Secular Growth Trends in Greece: Childhood Obesity, a Social Phenomenon George P. Chrousos Athens University Medical School
Secular Growth Trends
 
 
Secular Trends in Obesity Mascie-Taylor and Goto, 2007
90th Centile Abdominal Circumference in cm Brambilla IJO 2007
Obesity Epidemic in Childhood and Adolescence,  the First Reports, USA <ul><li>>100%  increase in the number of   children...
Global Prevalence of Overweight and Obesity Country, Year Criteria of Definition Age  group Prevalence of OW and  OB % Inc...
Prevalence of BMI ≥85 th  and ≥ 95 th  Percentile of 15 y of Age:  Consensus Statement, 2004 Speiser, 2005
Secular Trends in Height and Weight, Males, Greece, 1978-2001   Height, Boys Weight, Boys Chiotis, Ann Clin Ped Univ Ath 2...
Secular Trends in Height and Weight, Females, Greece, 1978-2001   Chiotis, Ann Clin Ped Univ Ath 2003 Weight, Girls Height...
Secular Growth Trends in Greece, 1978-2001, Conclusions   <ul><li>Same methodology and research center </li></ul><ul><li>S...
Secular Growth Trends in Greece, 2001 in Relation to USA, 2000 Differences in males, aged 18 Differences in females, aged ...
BMI curves, 2001 Boys Girls
BMI Curves in Relation to   BMI 25 or 30 Boys Girls
Evidence from Greece, Males, 2001:   BMI and prevalence of obesity in  10.925  subjects (5.537 males) of Hellenic origin a...
Evidence from Greece, Females, 2001:   BMI and prevalence of obesity in  10.925  subjects (5.388 females) of Hellenic orig...
Other Reports from Greece <ul><li>Thessaloniki, 2001: aged 6-17 years </li></ul><ul><li>N=2.458 </li></ul>Krassas, 2001 Ag...
<ul><li>Crete, 1982-2002 : aged 12.1  ± 0.1  y,  </li></ul><ul><li>N=528,  N=620   </li></ul>Other Reports from Greece Man...
Associated Nosology
Metabolic Syndrome   Χ ,  1988 <ul><li>Reaven and colleagues: </li></ul><ul><li>clustering of:   </li></ul><ul><li>obesity...
NCEP Definition (National Cholesterol Education Panel) <ul><li>≥ 3 criteria </li></ul><ul><li>Central obesity  ( Waist Cir...
IDF Definition (International Diabetes Federation) <ul><li>Ν CEP +   Waist Circumference:  </li></ul><ul><li>Fixed compone...
WHO Definition (World Health Organization) <ul><li>Impaired glucose tolerance , </li></ul><ul><li>diabetes ,  </li></ul><u...
NHANES III (1988-1994) Metabolic Syndrome Επίπτωση Age (years) Prevalence Park et al., 2003 Total: 4.2% OB: 28.7% OW: 6.1%...
Risk Factors Arterial Hypertension ,  Obesity ,  Insulin Resistance,  Dyslipidemia, Chronic stress (real or perceived) Met...
G E N E T I C B A C K G R O U N D , R A C E SOCIAL & DEVELOPMENTAL FACTORS SOCIAL ENVIRONMENT  &  CULTURE PERINATAL &  DEV...
Published pediatric papers concerning the metabolic syndrome <ul><li>15 published reports from 1999 to 2006 </li></ul><ul>...
 
Methods:  Children & Adolescents <ul><li>≥ 3 </li></ul><ul><li>-BMI > 95 th   percentile </li></ul><ul><li>-Τ G  >  95 th ...
Data from a Childhood-Adolescence Obesity Clinic <ul><li>420 Greek children (198 girls, 222 boys) </li></ul><ul><li>White ...
Data from a Childhood-Adolescence Obesity Clinic <ul><li>Defined as having the MS when   ≥ 3  were positive:   </li></ul><...
Data from a Childhood-Adolescence Obesity Clinic <ul><li>Additional  29%  of boys and  30%  of girls had partial MS (2 cri...
p< 0.001 N=31 N=36 N=36 N=35 Metabolic s. Prevalence across BMI z-score Quartiles among Males 100 % Metabolic Syndrome 00 ...
% Metabolic  Syndrome Metabolic s. Prevalence across BMI z-Score Quartiles among Females p< 0.001 N=55 N=56 N=55 N=56 100 ...
100 % Metabolic Syndrome 00 90 80 70 60 50 40 30 20 10 Metabolic s. Prevalence across Insulin Quartiles ( μ U/ml) among Ma...
100 00 Metabolic s. Prevalence across Insulin  Quartiles ( μ U/ml) among Females p< 0.001 N=48 N=50 N=50 N=50 % Metabolic ...
 
 
Prevalence of the Metabolic Syndrome and Metabolic Abnormalities in 420 Greek Children and Adolescents Assessed for Simple...
Depression & Obesity: age 14-19 Shape up America, NHANES III Martin & Moore, 2002 30% 20%
Obesity and Depression <ul><li>CDI, depressive symptomatology </li></ul><ul><li>22%  of the entire population (N=73, aged ...
24 H SAMPLING OVERNIGHT DEXAMETHASONE TEST A. B. PLASMA CORTISOL 8 am 8 pm 8 am TARGET TISSUE SENSITIVITY TARGET TISSUE RE...
Influence of Circadian Clock on HPA Axis SCN Circadian Center PVN CRH AVP ACTH F/B TARGET TISSUES Stress Other Inputs - - ...
«Συμπάσχει η ψυχή τω σώματι νοσούντι και τεμνομένω, το δε σώμα τη ψυχή» “The soul suffers when the body is diseased or tra...
«Παχέες ταχυθάνατοι μάλλον των ισχνών» “Obese people die earlier than thin ones” Hippocrates
Conclusions <ul><li>Greece, like the US and other EU countries, has an increase of its OW and OB population in childhood a...
 
Stress System and the Metabolic Syndrome _________________________________ <ul><li>Cushing Syndrome </li></ul><ul><li>Pseu...
PREGNANCY FETUS <ul><li>Nutrition </li></ul><ul><li>Gestational diabetes </li></ul>   Nutrition /Stress <ul><li>Insulin <...
<ul><ul><li>Depression </li></ul></ul>   visceral fat <ul><ul><li>   cortisol </li></ul></ul><ul><ul><li>   catecholami...
    70-75 Προσδόκιμο Ζωής (1998)     75 - 80     65-70     60-65    55-60    under 55     NA
Age adjusted death rates for CAD by country and sex, age 35-74  (British Heart Foundation, Statistics Database 2003)
 
 
Greek Trends: Athens GMA <ul><li>C-Sections   >70%  <20% </li></ul><ul><li>Breast Feeding  <20%  >90% </li></ul>Real  Expe...
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Παρουσίαση καθ. Παιδιατρικής Γ. Χρούσου

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Για τις νέες προκλήσεις που αντιμετωπίζουμε έκανε λόγο ο Θόδωρος Σκυλακάκης

Στο μείζον θέμα της πρόληψης στον τομέα της υγείας αλλά και τις νέες προκλήσεις που προκύπτουν έκανε λόγο ο ευρωβουλευτής του ΕΛΚ και ιδρυτικό στέλεχος της Δημοκρατικής Συμμαχίας κ. Θόδωρος Σκυλακάκης σε εκδήλωση με θέμα

«Πρόληψη: στρατηγική επιλογή για την πολιτική δημόσιας υγείας στην Ελλάδα και την Ε.Ε.».

Σύμφωνα με τον έλληνα ευρωβουλευτή «όλοι είναι υπέρ της πρόληψης, στο τέλος όμως κανείς δεν ενδιαφέρεται να πάρει πρωτοβουλίες». Ωστόσο ο κ. Σκυλακάκης τόνισε ότι «δεν είναι ελληνικό αλλά ευρωπαϊκό φαινόμενο».

Παράλληλα έκανε λόγο για τις νέες προκλήσεις που έχουμε να αντιμετωπίσουμε όπως η γήρανση του πληθυσμού, η υπόθεση του ανθρώπινου γονιδιώματος αλλά και οι δυνατότητες που έχει το marketing στον τομέα της πρόληψης.

Όσον αφορά το ανθρώπινο γονιδίωμα (αποτελείται από το σύνολο των γονιδίων ενός οργανισμού και κατευθύνει την φυσική ανάπτυξη και την συμπεριφορά του), ο κ. Σκυλακάκης ανέφερε ότι σε 3-4 χρόνια θα υπάρχει η δυνατότητα εξέτασης γονιδιωμάτων με 100 δολάρια.

Στην εκδήλωση ήταν καλεσμένος και ο βουλευτής του ΠΑΣΟΚ και καθηγητής στο London School of Economics κ. Η. Μόσιαλος, ο οποίος όμως δεν κατάφερε να παρευρεθεί λόγω της κακοκαιρίας.

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Παρουσίαση καθ. Παιδιατρικής Γ. Χρούσου

  1. 1. Secular Growth Trends in Greece: Childhood Obesity, a Social Phenomenon George P. Chrousos Athens University Medical School
  2. 2. Secular Growth Trends
  3. 5. Secular Trends in Obesity Mascie-Taylor and Goto, 2007
  4. 6. 90th Centile Abdominal Circumference in cm Brambilla IJO 2007
  5. 7. Obesity Epidemic in Childhood and Adolescence, the First Reports, USA <ul><li>>100% increase in the number of children diagnosed as overweight (OW) and obese (OB) during the past 30 years </li></ul><ul><li>1983 : 18.6% preschoolers OW, 8.5% OB </li></ul><ul><li>2000 : 22.6% OW, 10.3% OB Rocchini, NEJM, 2002 </li></ul><ul><li>NHANES 1999-2002 : 31% and 16% of 6-19 years old in the USA are overweight and obese </li></ul><ul><li>Hannon, Pediatrics, 2005 </li></ul>
  6. 8. Global Prevalence of Overweight and Obesity Country, Year Criteria of Definition Age group Prevalence of OW and OB % Increase of OW and OB % (time interval) Australia, 1995 IOTF 4-6 7-11 12.8, 3.6 14.4, 5 (1985-1995) OW:38%, OB:190% Brazil, 1997 IOTF 6-9 10-18 17.4 12.6 (1974-1997) OW: 250% China, 1997 IOTF 6-9 10-18 11.3 6.2 (1991-1997) OW: 7.6%, 38% UK, 1994 IOTF 4-11 11.2, 2.1 (1984-1994) OW: 44.5% Germany, 1997 IOTF 5-6 12, 2.8 (1982-1997) OW: 44% Japan, 1996  120% of standard weight 6 12 4.5 9.5 (1970-1996) OW: 185%, 188% USA, 2000 CDC 2-19 27, 13.7 (1971-2000) OB: (6-11) 283%, (12-19): 154%
  7. 9. Prevalence of BMI ≥85 th and ≥ 95 th Percentile of 15 y of Age: Consensus Statement, 2004 Speiser, 2005
  8. 10. Secular Trends in Height and Weight, Males, Greece, 1978-2001 Height, Boys Weight, Boys Chiotis, Ann Clin Ped Univ Ath 2003
  9. 11. Secular Trends in Height and Weight, Females, Greece, 1978-2001 Chiotis, Ann Clin Ped Univ Ath 2003 Weight, Girls Height, Girls
  10. 12. Secular Growth Trends in Greece, 1978-2001, Conclusions <ul><li>Same methodology and research center </li></ul><ul><li>Same area and origins </li></ul>Differences in males, 1978-2001, aged 18 Differences in females, 1978-2001 aged 18 3 th percentile 50 th percentile 97 th percentile Height +2 cm +1 cm +3 cm Weight +4 kg +6 kg +15 kg 3 th percentile 50 th percentile 97 th percentile Height - - +1 cm Weight - - +7 kg
  11. 13. Secular Growth Trends in Greece, 2001 in Relation to USA, 2000 Differences in males, aged 18 Differences in females, aged 18 3 th percentile 50 th percentile 97 th percentile Height +3 cm +1 cm +1.5cm Weight +6 kg +7 kg +6 kg 3 th percentile 50 th percentile 97 th percentile Height +3 cm +1 cm +1 cm Weight +2 kg +2 kg -4 kg
  12. 14. BMI curves, 2001 Boys Girls
  13. 15. BMI Curves in Relation to BMI 25 or 30 Boys Girls
  14. 16. Evidence from Greece, Males, 2001: BMI and prevalence of obesity in 10.925 subjects (5.537 males) of Hellenic origin aged 0-18 years, living in the Athens area <ul><li>Chiotis, Ann Clin Ped Univ Ath, 2004 </li></ul>OW: 25<BMI ≤30, extrapolated OB: BMI>30, extrapolated Age years Normal% OW% OB% 0-1 87.05 2.88 10.07 1-6 79.95% 10.88 9.17 7-12 72.10 18.48 9.42 13-18 67.5 20.63 11.80 Total 72.11 17.48% 10.40%
  15. 17. Evidence from Greece, Females, 2001: BMI and prevalence of obesity in 10.925 subjects (5.388 females) of Hellenic origin aged 0-18 years, living in the Athens area <ul><li>Chiotis, Ann Clin Ped Un Ath, 2004 </li></ul>OW: 25<BMI ≤30, extrapolated OB: BMI>30, extrapolated Age years Normal% OW% OB% 0-1 81.68 9.16 9.16 1-6 88.68 8.00 3.31 7-12 81.82 14.49 3.69 13-18 81.87 14.48 3.65 Total 83.22 13.05% 3.73%
  16. 18. Other Reports from Greece <ul><li>Thessaloniki, 2001: aged 6-17 years </li></ul><ul><li>N=2.458 </li></ul>Krassas, 2001 Age Normal% OW% OB% 6-10 69.1 25.3 5.6 11-17 78.4 19 2.6 Total 73.7 22.2 4.1
  17. 19. <ul><li>Crete, 1982-2002 : aged 12.1 ± 0.1 y, </li></ul><ul><li>N=528, N=620 </li></ul>Other Reports from Greece Manios, 2005
  18. 20. Associated Nosology
  19. 21. Metabolic Syndrome Χ , 1988 <ul><li>Reaven and colleagues: </li></ul><ul><li>clustering of: </li></ul><ul><li>obesity </li></ul><ul><li>insulin resistance </li></ul><ul><li>arterial hypertension </li></ul><ul><li>dyslipidemia </li></ul><ul><li>glucose intolerance </li></ul>Increased cardiovascular risk
  20. 22. NCEP Definition (National Cholesterol Education Panel) <ul><li>≥ 3 criteria </li></ul><ul><li>Central obesity ( Waist Circumference M >102 cm , </li></ul><ul><li>F > 88 cm ) </li></ul><ul><li>Impaired fasting glucose (>110 mg/dl) </li></ul><ul><li>Low HDL ( Α <40 mg/dl , Γ <50 mg/dl) </li></ul><ul><li>High Triglycerides ( >150 mg/dl) </li></ul><ul><li>Arterial Hypertension >130/85 mmHg </li></ul><ul><li>JAMA 2001 </li></ul>
  21. 23. IDF Definition (International Diabetes Federation) <ul><li>Ν CEP + Waist Circumference: </li></ul><ul><li>Fixed component: </li></ul><ul><li>M >94 cm, F>8 0 cm </li></ul><ul><li>Alberti K et al. , Lancet 2005 </li></ul>
  22. 24. WHO Definition (World Health Organization) <ul><li>Impaired glucose tolerance , </li></ul><ul><li>diabetes , </li></ul><ul><li>insulin resistance </li></ul><ul><li>+ ≥2 </li></ul><ul><li>Arterial Hypertension ≥ 1 4 0/90 mmHg </li></ul><ul><li>Η DL: M<40 mg/dl, F<50mg/dl Τ G ≥ 150mg/dl </li></ul><ul><li>Central Obesity – waist circumference or ΒΜΙ >30 </li></ul><ul><li>Μ icroalbuminuria </li></ul><ul><li>Alberti K et al Diabet Med, 1998 </li></ul>
  23. 25. NHANES III (1988-1994) Metabolic Syndrome Επίπτωση Age (years) Prevalence Park et al., 2003 Total: 4.2% OB: 28.7% OW: 6.1% NW: 0.1%
  24. 26. Risk Factors Arterial Hypertension , Obesity , Insulin Resistance, Dyslipidemia, Chronic stress (real or perceived) Metabolic Markers Cholesterol , LDL, HDL, Tg, Lp(a), Apo-A1, Apo-B, Glucose , HbA1c, Insulin, Albumin Adiponectin , hsCRP Metabolic Syndrome Diabetes Type II Cardio- Vascular Disease Background Age , Gender, Developmental History (SGA, LGA) , Diet, Physical Activity,Genes
  25. 27. G E N E T I C B A C K G R O U N D , R A C E SOCIAL & DEVELOPMENTAL FACTORS SOCIAL ENVIRONMENT & CULTURE PERINATAL & DEVELOPMENTAL PARAMETERS UNFAVORABLE CLINICAL CHARACTERISTICS: +Body fat, - - Lean mass, + Visceral fat O BESITY RELATED DIABETES OF THE YOUNG CARDIOVASCULAR DISEASE METABOLIC SYNDROME ( PRE DISEASE)  3 of:  IR, IFG, IGT  Hyperten si on  Obesity  Dyslipidaemia SECONDARY METABOLIC ABNORMALITIES: Hypoadiponectinaemia Urine microalbuminuria Liver disease BEHAVIOR PSYCHOLOGY Chronic stress Eating disorders Depression CLINICAL PHENOTYPE (OBESITY) DIETARY BEHAVIOR PHYSICAL ACTIVITY
  26. 28. Published pediatric papers concerning the metabolic syndrome <ul><li>15 published reports from 1999 to 2006 </li></ul><ul><li>No of criteria:  3, or  4 </li></ul><ul><li>Adiposity: BMI or waist circumference </li></ul><ul><li>Cut-off points: 75 th , 85 th , or 95 th </li></ul><ul><li>centile </li></ul><ul><li>Glucose metabolism: IFG, IGT, HOMA, </li></ul><ul><li>Fasting Insulin </li></ul>
  27. 30. Methods: Children & Adolescents <ul><li>≥ 3 </li></ul><ul><li>-BMI > 95 th percentile </li></ul><ul><li>-Τ G > 95 th percentile , </li></ul><ul><li>-HDL < 5 th percentile , </li></ul><ul><li>-Systolic or Diastolic Blood Pressure > 95 th percentile </li></ul><ul><li>-Impaired glucose tolerance: </li></ul><ul><li>impaired fasting glucose >105 mg/dl or </li></ul><ul><li>>140 mg/dl but < 200 mg/dl , 2 hours after </li></ul><ul><li>the OGTT </li></ul><ul><li>Weiss R, NEJM 2004 </li></ul><ul><li>Sharma AM, Acta Diabet 2005 </li></ul>
  28. 31. Data from a Childhood-Adolescence Obesity Clinic <ul><li>420 Greek children (198 girls, 222 boys) </li></ul><ul><li>White race </li></ul><ul><li>Mean age 10.2 years (3-16) </li></ul><ul><li>75.8% prepubertal boys and </li></ul><ul><li>54.2% prepubertal girls </li></ul>
  29. 32. Data from a Childhood-Adolescence Obesity Clinic <ul><li>Defined as having the MS when ≥ 3 were positive: </li></ul><ul><li>BMI > 95 th percentile </li></ul><ul><li>Τ G > 95 th percentile , </li></ul><ul><li>HDL < 5 th percentile , </li></ul><ul><li>Systolic or Diastolic Blood Pressure > 95 th percentile </li></ul><ul><li>Impaired glucose tolerance: </li></ul><ul><li>impaired fasting glucose >105 mg/dl or </li></ul><ul><li>>140 mg/dl but < 200 mg/dl , 2 hours after </li></ul><ul><li>the OGTT </li></ul><ul><li>Weiss R, NEJM 2004 </li></ul>
  30. 33. Data from a Childhood-Adolescence Obesity Clinic <ul><li>Additional 29% of boys and 30% of girls had partial MS (2 criteria) </li></ul><ul><li>44% of the entire population had at least one metabolic abnormality </li></ul><ul><li>15% of boys and 16% of girls had the full MS </li></ul><ul><li>Low HDL was the most common abnormality associated with obesity </li></ul>Pervanidou, ECOG 2007
  31. 34. p< 0.001 N=31 N=36 N=36 N=35 Metabolic s. Prevalence across BMI z-score Quartiles among Males 100 % Metabolic Syndrome 00 90 80 70 60 50 40 30 20 10
  32. 35. % Metabolic Syndrome Metabolic s. Prevalence across BMI z-Score Quartiles among Females p< 0.001 N=55 N=56 N=55 N=56 100 00 90 80 70 60 50 40 30 20 10
  33. 36. 100 % Metabolic Syndrome 00 90 80 70 60 50 40 30 20 10 Metabolic s. Prevalence across Insulin Quartiles ( μ U/ml) among Males N=25 N=24 N=27 N=25 P=0.018
  34. 37. 100 00 Metabolic s. Prevalence across Insulin Quartiles ( μ U/ml) among Females p< 0.001 N=48 N=50 N=50 N=50 % Metabolic Syndrome 90 80 70 60 50 40 30 20 10
  35. 40. Prevalence of the Metabolic Syndrome and Metabolic Abnormalities in 420 Greek Children and Adolescents Assessed for Simple Obesity : preliminary results
  36. 41. Depression & Obesity: age 14-19 Shape up America, NHANES III Martin & Moore, 2002 30% 20%
  37. 42. Obesity and Depression <ul><li>CDI, depressive symptomatology </li></ul><ul><li>22% of the entire population (N=73, aged 8-14) had depressive symptoms </li></ul>Obesity and Life Events 2/3 presented with one or more stressful life events during the last year
  38. 43. 24 H SAMPLING OVERNIGHT DEXAMETHASONE TEST A. B. PLASMA CORTISOL 8 am 8 pm 8 am TARGET TISSUE SENSITIVITY TARGET TISSUE RESPONSE CORTISOL CONCENTRATION HS N R THRESHOLD FOR HARMFULNESS -D -D +D +D NS CS NS CS 24 H CORTISOL DARK
  39. 44. Influence of Circadian Clock on HPA Axis SCN Circadian Center PVN CRH AVP ACTH F/B TARGET TISSUES Stress Other Inputs - - A circadian rhythm indirectly regulates the functions of all organs/tissues through modulation of glucocorticoid actions. Circulating F/B Target Tissue Effect Time Circadian fluctuation
  40. 45. «Συμπάσχει η ψυχή τω σώματι νοσούντι και τεμνομένω, το δε σώμα τη ψυχή» “The soul suffers when the body is diseased or traumatized, while the body suffers when the soul is ailing” Aristotle
  41. 46. «Παχέες ταχυθάνατοι μάλλον των ισχνών» “Obese people die earlier than thin ones” Hippocrates
  42. 47. Conclusions <ul><li>Greece, like the US and other EU countries, has an increase of its OW and OB population in childhood and adolescence </li></ul><ul><li>These changes resulted in increased prevalence of MS traits in childhood and forecast an increased morbidity and mortality in later life </li></ul>
  43. 49. Stress System and the Metabolic Syndrome _________________________________ <ul><li>Cushing Syndrome </li></ul><ul><li>Pseudocushing Syndrome </li></ul><ul><li>Melancholic Depression </li></ul><ul><li>Metabolic Syndrome </li></ul><ul><li>“ Benign” Premature Adrenarche </li></ul><ul><li>Linkage Studies </li></ul><ul><li>Monkey Studies </li></ul><ul><li>AIDS-related insulin resistance/lipodystrophy </li></ul><ul><li>Seasonal Depression </li></ul><ul><li>Atypical Depression </li></ul><ul><li>__________________________________________ </li></ul>
  44. 50. PREGNANCY FETUS <ul><li>Nutrition </li></ul><ul><li>Gestational diabetes </li></ul> Nutrition /Stress <ul><li>Insulin </li></ul><ul><li>IGF-1 </li></ul><ul><li>cortisol </li></ul><ul><li>catecholamines </li></ul><ul><li>insulin </li></ul>LGA SGA Visceral Adiposity Metabolic Syndrome
  45. 51. <ul><ul><li>Depression </li></ul></ul> visceral fat <ul><ul><li> cortisol </li></ul></ul><ul><ul><li> catecholamines </li></ul></ul>Melancholic Atypical Metabolic Syndrome  visceral fat <ul><ul><li> lean body mass </li></ul></ul><ul><ul><li> bone mass </li></ul></ul> cortisol  catecholamines  insulin
  46. 52.   70-75 Προσδόκιμο Ζωής (1998)   75 - 80   65-70   60-65   55-60   under 55   NA
  47. 53. Age adjusted death rates for CAD by country and sex, age 35-74 (British Heart Foundation, Statistics Database 2003)
  48. 56. Greek Trends: Athens GMA <ul><li>C-Sections >70% <20% </li></ul><ul><li>Breast Feeding <20% >90% </li></ul>Real Expected

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