Physical activity, but not dietary intake, attenuates the effect of the FTO rs9939609 polymorphism on obesity and metabolic syndrome in Lithuanian adult population

OBJECTIVES

This study aimed to examine the associations between the fat mass and obesity associated (FTO) gene rs9939609 variant with obesity and metabolic syndrome and interactions between FTO alleles, dietary intake and physical activity in Lithuanian adult population.

STUDY DESIGN

Cross-sectional study.

METHODS

A health survey was carried out in randomly selected municipalities of Lithuania. The random sample was obtained from the lists of 25-64 year-old inhabitants. The data from 1020 individuals were analyzed. The single-nucleotide polymorphism, rs9939609, in the FTO gene was assessed using a real-time polymerase chain reaction. 24-hour recall was used for evaluation of dietary habits. Information on physical activity at work, traveling to and from work and at leisure time was gathered by a standard questionnaire.

RESULTS

The carriers of the AA genotype had the highest mean values of body mass index (BMI) and waist circumference (WC). They had 1.72 time higher odds of obesity (P = 0.009) and 1.67 time higher odds of increased WC (P = 0.013) than those with the TT genotype. Carriers of the T allele had lower prevalence of metabolic syndrome compared to carriers of the AA genotype (33.8% and 42.5% respectively; P = 0.018). No interaction between the rs9939609 variant and energy or dietary intakes on weight status was found. Significant effect of the interactions 'genotype×age' and 'genotype×physical activity' on BMI was demonstrated. The FTO rs9939609 polymorphism was associated with anthropometric parameters and metabolic syndrome in the younger age group (25-44 years) and in individuals having low level of physical activity.

CONCLUSIONS

Age and physical activity modulated the effect of the FTO polymorphism on weight status and metabolic syndrome in Lithuanian adult population.

[Dietary patterns and their association with lifestyle factors in Lithuanian adult population]

The aim of this study was to determine the association between dietary patterns and others lifestyle factors. In 1998-2004, four cross-sectional surveys were carried out within the FINBALT HEALTH MONITOR project. For every survey, a random sample of 3000 Lithuanians, aged 20-64 years, was taken from the National Population Register. The response rates varied from 61.7% to 74.4%. The study material was collected by mailed questionnaires. The 20 food groups were included into food frequency questionnaire. Factor analysis was employed in order to reduce the number of food items. Four main factors were identified: "Light food," "Sweets," "Heavy food," and "Cereals." They accounted for 46% of total variance in food intake in men and women. The associations between dietary patterns and lifestyle factors were examined by applying logistic regression analysis. Nonsmokers, physical active people, wine drinkers, and men consuming beer were more likely to follow the "Light food" pattern (consumption of fresh vegetables, fruits, chicken, and fish). People having positive values of the "Cereals" pattern smoked and drank alcohol less often and were more physical active than those with negative values of the factor. "Heavy food" factor was associated with daily smoking and drinking of strong alcohol in men and drinking of beer in women. The consumers of strong alcohol and people less physically active in leisure time were more likely to follow "Sweets" pattern. CONCLUSIONS. Nutrition habits were related to lifestyle factors. Men and women who followed the "Cereals" pattern have the healthiest lifestyle.

Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries

BACKGROUND

Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups.

METHODS

Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS).

RESULTS

Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban.

CONCLUSION

Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Risk factors for noncommunicable diseases in Lithuanian rural population: CINDI survey 2007

The aim of the study was to assess the risk profile for noncommunicable diseases in Lithuanian rural population.

MATERIAL AND METHODS

Within CINDI program, the risk factor survey was carried out in five rural regions of Lithuania in random sample of population aged 25-64 years in 2007. The risk factors were defined according to the WHO criteria. A total of 1739 participants were enrolled in the study.

RESULTS

The prevalence of hypertension was considerably higher among men than among women (60.3% and 44.6%, respectively). Hypercholesterolemia was identified in half of examined persons with no gender difference. The proportion of obese female persons was greater than male. Metabolic syndrome was diagnosed in 15.1% of men and in 21.5% of women. The significant gender difference was observed in the prevalence of regular smoking (47.5% in men and 18.1% in women) as well as risky alcohol consumption (26.7% of men and 3.1% of women). The majority of rural population was lacking leisure-time physical activity. The prevalence of hypertension, hypercholesterolemia, obesity, and metabolic syndrome was increasing with age in both men and women. Regular smoking and risky alcohol consumption were more common among younger than older population. Leisure-time physical activity tended to increase with age.

CONCLUSIONS

The prevalence of risk factors for noncommunicable diseases in Lithuanian rural population is high. The obtained data prove that comprehensive and intersectorial preventive actions aimed at the reduction in the risk of noncommunicable diseases are urgently needed in Lithuania.

Matrix metalloproteinase-3 gene polymorphism and dilatative pathology of ascending thoracic aorta

Matrix metalloproteinase-3 (MMP-3) degrades extracellular matrix and may lead to development of dilatative pathology of ascending thoracic aorta. Expression of MMP-3 depends upon the 5A/6A polymorphism in the promoter region. An increased number of 5A alleles leads to high expression of MMP-3. Thus, objective of the study was to determine whether the 5A/6A polymorphism in the promoter region of MMP-3 gene is associated with the development of dilatative pathology of ascending thoracic aorta. We studied 76 patients (age ranged from 31 to 81 years; median age, 64 years) who underwent aortic reconstruction surgery due to dilatative pathology of ascending thoracic aorta and a random sample of the population (n=604) aged 25-64 years, all from Lithuania. DNA was analyzed by using real-time polymerase chain reaction to genotype polymorphism 5A/6A at a position -1171 of the MMP3 gene promoter. The prevalence of MMP-3 genotypes was similar in the group of dilatative pathology of ascending thoracic aorta and random sample of population. The frequency of 5A allele did not differ significantly between both groups and was 0.506 and 0.514, respectively. Male carriers of 5A/5A genotype were significantly younger compared with those with the 6A/6A genotype. In conclusion, the frequency of MMP-3 promoter 5A/6A genotypes did not differ between the group of patients with dilatative pathology of ascending thoracic aorta and the random sample of population, but the males with dilatative pathology of ascending thoracic aorta and 5A/5A genotype required aortic reconstruction surgery at the younger age than the males carrying 6A/6A genotype in the MMP-3 promoter region.

Dietary patterns and their association with sociodemographic factors in Lithuanian adult population

SUMMARY

The aim of the study was to determine the association between dietary patterns and sociodemographic factors using the data of Lithuanian health behavior monitoring.

MATERIAL AND METHODS

In 1998-2004, four cross-sectional surveys were carried out within the Finbalt Health Monitor project. For every survey, a random sample of 3000 Lithuanians aged 20-64 years was taken from the National Population Register by mailed questionnaires. The response rates varied from 61.7% to 74.4%. Factor analysis was employed in order to reduce the number of food items. Four main factors were defined: "light food," "sweets," "heavy food," and "cereals" factors. The associations between dietary patterns and sociodemographic factors were examined by applying a logistic regression analysis.

RESULTS

Four major factors accounted for 45.9% of the total variance in food intake in men and 46.5% in women. The "sweets" factor was inversely associated with age both in men and women. A strong positive association was found between age and the "cereals" factor. Men and women with a higher level of education were more likely to follow "light food" and "sweets" pattern and less likely "heavy food" if compared with people with a lower level of education. The odds of consuming "light food" were higher in cities than in rural areas. Married men and women were more likely to follow "heavy food" pattern compared to unmarried.

CONCLUSION

This study identified four main dietary patterns in Lithuanian population. Dietary patterns of people with a higher level of education and inhabitants of cities are closer to the recommendations on healthy nutrition.

[The prevalence of metabolic syndrome in middle-aged in Kaunas population]

AIM

To assess the prevalence of the metabolic syndrome among middle-aged Kaunas population.

MATERIAL AND METHODS

A total of 433 (192 males and 241 females, mean age 38.8+/-0.3 years) asymptomatic individuals have been investigated. Metabolic syndrome was diagnosed using International Diabetes Federation definition criteria - central obesity (the waist circumference > or =94 cm for men and > or =80 cm for women) plus any two of the following four factors: elevated triglycerides (Tg) (> or =1.7 mmol/L), low high-density lipoprotein cholesterol (HDL-C) levels (<1.0 mmol/L for men and <1.3 mmol/L for women), blood pressure (BP) of 130/85 or higher (systolic pressure >130 mmHg or a diastolic pressure >85 mmHg) or hyperglycemia (> or =5.6 mmol/L).

RESULTS

The metabolic syndrome was present in 21.7% (28.1% among males and 16.6% among females) of individuals. Furthermore, 41.1% had an increased waist circumference, 56.4% had elevated BP (130/85 or higher), 31.2% had elevated plasma glucose concentration, 19.9% had low HDL-C cholesterol values and 14.1% had increased Tg values. Significantly higher concentration (1.16 mg/L, alpha<0,001, beta<0.001) of high-sensitivity C-reactive protein has been established in individuals with the metabolic syndrome. An increased concentration (>3 mg/L) of high-sensitivity C-reactive protein was more prevalent (17.3%) in the cohort with metabolic syndrome. Concentration of high-sensitivity C-reactive protein directly correlated with the waist and hips circumference, body mass index, concentration of Tg, glucose and BP.

CONCLUSIONS

The prevalence of the metabolic syndrome among middle-aged Kaunas residents was 22%. Metabolic syndrome and central obesity correlated with elevated concentration of high-sensitivity C-reactive protein. Moderately (1-3 mg/L) and severely (>3 mg/L) elevated high-sensitivity C-reactive protein levels increase the chance of metabolic syndrome by 4.15 and 7.39 times, respectively (p=0,000). An innovative approach towards cardiovascular risk assessment integrating traditional cardiovascular risk factors, metabolic syndrome and high-sensitivity C-reactive protein values could improve the risk stratification in asymptomatic middle-aged population.

Changes in health behavior of Lithuanian adolescents and adults over 1994-2002

The aim of the study was to investigate the time trends in health behavior during the period 1994-2002 in Lithuanian schoolchildren and adult population. The data on smoking, alcohol drinking, consumption of fresh vegetables and fruits, physical activity habits are presented in the article. The study material was collected in 1994, 1998 and 2002 within the framework of two international projects: Health Behavior in School-aged children coordinated by WHO and Finbalt Health Monitor assessing health behavior among adults in Finland and Baltic countries. The data of our study showed that since 1994 prevalence of smoking substantially increased among Lithuanian teenagers aged 11-15 years and adult women. The increase in alcohol consumption was recorded in schoolchildren as well as in adult population. The adults started eating fresh vegetables and fruits more frequently while the usage of fresh fruits among teenagers declined. In 2002 70% of schoolboys and 45% of schoolgirls were physically active. There were no changes in physical activity among teenagers over the period of the study. The proportion of physically active persons in adult population has increased since 1994.

CONCLUSION

The health behavior is unhealthy in large proportion of Lithuanian teenagers and adults. The negative trends in health behavior especially among teenagers may increase the risk of noncommunicable diseases in Lithuanian population. Therefore the elaboration and implementation of effective health promotion programs, which should start in early childhood and would be adopted to the needs of different age groups, is urgently needed.

Health inequalities in Lithuania: education and nutrition habits

The aim of the study was to evaluate the associations between food behavior and educational level among Lithuanian adult population. Five health behavior surveys were carried out within the international Finbalt Health Monitor project in 1994-2002. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering sociodemographic characteristics and some nutrition habits. The respondents were categorized according to the level of education into three groups: persons having incomplete secondary, secondary and university education. Multiple regression analysis was used for evaluation of associations between level of education and nutrition habits. The persons with university education have a healthier diet than those with incomplete secondary education. The consumption of fish, vegetables and fruit, use of vegetable oil for cooking, was substantially higher in those with university education as compared to persons with incomplete secondary education. The proportion of persons drinking whole milk was the highest among the low educated men and women. The high-educated women consumed meat less often than those with incomplete secondary education did. However, persons with university education preferred butter on bread. The high-educated men consumed cheese daily more often than those with low education. The positive trends in nutrition habits of Lithuanians were observed between 1994 and 2002. However, educational differences in nutrition habits still remain significant. In conclusion, alongside with other health interventions, the programs aimed at reducing inequalities in health should consider the educational differences in nutrition habits of Lithuanians paying more attention to less educated persons.

Prevalence of dyslipidemias among Lithuanian rural population (CINDI program)

The aim of this study is to describe trends in serum total, low and high density lipoprotein cholesterol, triglycerides and nutrition habits in Lithuanian rural population between 1987 and 1999. The article presents the data of three screenings of random samples of the population aged 25-64 of five Lithuanian rural regions. Since 1987 the prevalence of hypercholesterolemia has decreased. The greatest decrease was observed in the proportion of persons with elevated level of low-density lipoprotein cholesterol. The prevalence of low level of high-density lipoprotein cholesterol decreased more significantly among women compared to men. The most remarkable changes in the prevalence of dyslipidemias were observed between 1993 and 1999. The increasing age was strongly correlated with higher prevalence of hypercholesterolemia in both genders. The prevalence of hypercholesterolemia was higher among men with higher education, overweight, hypertension and smokers than among those with low education, normal weight, normal level of blood pressure and nonsmokers. In women hypercholesterolemia was associated only with hypertension. The nutrition habits of Lithuanian rural population have changed, especially over the last five years. The consumption of animal fat has decreased and the usage of vegetable oil and margarine has increased. Women increased consumption of vegetables and fruits. The strengthening of favorable trends in nutrition habits in Lithuanian population should be one of the most important strategies in the implementation of cardiovascular disease prevention programs.

The prevalence of overweight and obesity in relation to social and behavioral factors (Lithuanian health behavior monitoring)

The aim of the study is to estimate the trends in the prevalence of overweight and obesity among Lithuanian adult population and to examine the association of social and health behavior factors with overweight and obesity. Since 1994 five cross-sectional surveys have been conducted among adult population aged 20-64 within the international FINBALT HEALTH MONITOR project. An independent national random sample of 3000 inhabitants of Lithuania was drawn from National Population Register for each survey. The data were collected through mailed questionnaires (covering sociodemographic characteristics, health behaviors, and self-reported height and weight). Overweight was defined as BMI>25 kg/m ( 2 ) and obesity - as BMI>30 kg/m ( 2 ). In 2002 the overall prevalence of obesity was 16% and the prevalence of overweight - 49.1%. Since 1994 both indicators have increased in men while in women the prevalence of overweight has decreased. The prevalence of obesity and overweight increased with age. Obesity and overweight were least prevalent among the highly educated women, but most prevalent among the highly educated men. Women living in cities were less obese and overweight than those living in towns and villages. Obesity and overweight were less prevalent among daily smokers and physically active persons. Women drinking beer at least once a week were less obese and overweight than those who consumed beer more rarely. There was no consistent association between nutrition habits and the prevalence of obesity and overweight. The National obesity control program aimed at promotion of healthy nutrition and physical activity should be elaborated in order to decrease the prevalence of obesity and overweight in Lithuanian population.

[Trends in the prevalence of risk factors of noncommunicable diseases during 1987-1999]

The trends in the prevalence of hypertension, hypercholesterolemia, overweight and smoking among Lithuanian rural population were assessed from 1987 to 1999. Three independent surveys in 1987, 1993 and 1999 were carried out in five rural regions of Lithuania in random samples of men and women aged 25-64 involving 2695, 1550 and 1838 persons respectively. The risk factors were defined according to the WHO criteria. During the 13 years the prevalence of hypercholesterolemia and overweight has significantly decreased among men (by 23.2% and 4.9% respectively) as well as among women (by 19.9% and 10.7% respectively). The prevalence of hypertension among women has decreased by 9.1%, with no significant changes among men. The prevalence of smoking has increased by 8.9% among women and has not changed among men. Age was positively correlated with the prevalence of all risk factors, except smoking. Younger persons smoked more often than elderly did. Prevalence of risk factors varied by educational level. Hypertension and overweight have been more prevalent among women with incomplete secondary education, than among those with university education. The prevalence of overweight and hypercholesterolaemia has been higher among highly educated men compared to low educated. The inverse relationship between smoking and education has been observed in men. In conclusion, the decreasing trends in the prevalence of some risk factors have been estimated in Lithuania within last decade. Sociodemographic differences in the prevalence of risk factors should be taken into account while developing health promotion and diseases prevention programmes.

Smoking and passive smoking in Estonia, Lithuania and Finland. Identifying target groups of tobacco policy

BACKGROUND

The aim of this study was to identify population groups which are the most crucial as targets for anti-tobacco action.

METHODS

A comparison was made of the prevalence and patterns of smoking and passive smoking in Estonia, Finland and Lithuania.

RESULTS

Total exposure to smoking, both one's own and passive smoking, was more common in two Baltic countries than in Finland. In these Baltic countries passive smoking was notably common among women. In all countries the exposure was more prevalent among the younger and less educated, but no difference emerged between urban and rural areas.

CONCLUSIONS

The following target groups were identified as priorities for anti-tobacco actions: i) men of all ages in Estonia and Lithuania to stop their already established tobacco use, ii) young women in all three countries to prevent their starting a career of tobacco use and iii) young and less educated women in Estonia and Lithuania to prevent passive smoking, i.e. their exposure to environmental tobacco smoke.

The relationship of childhood to adult blood pressure: longitudinal study of juvenile hypertension in Lithuania

OBJECTIVE

To assess changes in blood pressure from childhood to adulthood and the ability to predict adult blood pressure.

DESIGN

Longitudinal study of a cohort of children with baseline data and a follow-up survey after 20 years.

SETTING

Epidemiological survey of schoolchildren and subsequent inhabitants of Kaunas, a town in Lithuania.

PARTICIPANTS

The children came from 15 schools and accounted for 25% of all 12- and 13-year-old children born in 1964 in Kaunas. The first survey (n = 1082) was carried out in 1977. The same population was re-examined in 1997 (n = 505). Data from 217 men and 288 women, who participated in both the first and the most recent surveys, is presented.

MAIN OUTCOME MEASURES

Systolic and diastolic blood pressure at the age of 32-33 years.

RESULTS

In the 20 years between the two surveys blood pressure increased more in men than in women. Statistically significant correlation between childhood and adult blood pressure levels was estimated (for systolic blood pressure r=0.40 in men and r=0.24 in women; for diastolic blood pressure r=0.14 in men and r=0.34 in women). Stepwise regression analysis of the data showed that the best predictors of adult blood pressure were the initial childhood blood pressure levels and change in BMI during the 20-year period for both men and women. Other factors were less predictive.

CONCLUSIONS

Childhood blood pressure is related to adult levels and, together with changes in body mass index, is a significant predictor of adult blood pressure.