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Purpose: The aim of the study was to assess the content of specific fatty acids in the diet and adipose tissue in a selected group of inhabitants of Lower Silesia in Poland., Methods: The study group consisted of 95 inhabitants of Wroclaw and surrounding villages (22 men and 23 women from the urban area, 23 men and 27 women from the rural area). Fatty acid content in subcutaneous fat samples was assessed by gas-chromatography. Dietary assessment was carried out using food frequency questionnaire. Dietary intake was analyzed using computer programme The Food Processor SQL 10.5.2 produced by ESHA Research USA, with a Polish database., Results: Mean daily energy and fatty acids intake was significantly higher among rural than urban inhabitants. Intake of alpha-linolenic acid (ALA), mainly from rapeseed oil, in urban inhabitants was 1.5 g/day in men and 1.6 g/day in women, and in rural inhabitants 2.6 g/day and 2.1 g/day, respectively. Dietary n-6 to n-3 ratio was higher among urban compared to rural inhabitants (6.7 vs. 5.5 among men and 6.4 vs. 5.5 among women, respectively). Content of ALA in adipose tissue was higher in rural women than in urban men (1.08% vs. 0.92% of total fat). Content of eicosapentaenoic acid (EPA) in adipose tissue in rural men (0.04% of total fat) and women (0.05% of total fat) was higher than in urban men (0.01% of total fat). The positive correlation (r=0.43) between the level of EPA in adipose tissue and percentage of energy from dietary EPA was observed among rural men. Overall, positive correlations were found between saturated (SFA) and polyunsaturated (PUFA) n-3 level in adipose tissue and percentage of energy from these fatty acids in a diet (r=0.20 and r=0.22, respectively)., Conclusions: Mean daily n-3 fatty acid intake in urban inhabitants was lower than the recommended daily consumption in Poland. The positive correlation between fatty acids level in adipose tissue and dietary fatty acid intake was observed only for EPA among rural men, and in the all-study population for SFA and PUFA n-3. A high n-6 to n-3 ratio in the study group was observed.

Objective: The aim of the study was to evaluate the prevalence of overweight and obesity in the population of Świętokrzyskie Province in Poland., Methods: Body mass index (BMI), waist to hip ratio (WHR) and waist circumference (WC) in the Polish-Norwegian Study (PONS) was measured in 2,567 females and 1,287 males. Anthropometric measurements included fat mass, height, weight, waist and hip circumference. BMI and WHR were calculated., Results: Data showed that 52% of males and 42% of females were overweight (25.0 ≤ BMI<30.0 kg/m2), and the prevalence of obesity (BMI ≥ 30.0 kg/m2) was 35% in both genders. The average BMI was higher in males (28.5 kg/m2) than in females (28.2 kg/m2). Analysis of WC showed that 36% of males and 45% of females had abdominal obesity, whereas measurements of WHR showed abdominal obesity in 64% of males and 79% of females. Generally, the prevalence of obesity was higher in the older age group (55-64 years) and in rural inhabitants. The prevalence of overweight increased with educational level, but the prevalence of obesity decreased with level of education in both males and females., Conclusions: Almost 80% of the PONS population were either overweight or obese; therefore, the PONS population is at increased risk of developing obesity-related diseases.

Objective: The aim of this cohort study was to evaluate selected mineral and vitamin intake of the Polish-Norwegian Study (PONS) participants., Methods: Daily mineral and vitamin intake of PONS study participants was estimated using Food Frequency Questionnaire (FFQ). Overall, 3,862 inhabitants of Świętokrzyskie Province aged 45-64 (2,572 females and 1,290 males) enrolled in the study., Results: Mean calcium, iron, magnesium, phosphorus, potassium, and sodium intake were, in males: 660.6 mg/day, 15.4 mg/day, 218.5 mg/day, 889.3 mg/day, 2,453.4 mg/day and 2,571.5 mg/day, and in females: 703.6 mg/day, 13.9 mg/day, 220.8 mg/day, 916.3 mg/day, 2,497.3 mg/day and 2,301.8 mg/day, respectively. Iron and sodium intake was significantly higher in males compared to females. Calcium intake was lower in males than in females and in participants aged 55-64 then those aged 45-54. Estimated daily sodium intake was similar among individuals with and without hypertension. Mean vitamin C, thiamin, riboflavin, vitamin B6, A and E were, in males: 80.1 mg/day, 1.3 mg/day, 1.5 mg/day, 1.6 mg/day, 8,454.0 IU/day and 5.4 mg/day and in females: 83.7 mg/day, 1.1 mg/day, 1.6 mg/day, 1.6 mg/day, 9,494.6 IU/day and 4.9 mg/day, respectively. Females had a higher intake of vitamin C and A , while males had higher thiamin and vitamin E intakes. Higher daily vitamin C intake was observed in the younger than in the older group, and in participants with higher education than those with a lower level of education., Conclusion: Significant differences were observed in daily intake of some vitamins and minerals by gender, age, level of education, and place of residence. Some participants had a lower intake of some minerals and vitamins than Polish recommendations.

Objective: A large-scale population study of health and disease would represent the most powerful tool to address these important issues in Poland. The aim is to extensively survey the study population with respect to important factors related to health and wellbeing, and subsequently, the intention is to follow-up the population for important health outcomes, including the incidence and mortality of cancer, cardiovascular disease, and other major causes of morbidity and mortality. The infrastructure for establishing a large cohort of people in Poland is needed; therefore, the PONS (Polish-Norwegian Study) project represents an eff ort to establish such infrastructure., Methods: The PONS Study is enrolling individuals aged 45-64 years. Structured lifestyle and food frequency questionnaires are administered. Study participants undergo medical check-up, anthropometric measurements and provide blood and urine sample for long-term storage. Fasting glucose and lipids profile are checked in the laboratory., Results: This report describes the design, justification and methodology of the presented prospective cohort study. Recruitment of participants began in September 2010, and by the end of 2011 it is planned to achieve a total of between 10,000 – 15,000 participants., Summary: The PONS study is the fi rst prospective cohort study with blood and urine collection ever conducted in Central and Eastern Europe. It will provide reliable new data on both established and emerging risk factors for several major chronic diseases in a range of different circumstances.

The enormous health gap between the 'new' (eastern) and 'old' (western) parts of the EU has evolved over many decades. The epidemiological transition - that is the decrease in the relative importance of infant and early child mortality and the shift in the composition of mortality risks from communicable to non-communicable diseases - which started in the western part of the region at the beginning of the 20th century, was substantially delayed in most of eastern Europe. However, after the World War II, health improvement in the east initially out-paced the west, such that, by the mid-1960s, only 1-2 years separated the average life expectancy for both sexes between the east and west. This convergence was short-lived and it reversed dramatically between the mid 1960s and 1990. During this period, adult health status in the east stagnated or deteriorated, whereas in the west it improved steadily: by 1990, life expectancy at the age of 20 years was more than fi ve years shorter in the east for men, and more than four years shorter for women. The biggest contributors to the health gap were cardiovascular diseases and injuries. A substantial fraction of the gap can, with confidence, be attributed to the higher volume and more irregular pattern of alcohol consumption in the east, and to the delayed onset of the tobacco smoking epidemics. Much of the remainder of the gap is likely to be attributable to the composition of the diet, but the contribution of different dietary factors cannot be estimated with confidence. Leading candidates are a high consumption of saturated animal fats, a low consumption of fresh fruit and vegetables (especially in winter and spring), a very low consumption of fats supplying omega 3 fatty acids – both vegetable oils and fi sh oils rich in alpha-linolenic acid – and a high consumption of salt. Behaviours unfavourable to health did not change in the east, as they did in the west in response to the credible dissemination of scientific findings linking disease and injury risks both to individual behaviours and to the social and economic circumstances that fostered those behaviours. The eastern countries failed to equip themselves with the science and with the forms of social organisation that were needed to effectively counter epidemics of chronic disease and injury. The poor health-related behavioural determinants resulted from the institutional infrastructures based on an authoritarian, conservative and medicalised model of health, which inhibited modern approaches to social problems, an almost exclusive focus of epidemiology on communicable as opposed to non-communicable diseases, a lack of understanding and access to modern epidemiology and public health, a lack of understanding and access to evidence-based medicine, and a lack of public health education and health promotion.

Introduction: Alcohol drinking is a major contributing factor to death, disease, injury and social problems such as violence or child neglect and abuse, especially in Eastern Europe., Objectives: To preliminary evaluate the prevalence and social and behavioural patterns of alcohol drinking in a pilot group of the Polish-Norwegian Study (PONS study) subjects., Material and Methods: Open-ended prospective cohort study conducted in Świetokrzyskie province. A pilot group of subjects aged 45-64 years has been examined. Data on alcohol drinking were collected for 3,845 respondents with the use of the Health State Questionnaire administered by the CAPI method., Results: In males, 72.3% drank alcohol currently, 22.7% were former drinkers, and only 5% never drinkers. Among females, the percentage of current alcohol drinkers was significantly lower than in males, while the percentages of former and never drinkers was higher (50.3%, 35.4% and 14.6%, respectively). 7.4% of males and 0.8% of females drank alcohol daily or almost daily, and weekly alcohol drinking was respectively at level of 32.2% and 15.7%. Males drank mainly vodka (or other spirits) and beer, females grape wine and vodka., Conclusions: PONS study includes interesting dataset for assessing prevalence and patterns of alcohol drinking at population level. Alcohol drinking seems to be common among PONS subjects. Comparison with nation-wide surveys shows on higher number of alcohol abstainers and lower number of binge drinkers among PONS study subjects. On the other hand, frequency and social patterns of alcohol drinking seem to be consistent with data found in national studies.

After 30 years (1960-1990) of adult health decline, since the beginning of the political and economic transformation in the early 1990s.a dramatic reversal of health trends is being observed in Poland, In contrast, in the countries of Western Europe, a significant, steady health gain has been observed already since the end of World War II. At the beginning of the 21 st century one in three men in Poland still do not reach the age of 65, which dramatically contrasts with the one-digit premature mortality in Western Europe (EU15). In Poland very high proportion of this mortality (men ~30%, women ~15%) occur in working age population hampering social and economic development. Non-communicable diseases and risk factors (smoking, drinking, obesity) are major cause of heath inequality and contribute to poverty. This health gap, leading to an over-proportional loss of human capital in Eastern Europe, is one of the most crucial challenges for the European Union during the period of economic crisis.

Objective: The aim of this cohort study was to evaluate the prevalence of hypertension and cardiovascular risk factors in the studied population., Methods: Presented results are a part of the Polish-Norwegian Study (PONS) project. The study group consisted of 3,862 inhabitants of Świętokrzyskie Province aged 45-64 years (2,572 females and 1,290 males)., Results: Prevalence, awareness and control of hypertension was evaluated in the studied population of 3,854 urban and rural inhabitants. Mean blood pressure in the whole studied population was 139.6/81.9 mmHg; of the studied population 61.7% were hypertensive. Hypertension was more prevalent in the studied males (70.63%) than in the females (57.24%). In both males and females, the older subgroups (55-64 y.o.) had significantly higher blood pressure than the younger subgroups (45-54). Education had a significant impact on the prevalence of hypertension, and the highest prevalence of hypertension was observed in the middle level educated groups of females and males. No significant difference was observed between rural and urban inhabitants. In both females and males, the prevalence of hypertension significantly decreased with level of education. Hypertension was well-controlled in only 13.8% of the subjects. More studied females than males achieved good control of blood pressure (14.09 vs. 12.7%), and better control of blood pressure was significantly more frequent in better those who were better educated. Hypertension was not diagnosed in 23.2% of studied population. Significantly, more males than females had undiagnosed hypertension (30.4 vs. 19.5%). No significant difference between rural and urban populations was observed. Interestingly, both in females and males, the better educated groups had more undiagnosed hypertension than those who were well-educated., Conclusions: The studied group had a high prevalence of hypertension (61.7%), which was less frequent and better controlled in the studied females than in the males. No significant difference was observed between the urban and rural populations. Level of education had significant impact on the prevalence of hypertension.

Introduction and Objectives: Previous community research has shown differences in depression and depressive symptoms across different socioeconomic and demographic groups. However, very few population-based studies on depression have been conducted in Poland. The purpose of the present study is to assess depressive episodes and depressive tendencies, and associations of the latter with selected socio-economic and demographic predictors among a sample of adults from Poland., Materials and Methods: Data stem from a community health survey carried out as part of a large prospective study among people aged 45-64 in the Kielce province of south-eastern Poland (n=3,862). Self-reported depressive episodes, depressive tendencies (7 items) and use of antidepressants were measured. Depressive tendencies were modelled as a latent variable and analyzed against selected demographic and socioeconomic predictors., Results: The prevalence of depressive episodes was higher among females (25.0%) than among males (14.7%). When depressive tendencies were modelled as a latent variable, the following predictors were associated with high scores: age (females only), living in rural districts, being a pensioner (not including old age pension), and being unemployed (males only). Scores on depressive tendencies were negatively associated with high education, being self-employed (borderline significance only) and high personal income., Conclusions: Depressive episodes were prevalent among the sample. If the associations between depressive tendencies and demographic variables shown in this study are confirmed by future studies, it suggests that action should be taken to offer improved preventive action and improved mental health services – such as early treatment – to females, people living in rural areas, and selected low status segments of the population in particular.

Unlabelled: The aim of the study was to evaluate the prevalence, socio-demographic patterns and behavioural characteristics of leisure time physical activity in a pilot group of respondents of the Polish-Norwegian Study (PONS)., Materials and Methods: PONS is an open-ended prospective study set in Świętokrzyski Province with study cohort consisting of adults aged 45-64 years. The physical activity section of the questionnaire was based on the International Physical Activity Questionnaire., Results: 43% of the respondents had not walked for at least 10 minutes in their leisure time during the last week. The majority did not engage in any moderate or vigorous physical activity (PA). Being physically active was more prevalent among residents of urban areas and among respondents with a higher level of education. Performing PA was also positively associated with higher net income per household member. On average, respondents had spent 47 hours in a sedentary position during last week. The majority of subjects reported watching TV for 6-20 hours per week. Not having enough time and lack of willingness were given as the main reasons for being inactive., Conclusions: A significant proportion of participants were inactive in their leisure time, even activity less than 10 minutes during the last 7 days was common. Walking was the most popular form of PA in this domain. Urban residence, higher level of education and better financial situation were strongly associated with higher levels of PA.

Introduction: In Central and Eastern European countries, cardiovascular disorders (CVD) in middle age are much more common than in Western Europe, and it is imperative to understand the causes underlying this excess disease burden. The metabolic syndrome comprises a constellation of metabolic abnormalities that increase the risk of cardiovascular disease., Methods: Data were obtained by structured interview, and by measurements of anthropometric factors and blood analyses among 3,862 individuals. Metabolic syndrome was defined according the International Diabetes Federation Task Force on Epidemiology and Prevention, as the presence of at least 3 of 5 abnormalities: 1) abdominal obesity, 2) glucose intolerance, 3) high triglycerides, 4) low HDL cholesterol, 5) high blood pressure., Results: Overall, 1,518 participants (39.5%) had metabolic syndrome. The prevalence among females was 34.3% (877 females) vs. 49.9% (641 males) among males, and increased with age in both genders. Abdominal obesity was the most common abnormality (2,897 participants, 75.1%), followed by high blood pressure (2,741 participants, 71%), glucose intolerance (1,437 participants, 37.3%), elevated triglycerides (817 participants, 21.2%) and low HDL (615 participants, 15.9%)., Conclusion: The prevalence of metabolic syndrome and metabolic abnormalities is high and represents strong risk factors for CVD morbidity and mortality. However, these factors are all potentially preventable by lifestyle modification and/or by pharmacological treatment. There is an urgent need for the health service to act, and to increase public awareness of metabolic syndrome.

Introduction: The burden of cancer in Eastern Europe is expected to increase, and in 2006, Polish males were ranked second in lifetime risk of lung cancer. The Polish-Norwegian Study (PONS) is a population study in the Kielce District, and the presented study describes the distribution of preventable causes of cancer according to gender, age, education, and urban/rural status., Methods: PONS comprises individuals 45-64 years of age at baseline. A structured lifestyle interview was conducted, and the following risk factors were recorded: smoking, alcohol consumption and obesity. Binomial regression analysis was used to estimate age and gender adjusted prevalence ratios (PR) for the associated factors., Results: A total of 3,862 adults were included in the analysis. Approximately 17% reported current tobacco smoking on a daily basis, 34% were former smokers, and 49% were non- smokers. Current smoking was more prevalent in males (20%) than females (15%), but there was no clear association with educational level or urban/rural status. Females also reported a lower frequency of alcohol consumption than males. Among males, 15% reported drinking alcohol more than once a week, as compared to 2% of the females. There was no clear association with urban/rural status, or with level of education. The total prevalence of obesity (BMI ≥ 30) was 30%; the prevalence of obesity class 2 (BMI ≥ 35) and class 3 (BMI ≥ 40) was 8% and 1.7%, respectively. Obesity increased by age, especially in females, and was less frequent among people with high education and people with urban residence., Conclusions: The Kielce region of Poland is experiencing a significant burden of cancer risk factors, including obesity and tobacco smoking, but smoking may be a decreasing habit. It is necessary to increase the awareness of the population to the harmful eff ects of smoking and obesity to prevent cancer and other lifestyle related diseases.

Objective: The aim of this cross-sectional study was to assess the prevalence of diabetes mellitus and impaired fasting glucose (IFG) in the Polish-Norwegian Study (PONS) population in Poland., Methods: The presented results are part of the PONS project, and cover information from 3,854 people aged 45-64 (2,567 females and 1,287 males) who are inhabitants of Świętokrzyski Province., Results: In the study group there were 62.8% participants with normoglycaemia, 28.9% participants with IFG and 8.4% participants with diabetes. In those with diabetes, there were 95 participants (2.5%) whose diabetes was unknown prior to this study. Among 5.9% patients with known diabetes 52.9% of the participants had a fasting blood glucose level of ≥ 126 mg%. There were 46.8% males and 70.8% females with normoglycaemia, 41.0% males and 22.8% females with IFG, and 12.2% males and 6.4% females with diabetes. The prevalence of diabetes was higher in participants in the older age group (55-64) compared to younger participants (45-54). The prevalence of diabetes decreased with increasing education and was higher among overweight or obese participants compared to normal weight participants., Conclusion: The prevalence of diabetes mellitus in study population was generally high, but especially high in males, and the awareness of diabetes in the population was generally low. Among participants with known diabetes more than half was not well controlled.

Objective: The aim of this study was to assess the dietary intake of participants in the Polish-Norwegian Study (PONS)., Methods: The presented study comprised 3,862 inhabitants of Świętokrzyskie Province aged 45-64 (2,572 females and 1,290 males). Daily intakes of energy, protein, carbohydrate, fat and fatty acid were estimated using the Food Frequency Questionnaire (FFQ)., Results: Energy intake was significantly higher in males than females (1,461.4 vs 1,320.7 kcal/day), and in participants aged 45-54 than in those aged 55-64 (1,409.5 vs 1,338.5 kcal/day). The percentage of energy from saturated fatty acids was higher than dietary recommendations. Protein, fat and carbohydrate intakes were significantly higher in males compared to females, and in younger than in older group. Daily cholesterol intake was significantly higher in males compared to females and in younger than in older group. People with a higher level of education had a higher energy, protein and fat intake., Conclusion: Under-reporting of energy intake was observed in a significant percentage of participants, especially in males. Gender, age and education status had statistically significant impact on dietary intake. Increase in the intake of dietary fibre, mono- and polyunsaturated fatty acids with diet by the studied participants will make the diets more healthy.

Introduction: Large-scale epidemiologic studies can assess health indicators differentiating social groups and important health outcomes of the incidence and mortality of cancer, cardiovascular disease, and others, to establish a solid knowledgebase for the prevention management of premature morbidity and mortality causes. This study presents new advanced methods of data collection and data management systems with current data quality control and security to ensure high quality data assessment of health indicators in the large epidemiologic PONS study (The Polish-Norwegian Study)., Material and Methods: The material for experiment is the data management design of the large-scale population study in Poland (PONS) and the managed processes are applied into establishing a high quality and solid knowledge., Results: The functional requirements of the PONS study data collection, supported by the advanced IT web-based methods, resulted in medical data of a high quality, data security, with quality data assessment, control process and evolution monitoring are fulfilled and shared by the IT system. Data from disparate and deployed sources of information are integrated into databases via software interfaces, and archived by a multi task secure server., Conclusions: The practical and implemented solution of modern advanced database technologies and remote software/hardware structure successfully supports the research of the big PONS study project. Development and implementation of follow-up control of the consistency and quality of data analysis and the processes of the PONS sub-databases have excellent measurement properties of data consistency of more than 99%. The project itself, by tailored hardware/software application, shows the positive impact of Quality Assurance (QA) on the quality of outcomes analysis results, effective data management within a shorter time. This efficiency ensures the quality of the epidemiological data and indicators of health by the elimination of common errors of research questionnaires and medical measurements.

Aim: To evaluate the prevalence, socio-demographic patterns and behavioural characteristics of tobacco smoking in a pilot group of PONS respondents., Materials and Methods: Open-ended prospective cohort study conducted in Świetokrzyskie Province. A pilot group of subjects aged 45-64 years was examined. Data on smoking were collected with the use of the Health State Questionnaire administered by the CAPI method., Results: 62.6% of males and 45.5% of females participating in the PONS study were ever smokers. In the male population, the percentage of current and former smokers were 19.8% and 42.8%. In females, these percentages were at the lower level of 15.3% and 30.3%, respectively. Self-reported data on smoking prevalence seem to be consistent with objective assessment of exposure to tobacco smoke (measured by carbon monoxide level in exhaled lung air), especially for non-smokers., Conclusions: The analysis found substantial differences in the level of current and former smoking between PONS study and nation-wide surveys conducted in the adult Polish population. Percentages of current smokers in the PONS study are two or even more times lower, and the prevalence of former smoking is almost two times higher than among adult Poles. The above differences may result from social characteristics of the fi rst group of PONS subjects and their health behaviours. PONS subjects who decided to take pat in the fi rst phase of the study are proportionally better educated than a comparable age group of the adult Polish population, and therefore may be more health-oriented than respondents from the general population. Therefore, it is recommended that the next phase of the PONS study should promote and focus on the less educated inhabitants of the study areas, especially males.

Objective: Cardiovascular diseases (CVD) are a major cause of mortality and morbidity in Poland. Data on risk factors of CVD in this country are limited. The presented study investigated risk factors of self-reported CVD within the Polish- Norwegian Study (PONS)., Methods: PONS is an ongoing prospective study in Poland. The data used was provided by 3,853 participants, aged 45-64, during baseline interviews., Results: Prevalence of chronic diseases among participants was as follows: hypertension, 38.4%; diabetes, 5.9%; and CVD, 11.0%. There was no association between CVD and gender and place of residence. CVD was associated with ever-smoking (OR= 1.25; 95% CI: 1.00-1.55), whereas there was an inverse association with alcohol drinking in the year preceding enrolment in the study (OR= 0.50; 95% CI: 0.39-0.63). CVD was associated with body mass index (BMI), as well as with measures of abdominal adiposity, in the following order: waist to height ratio>waist circumference>waist to hip ratio; however, none of these measures showed a stronger association with CVD than BMI. Both hypertension (OR= 1.33; 95% CI: 1.05-1.68) and diabetes (OR= 1.33; 95% CI: 1.05-1.68) were associated with CVD in adjusted models., Conclusions: This study shows the association between several risk factors and prevalence of self-reported CVD and provides information about distribution of those factors among an adult population in Poland. The results of the ongoing PONS study in a prospective setting will provide more accurate risk estimates for the observed associations, as well as risk estimates for other risk factors of CVD, including dietary factors, and attributable risks for various factors.