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Unlabelled: To evaluate the receiver operating characteristics (ROC) to determine the cutoffs of waist circumference as a potential population directed screening tool for hypercholesterolaemia (> or = 6.5 mmol/L), low high density lipoprotein cholesterol (< 0.9 mmol/L), and hypertension (treated and/or systolic > or = 160 and/or diastolic blood pressure > or = 95 mmHg), in 2183 men and 2698 women aged 20 to 59 years selected at random from Dutch civil registries., Main Outcome Measures: Height, weight, body mass index (BMI), waist circumference, total plasma cholesterol and high density lipoprotein cholesterol concentrations, and blood pressure., Results: ROC curves showed that sensitivity equalled specificity at waist circumferences between 93-95 cm in men and 81-84 cm in women for identifying individual risk factors, and 92 cm in men and 81 cm in women for identifying those with at least one risk factor. Sensitivity and specificity were equal at levels between 61% to 69% for identifying individual risk factors, with positive predictions (56.8% in men and 37.8% in women) within 2% of those using previously defined 'Action Level 1' of waist circumference 94 cm in men and 80 cm in women (58.8% in men and 37.4% in women). Risk prediction by anthropometric methods was relatively low: ROC areas for identifying each risk factor by waist varied from 55% to 60%, and reached about 65% for identifying at least one risk factor. Height accounted for less than 0.3% of variance in waist circumference. Using BMI at 25 kg/m2 gave similar prediction to waist, but its combination with waist did not improve predictive values., Conclusions: Measurement of waist circumference 'Action Level 1' at 94 cm (37 inches) in men and 80 cm (32 inches) in women could be adopted as a simpler valid alternative to BMI for health promotion, to alert those at risk of cardiovascular disease, and as a guide to risk avoidance by self-weight management.

Background: The quantitative contribution of dietary calcium, potassium and magnesium to blood pressure levels remains unknown as does the combined effect of dietary calcium, potassium and magnesium., Methods: The relation between blood pressure and dietary calcium, potassium and magnesium and the combined effect of these minerals on blood pressure was studied in 20,921 Dutch men and women aged 20-59 years. Food intake was measured by a food frequency questionnaire. The data were adjusted for age, body mass index, heart rate, alcohol and energy intake., Results: An inverse association was observed between blood pressure and dietary potassium and magnesium in both men and women. Dietary calcium was inversely related to systolic blood pressure (SBP) in women and with diastolic blood pressure (DBP) in men. The relation between magnesium intake and blood pressure was stronger than those between blood pressure and intakes of potassium and calcium. Men and women who consumed a diet with intakes in the upper tertiles of all three minerals had a lower SBP and DBP compared to those who had intakes in the lower tertiles (men: SBP = -1.3 (95% CI: -2.6, -0.1), DBP = -1.9 (95% CI: -2.7, -1.0), women: SBP = -1.8 (95% CI: -3.1, -0.5), DBP = -1.5 (95% CI: -2.4, -0.7)., Conclusion: These results suggest that diets rich in calcium, potassium and magnesium are associated with lower blood pressure.

Objective: To determine the frequency of cardiovascular risk factors in people categorised by previously defined "action levels" of waist circumference., Design: Prevalence study in a random population sample., Setting: Netherlands., Subjects: 2183 men and 2698 women aged 20-59 years selected at random from the civil registry of Amsterdam and Maastricht., Main Outcome Measures: Waist circumference, waist to hip ratio, body mass index (weight (kg)/height (m2)), total plasma cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, age, and lifestyle., Results: A waist circumference exceeding 94 cm in men and 80 cm in women correctly identified subjects with body mass index of > or = 25 and waist to hip ratios > or = 0.95 in men and > or = 0.80 in women with a sensitivity and specificity of > or = 96%. Men and women with at least one cardiovascular risk factor (total cholesterol > or = 6.5 mmol/l, high density lipoprotein cholesterol < or = 0.9 mmol/l, systolic blood pressure > or = 160 mm Hg, diastolic blood pressure > or = 95 mm Hg) were identified with sensitivities of 57% and 67% and specificities of 72% and 62% respectively. Compared with those with waist measurements below action levels, age and lifestyle adjusted odds ratios for having at least one risk factor were 2.2 (95% confidence interval 1.8 to 2.8) in men with a waist measurement of 94-102 cm and 1.6 (1.3 to 2.1) in women with a waist measurement of 80-88 cm. In men and women with larger waist measurements these age and lifestyle adjusted odds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively., Conclusions: Larger waist circumference identifies people at increased cardiovascular risks.

The positive association between alcohol consumption and blood pressure is well known. Little is known, however, about effect modification by age, gender, and smoking on the alcohol-blood pressure association. We used data of a cross-sectional study conducted in the Netherlands to investigate the association between alcohol consumption and blood pressure. Between 1987 and 1990, we examined about 30,000 men and women age 20-59 years. After adjustment for age, body mass index, and smoking, we found that in men systolic and diastolic blood pressure increased by 0.9 and 0.6 mmHg per daily drink, respectively. In women, systolic and diastolic blood pressure were 2 and 1 mmHg higher in those who consumed 2 or more glasses per day compared with nondrinkers, respectively. We observed a stronger association between alcohol and blood pressure in older men compared with younger men and in male and female smokers compared with nonsmokers. These data show that gender, age, and smoking all are important effect modifiers of the alcohol-blood pressure relation.

Levels and trends in blood pressure (BP), as well as prevalence and treatment of hypertension, were studied in The Netherlands between 1987 and 1991. BP was measured continuously using a standardized method in 36,273 men and women 20-59 years of age. The data were weighted for the age distribution of the general Dutch population in 1990 and adjusted for each technician who measured BP. In summer in both men and women, systolic blood pressure (SBP) was about 1.5-2.0 mm Hg lower than in the other seasons, and diastolic blood pressure (DBP) was 0.5-1.0 mm Hg lower. In 1987 SBP was 124 mm Hg in men and 117 mm Hg in women. DBP was 78 mm Hg in men and 75 mm Hg in women. The prevalence of hypertension was 8% in both men and women. Between 1987 and 1991, SBP decreased slightly while DBP increased slightly. The prevalence of hypertension did not change in this period. The percentage of treated hypertensive men decreased significantly from 44% in 1987 to 34% in 1991 and from 60% to 49%, in women. We conclude that the prevalence of hypertension did not change between 1987 and 1991, yet the treatment of hypertension decreased, possibly because of a change in the pattern of treatment by Dutch physicians.

To investigate trends in blood pressure and the prevalence and treatment of hypertension in the Netherlands between 1974 and 1986, data from two screening projects on cardiovascular risk factors were used. Between 1974 and 1980 about 30,000 men and women aged 37-43 were screened. Between 1981-1986 about 80,000 men aged 33-37 were examined. An increase in average systolic blood pressure by 2 mmHg in men in the period 1974-1980 was followed by an insignificant change during the period 1981-1986. Average diastolic blood pressure increased by 4 mmHg between 1974 and 1980 but decreased by the same amount between 1981 and 1986. The prevalence of hypertension in 40-year-old men increased from 12.7% in 1974 to 17.8% in 1980. The prevalence of hypertension in 35-year-old men did not change between 1981 and 1986 and amounted to 9.6%. Treatment of 40-year-old hypertensive men increased from 8% in 1974 to 21% in 1980 and from 9% in 1981 to 13% in 1986 among 35-year-old men. Average systolic blood pressure did not change in 40-year-old women between 1974-1980 but average diastolic blood pressure increased by 2 mmHg during that period. The percentage of hypertensive women was 8.5% and did not change between 1974 and 1980. Also, the percentage of treated hypertensive women did not change and amounted to 28%.(ABSTRACT TRUNCATED AT 250 WORDS)

Between 1984 and 1987, adult height, sitting height, arm span, and iliac crest height were measured in 13,386 women of the DOM project. Combined effects of secular trends between cohorts born in 1911 to 1945 and aging between ages 40 to 74 years showed a decrease in stature of 4.9 +/- 0.3 cm (mean +/- standard error of mean) and in sitting height of 3.9 +/- 0.2 cm. Height and sitting height diminished but no effect of aging on arm span was found in 380 women measured again after 5 years. When arm span and iliac crest height did not change with age, they reflected a secular trend (1.6 +/- 0.3 cm and 0.5 +/- 0.3 cm). This implies an age-related decline in stature of -3 cm in 35 years.

Combinations of dietary factors were studied in relation to breast-cancer occurrence among 133 breast cancer cases and 289 population controls in The Netherlands. Dietary factors were classified according to their possible mechanism of action, i.e., relating either to the intestinal microflora (total fat, fiber, fermented milk products) or to the anti-oxidant hypothesis (beta-carotene, selenium and polyunsaturated fatty acids). From 6 interactions evaluated, the combination of high fiber intake and high intake of fermented milk products was the only one suggesting synergistic protection (age-and-fat-adjusted OR for interaction = 0.48, 95% confidence interval (CI) = 0.21 - 1.13). In order to estimate the extent to which the above dietary factors together might be related to breast cancer, subjects with a supposedly favorable dietary pattern (low fat intake, high fiber intake, high intake of fermented milk products; high intake of beta-carotene and selenium, low intake of polyunsaturated fatty acids) were compared with subjects with an unfavorable dietary pattern. This resulted in an age-adjusted odds ratio of 0.40 (95% CI = 0.14 - 1.15), which was largely attributable to the combination of low intake of fat and high intake of fermented milk products and fiber (age-adjusted OR = 0.33, 95% CI = 0.15 - 0.73). The other factors did not appreciably affect the odds ratio. These analyses show in a quantitative way that a dietary pattern which combines low intake of fat and high intake of fiber and fermented milk products might provide substantial protection against breast cancer.