens is of limited value in predicting the Goseki group assigned to the resected carcinoma.

Trends in body mass index from 1948 to 1968: results from the Glasgow Alumni Cohort

Most published studies suggest that the rising prevalence of overweight and obesity is a recent phenomenon. We have investigated whether secular trends in body mass index (BMI) existed in the 1950s and 1960s, using data collected from young adults attending Glasgow University. Mean BMI increased from 1948 to 1968 in men, and decreased slightly in women. The proportion of men who were overweight increased, whereas that of women changed little. These data must be interpreted in light of the fact that the study participants were relatively affluent, and not representative of the whole population in terms of socioeconomic position in childhood. The increases of BMI in men evident from 1948 to 1968 suggest that recent changes in exercise and dietary patterns do not fully explain changes in body weight over time.

Fruit, vegetables, and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort

STUDY OBJECTIVE

To examine associations between food and nutrient intake, measured in childhood, and adult cancer in a cohort with over 60 years follow up.

DESIGN AND SETTING

The study is based on the Boyd Orr cohort. Intake of fruit and vegetables, energy, vitamins C and E, carotene, and retinol was assessed from seven day household food inventories carried out during a study of family diet and health in 16 rural and urban areas of England and Scotland in 1937-39.

PARTICIPANTS

4999 men and women, from largely working class backgrounds, who had been children in the households participating in the pre-war survey. Analyses are based on 3878 traced subjects with full data on diet and social circumstances.

MAIN RESULTS

Over the follow up period there were 483 incident malignant neoplasms. Increased childhood fruit intake was associated with reduced risk of incident cancer. In fully adjusted logistic regression models, odds ratios (95% confidence intervals) with increasing quartiles of fruit consumption were 1.0 (reference), 0.66 (0.48 to 0.90), 0.70 (0.51 to 0.97), 0.62 (0.43 to 0.90); p value for linear trend=0.02. The association was weaker for cancer mortality. There was no clear pattern of association between the other dietary factors and total cancer risk.

CONCLUSIONS

Childhood fruit consumption may have a long term protective effect on cancer risk in adults. Further prospective studies, with individual measures of diet are required to further elucidate these relations.

Sensory fibres expressing capsaicin receptor TRPV1 in patients with rectal hypersensitivity and faecal urgency

BACKGROUND

Faecal urgency and incontinence with rectal hypersensitivity is a distressing, unexplained disorder that is inadequately treated. We aimed to determine whether expression of the heat and capsaicin receptor vanilloid receptor 1 (TRPV1 or VR1) was changed in rectal sensory fibres, and to correlate nerve fibre density with sensory abnormalities.

METHODS

We compared full-thickness rectal biopsy samples from nine patients with physiologically characterised rectal hypersensitivity with tissue samples from 12 controls. Sensory thresholds to rectal balloon distension and heating the rectal mucosa were measured before biopsy. We assessed specimens with immunohistochemistry and image analysis using specific antibodies to TRPV1; nerve growth factor (NGF) receptor tyrosine kinase A; glial cell line-derived neurotrophic factor (GDNF); neuropeptides calcitonin gene-related peptide (CGRP) and substance P; the related vanilloid receptor-like protein (VRL) 2; glial markers S-100 and glial fibrillary acid protein (GFAP); and the nerve structural marker peripherin.

FINDINGS

In rectal hypersensitivity, nerve fibres immunoreactive to TRPV1 were increased in muscle, submucosal, and mucosal layers: in the mucosal layer, the median% area positive was 0.44 (range 0.30-0.59) in patients who were hypersensitive and 0.11 (0.00-0.21) in controls (p=0.0005). The numbers of peripherin-positive fibres also increased in the mucosal layer (hypersensitive 3.00 [1.80-6.50], controls 1.20 [0.39-2.10]: (p=0.0002). The increase in TRVP1 correlated significantly with the decrease in rectal heat (p=0.03) and the distension (p=0.02) sensory thresholds. The thresholds for heat and distension were also significantly correlated (p=0.0028). Expression of nerve fibres positive for GDNF (p=0.001) and tyrosine kinase A (p=0.002) was also increased, as were cell bodies of the submucosal ganglia immunoreactive to CGRP (p=0.0009).

INTERPRETATION

Faecal urgency and rectal hypersensitivity could result from increased numbers of polymodal sensory nerve fibres expressing TRPV1. The triggering factor or factors remain uncertain, but drugs that target nerve terminals that express this receptor, such as topical resiniferatoxin, deserve consideration.

Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan Family Study

BACKGROUND

Taller people and those with better lung function are at reduced risk of coronary heart disease (CHD). Biological mechanisms for these associations are not well understood, but both measures may be markers for early life exposures. Some studies have shown that leg length, an indicator of pre-pubertal nutritional status, is the component of height most strongly associated with CHD risk. Other studies show that height-CHD associations are greatly attenuated when lung function is controlled for. This study examines (1) the association of height and the components of height (leg length and trunk length) with CHD risk factors and (2) the relative strength of the association of height and forced expiratory volume in one second (FEV(1)) with risk factors for CHD.

SUBJECTS AND METHODS

Cross sectional analysis of data collected at detailed cardiovascular screening examinations of 1040 men and 1298 women aged 30-59 whose parents were screened in 1972-76. Subjects come from 1477 families and are members of the Midspan Family Study.

SETTING

The towns of Renfrew and Paisley in the West of Scotland.

RESULTS

Taller subjects and those with better lung function had more favourable cardiovascular risk factor profiles, associations were strongest in relation to FEV(1). Higher FEV(1) was associated with lower blood pressure, cholesterol, glucose, fibrinogen, white blood cell count, and body mass index. Similar, but generally weaker, associations were seen with height. These associations were not attenuated in models controlling for parental height. Longer leg length, but not trunk length, was associated with lower systolic and diastolic blood pressure. Longer leg length was also associated with more favourable levels of cholesterol and body mass index than trunk length.

CONCLUSIONS

These findings provide indirect evidence that measures of lung development and pre-pubertal growth act as biomarkers for childhood exposures that may modify an individual's risk of developing CHD. Genetic influences do not seem to underlie height-CHD associations.

Reduced dietary salt for prevention of cardiovascular disease

BACKGROUND

Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear.

OBJECTIVES

To assess in adults the long term effects (mortality, cardiovascular events, blood pressure, quality of life, weight, urinary sodium excretion, other nutrients and use of anti-hypertensive medications) of advice to restrict dietary sodium using all relevant randomised controlled trials.

SEARCH STRATEGY

The Cochrane Library, MEDLINE, EMBASE, bibliographies of included studies and related systematic reviews were searched for unconfounded randomised trials in healthy adults aiming to reduce sodium intake over at least 6 months. Attempts were made to trace unpublished or missed studies and authors of all included trials were contacted. There were no language restrictions.

SELECTION CRITERIA

Inclusion decisions were independently duplicated and based on the following criteria: 1) randomisation was adequate; 2) there was a usual or control diet group; 3) the intervention aimed to reduce sodium intake; 4) the intervention was not multifactorial; 5) the participants were not children, acutely ill, pregnant or institutionalised; 6) follow-up was at least 26 weeks; 7) data on any of the outcomes of interest were available.

DATA COLLECTION AND ANALYSIS

Decisions on validity and data extraction were made independently by two reviewers, disagreements were resolved by discussion or if necessary by a third reviewer. Random effects meta-analysis, sub-grouping, sensitivity analysis and meta-regression were performed.

MAIN RESULTS

Three trials in normotensives (n=2326), five in untreated hypertensives (n=387) and three in treated hypertensives (n=801) were included, with follow up from six months to seven years. The large, high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported; only 17 deaths equally distributed between intervention and control groups occurred. Systolic and diastolic blood pressures were reduced at 13 to 60 months in those given low sodium advice as compared with controls (systolic by 1.1 mm Hg, 95% CI 1.8 to 0.4, diastolic by 0.6 mm hg, 95% CI 1.5 to -0.3), as was urinary 24 hour sodium excretion (by 35.5 mmol/ 24 hours, 95% CI 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls, while maintaining similar blood pressure control.

REVIEWER'S CONCLUSIONS

Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.

Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study

OBJECTIVE

To study the impact of childhood and adulthood social circumstances on cause specific adult mortality.

DESIGN

Census data on housing conditions from 1960 and Personal Register income data for 1990 were linked to 1990-94 death registrations, and relative indices of inequality were computed for housing conditions in 1960 and for household income in 1990.

PARTICIPANTS

The 128 723 inhabitants in Oslo aged 31-50 years in 1990.

MAIN RESULTS

Adulthood mortality was strongly associated with both childhood and adulthood social circumstances among both men and women. Cardiovascular disease mortality was more strongly associated with childhood than with adulthood social circumstances, while the opposite was found for psychiatric and accidental/violent mortality. Smoking related cancer mortality was related to both adulthood and childhood social circumstances in men, but considerably more strongly to adult social circumstances.

CONCLUSIONS

Childhood social circumstances have an important influence on cardiovascular disease risk in adulthood. Current increases in child poverty that have been seen in Norway over the past two decades could herald unfavourable future trends in adult health.

Change in health inequalities among British civil servants: the Whitehall II study

STUDY OBJECTIVE

Despite an overall decline in mortality rates, the social gradient in mortality has increased over the past two decades. However, evidence on trends in morbidity and cardiovascular risk factors indicates that socioeconomic differences are static or narrowing. The objective of this study was to investigate morbidity and cardiovascular risk factor trends in white collar British civil servants.

DESIGN

Self rated health, longstanding illness, minor psychiatric morbidity (General Health Questionnaire (GHQ) 30 score, GHQ caseness and GHQ depression subscale), cholesterol, diastolic and systolic blood pressure, body mass index, alcohol over the recommended limits, and smoking were collected at baseline screening (1985-88) and twice during follow up (mean length of follow up 5.3 and 11.1 years). Employment grade gradients in these measures at each phase were compared.

SETTING

Whitehall II, prospective cohort study.

PARTICIPANTS

White collar women and men aged 35-55, employed in 20 departments at baseline screening. Analyses included 6770 participants who responded to all three phases.

RESULTS

Steep employment grade gradients were observed for most measures at second follow up. In general, there was little evidence that employment grade gradients have increased over the 11.1 years of follow up, but marked increases in the gradient were observed for GHQ score (p<0.001) and depression (p=0.05) in both sexes and for cholesterol in men (p=0.01).

CONCLUSIONS

There is little evidence of an increase in inequality for most measures of morbidity and cardiovascular risk factors in white collar civil servants over the 11.1 years to 1998. Inequalities have increased significantly for minor psychiatric morbidity in both sexes and for cholesterol in men.

Association between breast feeding and growth: the Boyd-Orr cohort study

OBJECTIVE

To investigate the association of breast feeding with height and body mass index in childhood and adulthood.

DESIGN

Historical cohort study, based on long term follow up of the Carnegie (Boyd-Orr) survey of diet and health in pre-war Britain (1937-1939).

SETTING

Sixteen urban and rural districts in Britain.

SUBJECTS

A total of 4999 children from 1352 families were surveyed in 1937-1939. Information on infant feeding and childhood anthropometry was available for 2995 subjects.

MAIN OUTCOME MEASURES

Mean differences in childhood and adult anthropometry between breast and bottle fed subjects.

RESULTS

Breast feeding was associated with the survey district, greater household income, and food expenditure, but not with number of children in the household, birth order, or social class. In childhood, breast fed subjects were significantly taller than bottle fed subjects after controlling for socioeconomic variables. The mean height difference among boys was 0.20 standard deviation (SD) (95% confidence interval (CI) 0.07 to 0.32), and among girls it was 0.14 SD (95% CI 0.02 to 0.27). Leg length, but not trunk length, was the component of height associated with breast feeding. In males, breast feeding was associated with greater adult height (difference: 0.34 SD, 95% CI 0.13 to 0.55); of the two components of height, leg length (0.26 SD, 95% CI 0.02 to 0.50) was more strongly related to breast feeding than trunk length (0.16 SD, 95% CI -0.04 to 0.35). Height and leg length differences were in the same direction but smaller among adult females. There was no association between breast feeding and body mass index in childhood or adulthood.

CONCLUSIONS

Compared with bottle fed infants, infants breast fed in the 1920s and 1930s were taller in childhood and adulthood. As stature is associated with health and life expectancy, the possible long term impact of infant feeding on adult mortality patterns merits further investigation.

A longitudinal study through adolescence to adulthood: the Young Hearts Project, Northern Ireland

The Young Hearts (YH) Project is an ongoing study of biological and behavioural risk factors for cardiovascular disease in a representative sample of young people from Northern Ireland, a region of high coronary mortality. This article describes the cross-sectional clinical, dietary and lifestyle data obtained from individuals (aged 20-25 y) who participated in phase 3 of the project (YH3). A total of 489 individuals (251 males, 238 females) participated in YH3 (48.2% response rate). Some 31.1% of participants at YH3 were overweight (BMI >25 kg/m(2)) with 4.4% of males and 8.0% of females were obese (BMI >30 kg/m(2)). More females than males had a very poor fitness (55.0 vs 22.1%, chi-squared 51.70, d.f. 1, P<0.001) and did not participate in any sporting or exercise activity (38.4 vs 24.9%, chi-squared 10.26, d.f. 1, P=0.001). Over 20% of participants had a raised total serum cholesterol (>5.2 mmol/l). More females had a raised serum LDL-cholesterol (>3.0 mmol/l) than males (44.6 vs 34.6%, chi-squared 4.39, d.f. 1, P<0.05). Over 46% of participants reported energy intakes from fat above recommended levels, and 68.5% of participants had saturated fat intakes above those recommended (Dietary reference values for food energy and nutrients for the United Kingdom. HMSO: London, 1991). Just over half of the study population reported alcohol intakes in excess of recommended sensible limits set by the Royal College of Physicians (A great and growing evil: the medical consequences of alcohol abuse. Tavistock: London, 1987), with 36.7% of males and 13.4% of females reporting intakes over twice these recommended limits. A total of 37% of the study population smoked. During young adulthood, individuals may be less amenable to attend a health-related study and recruitment of participants to the current phase of the study proved a major problem. However, these data constitute a unique developmental record from adolescence to young adulthood in a cohort from Northern Ireland and provide additional information on the impact of early life, childhood and young adulthood on the development of risk for chronic disease.

Body mass index in young adulthood and cancer mortality: a retrospective cohort study

STUDY OBJECTIVE

To examine the relation between body mass index (BMI) in young adulthood and subsequent mortality from cancer.

DESIGN

Cohort study.

SETTING

University of Glasgow student health service. Weight and height were measured by a physician, and used to calculate BMI.

PARTICIPANTS

8335 men and 2340 women who attended the student health service while at university between 1948 and 1968, and who were followed up with the NHS central register.

MAIN RESULTS

The main outcome measure was cancer mortality. Three hundred and thirty nine men and 82 women died of cancer during the follow up (mean 41 years). BMI was associated with mortality from all cancers in men and women, although it did not reach conventional statistical significance. The adjusted hazard ratio (HR) (95% CI) per 5 kg/m(2), was 1.22 (0.97 to 1.53) in men and 1.43 (0.95 to 2.16) in women. Two hundred men and 61 women died from cancers not related to smoking. The adjusted HR for mortality from these were 1.36 (1.02 to 1.82) and 1.80 (1.13 to 2.86) respectively. These results are adjusted for height, number of siblings, pulse rate, year of birth, age, smoking, birth order, number of siblings, and age at menarche in women. Site specific analyses, comparing the highest with the lowest quartile of the BMI distribution found increased risks of prostate cancer (n=28) and breast cancer among heavier subjects. No association between BMI and colorectal cancer was found.

CONCLUSIONS

BMI in adolescence has lasting implications for risk of cancer mortality in later life. Future research will include measures of BMI throughout the lifecourse, to determine the period of greatest risk of obesity, in terms of cancer mortality.

Secular changes in blood pressure in childhood, adolescence and young adulthood: systematic review of trends from 1948 to 1998

One plausible reason for the decline in cardiovascular disease (CVD), and in particular stroke, in the last century is population reductions in blood pressure. Blood pressure tracks from childhood into adulthood, and early-life blood pressure is associated with increased cardiovascular risk but few studies have reported on blood pressure trends among young individuals who are free of CVD and not taking antihypertensive medication. Knowledge of such trends may improve understanding of the causes of hypertension and enhance prevention. We report that declines in blood pressure have been taking place in high-income countries in 5 to 34-year-olds of both sexes and from a range of ethnic groups for at least the last 50 years, indicating that exposures acting in early life are important determinants of blood pressure. Possible explanations for these favourable trends include improvements in early-life diet and there is also intriguing evidence suggesting that blood pressure may be programmed by sodium intake in infancy. Occurring throughout the blood pressure distribution, these trends may have made important contributions to declining CVD rates. There may therefore be scope for intervening in early life to prevent high blood pressure in adulthood, and the downward trends reported in several recent studies suggest that the prevalence of adult hypertension and cardiovascular risk will continue to decline. However, persisting high rates of CVD in the developed world, the impending CVD epidemic in developing countries, along with increasing childhood obesity, and the possibility that favourable blood pressure trends may be plateauing point to the need for enhanced measures to control blood pressure, and for further research to improve understanding of its determinants.

Gender differences in self-reported minor mental disorder and its association with suicide. A 20-year follow-up of the Renfrew and Paisley cohort

BACKGROUND

Suicide rates are around three times higher in men than women; in contrast women have a higher prevalence of community-diagnosed depression. To investigate this paradox we examined the association of General Health Questionnaire (GHQ)-caseness (score > or = 4), a measure of possible minor mental disorder, with suicide risk in a general population cohort.

METHODS

Data were derived from a cohort study based on the 8,466 men and women in the Renfrew and Paisley cohort who completed a 30-item GHQ in the period from 1972 to 1976 and who were followed up to 1995 for all-cause and suicide mortality.

RESULTS

The long-term suicide risk associated with possible minor mental disorder was higher in men [hazard ratio 6.78 (1.36-33.71)] than women [hazard ratio 1.66 (0.43-6.45)]; test for interaction between gender and GHQ with respect to suicide risk: p = 0.09.

CONCLUSION

These findings indicate either that the long-term risk of suicide in the context of a past episode of minor mental disorder is higher in males than females or that there are sex differences in the validity of responses to mental health screening questionnaires. Further research is required to replicate our finding in larger studies and, if confirmed, clarify which explanation underlies it.

Socio-economic position and cardiovascular risk factors in an Italian rural population

Cardiovascular disease (CVD) is the leading industrial world cause of mortality. Lower social class groups have higher incidence of CVD and also display less favourable risk factor profiles. To investigate the association and gradient between major cardiovascular risk factors (smoking habit, serum lipid profile, blood pressure, relative body weight) and socio-economic position (proxy measures selected: education and occupation) data on 2592 men and 2866 women were analysed. The effect of potential confounding factors and effect modifiers was estimated. Linear and logistic regression modelling was performed for continuous and dichotomous outcomes respectively. The lower the grade of employment or the level of education, the higher was the prevalence of obesity in the study population. The association was stronger in women than in men. Higher education was associated with a lower prevalence of smoking among men and a higher prevalence among women. Systolic blood pressure was negatively related to socio-economic position in both men and women in the age-adjusted models. Attention should be concentrated on socio-economic differences in obesity and blood pressure in this population.

Inflammatory bowel disease: developing a short disease specific scale to measure health related quality of life

AIM

To report on the preliminary development of a short scale, the Edinburgh inflammatory bowel disease questionnaire (EIBDQ) to measure disease specific aspects of inflammatory bowel disease (IBD) in terms of both physical impact and health related quality of life (HRQoL) consequences.

METHODS

A survey of individuals with Crohn's disease (n=50), ulcerative colitis (n=50) and psoriatic arthritis (n=28) was carried out using the EIBDQ. The data were subject to factor analysis in order to investigate underlying dimension of the EIBDQ which were then analysed for internal consistency. Data for disease specific aspects of the EIBDQ were compared between IBD patients and psoriatic arthritis patients using contingency tables and the underlying dimension of the EIBDQ were correlated with measures of quality of life and psychological morbidity and a disease specific measure.

RESULTS

There are three underlying dimensions to the EIBDQ: a disease specific factor, a bowel specific factor and an information factor. The disease specific factor and the bowel specific factor are internally consistent and correlate with other measures of disease activity, quality of life and psychological morbidity. The EIBDQ is able to discriminate between IBD and another inflammatory disease: psoriatic arthritis.

CONCLUSION

The EIBDQ is a reliable and valid instrument for measuring disease specific aspects of IBD but further development is required.

Physical activity and cause-specific mortality in men: further evidence from the Whitehall study

Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings. Some are hampered by low statistical power, owing to a low number of events, and a failure to adjust for potential confounding variables. The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospective cohort study of 11,663 men aged 40-64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969. During 25 years of follow-up there were 4672 deaths. Travel activity was inversely related to mortality attributable to all-causes, coronary heart disease, respiratory disease and lung cancer, whereas the association with stroke was positive. There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables. Our simplistic measure of physical activity may, in part, explain the weak associations seen.

The association between components of adult height and Type II diabetes and insulin resistance: British Women's Heart and Health Study

AIMS/HYPOTHESIS

The aim of this study was to investigate the associations between components of adult height (leg length, trunk length, ratio of leg to trunk length) and Type II (non-insulin-dependent) diabetes mellitus and insulin resistance.

METHODS

A cross sectional study was carried out on 4286 women of age 60 to 79 years from 23 towns across England, Scotland and Wales.

RESULTS

Total height was weakly and inversely associated with diabetes but this masked differences in the association with leg and trunk length. Leg length was inversely associated with Type II diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (4.3 cm) increase in leg length: 0.81 (0.73, 0.90)] whereas trunk length was not associated with diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (3.6 cm) increase in trunk length: 1.05 (0.94, 1.18)]. Adjustment for potential confounding factors attenuated but did not remove the inverse association between leg length and the prevalence of diabetes: fully adjusted odds ratio (95% CI) per standard deviation increase in leg length was 0.87 (0.77, 0.98) and that per standard deviation increase in the ratio of leg to trunk length was 0.88 (0.78, 0.99). In non-diabetic women leg length was inversely associated with insulin resistance, whereas trunk length was positively associated with insulin resistance.

CONCLUSION/INTERPRETATION

Leg length is an indicator of early childhood environmental circumstances, in particular of infant nutrition. These results suggest that poor infant nutrition is an important causal factor in the development of Type II diabetes and insulin resistance in later life.

TRPV3 is a temperature-sensitive vanilloid receptor-like protein

Vanilloid receptor-1 (VR1, also known as TRPV1) is a thermosensitive, nonselective cation channel that is expressed by capsaicin-sensitive sensory afferents and is activated by noxious heat, acidic pH and the alkaloid irritant capsaicin. Although VR1 gene disruption results in a loss of capsaicin responses, it has minimal effects on thermal nociception. This and other experiments--such as those showing the existence of capsaicin-insensitive heat sensors in sensory neurons--suggest the existence of thermosensitive receptors distinct from VR1. Here we identify a member of the vanilloid receptor/TRP gene family, vanilloid receptor-like protein 3 (VRL3, also known as TRPV3), which is heat-sensitive but capsaicin-insensitive. VRL3 is coded for by a 2,370-base-pair open reading frame, transcribed from a gene adjacent to VR1, and is structurally homologous to VR1. VRL3 responds to noxious heat with a threshold of about 39 degrees C and is co-expressed in dorsal root ganglion neurons with VR1. Furthermore, when heterologously expressed, VRL3 is able to associate with VR1 and may modulate its responses. Hence, not only is VRL3 a thermosensitive ion channel but it may represent an additional vanilloid receptor subunit involved in the formation of heteromeric vanilloid receptor channels.

Physical activity and cause-specific mortality in men with Type 2 diabetes/impaired glucose tolerance: evidence from the Whitehall study

AIMS

Given that studies of individuals with Type 2 diabetes or impaired glucose tolerance indicate that physical activity has a normalizing effect on several indices of coronary heart disease (CHD) risk-including body weight, blood pressure, blood lipids, and cardiorespiratory fitness-it is plausible that activity may reduce CHD incidence in this group in the long term. The aim of the present analysis was to explore this hypothesis using data from a prospective observational study.

METHODS

We examined the relation of two indices of physical activity-walking pace and leisure activity-to total mortality, CHD, and other cardiovascular diseases in a 25-year follow-up of 6408 male British Civil Servants who underwent an oral glucose tolerance test at study entry.

RESULTS

In 352 men who were identified as having Type 2 diabetes or impaired glucose tolerance (diabetes/IGT) at baseline, 215 had died at follow-up and, in 6056 normoglycaemics, 2550 deaths had occurred. The two indices of physical activity were inversely related to all-cause, CHD, and other cardiovascular disease mortality in both normoglycaemics and in men with diabetes/IGT. Although these associations were attenuated somewhat after statistical adjustment for a range of covariates, the majority held, suggesting an independent effect for physical activity. The gradient of the activity-mortality association was steeper in individuals with diabetes/IGT in comparison with the normoglycaemics, with the linear trend across activity levels for CHD risk differing markedly in the analyses of both walking pace (P-value for interaction test = 0.05) and leisure activity (P-value = 0.02).

CONCLUSIONS

The findings of the present analysis of men with Type 2 diabetes/IGT provide support for those from a small number of other studies of persons with Type 2 diabetes suggesting that this group may benefit from physical activity in terms of CHD risk reduction.

The long-term effect of dietary advice in men with coronary disease: follow-up of the Diet and Reinfarction trial (DART)

OBJECTIVE

To assess the long-term effect of dietary advice on diet and mortality after a randomised trial of men with a recent history of myocardial infarction.

DESIGN

Questionnaire survey and mortality follow-up after a trial of dietary advice.

SETTING

Twenty-one hospitals in south Wales and south-west England.

SUBJECTS

Former participants in the Diet and Reinfarction Trial.

MAIN OUTCOME MEASURES

Current fish intake and cereal fibre intake. All-cause mortality, stroke mortality and coronary mortality.

RESULTS

By February 2000, after 21147 person years of follow-up, 1083 (53%) of the men had died. Completed questionnaires were obtained from 879 (85%) of the 1030 men alive at the beginning of 1999. Relative increases in fish and fibre intake were still present at 10 y but were much smaller. The early reduction in all-cause mortality observed in those given fish advice (unadjusted hazard 0.70 (95% CI 0.54, 0.92)) was followed by an increased risk over the next 3 y (unadjusted hazard 1.31 (95% CI 1.01, 1.70). Fat and fibre advice had no clear effect on coronary or all-cause mortality. The risk of stroke death was increased in the fat advice group-the overall unadjusted hazard was 2.03 (95% CI 1.14, 3.63).

CONCLUSIONS

In this follow-up of a trial of intensive dietary advice following myocardial infarction we did not observe any substantial long-term survival benefit. Further trials of fish and fibre advice are feasible and necessary to clarify the role of these foods in coronary disease.

Alverine citrate fails to relieve the symptoms of irritable bowel syndrome: results of a double-blind, randomized, placebo-controlled trial

BACKGROUND

Alverine citrate has been used in the treatment of irritable bowel syndrome for many years.

AIMS

To compare the efficacy and safety of a new formulation of alverine citrate, a 120-mg capsule, with placebo given three times daily for 12 weeks.

METHODS

One hundred and seven patients with irritable bowel syndrome were entered into this three-centre, double-blind, randomized, placebo-controlled, parallel group trial. The primary end-point was relief of abdominal pain indicated by improvement in the scores for severity and frequency. Secondary efficacy variables included scores for other clinical symptoms and for overall well-being.

RESULTS

The severity and frequency of abdominal pain improved in 66% and 68% of patients treated with alverine citrate vs. 58% and 69% of the placebo group, but these differences were not significant. The mean percentage reduction in the scores for abdominal pain from baseline to the final assessment, although greater in the alverine citrate group (43.7%) compared with the placebo group (33.3%), was not statistically significant.

CONCLUSIONS

Alverine citrate is no better than placebo at relieving the symptoms of irritable bowel syndrome. Future trials should be designed to take into account the high and persistent placebo response seen in this condition.

Ethanol elicits and potentiates nociceptor responses via the vanilloid receptor-1

The vanilloid receptor-1 (VR1) is a heat-gated ion channel that is responsible for the burning sensation elicited by capsaicin. A similar sensation is reported by patients with esophagitis when they consume alcoholic beverages or are administered alcohol by injection as a medical treatment. We report here that ethanol activates primary sensory neurons, resulting in neuropeptide release or plasma extravasation in the esophagus, spinal cord or skin. Sensory neurons from trigeminal or dorsal root ganglia as well as VR1-expressing HEK293 cells responded to ethanol in a concentration-dependent and capsazepine-sensitive fashion. Ethanol potentiated the response of VR1 to capsaicin, protons and heat and lowered the threshold for heat activation of VR1 from approximately 42 degrees C to approximately 34 degrees C. This provides a likely mechanistic explanation for the ethanol-induced sensory responses that occur at body temperature and for the sensitivity of inflamed tissues to ethanol, such as might be found in esophagitis, neuralgia or wounds.

Relationship between physical activity and bone mineral status in young adults: the Northern Ireland Young Hearts Project

Physical activity during the first three decades of life may increase peak bone mass and reduce future osteoporosis risk. The aim of this study was to determine the extent to which different components of physical activity may influence bone mineral status within a representative population sample of young men and women. Bone mineral density (BMD) and content (BMC) were determined at the lumbar spine and femoral neck in 242 men and 212 women, aged 20-25 years, by dual-energy X-ray absorptiometry. Physical activity was assessed by a self-report questionnaire designed to measure the frequency and duration of physical activity and its components (i.e., work, non-sports leisure, sports-related activities, and peak strain sports activities). Potential confounding factors such as height, weight, diet, and smoking habits were also assessed. In multivariate linear regression models, sports activity and peak strain sports activity undertaken by men were strongly associated with both lumbar spine BMD (beta = 0.35 [0.21, 0.49] and beta = 0.31 [0.17, 0.44], respectively) and BMC (beta = 0.33 [0.21, 0.45] and beta = 0.26 [0.14, 0.38], respectively) and femoral neck BMD (beta = 0.35 [0.21, 0.48] and beta = 0.27 [0.14, 0.40], respectively) and BMC (beta = 0.32 [0.19, 0.44] and beta = 0.29 [0.17, 0.41], respectively) (all p < 0.01), but work and non-sports leisure activities were not. In women, there were no associations between bone measurements and any component of physical activity. In models involving all subjects the gender/sports activity, but not the gender/peak strain, interaction term was statistically significant. Sports activity explained 10.4% of the observed variance in lumbar spine BMD in men, but <1% in women. These results demonstrate the importance of sports activities, especially those involving high peak strain, in determining peak bone status in young men. Failure to observe this association in women reflects their lower participation in such activities, but they may have the same capacity to benefit from these activities as men. Intervention studies are warranted to determine whether peak bone density in women can be improved by participating, during childhood and adolescence, in sports activities involving high peak strain.