Greater Green Triangle Risk Factor Study

Very limited data exist for chronic diseases and their risk factors and behaviours in the Greater Green Triangle (GGT) region, or anywhere in rural Australia. To identify health problems and to target interventions and monitor their impact it is necessary to have objective data on chronic disease risk factors. Three cross-sectional surveys were carried out in 2004, 2005 and 2006 in the GGT region in the south east of Australia. In 2004 the survey area was the Limestone Coast in South Australia, 2005 the Corangamite Shire in the south west of Victoria, and in 2006 the Wimmera district in central western Victoria. The data comprises physical measurements and results of blood samples that were taken from patients by specially trained survey nurses. It also comprises data extracted from follow up survey questionnaires that were sent to each patient who returned them through the mail.<br /><br /><br />

Development and validation of the Diet Quality Tool for use in cardiovascular disease prevention settings

The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an individual&rsquo;s overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 individuals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P = 0.002, r = &ndash;0.500), dietary fibre (P &lt; 0.001, r = 0.559) and omega-3 fatty acids (P = 0.048, r = 0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2 g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, &ndash;4.8 to &ndash;0.8) for those with better DQT scores (&gt;60%) versus those with poorer scores (&le;60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n = 25) and cardiac rehabilitation health professionals (n = 8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.<br />

The duration of obesity and the risk of type-2 diabetes

<b>Objective </b>The evidence for the association between obesity and the risk of type 2 diabetes has been derived mainly from the analysis of the degree of obesity. The role of the duration of obesity as an independent risk has not been fully explored. The objective of the present study was to investigate the association between the duration of obesity and the risk of type 2 diabetes.<br /><br /><b>Design </b>Prospective cohort study.<br /><br /><b>Setting </b>The Framingham Heart Study (FHS), follow-up from 1948 to 1998.<br /><br /><b>Subjects </b>A total of 1256 FHS participants who were free from type 2 diabetes at baseline, but were obese on at least two consecutive of the study&rsquo;s twenty-four biennial examinations, were included. Type 2 diabetes status was collected throughout the 48 years of follow-up of the study. The relationship between duration of obesity and type 2 diabetes was analysed using time-dependent Cox models, adjusting for a number of covariates.<br /><br /><b>Results </b>The unadjusted hazard ratio (HR) for the risk of type 2 diabetes for men was 1&middot;13 (95 % CI 1&middot;09, 1&middot;17) and for women was 1&middot;12 (95 % CI 1&middot;08, 1&middot;16) per additional 2-year increase in the duration of obesity. Adjustment for sociodemographic variables, family history of diabetes, health behaviour and physical activity made little difference to these HR. For women the evidence of a dose&ndash;response relationship was less clear than for men, particularly for women with an older age at obesity onset.<br /><br /><b>Conclusions </b>The duration of obesity is a relevant risk factor for type 2 diabetes, independent of the degree of BMI.<br />

Co-morbid cardiovascular disease and depression : sequence of disease onset is linked to mental but not physical self-rated health. Results from a cross-sectional, population-based study

Purpose: Self-rated health has been linked to important health and survival outcomes in individuals with co-morbid depression and cardiovascular disease (CVD). It is not clear how the timing of depression onset relative to CVD onset affects this relationship. We aimed to first identify the prevalence of major depressive disorder (MDD) preceding CVD and secondly determine whether sequence of disease onset is associated with mental and physical self-rated health. Methods: This study utilised cross-sectional, populationbased data from 224 respondents of the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). Participants were those diagnosed with MDD and reported ever having a heart/circulatory condition over their lifetime. Age of onset was reported for each condition. Logistic regression was used to explore differences in self-rated mental and physical health for those reporting pre-cardiac and post-cardiac depression. Results: The proportion of individuals in whom MDD preceded CVD was 80.36% (CI: 72.57-88.15). One-fifth (19.64%, CI: 11.85-27.42) reported MDD onset at the time of, or following, CVD. After controlling for covariates, the final model demonstrated that those reporting post-cardiac depression were significantly less likely to report poor selfrated mental health (OR:0.36, CI: 0.14-0.93) than those with pre-existing depression. No significant differences were found in self-rated physical health between groups (OR:0.90 CI: 0.38-2.14). Conclusions: MDD is most common prior to the onset of CVD. Further, there is an association between pre-morbid MDD and poorer self-rated mental health. To our knowledge, this is the first time this has been demonstrated in a national, population-based survey. As self-rated health has been shown to predict important outcomes such as survival, we recommend that those with MDD be identified as vulnerable to CVD onset and poorer health outcomes