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Mitä tarkoittaa viitearvo :: Terveyskirjasto
Laboratoriokokeiden tuloslistassa annetaan yleensä suluissa niin sanotut normaaliarvot eli ne rajat, joiden välissä tulos on vielä "normaali". Sana normaali on lainausmerkeissä siksi, että sitä termiä ei haluta lääketieteessä käyttää, koska ei ole mitään jyrkkää rajaa sille, mikä on normaalia ja mikä ei.
Viitearvot ilmoittavat, että 95 %:lla terveistä ihmisistä arvot ovat annettujen lukujen välissä. Noin viidellä prosentilla terveistä ihmisistä tulos voi olla viitearvoa suurempi tai pienempi. Miksi ei pyritä sataan prosenttiin? Syynä on ihmisten suuri yksilöllisyys. Jos pyrittäisiin sataan prosenttiin eli siihen, että kaikki terveet sijoittuisivat viitearvojen sisälle, tulisi liikaa "vääriä normaaleja". Tämä tarkoittaa, että joillakin yksilöillä tulos olisi lähellä ylä- tai alarajaa mutta kuitenkin viitearvojen sisällä, vaikka heillä olisi sairaus.
Normaaliarvojen sijasta ammattikielessä puhutaan viitearvoista. Ne saadaan, kun tutkitaan riittävän suuri joukko terveitä ihmisiä. Ihmiset ovat yksilöitä ja sen vuoksi jokaisen laboratoriotutkimuksen tulos on yksilöllinen ja vaihtelee tiettyjen rajojen sisällä.
Viitearvot ilmoittavat, että 95 %:lla terveistä ihmisistä arvot ovat annettujen lukujen välissä. Noin viidellä prosentilla terveistä ihmisistä tulos voi olla viitearvoa suurempi tai pienempi. Miksi ei pyritä sataan prosenttiin? Syynä on ihmisten suuri yksilöllisyys. Jos pyrittäisiin sataan prosenttiin eli siihen, että kaikki terveet sijoittuisivat viitearvojen sisälle, tulisi liikaa "vääriä normaaleja". Tämä tarkoittaa, että joillakin yksilöillä tulos olisi lähellä ylä- tai alarajaa mutta kuitenkin viitearvojen sisällä, vaikka heillä olisi sairaus.
Viitearvojen 95 prosentin sääntö merkitsee, että viidellä prosentilla terveistä ihmisistä laboratoriotulos on viitearvojen ulkopuolella. Vastaavasti, jos tutkimuksia tehdään samalle ihmiselle paljon, todennäköisyys viiterajojen ulkopuolelle meneviin arvoihin kasvaa. Jos tehdään kaksikymmentä eri tutkimusta, yhdessä niistä tulos on todennäköisesti viitearvoa suur
All-New Review of Uffe Ravnskov's The Cholesterol Myths
"Cholesterol And Heart Disease — Just a Myth?
A Review of Uffe Ravnskov's The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease
August 21, 2008
Reviewed by Chris Masterjohn
Uffe Ravnskov's 2000 book The Cholesterol Myths was a blockbuster among skeptics of mainstream health and nutrition dogma. With the heavy credentials of an MD, PhD author, the book formed the impetus for a resurrection of once-popular cholesterol skepticism that eventually led to the formation of The International Network of Cholesterol Skeptics in 2003, of which Ravnskov is the spokesman."
Relationship of Dietary Linoleic Acid to Blood Pressure: The International Study of Macro-Micronutrients and Blood Pressure Study -- Miura et al. 52 (2): 408 -- Hypertension
Relationship of dietary linoleic acid to blood pressure. The International Study of Macro-Micronutrients and Blood Pressure Study [corrected]
Miura K, Stamler J, Nakagawa H, Elliott P, Ueshima H, Chan Q, Brown IJ, Tzoulaki I, Saitoh S, Dyer AR, Daviglus ML, Kesteloot H, Okayama A, Curb JD, Rodriguez BL, Elmer PJ, Steffen LM, Robertson C, Zhao L; International Study of Macro-Micronutrients and Blood Pressure Research Group.
Hypertension. 2008 Aug;52(2):408-14. Epub 2008 Jul 7. Erratum in: Hypertension. 2008 Sep;52(3):e29.
PMID: 18606902
doi: 10.1161/HYPERTENSIONAHA.108.112383
Dietary linoleic acid intake may contribute to prevention and control of adverse blood pressure levels in general populations
Cardiovascular Risk and {alpha}-Linolenic Acid: Can Costa Rica Clarify? -- Harris 118 (4): 323 -- Circulation
Cardiovascular risk and alpha-linolenic acid: can Costa Rica clarify?
Harris WS.
Circulation. 2008 Jul 22;118(4):323-4. Epub 2008 Jul 7. Review. PMID: 18606912
doi: 10.1161/CIRCULATIONAHA.108.791467
{alpha}-Linolenic Acid and Risk of Nonfatal Acute Myocardial Infarction -- Campos et al. 118 (4): 339 -- Circulation
Alpha-linolenic acid and risk of nonfatal acute myocardial infarction.
Campos H, Baylin A, Willett WC.
Circulation. 2008 Jul 22;118(4):339-45. Epub 2008 Jul 7. Erratum in: Circulation. 2008 Sep 16;118(12):e492.
PMID: 18606916
doi: 10.1161/CIRCULATIONAHA.107.762419
Conclusions - Consumption of vegetable oils rich in {alpha}-linolenic acid could confer important cardiovascular protection. The apparent protective effect of {alpha}-linolenic acid is most evident among subjects with low intakes
Alpha-linolenic acid reduces risk of nonfatal MI - theheart.org
"July 9, 2008 | Michael O'Riordan
Boston, MA - The consumption of a diet containing vegetable oils rich in alpha-linolenic acid (ALA) is associated with significant reductions in the risk of nonfatal MI, a new study has shown [1]. Investigators say the protective effect of ALA is evident among individuals with low intakes, suggesting the greatest benefit might be in developing countries, where fatty-acid consumption is limited.
"The potential for benefit is great when the baseline intake is low," said lead investigator Dr Hannia Campos (Harvard Medical School, Boston, MA). "In countries where people eat very little fish—and some of these countries have almost no sources of omega-3 fatty acids because they cook with corn or sunflower oils—the consumption of vegetable oils with ALA could have a major impact on heart disease."
In an editorial accompanying the published study [2], Dr William Harris (University of South Dakota, Sioux Falls) said that the data are suggestive and would be good news for individuals who will not or cannot eat fish, but more studies are still needed. "If ALA were able to do the same 'heavy lifting' that [eicosapentaenoic acid] EPA and [docosahexaenoic acid] DHA do, this would be welcomed news, because the capacity to produce ALA is essentially limitless, whereas there are only so many fish in the sea," he writes. "
Cooling Inflammation: anti-inflammatory diet
"Anti-inflammatory Diet
Components of an Anti-inflammatory Diet (focus on meats, fish, eggs and leafy vegetables)"
Low-Carb and Mediterranean Diets Beat Low-Fat for Weight Loss, Lipid Changes at 2 Years - Medscape
July 16, 2008 — Both a low-carbohydrate diet or a Mediterranean-style diet may be "effective alternatives" to a low-fat diet, with more favorable effects on lipids and/or glycemic control, new research suggests [1]. The two-year study, which managed to keep almost 85% of the 322 study participants on one of the three diets for the entire period, offers the hope that weight-loss diets can be tailored to personal preferences, without sacrificing efficacy, researchers say.
"Several recent one-year dietary studies have led the American Diabetes Association to state in January 2008 that low-carb diets should be considered for a maximum of one year," lead author on the study, Dr Iris Shai (Ben Gurion University of the Negev, Beer-Sheva, Israel), told heartwire . "The current two-year study suggests that one low-fat diet doesn't fit all, meaning that the old paradigm should be reconsidered."
Shai and colleagues publish the results of the Dietary Intervention Randomized Controlled Trial (DIRECT) in the July 17, 2008 issue of the New England Journal of Medicine
Low-carb and Mediterranean diets beat low-fat for weight-loss, lipid changes at two years - theheart.org
July 16, 2008 | Shelley Wood
Beer-Sheva, Israel - Both a low-carbohydrate diet or a Mediterranean-style diet may be "effective alternatives" to a low-fat diet, with more favorable effects on lipids and/or glycemic control, new research suggests [1]. The two-year study, which managed to keep almost 85% of the 322 study participants on one of the three diets for the entire period, offers the hope that weight-loss diets can be tailored to personal preferences, without sacrificing efficacy, researchers say.
"Several recent one-year dietary studies have led the American Diabetes Association to state in January 2008 that low-carb diets should be considered for a maximum of one year," lead author on the study, Dr Iris Shai (Ben Gurion University of the Negev, Beer-Sheva, Israel), told heartwire. "The current two-year study suggests that one low-fat diet doesn't fit all, meaning that the old paradigm should be reconsidered."
Shai and colleagues publish the results of the Dietary Intervention Randomized Controlled Trial (DIRECT) in the July 17, 2008 issue of the New England Journal of Medicine
Whole Health Source: Wheat is Invading China
"Tuesday, July 8, 2008
Wheat is Invading China
Dr. Michael Eades linked to an interesting study yesterday on his Health and Nutrition blog. It's entitled "Vegetable-Rich Food Pattern is Related to Obesity in China."
It's one of these epidemiological studies where they try to divide subjects into different categories of eating patterns and see how health problems associate with each one. They identified four patterns: the 'macho' diet high in meat and alcohol; the 'traditional' diet high in rice and vegetables; the 'sweet tooth' pattern high in cake, dairy and various drinks; and the 'vegetable rich' diet high in wheat, vegetables, fruit and tofu. The only pattern that associated with obesity was the vegetable-rich diet. The 25% of people eating closest to the vegetable-rich pattern were more than twice as likely to be obese as the 25% adhering the least.
The authors of the paper try to blame the increased obesity on a higher intake of vegetable oil from stir-frying the vegetables, but that explanation is juvenile and misleading. A cursory glance at table 3 reveals that the vegetable-eaters weren't eating any more fat than their thinner neighbors. Dr. Eades suggests that their higher carbohydrate intake (+10%) and higher calorie intake (+120 kcal/day) are responsible for the weight gain, but I wasn't satisfied with that explanation so I took a closer look.
Lack of vitamin D may increase heart disease risk
"DALLAS, Jan. 8 — The same vitamin D deficiency that can result in weak bones now has been associated with an increased risk of cardiovascular disease, Framingham Heart Study researchers report in Circulation: Journal of the American Heart Association.
“Vitamin D deficiency is associated with increased cardiovascular risk, above and beyond established cardiovascular risk factors,” said Thomas J. Wang, M.D., assistant professor of medicine at Harvard Medical School in Boston, Mass. “The higher risk associated with vitamin D deficiency was particularly evident among individuals with high blood pressure.”
In a study of 1,739 offspring from Framingham Heart Study participants (average age 59, all Caucasian), researchers found that those with blood levels of vitamin D below15 nanograms per milliliter (ng/mL) had twice the risk of a cardiovascular event such as a heart attack, heart failure or stroke in the next five years compared to those with higher levels of vitamin D."
Vitamin D Deficiency and Risk of Cardiovascular Disease -- Wang et al. 117 (4): 503 -- Circulation
Vitamin D deficiency and risk of cardiovascular disease.
Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, Benjamin EJ, D'Agostino RB, Wolf M, Vasan RS.
Circulation. 2008 Jan 29;117(4):503-11. Epub 2008 Jan 7.
PMID: 18180395
doi: 10.1161/CIRCULATIONAHA.107.706127
Conclusions— Vitamin D deficiency is associated with incident cardiovascular disease. Further clinical and experimental studies may be warranted to determine whether correction of vitamin D deficiency could contribute to the prevention of cardiovascular disease.
Vitamin D Deficiency and Risk of Cardiovascular Disease -- Wang et al., 10.1161/CIRCULATIONAHA.107.706127 -- Circulation (free full text PDF available)
Vitamin D deficiency and risk of cardiovascular disease.
Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, Benjamin EJ, D'Agostino RB, Wolf M, Vasan RS.
Circulation. 2008 Jan 29;117(4):503-11. Epub 2008 Jan 7.
PMID: 18180395
doi: 10.1161/CIRCULATIONAHA.107.706127
Conclusions—Vitamin D deficiency is associated with incident cardiovascular disease. Further clinical and experimental studies may be warranted to determine whether correction of vitamin D deficiency could contribute to the prevention of cardiovascular disease.
Consumption of omega-3 fatty acids is not associated with a reduction in carotid atherosclerosis: The Genetics of Coronary Artery Disease in Alaska Natives study - ScienceDirect - Atherosclerosis
Consumption of omega-3 fatty acids is not associated with a reduction in carotid atherosclerosis: the Genetics of Coronary Artery Disease in Alaska Natives study.
Ebbesson SO, Roman MJ, Devereux RB, Kaufman D, Fabsitz RR, Maccluer JW, Dyke B, Laston S, Wenger CR, Comuzzie AG, Romenesko T, Ebbesson LO, Nobmann ED, Howard BV.
Atherosclerosis. 2008 Aug;199(2):346-53. Epub 2007 Dec 4.
PMID: 18054937
doi:10.1016/j.atherosclerosis.2007.10.020
Conclusions
Dietary intake of omega-3 FAs in a moderate-to-high range does not appear to be associated with reduced plaque, but is negatively associated with IMT. The presence and extent of carotid atherosclerosis among Eskimos is higher with increasing consumption of saturated FAs.
Prevalence and Correlates of Subclinical Atherosclerosis in Alaska Eskimos: The GOCADAN Study -- Cutchins et al. 39 (11): 3079 -- Stroke
Prevalence and correlates of subclinical atherosclerosis in Alaska Eskimos: the GOCADAN study.
Cutchins A, Roman MJ, Devereux RB, Ebbesson SO, Umans JG, Zhu J, Weissman NJ, Howard BV.
Stroke. 2008 Nov;39(11):3079-82. Epub 2008 Jul 10.
PMID: 18617652
doi: 10.1161/STROKEAHA.108.519199
Conclusions— Alaska Eskimos have similar traditional risk factors for carotid atherosclerosis as other ethnic and racial populations but have higher prevalences of atherosclerosis, possibly attributable to higher rates of smoking.
Smoking trumps omega-3s to drive up atherosclerosis rates in Alaskan Eskimos - theheart.org
"July 10, 2008 | Shelley Wood
New York, NY - Despite eating a diet rich in omega-3 fatty acids, Alaskan Eskimo are developing subclinical atherosclerosis at an early age, likely due in large part to heavy smoking, a new study shows [1]. According to investigators, in a paper published online July 10, 2008 in Stroke, rates of carotid atherosclerosis in the mostly young to middle-aged subjects participating in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study were significantly higher than those reported in US population-based studies of other ethnic groups.
But as Dr Alexis Cutchins (Weill Cornell Medical College, New York, NY) and colleagues report, rates of current smoking among the Eskimo population studied were also four to six times higher than that of other US populations in similar studies.
"I don't think there's anything very surprising here, but I guess what is novel is that the findings relate to a population that has not been studied much, if at all, in this regard," study coauthor Dr Mary J Roman (Weill Cornell Medical College) told heartwire. "And I think that the message is one that has public-health implications for everybody else: this is basically a reiteration of the fact that smoking is a very potent cardiovascular risk factor, and I think the indoctrination that most of us have received about the ills of smoking have clearly not penetrated the Alaska Eskimo population.""
Omega-3 rather than genetics is key to lack of CHD in Japanese? - theheart.org
July 28, 2008 | Sue Hughes
Pittsburgh, PA and Shiga, Japan - The low rate of atherosclerosis and heart disease in Japanese people may be related to their very high levels of marine-derived omega-3 fatty acids rather than genetic factors, a new study suggests [1].
The study, published in the August 5, 2008 issue of the Journal of the American College of Cardiology (available online July 28), was conducted by a group led by Dr Akira Sekikawa (University of Pittsburgh, PA, and Shiga University of Medical Science, Japan).
They found that compared with white or Japanese American men living in the US, Japanese men living in Japan had twice the blood levels of omega-3 fatty acids—a finding that was independently linked to low levels of atherosclerosis.
"The death rate from coronary heart disease in Japan has always been puzzlingly low. Our study suggests that the very low rates of coronary heart disease among Japanese living in Japan may be due to their lifelong high consumption of fish," Sekikawa said."
Results showed that the Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar higher levels. The Japanese men also had twofold higher levels of marine-derived omega-3 fatty acids than white and Japanese Americans.
In addition, the significant differences between Japanese and American men in multivariable-adjusted IMT and CAC prevalence became nonsignificant after adjustment further for marine-derived omega-3 fatty acids.
Omega-3 Rather Than Genetics Is Key to Lack of CHD in Japanese? - Medscape
July 29, 2008 — The low rate of atherosclerosis and heart disease in Japanese people may be related to their very high levels of marine-derived omega-3 fatty acids rather than genetic factors, a new study suggests [1].
The study, known as Electron-Beam Tomography, Risk Factor Assessment Among Japanese and US Men in the Post-World War II Birth Cohort (ERA JUMP) included 868 randomly selected men aged 40 to 49. Of these, 281 were Japanese men living in Japan; 306 were white men living in the US, and 281 were third- or fourth-generation Japanese American men from Hawaii. All study participants had a physical examination, completed a lifestyle questionnaire, and had blood tests to measure cholesterol levels and levels of omega-3 fatty acids. Atherosclerosis was assessed by measuring carotid intima-medial thickness (IMT) and coronary artery calcification (CAC).
Results showed that the Japanese men had the lowest levels of atherosclerosis, whereas whites and Japanese Americans had similar higher levels. The Japanese men also had twofold higher levels of marine-derived omega-3 fatty acids than white and Japanese Americans.
The study, published in the August 5, 2008 issue of the Journal of the American College of Cardiology (available online July 28), was conducted by a group led by Dr Akira Sekikawa (University of Pittsburgh, PA, and Shiga University of Medical Science, Japan).
They found that compared with white or Japanese American men living in the US, Japanese men living in Japan had twice the blood levels of omega-3 fatty acids — a finding that was independently linked to low levels of atherosclerosis.
Intima-media thickness of the carotid artery and the distribution of lipoprotein subclasses in men aged 40-49 between whites in the U.S. and the Japanese in Japan for the ERA JUMP Study
Intima-media thickness of the carotid artery and the distribution of lipoprotein subclasses in men aged 40 to 49 years between whites in the United States and the Japanese in Japan for the ERA JUMP study.
Sekikawa A, Ueshima H, Sutton-Tyrrell K, Kadowaki T, El-Saed A, Okamura T, Takamiya T, Ueno Y, Evans RW, Nakamura Y, Edmundowicz D, Kashiwagi A, Maegawa H, Kuller LH.
Metabolism. 2008 Feb;57(2):177-82.
PMID: 18191046
doi: 10.1016/j.metabol.2007.08.022.
In men in the post World War II birth cohort, i.e., men aged 40–49, whites in the United States (U.S.) had significantly higher levels of intima-media thickness of the carotid arteries (IMT) than the Japanese in Japan.
The whites had significantly higher levels of large very-low-density-lipoprotein particles and significantly lower levels of large high-density-lipoprotein particles than the Japanese, whereas the two populations had similar levels of small low-density-lipoprotein particles. The two populations had similar associations of IMT with NMR lipoproteins. Adjusting for NMR lipoproteins did not attenuate the significant difference in IMT between the two populations (0.671 ± 0.006 for the whites and 0.618 ± 0.006 mm for the Japanese, P=0.01, mean (standard error)). Differences in the distributions of NMR lipoproteins between the two populations did not explain the higher IMT in the whites.
Marine-derived n-3 fatty acids and atherosclerosis in Japanese, Japanese Americans, and Whites: a cross-sectional study
Marine-derived n-3 fatty acids and atherosclerosis in Japanese, Japanese-American, and white men: a cross-sectional study.
Sekikawa A, Curb JD, Ueshima H, El-Saed A, Kadowaki T, Abbott RD, Evans RW, Rodriguez BL, Okamura T, Sutton-Tyrrell K, Nakamura Y, Masaki K, Edmundowicz D, Kashiwagi A, Willcox BJ, Takamiya T, Mitsunami K, Seto TB, Murata K, White RL, Kuller LH; ERA JUMP (Electron-Beam Tomography, Risk Factor Assessment Among Japanese and U.S. Men in the Post-World War II Birth Cohort) Study Group.
J Am Coll Cardiol. 2008 Aug 5;52(6):417-24.
PMID: 18672160
Conclusions
Very high levels of marine-derived n-3 FAs have anti-atherogenic properties independent of traditional cardiovascular risk factors and may contribute to lower burden of atherosclerosis in Japanese in Japan, which is unlikely due to genetic factors.
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