Jean Ferrières

Relation between body mass index and cognitive function in healthy middle-aged men and women

Objective: To assess whether body mass index (BMI) is associated with cognitive function and cognitive decline in healthy men and women. Methods: In this prospective cohort study, we analyzed data from 2,223 healthy workers aged 32 to 62 years at baseline. Medical, psychosocial, and environmental data were collected in 1996 and in 2001. We tested cognitive functions at baseline and at follow-up with word-list learning (four recalls), a Digit–Symbol Substitution Test, and a selective attention test. Results: Cross-sectionally, a higher BMI was associated with lower cognitive scores after adjustment for age, sex, educational level, blood pressure, diabetes, and other psychosocial covariables. A higher BMI at baseline was also associated with a higher cognitive decline at follow-up, after adjustment for the above-cited confounding factors. This association was significant for word-list learning. For the changes in scores at word-list learning (delayed recall), regression coefficients were −0.008 ± 0.13, −0.09 ± 0.13, −0.17 ± 0.14, and −0.35 ± 0.14 (p for trend < 0.001) for the second, third, fourth, and fifth quintiles of BMI at baseline when compared with the first quintile. No significant association was found between changes in BMI and cognitive function. Conclusions: Body mass index was independently associated both with cognitive function (word-list learning and Digit–Symbol Substitution Test) and changes in word-list learning in healthy, nondemented, middle-aged men and women.

Contributions of Depressive Mood and Circulating Inflammatory Markers to Coronary Heart Disease in Healthy European Men The Prospective Epidemiological Study of Myocardial Infarction (PRIME)

Background—Data on the possible association between depressive disorders and inflammatory markers are scarce and inconsistent. We investigated whether subjects with depressive mood had higher levels of a wide range of inflammatory markers involved in coronary heart disease (CHD) incidence and examined the contribution of these inflammatory markers and depressive mood to CHD outcome. Methods and Results—We built a nested case-referent study within the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study of healthy middle-aged men from Belfast and France. We considered the baseline plasma sample from 335 future cases (angina pectoris, nonfatal myocardial infarction, coronary death) and 670 matched controls (2 controls per case). Depressive mood characterized men whose baseline depression score (13-item modification of the Welsh depression subscale) was in the fourth quartile (mean score, 5.75; range, 4 to 12). On average, men with depressive mood had 46%, 16%, and 10% higher C-reactive protein, interleukin-6, and intercellular adhesion molecule-1 levels, respectively, independently of case-control status, social characteristics, and classic cardiovascular risk factors; no statistical difference was found for fibrinogen. The odds ratios of depressive mood for CHD were 1.35 (95% CI, 1.05 to 1.73) in univariate analysis and 1.50 (95% CI, 1.04 to 2.15) after adjustment for social characteristics and classic cardiovascular risk factors. The latter odds ratio remained unchanged when each inflammatory marker was added separately, and in this analysis, each inflammatory marker contributed significantly to CHD event risk. Conclusions—These data support an association of depressive mood with inflammatory markers and suggest that depressive mood is related to CHD even after adjustment for these inflammatory markers.

Endothelial Cell Markers and the Risk of Coronary Heart Disease The Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study

Background—Tissue factor pathway inhibitor (TFPI), von Willebrand factor (vWF), and thrombomodulin (TM) are 3 major hemostatic regulatory molecules synthesized by endothelium. Data from epidemiological studies aiming to evaluate the relation between plasma levels of these molecules and the development of coronary heart disease (CHD) are sparse or contradictory. Methods and Results—We examined the association between these endothelial-cell markers and the incidence of fatal or nonfatal myocardial infarction (hard CHD) and stable or unstable angina (angina pectoris) in a prospective cohort (the PRIME Study) of nearly 10 000 healthy men recruited in France and Northern Ireland. We measured baseline plasma concentration of the free form of TFPI (f-TFPI), vWF, and the soluble form of TM (sTM) among 296 participants who subsequently developed CHD over the 5-year follow-up (158 with hard CHD and 142 with angina pectoris) and in 563 control subjects by use of a nested case-control design. Individuals with plasma vWF levels in the highest quartile showed a 3.04-fold increase in the risk of hard CHD compared with those in the lowest quartile (95% CI, 1.59 to 5.80). Individuals with f-TFPI levels below the 10th percentile had a 2.13-fold increased risk of hard CHD compared with those with levels above it (95% CI, 1.08 to 4.18). The risk for both molecules persisted after control for inflammatory parameters. Individuals with vWF levels in the highest quartile and f-TFPI levels below the 10th percentile presented a 6.9-fold increased risk of hard CHD compared with those with vWF levels in the lowest quartile and f-TFPI levels above the 10th percentile (95% CI, 1.3 to 37.8). Conclusions—vWF and f-TFPI plasma levels were independent risk factors for hard CHD events.

Leisure time physical activity and regular walking or cycling to work are associated with adiposity and 5 y weight gain in middle aged men the PRIME study

OBJECTIVE: To examine the influence of physical activity on body mass index (BMI), waist circumference (W) and body mass changes (ΔBMI) in middle-aged men, with special regard to moderate-intensity activities.DESIGN: Longitudinal study of adults who participated in the PRIME Study.SUBJECTS: A cohort of 8865 men aged 50–59 y, free of coronary heart disease.MEASUREMENTS: BMI and W at baseline, body mass changes over a 5 y period. Detailed baseline assessment of net energy expenditure due to physical activity (PAE) in the preceding year, according to category of activity, by means of the MOSPA Questionnaire. PAE was expressed in weekly metabolic equivalent scores (MET h/week).RESULTS: After adjustment for confounders, the multiple regression analyses indicated that BMI, W and ΔBMI were inversely associated with PAE spent in getting to work (P<10−5, <10−5 and 0.04, respectively) and practice of high-intensity (≥6 MET) recreational activities (<0.01, <10−5 and <0.01). Men who regularly spent more than 10 MET h/week in walking or cycling to work had a mean BMI, W and ΔBMI respectively 0.3 kg/m2, 1 cm and 0.06 kg/m2 lower than those who did not expend energy in getting to work. In the subgroup of subjects who did not perform high-intensity activities, the level of recreational PAE was inversely associated with BMI and W but not with subsequent weight-gain.CONCLUSION: These findings indicate that, in middle-aged men, physical activities of moderate-intensity, which are probably easier to promote than more vigorous activities and, in particular, a more current daily activity, walking or cycling to work, may have a favourable effect on body fat markers and body mass gain.

Circulating soluble adhesion molecules ICAM-1 and VCAM-1 and incident coronary heart disease: The PRIME Study

The Epidemiological Study of Myocardial Infarction Study which enrolled 9758 apparently healthy men aged 50-59 years, is a prospective cohort study designed to evaluate markers of coronary risk. Soluble forms of the intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels were measured in plasma obtained at baseline from 317 subjects who suffered a coronary event during the 5-year follow-up and in twice the number of control subjects who were matched for center, age and day of inclusion in a nested case-control design. The relative risk associated with the highest compared with the lowest thirds of ICAM-1 (>625 versus <502 ng/ml) was 2.45 (95% CI: 1.64-3.65, P<0.001) without adjustment; it decreased moderately (RR: 2.09; 95% CI: 1.34-3.24, P<0.001) after control for lipid and non-lipid factors and remained significantly elevated after adjustment for C-reactive protein (CRP) (RR: 1.90; 95% CI: 1.21-2.96, P=0.005). Plasma ICAM-1 was essentially associated with the risk of myocardial infarction or coronary death and also with angina pectoris. Subjects with CRP presented elevated coronary risk only if ICAM-1 was high. An elevated level of VCAM-1 was not associated with any risk of future acute coronary event, or with angina pectoris. This data indicates that plasma levels of ICAM-1 may serve as risk markers for future coronary events whatever their clinical presentation and that risk is better defined using simultaneous measurements of ICAM-1 and CRP than any of these levels separately.

Shift work and cardiovascular risk factors : New knowledge from the past decade

Cardiovascular diseases remain a major public health problem. The involvement of several occupational factors has recently been discussed, notably the organization of work schedules, e.g. shift work. To analyse the progress of knowledge on the relationship between cardiovascular risk factors and shift work. A review of English-language literature dealing with the link between cardiovascular factors and shift workers (published during 2000-2010) was conducted. Studies published in the past 10 years tend to document an impact of shift work on blood pressure, lipid profile (triglyceride levels), metabolic syndrome and, possibly, body mass index. However, the consequences on glucose metabolism are unclear. These results are not yet firmly established, but are supported by strong hypotheses. Some advice could reasonably be proposed to guide the clinical practitioner.

Influence of alcohol consumption and various beverages on waist girth and waist-to-hip ratio in a sample of French men and women

OBJECTIVE: The goal of the present study was to assess the association between alcohol consumption and abdominal fat deposition in France, a country where wine is the most commonly consumed alcoholic beverage.METHODS: We analyzed the association between alcohol consumption and various markers of body weight, in a population sample recruited in three distinct geographical areas of France (MONICA centers). This sample included men (n=1778) and women (n=1730) aged 35– 64 y, randomly selected from electoral rolls. Alcohol consumption was assessed with a quantitative frequency questionnaire.RESULTS: Alcohol intake ranged from 0–1655 ml of alcohol per week. Wine was the main source of alcohol, representing 67% of total alcohol intake in both genders. In men, there was no association between alcohol intake and body mass index (BMI) or body weight, whereas in women, alcohol consumption was inversely correlated with BMI (P<0.0001) and body weight (P<0.0002). In men, total alcohol consumption was positively associated with waist-to-hip ratio (WHR, P<0.0002) and waist girth (P<0.004), independently of BMI. Similarly, in women, positive associations were found between alcohol intake and WHR (P<0.0001) as well as waist girth (P<0.0001), independently of BMI. In a linear regression model including types of beverages and usual confounders, reporting consumption of either wine, beer or spirit was poorly associated with WHR in men, whereas wine (P<0.0008) and beer (P<0.0001) consumptions were both positively associated with WHR in women. However, there was no evidence of a statistically significant heterogeneous effect of wine, beer and spirits on WHR in both genders.CONCLUSION: In a sample of representative French people, in whom wine is the most common alcoholic beverage, alcohol consumption is associated with greater WHR independently of BMI in both men and women.

Eating frequency and body fatness in middle-aged men

OBJECTIVE: The relationship between eating frequency and body fatness was tested in a population sample.DESIGN: A cross-sectional survey on cardiovascular risk factors and a nutritional survey were carried out from June 1996 to April 1997.SUBJECTS: Population sample of 330 free-living middle-aged men (45–64 y).MEASUREMENTS: Body mass index (BMI), waist-to-hip ratio (WHR) and nutritional survey (3-day record).RESULTS: In the whole sample, BMI and WHR decreased significantly (P<0.05) along with the increase of the number of eating occasions. When low energy records were excluded, the trend for BMI and WHR according to eating categories remained significant. For WHR, averages were 0.98, 0.95, 0.94 and 0.93 for 1–2, 3, 4 or 5 or more feedings a day, respectively. For BMI, mean values were 28.1, 26.2, 26.2 and 24.5 kg/m2, respectively. After adjustment for confounders (total energy intake or macronutrients, age, educational level, smoking habits, physical activity and restrained diet), the linear trend for BMI and WHR throughout feeding categories was significant when the whole sample was considered. This relationship remained similar when low energy records or when dieters were excluded.CONCLUSION: These results suggest that for an isoenergetic intake the increase of eating frequency is associated with lower body fatness.

Bilirubin and coronary heart disease risk in the Prospective Epidemiological Study of Myocardial Infarction (PRIME)

Background Classic coronary heart disease risk factors fail to explain the large coronary heart disease incidence gradient between Northern Ireland and France. The Prospective Epidemiological Study of Myocardial Infarction (PRIME), a multicentre prospective study of 10 593 men, aims to investigate novel risk factors in these populations. We tested the hypothesis that higher bilirubin, a bile pigment possessing antioxidant properties, is associated with decreased coronary heart disease risk. Methods Bilirubin was measured in 216 participants who had developed coronary heart disease at 5-year follow-up and in 434 matched controls. Results Bilirubin was significantly lower in cases (geometric mean 7.95 μmol/l; interquartile range 5.32–12.33 μmol/l) compared with controls (9.07; 6.16–12.76; P = 0.005). Conditional logistic regression, adjusted for classical and putative risk factors, showed a U-shaped pattern, with coronary heart disease risk significantly lower for bilirubin in the third and fourth fifths, compared with the first. Additionally, there was a significant quadratic relationship between coronary heart disease risk and fifths of bilirubin concentration (χ2 = 6.80, df = 2; P = 0.035). Conclusions These findings suggest that bilirubin is a novel coronary heart disease risk marker in middle-aged men, with a U-shaped relationship observed between bilirubin concentration and coronary heart disease risk. Eur J Cardiovasc Prev Rehabil 14: 79-84

Change in cardiovascular risk factors in France, 1985–1997

The change in the main cardiovascular risk factors in France was assessed using the MONICA population surveys conducted in the Urban Community of Lille, Bas-Rhin and Haute-Garonne. Trends in obesity, tobacco smoking, hypertension, hypercholesterolaemia and self-reported diabetes were established for the first (1985–1988) and the last (1995–1997) survey. The results indicate that the prevalence of overweight and obesity remained stable in both genders; tobacco smoking decreased in men but increased in women. Prevalence of hypertension decreased, and preventive measures improved in both genders. Prevalence of hypercholesterolaemia remained stable, and preventive measures improved only in men. Prevalence of self-reported diabetes increased solely in women, and preventive measures improved in both genders. However, in 1995–1997 still 40% of the treated hypertensive and 30% of the treated hypercholesterolaemic subjects were not adequately controlled. We conclude that prevalence and prevention of the main cardiovascular risk factors have evolved favourably in France, but the management of hypercholesterolaemia and hypertension can still be improved.