nutrition pattern and physical activity in romania nutrition pattern and physical activity result in...
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Nutrition pattern and physical activity in Romania
Nutrition pattern and physical activity result in a rather favorable lipids profile in a typical community:
the weak vegetarian component is compensated by sustained domestic work
Prof. Dr. Radu NegoescuMember of The Academy of Medical Sciences
The Institute of Public Health in Bucharest
Symposium on Vegetarian Diet, Bucharest – Cernica, September 2008Symposium on Vegetarian Diet, Bucharest – Cernica, September 2008
Romanian perspective on health and Romanian perspective on health and public healthpublic health
We understand, together with Prof. Iuliu Moldovan* We understand, together with Prof. Iuliu Moldovan* (1947 – Institute of Hygiene in Cluj),(1947 – Institute of Hygiene in Cluj),
““ that that healthhealth not only includes the not only includes the physicalphysical, , mentalmental, and, and moralmoral taken together, and also not only the present, but also taken together, and also not only the present, but also the future, embracing individual’s entire lifespan or series of the future, embracing individual’s entire lifespan or series of generations to come - when we are thinking of family or generations to come - when we are thinking of family or nation. nation.
So that So that Public HealthPublic Health is the state of biological integrity: that is is the state of biological integrity: that is physicalphysical, , mentalmental and and spiritualspiritual, , not only in the not only in the present but present but also in the futurealso in the future, for the , for the whole populationwhole population of a country” of a country”
**Compare with the definition in the 1949 Constitution of the World Health Compare with the definition in the 1949 Constitution of the World Health Organization (WHO) : “Complete wellness from the physical, mental, and Organization (WHO) : “Complete wellness from the physical, mental, and social points of view”.social points of view”.
The new public healthThe new public health
Improvement or renewal of human being*,, become topical in the last decades for life sciences equally, particularly for preventive medicine.
* Theologically it is considered the way to Salvation:* Theologically it is considered the way to Salvation: “…you have to get clothed into the renewed man, that …you have to get clothed into the renewed man, that following God, that built into Rightness and sanctity of Truth” following God, that built into Rightness and sanctity of Truth” (Ephesians, 4, 24). (Ephesians, 4, 24).
The new public healthThe new public healthLife sciences deal with the miracle of living, as opposite to (inanimate) nature sciences .
Preventive medicine deals with health preserving & promoting.
The life of quality & performance in both individual and collective meanings is steadily based upon spiritual, mental and physical health.
The new public healthThe new public healthProgress inProgress in HeAlthy Life Expectance (HALE)HeAlthy Life Expectance (HALE) indices, that in developed countries are quite closely indices, that in developed countries are quite closely tracking the verytracking the very average life expectance at birthaverage life expectance at birth,, sensibly displaced the object of medicine:sensibly displaced the object of medicine:
from the despair zone neighboring irreversible from the despair zone neighboring irreversible suffering & announced death suffering & announced death
towards towards sereneserene contents of healthcontents of health. .
* * for example, Canada features a HALE index of 72 for for example, Canada features a HALE index of 72 for an life expectance near to 80 years (source: Pfizer),an life expectance near to 80 years (source: Pfizer),
New New public healthpublic health versus old medicineversus old medicine
3. whereas health is a normal point on a temporal axis, fitness 3. whereas health is a normal point on a temporal axis, fitness is projected to the future while death retrogrades to the past.is projected to the future while death retrogrades to the past.
Notice that: Notice that: 1.1. we provisionally used we provisionally used
fitnessfitness for pointing to for pointing to performance + fulfillment +performance + fulfillment +
happiness + beatitude+happiness + beatitude+ Salvation.Salvation.2. 2. death is (strictly) death is (strictly) individualindividual, ,
health has clear health has clear communitycommunity co-notation while fitness co-notation while fitness has definitely a has definitely a socialsocial significancesignificance..
New New public healthpublic health versus old medicineversus old medicine
Thus, nowadays individuals and health systems change the Thus, nowadays individuals and health systems change the orientation orientation from disease to fitnessfrom disease to fitness, , from conservation tofrom conservation to improvementimprovement of human species of human species, , from the past to the futurefrom the past to the future..
European Society of Cardiology (ESC)
recommendations for CVD prevention• Stop smoking• Make healthier food choices• Be physically active• Get a body-mass index (weight /squared height) <
25 kg/sq.m• Keep blood pressure <140/90 mmHg• Cholesterol concentration <5 mmol/l(200 mg/dl)• LDL cholesterol < 3 mmol/l(120 mg/dl)• Control blood glucose (glycaemia)• Screen close relatives• Prohylactic drugs when necessary.
INTERHEART study:almost all myocardial infarctions are predictable on the basis of known risk factor (RF) tableau
• INTERHEART, a landmark, decade long study included 15,000 1st acute myocardial infarction (AMI) pts. And 15,000 healthy, age and gender matched people (controls) of 52 countries around the globe.
Key message:Though there are differences in life-styles over regions and ethnic
groups, 90 % of AMIs are explained by 9 known RFs: • Smoking-q, dyslipidemia-l, diabetes-q and hypertension-
q significantly differed between AMI and controls• poor psycho-social index-q and abdominal obesity-m are
independently related to AMI (2nd rank RF)• physical activity-q, fruits and vegetable-q in the diet and
moderate alcohol-q consumption are cardioprotective(q,l and m denote questionnaire, lab and measurement tools)
How difficult is to assess the RFs ?
• 7 out of 9 Rfs come from questionnaires, 1 from simple measurement of waist and hip circumference (obesity) and 1 from laboratory assay of apolipoprotein (apo) B/apo A1 ratio in non-fasting plasma (dyslipidemia).
• Smoking + hypertension + diabetes only, from q, associate an OR (odds ratio) of 13, that is a PAR (population attributable risk) for AMI of 53 %
• Adding dyslipidemia, OR ->27.7 and PAR ->75.6 % • Putting together all 9 RFs: OR ->129.2 and PAR ->90.4 %, that
is
over 90 % of AMIs reside in presence of the known 9RFs, most of them being nutrition-dependent if not mere nutrition.
Cardiovascular health and mortality in Romania
• In Romania standardized mortality by CVDs peaked 785 per cento mille in 1996 (Europe’s 3rd worst), slowly decreasing afterward. CVDs account for 61 % of all deaths vs 37 % for the EU 15 before 2004 or 53 % for the EU new members in 2004.
• Following 1999 country’s admission in CINDI program*, town of Pucioasa in Sub-Carpathians (16,3000 inhabitants) was selected as national demonstration area in view of it’s mix urban&rural life-style very common in Romania.
**CCountry-wide ountry-wide IIntegrated ntegrated NNon-communicable on-communicable DDisease isease IIntervention – an ntervention – an West&East new public health program led by WHO Euro region. West&East new public health program led by WHO Euro region. Romania entered CINDI in 1999.Romania entered CINDI in 1999.
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60Mean age = 43.816.6 y(SD)
Menmean age 43.515.43 yearsn = 274
Women mean age 44.1415.43 yearsn = 290
CINDI Pucioasa study:CINDI Pucioasa study:
Age distributionsAge distributions
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CVDCancerPsychosis
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prevalence in menCVD = 19.9%Cancer = 0.4%
Psychiatric disorder = 4.1%n = 274
prevalence in womenCVD = 26.7%Cancer = 1.5%
Psychiatric disorder = 6.3%n = 290
Total CVD = 23.4%Cancer = 1.0%Psychiatric disorder = 5.2%
CINDI Pucioasa study CINDI Pucioasa study
Main psycho-somatic diseases versus ageMain psycho-somatic diseases versus age
53,00%29,00%
18,00%
58,80%
26,00%
15,20%
Body Mass Index prevalence 15 - 64 years< 25.0 kg/sq.m25.0-29.9 kg/sq.m>= 30.0 kg/sq.m
Age-standardizedprevalence 15-64 y <25 60.2%25-29 25.3%>30 14.5%
Age-standardized prevalence 15-64 y <25 54.5%25-29 28.4%>30 17.1%
menn = 273
womenn = 289
49.1%>25.0 kg/m2
CINDI Pucioasa study - objective data CINDI Pucioasa study - objective data
Body Mass IndexBody Mass Index
67,30%
15,60%17,10%
Systolic blood pressure prevalence (%) 15 - 64 years< 140 mmHg140-159 mmHg>= 160 mmHg
64,90%
12,60%
22,50%
Age-standardized prevalence 15-64 y <140 69.3%140-159 15.1%>160 15.6%
Age-standardized prevalence 15-64 y <140 67.1%140-159 12.1%>160 20.8%
Menmean SBP = 139.6 mmHgn = 273
Womenmean SBP = 140.7 mmHgn = 290
SBP = 140.2 mmHg
CINDI Pucioasa study – objective dataCINDI Pucioasa study – objective data
Systolic blood pressureSystolic blood pressure
Nutrition
• Nutrition has local accents (more dairy products) and stigma of poverty (less sugar vs norm).
• Carbohydrates favor men in all life epochs.
• Total lipids input is still favorable to men but women somehow compensate by preferential vegetal fats vs men’s animal lipids propensity.
Vegetarian nutrition
• The strictly vegetarian diet with religious motivation (Orthodox Christian) lasts about 157/365 days per year for 7.8 % M and 10.3 % F;
• 17.4 % M and 34.5 % F fast sporadically.
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vegetalanimalmixed
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prevalence in men:prevalence in men:vegetal = 48.2 %vegetal = 48.2 %animal = 8.1 %animal = 8.1 %mixed = 44.0 %mixed = 44.0 %n = 274n = 274
prevalence in women:prevalence in women:vegetal = 57.4 %vegetal = 57.4 %animal = 8.6 %animal = 8.6 %mixed = 33.8 %mixed = 33.8 %n = 289n = 289
CINDI Pucioasa study: life study dataCINDI Pucioasa study: life study data
FAT INTAKE FROM COOKED MEALSFAT INTAKE FROM COOKED MEALS
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non drinkerocassional drinkerdrinker
prevalence in mennon drinker = 13.1%
occasional drinker = 57.6%drinker = 26.1%
n = 274
prevalence in womennon drinker = 35.8%
occasional drinker = 53.9%drinker = 10.5%
n = 290
Regular drinking prevalence:26.1% of men10.5% of women
CINDI Pucioasa study : life study dataCINDI Pucioasa study : life study data
Alcohol ingestion versus ageAlcohol ingestion versus age
Physical Activity
• Physical activity (PA) at work is 25.9 hours equivalent mild effort/week (emew) in F and 56.2 in M, from a maximum of 111.2.
• In spare-time 57.0 % M and 33.2 % F are active featuring 301.1 minutes (min) emew in M and 289.7 mins emew in F vs a minimal norm of 120.
• Total PA is small in 31.9 %, medium in 52.1 % and higher in 15.9 % of Pucioasa inhabitants (more in M).
• At closer examination spare-time PA proved essentially to stand for work at home or around (farm type) to get extra living means.
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very highhighmediumlight
prevalence in men:prevalence in men:very high = 16.6 %very high = 16.6 %high = 22.6 %high = 22.6 %medium = 29.3 %medium = 29.3 %light = 28.0 %light = 28.0 %n = 266n = 266
prevalence in women:prevalence in women:very high = 8.9 %very high = 8.9 %high = 9.2 %high = 9.2 %medium = 34.4 %medium = 34.4 %light = 42.6 %light = 42.6 % n = 277n = 277
CINDI Pucioasa study: life study dataCINDI Pucioasa study: life study data
PHYSICAL ACTIVITY AT WORKPHYSICAL ACTIVITY AT WORK
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highmediumnoneintense
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prevalence in men:prevalence in men:high = 20.4 %high = 20.4 %medium = 36.0 %medium = 36.0 %non = 42.2 %non = 42.2 %intense = 3.7 %intense = 3.7 %n = 270n = 270
prevalence in women:prevalence in women:high = 6.0 %high = 6.0 %medium = 30.2 %medium = 30.2 %non = 63.1 %non = 63.1 %intense = 0.2 %intense = 0.2 %n = 288n = 288
CINDI Pucioasa study: life study dataCINDI Pucioasa study: life study data
PHYSICAL ACTIVITY IN SPARE TIMEPHYSICAL ACTIVITY IN SPARE TIME
Lipidic Profile
Triglycerides of 107.079.7 mg/dL with 16.3 % over 150 mg/dL,
• total serum cholesterol (CHOL) of 180.547.2 mg/dL (173.846.7 M and 185.346.6 F) and
• HDL-CHOL (dosed for total CHOL > 200 only) of 41.523.0 mg/dL (37.922.9 M and 44.9 22.8 F).
• Only 29 % had CHOL over 200 mg/dL.
76,90%
17,60% 5,60%
Serum cholesterol prevalence (%) 15 - 64 years< 200 mg/dl200-249 mg/dl>= 250 mg/dl
73,40%
20,80% 5,80%
Age-standardized prevalence 15-64 y <200 77.6%200-249 17.1%>250 5.3%
Age-standardized prevalence 15-64 y <200 74.2%200-249 20.0%>250 5.4%
Menmean chol = 179.6 mg/dln = 269
Womenmean chol = 185.1 mg/dln = 286
Total serum cholesterol = 182.448.6 mg/dl
CINDI Pucioasa study - objective data CINDI Pucioasa study - objective data
Serum cholesterolSerum cholesterol
Discussion
• Prevalence of CHOL > 200 mg/dL is under European average.
• Higher percentage of HT cases, borderline or clinically patent, may relate to overweight tendency, mainly in women, to smoking, and
• to chronic psycho-social stress ranked elsewhere as 1st among CVD risk factors.
48,00%
52,00%
Smoking prevalence (%) 15 - 64 yearsNoYes
69,40%
30,60%
Age-standardized prevalence 15-64 y52.7%
Age-standardized prevalence 15-64 y31.6%
Smoking prevalence = 39.9%
menn = 274
womenn = 290
CINDI Pucioasa study - life style dataCINDI Pucioasa study - life style data
SSmokingmoking
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prevalence in menprevalence in menloss of the job = 21.9%loss of the job = 21.9%
family dissolution = 1.1%family dissolution = 1.1%n = 274n = 274
prevalence in womenprevalence in womenloss of the job = 19.9%loss of the job = 19.9%
family dissolustion = 1.2%family dissolustion = 1.2%n = 290n = 290
family dissolution 1.15%loss of the job 20.8%
Total
CINDI Pucioasa study: life study dataCINDI Pucioasa study: life study data
Major Stress factors: Loss of the job and Family Major Stress factors: Loss of the job and Family dissolution versus agedissolution versus age
Conclusion• The quite favorable lipids profile in
a middle-aged sample from a typical Romanian town seems related with moderation present in nutrition due to lower income, while the semi-rural habitat involving extra-job work at home boosts physical activity.
Acknowledgements:Acknowledgements: We thank to many people of Bucharest and Pucioasa who We thank to many people of Bucharest and Pucioasa who made possible the Romanian CINDI venture. made possible the Romanian CINDI venture.
I also thank to the Association for Health & Education for organizing this I also thank to the Association for Health & Education for organizing this debate.debate.