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Lina J. Leurs, (1) Leo J. Schouten, (1) Margreet Letter. Mons, (2) R. Alexandra Goldbohm, (3) and PietA. van den Brandt (1)
Looking a competent framework to have determining exposure-disease relationship when you look at the a put together cohort
(1) Maastricht College or university, GROW-College or university getting Oncology and Developmental Biology, Company of Epidemiology, Maastricht, holland; (2) KWR, Watercycle Research Institute, Nieuwegein, holland; (3) TNO Well being, Service off Protection and you will Health, Leiden, the netherlands
Target communications so you can L.J. Leurs, Maastricht College or university, GROW-College to own Oncology and you may Developmental Biology, Agencies regarding Epidemiology, P.O. Container 616, 6200 MD Maastricht, holland. Telephone: 31 0 43 3882392 mejores sitios de citas americanas. Fax: 30 0 43 3884128. E-mail:
We are in financial trouble to your participants on the studies and require saying thanks to this new Dutch Central Bureau out-of Family history and Statistics Netherlands for delivering analysis. I and give thanks to A. Volovics and you will An excellent. Kester to own analytical pointers; S. van de Crommert, H. Brants, J. Nelissen, C. de Zwart, Meters. Moll, W. van Dijk, and A beneficial. Pisters getting assistance; and H. van Montfort, T. van Moergasiel, L. van den Bosch, Roentgen. Schmeitz, and you can J. Berben to have programming recommendations.
That it opportunity was held into the Combined Search Program of your Dutch liquid businesses of the researchers off Maastricht School and you may KWR, Watercycle Look Institute. This research was financed by KWR, Watercycle Browse Institute.
Roentgen.A.G. and you will Meters.Letter.Yards. benefit consulting organizations (TNO Well being and you will KWR, respectively); not, none enjoys ever before performed one early in the day lookup on latest procedure demonstrated regarding the manuscript. Additionally, additional report on the shape and you can performance are conducted because of the a good Scientific Consultative Committee comprising P. Hunter (University away from Eastern Anglia), Roentgen. Rylander (emeritus professor), and you will M.We. Sinclair (Water Quality Lookup Australian continent Restricted, Monash School).
Very knowledge one to stated an inverse connection ranging from liquid stiffness and you can IHD or heart attack mortality was in fact ecologic knowledge (Kousa et al. 2004, 2006, 2008; Maheswaran mais aussi al. 1999; ; Sauvant and you will Pepin 2000). The latest accuracy of these types of degree can often be expected because the of your own possible ecologic fallacy. A few case-handle and you will cohort training with little if any adjustment getting confounding factors in addition to ideal a possible defensive effectation of drinking water hardness, calcium otherwise magnesium levels inside liquids, into mortality on account of IHD or heart attack (Luoma mais aussi al. 1983; Punsar and Karvonen 1979; Rubenowitz et al. 1996, 1999; Yang 1998; Yang mais aussi al. 2006). Additionally, very case-control and you can cohort training you to modified getting several thousand prospective confounders, for example cardiovascular exposure circumstances and h2o attributes, discover no matchmaking anywhere between liquid stiffness and you will IHD otherwise coronary attack death (Comstock et al. 1980; Morris et al. 2001; Rosenlund mais aussi al. 2005). The exception to this rule was your situation-control study conducted by Rubenowitz et al. (2000) you to stated down mortality away from severe myocardial infarction (yet not on the overall incidence) and magnesium when you look at the drinking water immediately following changing to own an over-all spectrum out of possible confounders.
Nutrient intake is actually modified to have time consumption because of the residual approach (Willett and you will Stampfer 1986). The fresh new survey data were secret-entered twice and you can processed in the a standardized trend blinded relating to help you instance/subcohort standing to minimize observer prejudice within the programming and investigation interpretation.
The analyzed exposure variables were total tap water hardness, tap water magnesium, and calcium concentration. In the multivariate analysis, we corrected for potential confounding of other known IHD risk factors: age at baseline (years), cigarette smoking (coded as current vs. never/former smoker and number of cigarettes smoked per day, and years of active smoking), hypertension (yes/no), diabetes (yes/no), body mass index (BMI) (coded as < 18.5 kg/[m.sup.2], 18.5-25 kg/[m.sup.2], 25-30 kg/[m.sup.2], [greater than or equal to] 30 kg/[m.sup.2]), nonoccupational physical activity (coded in tour categories: very little, average, active, or very active), educational level [coded as primary school, lower vocational, high school (junior and senior), and higher vocational/university], total energy intake (kilocalories per day), alcohol consumption (coded in five categories: 0 g/day, 0.1-5 g/day, 5-15 g/day, 15-30 g/day, 2 30 g/day). energy-adjusted saturated/monounsaturated/ polyunsaturated fat consumption (grams per day), and fruit and vegetable consumption (grams per day). We included additional factors that influence the amount of calcium or magnesium absorption from tap water: use of diuretics (yes/no), multivitamin intake (yes/no), calcium supplement intake (yes/no), energy-adjusted dietary calcium and magnesium consumption (milligrams per clay), and total volume of tap water consumption (milliliters per day) (Elin 1988; Greenland et al. 2003; Hornstra et al. 1998; Wilson 1999). When tap water calcium concentration (milligrams per liter) was analyzed, additional adjustment for tap water magnesium concentration (milligrams per liter) occurred and vice versa.
Gillies Myself, Paulin HV. 1983. Variability out of nutrient intakes away from water: a potential reason on the conflict over the dating off liquids high quality to help you cardiovascular illnesses. Int J Epidemiol 12(1):45-fifty.