Difference in fruit and vegetable consumption has been suggested as a possible reason for the lar... more Difference in fruit and vegetable consumption has been suggested as a possible reason for the large gap in cardiovascular disease (CVD) mortality rates between Eastern and Western European populations. However, individual-level dietary data which allow direct comparison across the two regions are rare. In this systematic review we aimed to answer the question whether cross-national studies with comparable individual-level dietary data reveal any systematic differences in fruit and vegetable consumption between populations in Central and Eastern Europe (CEE) and the Former Soviet Union (FSU) compared to Western Europe (WE). Studies were identified by electronic search of MEDLINE, EMBASE and Web of Science databases from inception to September 2014, and hand search. Studies which reported data on fruit, vegetable consumption or carotene and vitamin C intake or tissue concentrations of adult participants from both CEE/FSU and WE countries were considered for inclusion. Quality of the included studies was assessed by a modified STROBE statement. Power calculation was performed to determine the statistical significance of the comparison results. Twenty-two studies fulfilled the inclusion criteria. Fruit consumption was found to be consistently lower in CEE/FSU participants compared to Western Europeans. Results on vegetable intake were less unambiguous. Antioxidant studies indicated lower concentration of beta-carotene in CEE/FSU subjects, but the results for vitamin C were not consistent. This systematic review suggests that populations in CEE and FSU consume less fruit than Western Europeans. The difference in the consumption of fruit may contribute to the CVD gap between the two regions.
European journal of preventive cardiology, Jan 22, 2015
It is estimated that disease burden due to low fruit and vegetable consumption is higher in Centr... more It is estimated that disease burden due to low fruit and vegetable consumption is higher in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) than any other parts of the world. However, no large scale studies have investigated the association between fruit and vegetable (F&V) intake and mortality in these regions yet. The Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study is a prospective cohort study with participants recruited from the Czech Republic, Poland and Russia. Dietary data was collected using food frequency questionnaire. Mortality data was ascertained through linkage with death registers. Multivariable adjusted hazard ratios were calculated by Cox regression models. Among 19,333 disease-free participants at baseline, 1314 died over the mean follow-up of 7.1 years. After multivariable adjustment, we found statistically significant inverse association between cohort-specific quartiles of F&V intake and stroke mortality: the highest ...
To assess the relationship between green space proximity, use of green space and depressive sympt... more To assess the relationship between green space proximity, use of green space and depressive symptoms and perceived general health among a random sample men and women. Cross-sectional study of a population-based sample of 6,944 45-72 year old Kaunas city residents. Self-reported questionnaires provided information on sociodemographic variables, health behaviours, depressive symptoms and poor and very poor perceived general health. Residential proximity to green spaces was defined as living less than 300 m, within interval of 300-999 m, and equal or more than 1 km from a park. The use of the park was divided into two categories: no park use or use <4hrs/week and use of the park ≥4 h/week. The study received approval from the Kaunas Regional Research Ethics Committee. Multiple logistic regression assessed the associations controlling for confounding variables. The prevalence of depressive symptoms and poor and or very poor perceived general health was higher in women than in men. Th...
Conflicting evidence exists on whether smoking acts as an effect modifier of the association betw... more Conflicting evidence exists on whether smoking acts as an effect modifier of the association between APOE genotype and risk of coronary heart disease (CHD). We searched PubMed and EMBASE to June 11, 2013 for published studies reporting APOE genotype, smoking status and CHD events and added unpublished data from population cohorts. We tested for presence of effect modification by smoking status in the relationship between APOE genotype and risk of CHD using likelihood ratio test. In total 13 studies (including unpublished data from eight cohorts) with 10,134 CHD events in 130,004 individuals of European descent were identified. The odds ratio (OR) for CHD risk from APOE genotype (ε4 carriers versus non-carriers) was 1.06 (95% confidence interval (CI): 1.01, 1.12) and for smoking (present vs. past/never smokers) was OR 2.05 (95%CI: 1.95, 2.14). When the association between APOE genotype and CHD was stratified by smoking status, compared to non-ε4 carriers, ε4 carriers had an OR of 1.1...
The Russian mortality crisis of the early 1990s attracted considerable attention, but information... more The Russian mortality crisis of the early 1990s attracted considerable attention, but information on possible covariates of mortality is lacking, and concerns have been raised about the validity of official mortality data. To help elucidate the determinants of mortality, we examined whether indirect demographic techniques could be used to study mortality in countries such as the Russian Federation, where mortality data are inadequate, using input data independent from official vital statistics. A national sample of the population was interviewed (n = 1600, response rate = 67%). Participants who had ever been married (82% of the sample) were asked about the date of birth and vital status of their first spouse. Spousal mortality was then estimated indirectly for the 531 men and 710 women for whom valid data were available. The estimated risk of death between the ages of 35-69 years was 57% for male spouses and 17% for female spouses. Corresponding figures derived from national data fo...
To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to inv... more To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Mendelian randomisation meta-analysis of 56 epidemiological studies. 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (-0.88 (-1.19 to -0.56) mm Hg), interleukin-6 levels (-5....
Contraindications and requests for alternative vaccines can have important implications on vaccin... more Contraindications and requests for alternative vaccines can have important implications on vaccination coverage but population rates of contraindications and alternative vaccination occurring in routine immunisation programmes have not been reported. We investigated the rates of contraindications, the proportion of children who fail to complete regular vaccination, and the use of alternative vaccines within the compulsory immunisation of children in the Czech Republic. We conducted a retrospective review of medical records of all 5038 children born between 1 January 2000 and 31 December 2004 and registered in 24 primary paediatric practices. Contraindications against at least one vaccine were found in 291 (5.8%) children. Contraindications were most commonly reported for the DTP-Hib vaccine (263 children, 5.2%), and the most frequent type were central nervous system disorders (171 cases). Contraindications resulted in 181 (3.6%) of incomplete immunisations by at least 1 vaccine, with 80 children (1.6%) remaining unprotected. Alternative vaccines were administered to 935 (18.6%) children; of these, 271 were due to contraindication and 664 on parental request. The rates of contraindications, incomplete immunisations and alternative vaccine use more than tripled over the study period. This study suggests that within the routine immunisation programme, contraindications occur in approximately 6% of children, and many of these children remain incompletely vaccinated.
Recent studies suggested that air pollution might be related to low birth weight. We tested this ... more Recent studies suggested that air pollution might be related to low birth weight. We tested this hypothesis on data from the British 1946 birth cohort. We found a strong association between birth weight and an air pollution index based on coal consumption. Babies born in the most polluted areas were on average 87 grams lighter than those born in the areas with the cleanest air. Adjustment for a number of sociodemographic factors did not change these estimates. While confounding by unmeasured factors cannot be ruled out, these historical data support the hypothesis that birth weight could be affected by air pollution.
Hubacek, JA and Adamkova, V and Stavek, P and Hubacek, JA and Kubinova, R and Peasey, A and Pikha... more Hubacek, JA and Adamkova, V and Stavek, P and Hubacek, JA and Kubinova, R and Peasey, A and Pikhart, H and Mar-Mot, M and Bobak, M (2008) Apolipoprotein E Arg136 -> Cys mutation and hyperlipidemia in a large central European population sample. CLIN CHIM ...
A possible association between end-stage renal disease (ESRD) and apolipoprotein E (APOE) polymor... more A possible association between end-stage renal disease (ESRD) and apolipoprotein E (APOE) polymorphism was found in some but not all studies. We have analyzed the APOE genotypes in 995 hemodialyzed patients (cases) and a sample of 6242 healthy individuals (controls) in the Czech Republic. There was a statistically significant difference in the frequency of APOE alleles between cases and controls, with more carriers of the APOE2 allele in ESRD patients (15.9%) than in controls (12.2%) (P = 0.005). The odds ratio of ESRD for the APOE2 allele, compared with APOE3E3 homozygotes, was 1.37 (95% confidence interval 1.13-1.67). The strength of the association increased with the time spent on hemodialysis: the odds ratio of all-cause ESRD in patients dialyzed for eight or more years was 1.27 (0.94-1.71), for 1-8 years 1.41 (1.09-1.81), and less than 1 year (nonsurvivors) 1.94 (0.88-4.18). This study suggests that the APOE2 allele is a possible genetic risk factor for all-cause ESRD in Caucasians.
Difference in fruit and vegetable consumption has been suggested as a possible reason for the lar... more Difference in fruit and vegetable consumption has been suggested as a possible reason for the large gap in cardiovascular disease (CVD) mortality rates between Eastern and Western European populations. However, individual-level dietary data which allow direct comparison across the two regions are rare. In this systematic review we aimed to answer the question whether cross-national studies with comparable individual-level dietary data reveal any systematic differences in fruit and vegetable consumption between populations in Central and Eastern Europe (CEE) and the Former Soviet Union (FSU) compared to Western Europe (WE). Studies were identified by electronic search of MEDLINE, EMBASE and Web of Science databases from inception to September 2014, and hand search. Studies which reported data on fruit, vegetable consumption or carotene and vitamin C intake or tissue concentrations of adult participants from both CEE/FSU and WE countries were considered for inclusion. Quality of the included studies was assessed by a modified STROBE statement. Power calculation was performed to determine the statistical significance of the comparison results. Twenty-two studies fulfilled the inclusion criteria. Fruit consumption was found to be consistently lower in CEE/FSU participants compared to Western Europeans. Results on vegetable intake were less unambiguous. Antioxidant studies indicated lower concentration of beta-carotene in CEE/FSU subjects, but the results for vitamin C were not consistent. This systematic review suggests that populations in CEE and FSU consume less fruit than Western Europeans. The difference in the consumption of fruit may contribute to the CVD gap between the two regions.
European journal of preventive cardiology, Jan 22, 2015
It is estimated that disease burden due to low fruit and vegetable consumption is higher in Centr... more It is estimated that disease burden due to low fruit and vegetable consumption is higher in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) than any other parts of the world. However, no large scale studies have investigated the association between fruit and vegetable (F&V) intake and mortality in these regions yet. The Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study is a prospective cohort study with participants recruited from the Czech Republic, Poland and Russia. Dietary data was collected using food frequency questionnaire. Mortality data was ascertained through linkage with death registers. Multivariable adjusted hazard ratios were calculated by Cox regression models. Among 19,333 disease-free participants at baseline, 1314 died over the mean follow-up of 7.1 years. After multivariable adjustment, we found statistically significant inverse association between cohort-specific quartiles of F&V intake and stroke mortality: the highest ...
To assess the relationship between green space proximity, use of green space and depressive sympt... more To assess the relationship between green space proximity, use of green space and depressive symptoms and perceived general health among a random sample men and women. Cross-sectional study of a population-based sample of 6,944 45-72 year old Kaunas city residents. Self-reported questionnaires provided information on sociodemographic variables, health behaviours, depressive symptoms and poor and very poor perceived general health. Residential proximity to green spaces was defined as living less than 300 m, within interval of 300-999 m, and equal or more than 1 km from a park. The use of the park was divided into two categories: no park use or use <4hrs/week and use of the park ≥4 h/week. The study received approval from the Kaunas Regional Research Ethics Committee. Multiple logistic regression assessed the associations controlling for confounding variables. The prevalence of depressive symptoms and poor and or very poor perceived general health was higher in women than in men. Th...
Conflicting evidence exists on whether smoking acts as an effect modifier of the association betw... more Conflicting evidence exists on whether smoking acts as an effect modifier of the association between APOE genotype and risk of coronary heart disease (CHD). We searched PubMed and EMBASE to June 11, 2013 for published studies reporting APOE genotype, smoking status and CHD events and added unpublished data from population cohorts. We tested for presence of effect modification by smoking status in the relationship between APOE genotype and risk of CHD using likelihood ratio test. In total 13 studies (including unpublished data from eight cohorts) with 10,134 CHD events in 130,004 individuals of European descent were identified. The odds ratio (OR) for CHD risk from APOE genotype (ε4 carriers versus non-carriers) was 1.06 (95% confidence interval (CI): 1.01, 1.12) and for smoking (present vs. past/never smokers) was OR 2.05 (95%CI: 1.95, 2.14). When the association between APOE genotype and CHD was stratified by smoking status, compared to non-ε4 carriers, ε4 carriers had an OR of 1.1...
The Russian mortality crisis of the early 1990s attracted considerable attention, but information... more The Russian mortality crisis of the early 1990s attracted considerable attention, but information on possible covariates of mortality is lacking, and concerns have been raised about the validity of official mortality data. To help elucidate the determinants of mortality, we examined whether indirect demographic techniques could be used to study mortality in countries such as the Russian Federation, where mortality data are inadequate, using input data independent from official vital statistics. A national sample of the population was interviewed (n = 1600, response rate = 67%). Participants who had ever been married (82% of the sample) were asked about the date of birth and vital status of their first spouse. Spousal mortality was then estimated indirectly for the 531 men and 710 women for whom valid data were available. The estimated risk of death between the ages of 35-69 years was 57% for male spouses and 17% for female spouses. Corresponding figures derived from national data fo...
To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to inv... more To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. Mendelian randomisation meta-analysis of 56 epidemiological studies. 261 991 individuals of European descent, including 20 259 coronary heart disease cases and 10 164 stroke events. Data were available on ADH1B rs1229984 variant, alcohol phenotypes, and cardiovascular biomarkers. Odds ratio for coronary heart disease and stroke associated with the ADH1B variant in all individuals and by categories of alcohol consumption. Carriers of the A-allele of ADH1B rs1229984 consumed 17.2% fewer units of alcohol per week (95% confidence interval 15.6% to 18.9%), had a lower prevalence of binge drinking (odds ratio 0.78 (95% CI 0.73 to 0.84)), and had higher abstention (odds ratio 1.27 (1.21 to 1.34)) than non-carriers. Rs1229984 A-allele carriers had lower systolic blood pressure (-0.88 (-1.19 to -0.56) mm Hg), interleukin-6 levels (-5....
Contraindications and requests for alternative vaccines can have important implications on vaccin... more Contraindications and requests for alternative vaccines can have important implications on vaccination coverage but population rates of contraindications and alternative vaccination occurring in routine immunisation programmes have not been reported. We investigated the rates of contraindications, the proportion of children who fail to complete regular vaccination, and the use of alternative vaccines within the compulsory immunisation of children in the Czech Republic. We conducted a retrospective review of medical records of all 5038 children born between 1 January 2000 and 31 December 2004 and registered in 24 primary paediatric practices. Contraindications against at least one vaccine were found in 291 (5.8%) children. Contraindications were most commonly reported for the DTP-Hib vaccine (263 children, 5.2%), and the most frequent type were central nervous system disorders (171 cases). Contraindications resulted in 181 (3.6%) of incomplete immunisations by at least 1 vaccine, with 80 children (1.6%) remaining unprotected. Alternative vaccines were administered to 935 (18.6%) children; of these, 271 were due to contraindication and 664 on parental request. The rates of contraindications, incomplete immunisations and alternative vaccine use more than tripled over the study period. This study suggests that within the routine immunisation programme, contraindications occur in approximately 6% of children, and many of these children remain incompletely vaccinated.
Recent studies suggested that air pollution might be related to low birth weight. We tested this ... more Recent studies suggested that air pollution might be related to low birth weight. We tested this hypothesis on data from the British 1946 birth cohort. We found a strong association between birth weight and an air pollution index based on coal consumption. Babies born in the most polluted areas were on average 87 grams lighter than those born in the areas with the cleanest air. Adjustment for a number of sociodemographic factors did not change these estimates. While confounding by unmeasured factors cannot be ruled out, these historical data support the hypothesis that birth weight could be affected by air pollution.
Hubacek, JA and Adamkova, V and Stavek, P and Hubacek, JA and Kubinova, R and Peasey, A and Pikha... more Hubacek, JA and Adamkova, V and Stavek, P and Hubacek, JA and Kubinova, R and Peasey, A and Pikhart, H and Mar-Mot, M and Bobak, M (2008) Apolipoprotein E Arg136 -> Cys mutation and hyperlipidemia in a large central European population sample. CLIN CHIM ...
A possible association between end-stage renal disease (ESRD) and apolipoprotein E (APOE) polymor... more A possible association between end-stage renal disease (ESRD) and apolipoprotein E (APOE) polymorphism was found in some but not all studies. We have analyzed the APOE genotypes in 995 hemodialyzed patients (cases) and a sample of 6242 healthy individuals (controls) in the Czech Republic. There was a statistically significant difference in the frequency of APOE alleles between cases and controls, with more carriers of the APOE2 allele in ESRD patients (15.9%) than in controls (12.2%) (P = 0.005). The odds ratio of ESRD for the APOE2 allele, compared with APOE3E3 homozygotes, was 1.37 (95% confidence interval 1.13-1.67). The strength of the association increased with the time spent on hemodialysis: the odds ratio of all-cause ESRD in patients dialyzed for eight or more years was 1.27 (0.94-1.71), for 1-8 years 1.41 (1.09-1.81), and less than 1 year (nonsurvivors) 1.94 (0.88-4.18). This study suggests that the APOE2 allele is a possible genetic risk factor for all-cause ESRD in Caucasians.
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