Lėtinių ligų rizikos veiksnių raida nuo vaikystės (Kauno m. gyventojų kohortinis tyrimas)

Show simple item record Sakalauskienė, Giedrė Valdonė 2017-08-21T08:06:59Z 2017-08-21T08:06:59Z 2006
dc.description.abstract Good health is a fundamental resource for social and economic development. Non-communicable chronic diseases (NCDs) such as cardiovascular diseases (CVD), cancer, chronic respiratory diseases and diabetes mellitus are reaching epidemic proportions worldwide. Over the last decades NCDs remain the main public health problem in Lithuania also. The leading NCD’s in the Lithuania are CVD and cancer. The key targets of the Health 21 policy for WHO European Region as well as of Lithuanian Health Programme are reduction of morbidity and mortality from CVD, cancer and other NCD’s. The leading strategy to tackle NCDs is control and prevention of risk factors. Common, modifiable risk factors underlie the major NCD’s. Seven risk factors are responsible for the majority of NCD in the European region: high blood pressure, tobacco, alcohol, high cholesterol, being overweight, low intake of fruits and vegetables, and physical inactivity. The lifestyle habits start to develop in childhood. Children and adolescents begin to smoke and use alcohol, adopt unhealthy nutrition habits and sedentary lifestyle. Harmful lifestyle choices lead to children’s overweight, increase of their blood pressure (BP), and metabolic disorders. Many epidemiological studies designed to assess the association between health indices in childhood and adulthood were conducted over the last years. However, the number of longitudinal, cohort studies that would follow people from childhood to middle age and would apply the standardized methods of examination is limited. The evidence obtained from longitudinal studies shows that BP and body mass index (BMI) track from childhood to adulthood. Childhood BP and BMI are significant predictors of adult arterial hypertension (AH) and obesity. The available evidence is insufficient to allow definite conclusions which factors determined in childhood and youth are the best predictors of adult AH and obesity. Overweight increases the risk of metabolic syndrome (MS), which is an important risk factor of CVD. There are few data concerning predictive value of children and young people health indices for the development of MS in adulthood. Kaunas Medical University started the epidemiological studies of children‘s and adoleswcents’ health more than two decades ago. This doctoral thesis is part of longitudinal study which began in 1976 within the framework of the International Study of Juvenile Hypertension among Kaunas schoolchildren born in 1964 and proceeded on as a cohort study. The cohort was examined for four times over the period of observation. The last survey took part in 2002-2003, when participants were at the age of 38-39. The aim of our study was to assess the evolution of NCDs risk factors since childhood to adulthood in Kaunas population born in 1964. Objectives were: 1. To evaluate the prevalence of NCDs risk factors in Kaunas population aged 38-39. 2. To examine the changes of blood pressure from childhood to 38-39 years of age and to assess the risk factors of arterial hypertension. 3. To investigate the changes of body mass index from childhood to 38-39 years of age and to evaluate the possibilities to predict adult body mass index. 4. To examine the changes of blood lipids and behavioural risk factors over 14 years (from 25-26 to 38-39). The first survey of 1082 participants aged of 12-13 included three BP measurements, determination of body weight and height, physical development, sexual maturity and heart rate using the methods recommended by the WHO. All these measurements, with the exception of the assesssment of chest circumference, triceps muscle and subscapular skinfold thickness, were performed in the second, third and fourth survey. An analysis of serum lipids was performed in all surveys, with the exception of the first one. Total cholesterol (TCHOL) concentration was measured from a venous blood sample taken after at least 12-hour fasting. TCHOL, high-density lipoprotein cholesterol (HDL CHOL) and triglyceride (TG) were determined using an enzymatic method. Low-density lipoprotein cholesterol (LDL CHOL) was calculating using the W.T. Friedwald formula. Glucose concentration was measured from a venous blood sample after at least 12-hour fasting in the last survey. Electrocardiography, echocardiography and eye ground examination was included in the last survey. The participants were questioned about their smoking habits, physical activity, family history of CVD, diabetes mellitus, obesity, and alcohol consumption (in the second, third and fourth survey), and nutrition habits (in the two most recent surveys). Rose questionnaire was used for detection angina pectoris. A person who smoked at least one cigarette per day was considered to be a regular smoker. The standard questionnaire on alcohol consumption contained questions about the frequency of alcohol consumption, the type and the amount of alcohol consumed on one occasion. The amount of alcohol consumed on one occasion was recalculated into standard alcohol units (SAU). Risky alcohol consumption was determined when men consumed ≥56 SAU or women consumed ≥28 SAU per month. The participants aged of 38-39 were considered physically passive if their working day was spent mainly sitting, and if they had leisure physical exercise for at least 30 min. causing them be at least mildly short of breath or to perspire at least four times a week. Statistical analysis was performed using the statistical software package SPSS 11.0 for Windows. The analysis was performed separately for men and women. The mean value and standard deviation was calculated in order to evaluate quantitative variables. The mean differences of two group independent samples were assessed using Student (t) test. Paired Student (t) test was used to compare the means of dependent samples, when distribution was normal. In absence of normal distribution Wilcoxon‘s test was used. The means and dispersions of more than two groups were compared using one way dispersion analysis (ANOVA). The differences in the distribution of qualitative variables were assessed by chi-squared test. Correlation between variables was estimated using Pearson‘s correlation coefficient (r) and Spearman‘s correlation coefficient (R). The association between quantitative variables was investigated using multivariable linear regression. The results were considered to be significant when p<0.05. The logistic regression analysis was used to analyze variables predicting AH and MS at the age of 38-39 years. The odds ratios and 95% confidence intervals were estimated in the applied models of logistic regression. When the 95% confidence interval did not include 1, the odds ratio was considered to be statistically significant. Results: 1. The prevalence of non-communicable chronic disease risk factors in Kaunas population aged 38-39 was high: half of men and a quarter of women had arterial hypertension; lipid disorders were detected in three quarters of examined people; 55% of men and 41% of women were overweight; metabolic syndrome was diagnosed for 13% of men and 8% of women. Every second man and every fifth woman regularly smoked. The majority of participants had several risk factors. Almost half of men and a quarter of women had damage of left ventricle; more than half examined people had damage of retinal arteries. 2. Over 25 years of observation systolic and diastolic blood pressure increased more in men than in women. The greatest increase in blood pressure was estimated from childhood to youth, with the exception of systolic blood pressure in women that increased mostly from the age of 32-33 to 38-39 years. Blood pressure in the middle age (38-39 years) was related to the blood pressure levels determined in childhood, at the ages of 25-26 and 32-33 years. More than a half of participants whose childhood blood pressure levels were in the highest quintiles maintained this rank at the age of 38-39 years. 3. The predictors of arterial hypertension were estimated using logistic regression analysis. The most significant predictive factors of adult arterial hypertension were systolic or diastolic blood pressure and body mass index in childhood, youth and at the age of 32-33 years and the change of body mass index over the follow-up period. 4. Body mass index of examined people was increasing continuously both in men and in women over the period of observation. A significant correlation between body mass index estimated in childhood, youth, at age of 32-33 years and at the age of 38-39 years was found. People having the highest values of body mass index in childhood had higher body mass index 25 years later. Thickness of subscapular skinfold measured in childhood and body mass index estimated in follow-up surveys were the best predictors of body mass index at the age of 38-39 years in men and women. Furthermore, body mass index at the age of 38-39 in women was also related to their waist circumference at the age of 32-33 years. 5. The greatest increase in the level of serum total cholesterol of examined people was established between the ages 25-26 and 32-33 years. The level of serum total cholesterol level at the age of 38-39 years was directly related to serum cholesterol determined in the young age. Persons having hypercholesterolaemia in the last survey had higher serum cholesterol in the previous surveys, used vegetables less frequently and more often reported having a history of family cardiovascular disease compared to those with normal cholesterol. Women with high serum cholesterol at the age of 38-39 years more frequently used butter than those with normal total serum cholesterol. 6. Systolic blood pressure in childhood and body mass index estimated in the young age were significant predictors of adult metabolic syndrome in men. Metabolic syndrome in women at the age of 38-39 years was related to childhood thickness of subscapular skinfold, systolic blood pressure measured in the young age, body mass index an
dc.language.iso lit
dc.subject Kohortinis tyrimas
dc.subject Arterial hypertension
dc.subject Body mass index
dc.subject Arterinė hipertenzija
dc.subject Kūno masės indeksas
dc.subject Rizikos veiksniai
dc.subject Metabolic syndrome
dc.subject Metabolinis sindromas
dc.subject Cohort study
dc.title Lėtinių ligų rizikos veiksnių raida nuo vaikystės (Kauno m. gyventojų kohortinis tyrimas)
dc.title.alternative Evolution of chronic noncommunicable diseases risk factors since childhood to adulthood (A cohort study in Kaunas population)
dc.type Daktaro disertacija

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