Orly Manor

Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial.

BACKGROUND The rapid emergence of coronary artery disease (CAD) in south Asian people is not explained by conventional risk factors. In view of cardioprotective effects of a Mediterranean style diet rich in alpha-linolenic acid, we assessed the benefits of this diet for patients at high risk of CAD. METHODS We did a randomised, single-blind trial in 1000 patients with angina pectoris, myocardial infarction, or surrogate risk factors for CAD. 499 patients were allocated to a diet rich in whole grains, fruits, vegetables, walnuts, and almonds. 501 controls consumed a local diet similar to the step I National Cholesterol Education Program (NCEP) prudent diet. FINDINGS The intervention group consumed more fruits, vegetables, legumes, walnuts, and almonds than did controls (573 g [SD 127] vs 231 g [19] per day p<0.001). The intervention group had an increased intake of whole grains and mustard or soy bean oil. The mean intake of alpha-linolenic acid was two-fold greater in the intervention group (1.8 g [SD 0.4] vs 0.8 g [0.2] per day, p<0.001). Total cardiac end points were significantly fewer in the intervention group than the controls (39 vs 76 events, p<0.001). Sudden cardiac deaths were also reduced (6 vs 16, p=0.015), as were non-fatal myocardial infarctions (21 vs 43, p<0.001). We noted a significant reduction in serum cholesterol concentration and other risk factors in both groups, but especially in the intervention diet group. In the treatment group, patients with pre-existing CAD had significantly greater benefits compared with such patients in the control group. INTERPRETATION An Indo-Mediterranean diet that is rich in alpha-linolenic acid might be more effective in primary and secondary prevention of CAD than the conventional step I NCEP prudent diet.

Fetal and early life growth and body mass index from birth to early adulthood in 1958 British cohort: longitudinal study.

Abstract Objectives: To determine the influence of birth weight on body mass index at different stages of later life; whether this relation persists after accounting for potential confounding factors; and the role of indicators of fetal growth (birth weight relative to parental size) and childhood growth. Design: Longitudinal study of the 1958 British birth cohort. Setting: England, Scotland, and Wales. Participants: All singletons born 3–9 March 1958 (10 683 participants with data available at age 33). Main outcome measures: Body mass index at ages 7, 11, 16, 23, and 33 years. Results: The relation between birth weight and body mass index was positive and weak, becoming more J shaped with increasing age. When adjustments were made for maternal weight, there was no relation between birth weight and body mass index at age 33. Indicators of poor fetal growth based on the mothers body size were not predictive, but the risk of adult obesity was higher among participants who had grown to a greater proportion of their eventual adult height by age 7. In men only, the effect of childhood growth was strongest in those with lower birth weights and, to a lesser extent, those born to lighter mothers. Conclusions: Maternal weight (or body mass index) largely explains the association between birth weight and adult body mass index, and it may be a more important risk factor for obesity in the child than birth weight. Birth weight and maternal weight seem to modify the effect of childhood linear growth on adult obesity in men. Intergenerational associations between the mothers and her offsprings body mass index seem to underlie the well documented association between birth weight and body mass index. Other measures of fetal growth are needed for a fuller understanding of the role of the intrauterine environment in the development of obesity. What is already known on this topic Birth weight has been shown to be positively related to subsequent fatness Few studies have investigated whether this relation is confounded by other factors, such as parental size Birth weight may be an inadequate indicator of the intrauterine environment What this study adds The relation between birth weight and adult body mass index was largely accounted for by mothers weight Fetal growth indexed by birth weight relative to parental body size was unrelated to adult obesity Rapid linear growth in childhood increased the risk of obesity in adulthood, especially in males with low birth weight Among boys who grew rapidly, the risk of obesity in adulthood was similar for both lower and higher birth weights

DEVELOPMENTAL DYSCALCULIA: PREVALENCE AND DEMOGRAPHIC FEATURES

One hundred and forty‐thrée 11‐year‐old children with developmental dyscalculia, from a cohort of 3029 students, were studied to determine demographic features and prevalence of this primary cognitive disorder. They were evaluated for gender, IQ, linguistic and perceptual skills, symptoms of attention‐deficit hyperactivity disorder (ADHD), socio‐economic status and associated learning disabilities. The IQs of the 140 children (75 girls and 65 boys) retained in the study group (thrée were excluded because of low IQs) ranged from 80 to 129 (mean 98.2, SD 9.9). 26 per cent of the children had symptoms of ADHD, and 17 per cent had dyslexia. Their socio‐economic status was significantly lower than that of the rest of the cohort, and 42 per cent had first‐degrée relatives with learning disabilities. The prevalence of dyscalculia in the original cohort was 6.5 per cent, similar to that of dyslexia and ADHD. However, unlike these other learning disabilities, dyscalculia affected the two sexes in about the same proportions.

Inequalities in self-rated health: explanations from different stages of life.

BACKGROUND Inequalities in health are a major public-health concern. A greater understanding is needed on the relative importance of different causes. We investigated the contribution of risk factors identified at different life stages to inequalities in self-rated health. METHODS We used data from 5606 men and 5799 women in the 1958 British birth cohort followed-up to age 33 years, on health behaviour, education, adolescent health, family structure and social support, work characteristics, and material circumstances. We assessed the contribution of different factors to social-class differences in self-rated health by adjustment of odds ratios (classes IV and V vs I and II). FINDINGS Odds ratios of poor-rated health at age 33 were 3.15 for men and 2.30 for women, which decreased to 2.06 and 1.34, respectively, after adjustment for previously identified factors from birth to early adulthood. Adjustment for adult work characteristics, material circumstances, and health behaviour between ages 23 years and 33 years further decreased the odds ratios to 1.64 (men) and 1.11 (women). Most factors contributed to the reduction in odds ratios, although adolescent socioemotional adjustment, class at birth, educational qualifications, and psychosocial job strain were especially important. Additional key factors for men were adult smoking and job insecurity, and for women, housing during childhood, adult income, and age at first child. INTERPRETATION There was no single cause of health inequality at age 33 years. Explanations spanned from early life to young adulthood. Policy implications include reduction of social differences in material circumstances and of differences in individual skills and resources acquired in early life.

Social inequalities in health: are there gender differences?

Some studies suggest that socio-economic status (SES) inequalities in health are smaller in women than men, but the evidence is inconsistent as to whether this applies across various health measures and life stages. The first aim of this paper was to establish whether the magnitude of social inequality in health differs for men and women during early adulthood, specifically in respect to self rated health, limiting long-standing illness, psychological distress, respiratory symptoms, asthma/wheezing, height and obesity; second, to determine whether explanations for socioeconomic inequality in poor self rated health differ for men and women. Analyses are based on longitudinal data from the British 1958 birth cohort study using information from birth to age 33. When gender differences in inequalities were examined using social class, no significant differences emerged across the seven health measures examined at ages 23 and 33. SES inequalities based on education, however, showed greater inequality among men at age 33 for limiting long-standing illness and respiratory symptoms, but greater inequality among women for poor rated health at age 23 and psychological distress at age 33. Hence, gender differences in the magnitude of health inequality were inconsistent across age and health measures. An analysis of the contribution of explanatory factors to social class differences in self-rated health suggested that causes of inequality were similar for men and women. However, some discrepancies emerged, notably in the greater contribution of job insecurity to class differences for men and in the greater contribution of age at first child for women. The magnitude and explanations for gender differences in SES health inequalities are likely to vary according to life stage and health measure.

Using an interactive framework of society and lifecourse to explain self-rated health in early adulthood.

This paper presents an integrated model of the determinants of adult health combining lifecourse factors and contemporary circumstances. Using the 1958 British Birth Cohort, it operationalises lifecourse influences in terms of factors from birth to age 33, which might act through latent, pathway, or cumulative effects. Contemporary circumstances are represented by variables at different levels of social aggregation: macro (socio-economic circumstances); meso (involvement in civil society functions); micro (personal social support); and intersecting (job insecurity and life control). Multiple regression models were fitted, using self-rated health at age 33 as the health outcome. To allow for temporal ordering of events, early life factors were entered first in the final model, followed by later childhood factors and, finally current factors. Self-rated health was predicted by variables representing both early and later stage of the lifecourse and also contemporary societal-level factors. The effects of childhood factors were not removed by including contemporary factors, and conversely, contemporary factors contributed to the prediction of self-rated health over and above lifecourse factors. The factors were not collinear; supporting the notion that each dimension was distinct from the others. Although the model accounted for only 9% of the variance in self-rated health, the general conclusion is that both lifecourse and contemporary circumstances should be considered together in explaining adult health.

Does religious observance promote health? Mortality in secular vs religious kibbutzim in Israel.

OBJECTIVES This study assessed the association of Jewish religious observance with mortality by comparing religious and secular kibbutzim. These collectives are highly similar in social structure and economic function and are cohesive and supportive communities. METHODS In a 16-year (1970 through 1985) historical prospective study of mortality in 11 religious and 11 matched secular kibbutzim in Israel, 268 deaths occurred among 3900 men and women 35 years of age and older during 41347 person-years of observation. RESULTS Mortality was considerably higher in secular kibbutzim. Cox proportional hazards analysis was used to adjust for age and the matched design; rate ratios were 1.67 (95% confidence interval [CI]=1.17, 2.39) for men, 2.67 (95% CI=1.55, 4.60) for women, and 1.93 (95% CI=1.44, 2.59) overall. Kaplan-Meier survival analysis of birth cohorts confirmed the association. The lower mortality in religious kibbutzim was consistent for all major causes of death. CONCLUSIONS Belonging to a religious collective was associated with a strong protective effect not attributable to confounding by sociodemographic factors. Elucidation of mechanisms mediating this effect may provide etiologic insights and leads for intervention.

Developmental dyscalculia : prevalence and prognosis

The prevalence of developmental dyscalculia (DC) in the school population ranges from 3–6%, a frequency similar to that of developmental dyslexia and ADHD. These studies fulfilled the criteria for an adequate prevalence study, i.e., were population based, using standardized measures to evaluate arithmetic function. Although the variation in prevalence is within a narrow range, the differences are probably due to which definition of dyscalculia was used, the age the diagnosis was made and the instrument chosen to test for DC. The relative predominance of girls with DC may reflect a greater vulnerability to environmental influences alone or in addition to a biological predisposition. DC is not only encountered as a specific learning disability but also in diverse neurological disorders, examples of which include ADHD, developmental language disorder, epilepsy, treated phenylketonuria and Fragile X syndrome. Although the long-term prognosis of DC is as yet unknown, current data indicate that DC is a stable learning disability persisting, at least for the short term, in about half of affected children. The long-term consequences of DC and its impact on education, employment and psychological well-being have yet to be determined.

The duration and timing of exposure : Effects of socioeconomic environment on adult health

OBJECTIVES This study investigated timing and duration effects of socioeconomic status (SES) on self-rated health at 33 years of age and established whether health risks are modified by changing SES and whether cumulative SES operates through education. METHODS Data were from the 1958 British birth cohort. Occupational class at birth and at 16, 23, and 33 years of age was used to generate a lifetime SES score. RESULTS At 33 years of age, 12% of men and women reported poor health. SES at birth and at 16, 23, and 33 years of age was significantly associated with poor health: all ages except 16 years in men made an additional contribution to the prediction of poor health. No large differences in effect sizes emerged, suggesting that timing was not a major factor. Odds of poor health increased by 15% (men) and 18% (women) with a 1-unit increase in the lifetime SES score. Strong effects of lifetime SES persisted after adjustment for education level. CONCLUSIONS SES from birth to 33 years of age had a cumulative effect on poor health in early adulthood. This highlights the importance of duration of exposure to socioeconomic conditions for adult health.

Child to adult socioeconomic conditions and obesity in a national cohort.

OBJECTIVE: Critical stages in childhood are suspected for adult obesity. We sought to identify (i) whether risk of adult obesity is influenced by childhood socioeconomic conditions in addition to those in adulthood; and (ii) whether conditions in childhood act independently or through their association with education or parental obesity.DESIGN: Longitudinal, 1958 British birth cohort.SUBJECTS: A total of 11 405 men and women followed to age 33 y.MEASUREMENTS: Social class at birth and ages 7, 11, 16, 23 and 33 y. Obesity (BMI⩾30) at age 33 y.RESULTS: Social class was related to obesity, cross-sectionally at ages 16 (women), 23 and 33 y, but not at younger ages. In analysis of adult obesity (age 33 y) and social class at five life stages, class at age 7 y significantly predicted obesity for women (adjusted odds ratio (OR)=1.31, that is, the odds increased by 31% for each decrease in social class). For men, class at birth and age 23 y predicted adult obesity (adjusted OR=1.19 and 1.16, respectively). Education was also associated with adult obesity, increasing the odds by 30% (men) and 35% (women) for each decrease in qualification level. Adjustment for education level and parental BMI did not abolish the effect on adult obesity of class at age 7 y among women, nor of class at birth among men, while class at age 23 y reduced to borderline significance.CONCLUSIONS: Cross-sectional associations for social class and obesity can be misleading and obscure effects of childhood socioeconomic conditions. Influences around birth to age 7 y have a long-lasting impact on the risk of adult obesity.