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Prof. Dr. Radu Negoescu Member of The Academy of Medical Sciences

Symposium on Vegetarian Diet, Bucharest – Cernica, September 2008.

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Prof. Dr. Radu Negoescu Member of The Academy of Medical Sciences

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  1. Symposium on Vegetarian Diet, Bucharest – Cernica, September 2008 Nutrition pattern and physical activity in RomaniaNutrition 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 Negoescu Member of The Academy of Medical Sciences The Institute of Public Health in Bucharest

  2. Romanian perspective on health and public health We understand, together with Prof. Iuliu Moldovan* (1947 – Institute of Hygiene in Cluj), “ that health not only includes the physical, mental, and moral taken together, and also not only the present, but also the future, embracing individual’s entire lifespan or series of generations to come - when we are thinking of family or nation. So that Public Health is the state of biological integrity: that is physical, mental and spiritual, not only in the present but also in the future, for the whole population of a country” *Compare with the definition in the 1949 Constitution of the World Health Organization (WHO) : “Complete wellness from the physical, mental, and social points of view”.

  3. 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: “…you have to get clothed into the renewed man, that following God, that built into Rightness and sanctity of Truth” (Ephesians, 4, 24). The new public health

  4. The new public health Life 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 physicalhealth.

  5. The new public health Progress inHeAlthy Life Expectance (HALE)indices, that in developed countries are quite closely tracking the veryaverage life expectance at birth, sensibly displaced the object of medicine: from the despair zone neighboring irreversible suffering & announced death towards serenecontents of health. * for example, Canada features a HALE index of 72 for an life expectance near to 80 years (source: Pfizer),

  6. New public healthversus old medicine • Notice that: • we provisionally used fitnessfor pointing to performance + fulfillment + • happiness + beatitude+ • Salvation. • 2. death is (strictly) individual, health has clear community co-notation while fitness has definitely a social significance. 3. whereas health is a normal point on a temporal axis, fitness is projected to the future while death retrogrades to the past.

  7. New public healthversus old medicine Thus, nowadays individuals and health systems change the orientation from disease to fitness, from conservation to improvement of human species, from the past to the future.

  8. 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.

  9. 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)

  10. 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.

  11. 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. *Country-wide Integrated Non-communicable Disease Intervention – an West&East new public health program led by WHO Euro region. Romania entered CINDI in 1999.

  12. CINDI Pucioasa study:Age distributions Men mean age 43.515.43 years n = 274 Mean age = 43.816.6 y(SD) Women mean age 44.1415.43 years n = 290

  13. CINDI Pucioasa study Main psycho-somatic diseases versus age prevalence in men CVD = 19.9% Cancer = 0.4% Psychiatric disorder = 4.1% n = 274 Total CVD = 23.4% Cancer = 1.0% Psychiatric disorder = 5.2% prevalence in women CVD = 26.7% Cancer = 1.5% Psychiatric disorder = 6.3% n = 290

  14. CINDI Pucioasa study - objective data Body Mass Index Age-standardized prevalence 15-64 y <25 60.2% 25-29  25.3% >30  14.5% men n = 273 49.1%>25.0 kg/m2 Age-standardized prevalence 15-64 y <25  54.5% 25-29  28.4% >30  17.1% women n = 289

  15. CINDI Pucioasa study – objective data Systolic blood pressure Age-standardized prevalence 15-64 y <140  69.3% 140-159  15.1% >160  15.6% Men mean SBP = 139.6 mmHg n = 273 SBP = 140.2 mmHg Women mean SBP = 140.7 mmHg n = 290 Age-standardized prevalence 15-64 y <140  67.1% 140-159  12.1% >160  20.8%

  16. 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.

  17. 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.

  18. CINDI Pucioasa study: life study data FAT INTAKE FROM COOKED MEALS prevalence in men: vegetal = 48.2 % animal = 8.1 % mixed = 44.0 % n = 274 prevalence in women: vegetal = 57.4 % animal = 8.6 % mixed = 33.8 % n = 289

  19. CINDI Pucioasa study : life study data Alcohol ingestion versus age prevalence in men non drinker = 13.1% occasional drinker = 57.6% drinker = 26.1% n = 274 Regular drinking prevalence: 26.1% of men 10.5% of women prevalence in women non drinker = 35.8% occasional drinker = 53.9% drinker = 10.5% n = 290

  20. 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.

  21. CINDI Pucioasa study: life study data PHYSICAL ACTIVITY AT WORK prevalence in men: very high = 16.6 % high = 22.6 % medium = 29.3 % light = 28.0 % n = 266 prevalence in women: very high = 8.9 % high = 9.2 % medium = 34.4 % light = 42.6 % n = 277

  22. CINDI Pucioasa study: life study data PHYSICAL ACTIVITY IN SPARE TIME prevalence in men: high = 20.4 % medium = 36.0 % non = 42.2 % intense = 3.7 % n = 270 prevalence in women: high = 6.0 % medium = 30.2 % non = 63.1 % intense = 0.2 % n = 288

  23. Lipidic Profile Triglycerides of 107.079.7 mg/dL with 16.3 % over 150 mg/dL, • total serum cholesterol (CHOL) of 180.547.2 mg/dL (173.846.7 M and 185.346.6 F) and • HDL-CHOL (dosed for total CHOL > 200 only) of 41.523.0 mg/dL (37.922.9 M and 44.9 22.8 F). • Only 29 % had CHOL over 200 mg/dL.

  24. CINDI Pucioasa study - objective data Serum cholesterol Age-standardized prevalence 15-64 y <200  77.6% 200-249  17.1% >250  5.3% Men mean chol = 179.6 mg/dl n = 269 Total serum cholesterol = 182.448.6 mg/dl Age-standardized prevalence 15-64 y <200  74.2% 200-249  20.0% >250  5.4% Women mean chol = 185.1 mg/dl n = 286

  25. 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.

  26. CINDI Pucioasa study - life style data Smoking Age-standardized prevalence 15-64 y 52.7% men n = 274 Smoking prevalence = 39.9% Age-standardized prevalence 15-64 y 31.6% women n = 290

  27. CINDI Pucioasa study: life study data Major Stress factors: Loss of the job and Family dissolution versus age family dissolution 1.15% loss of the job 20.8% prevalence in men loss of the job = 21.9% family dissolution = 1.1% n = 274 Total prevalence in women loss of the job = 19.9% family dissolustion = 1.2% n = 290

  28. 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.

  29. Acknowledgements: We thank to many people of Bucharest and Pucioasa who made possible the Romanian CINDI venture. I also thank to the Association for Health & Education for organizing this debate.

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