2

8 428 n=240 n=188 6 KAP 1/2 1 KAP 0.29mmol/L 5.61 p< 0.05 0.25mmol/L 7.06 p< 0.05 2. KAP KAP LPL Pvu +/+ +/- -/- 1

2

Effects of Comprehensive Intervention on Hyperlipidemia and Analysis of Related Factors among the Communities of Beijing City Graduate: Zhang Zhentao Supervisor: Prof. Xiao Ying Dept. of Nutrition and Food Hygiene School of Public Health, Peking University Abstract Based on the results of hyperlipidemia screening, 428 subjects with TG>1.69 mmol/l 150mg/dl and/or TC>5.20mmol/L 200mg/dl, were randomly divided into an intervention group (n=240) and a control group(n=188). Comprehensive intervention was available to the intervention group for 6 months. Dietary surveys, physical examinations and serum lipid indicators detection were performed and analyzed, respectively, at the onset and endpoint of the intervention period. The results show that: 1. Reductions could be observed in body weight BMI and WHR. Compared to the control group, the decreases of body weight and BMI in the intervention group were significantly greater. The control group had an increased mean waistline than the baseline value and the increase of waistline in the control group was significantly greater than the intervention group. Total calories, fat, cholesterol and cooking oil decreased by 13.20%, 24.75%, 24.40% and 22.43%, respectively, in the intervention group. The percentages of total calories provided by fat, carbohydrate and protein trended to be desirable. There were also 5.61% and 7.06 % reductions in total serum cholesterol and low-density lipoprotein cholesterol, respectively, in the intervention group, while the control group had no significant 3

variations. 2. The variations of TC and LDL-C were negatively related with the baseline of TC and LDL-C; the decrease of Keys may lead to the reduction of serum lipid; those subjects with better KAP credits had reductions of TC and LDL-C; compared to the (+/-) and (-/-) genetypes of LPL-Pvu II, those with (+/+) genetype had much decreases of TC and LDL-C. In summary, comprehensive intervention based at the community level can effectively improve dietary patterns, control body weight, and decrease the level of total serum cholesterol and low-density lipoprotein cholesterol. In order to have better intervention effects, we suggest baseline serum lipid level should be screened and the genetypes of serum related genes should be indicated. At the same time, dietary fats and cholesterol intakes should be controlled and unhealthy life styles should be changed. Key words: hyperlipidemia comprehensive intervention community 4

Abbreviations ( ) Apo A I Apolipoprotein A I A I Apo B Apolipoprotein B B BMI Body Mass Index CHD Coronary Heart Disease HDL-C High Density Lipoprotein Cholesterol KAP Knowledge Attitude Practice LDL-C Low Density Lipoprotein Cholesterol MRFIT Multiple Risk Factor Intervention Trial MUFA Mono-unsaturated Fat acid NCEP National Cholesterol Education Programme NHLBI National Heart, Lung, and Blood Institute PCR Polymerase Chain Reaction PUFA Poly- unsaturated Fat acid RFLP Restriction Fragment Length Polymorphism SFA Saturated Fat Acid TC Total Cholesterol TG Triglyceride V-Cholesterol Variation of Cholesterol V-Kap Variation of KAP KAP V-Keys Variation of Keys Keys V-TC Variation of TC TC V-TG Variation of TG TG WHR Waist-Hip Ratio 5

2000 20.81% 16.49% 37.30%, 1/3 27.23 [1] 1 [2] 34% 3/4 MONICA 1997 1/6-1/3 [3] 60 1.3 60-69 70% 70 100% 1982-1984 1992-1994 0.78mmol/L 30mg/dl [4] [5] 0.6mmol/L 5mmHg 1/3 [6] 58% 50% 20 70 CHD [7] / 150 20 50 Framingham Heart Study [8] Multiple Risk Factor Intervention Trial, MRFIT [9] MRFIT [12] 7.8mmol/L 300mg/dL 6.2mmol/L 240mg/dL 5.2mmol/L 200mg/dL 4 20 80 [10]- LDL-C [16] [17],[18] 6

CHD [19]-[21] [22] [23] CHD HDL-C CHD [24] LDL-C/HDL-C 5.0 2.3mmol/L 200mg/dL [25] [ A I A II A IV B C I C II C III E a CETP LPL LCAT [26] [27] ] [26],[28]-[35] [26] [26] 1979 Geoffrey Rose population strategy high risk [36] [37] [38] two pronged strategy CHD NHLBI 1985 NCEP NCEP CHD NCEP [39]-[43] CHD [5],[43],[44], [26],[27][45]-[54] NCEP 7

1982 1992 1982 77.5 1992 69.9 1982 18.4 1992 22.0 49.0 58.3 [55] 1984-1993 11.2mg/dl [3] NCEP 428 240 188 6 1 2 8

8 8 623 [TG >2.26 mmol/l 200mg/dl / TC >6.2mmol/L 240mg/dl ] [TG >1.69mmol/L 150mg/dl / TC >5.2mmol/L 200mg/dl ] [56],[57] 428 [ > 7.8 mmol/l, 2 >10mmol/L ] β 428 240 188 6 1. [58] BMI WHR BMI kg / m 2 WHR cm / 9

10 1 60, 0.1cm 0.5cm 2 0.1kg 0.5kg 3 0.1cm 0.5cm 4 0.1cm 0.5cm 5 10 2.5cm 30mmHg 30 2mmHg 0 2 4 6 8 1 3 5 7 9 2mmHg

2. 12-15 5ml DNA TC TG HDL-C AI ApoA I B ApoB GLU VITA LAB II TC TG HDL-C ApoA I ApoB LDL-C [59] LDL-C LDL-C=TC-TG/2.2-HDL-C CDC [58] [60] TC TG HDL-C 3 3 5 3 KAP 1 1 0 30 5 423 5 22 81.6 4 1/2 3 24 72 2 11

1. NCEP STEP 1 1 6 25g 4 2. 4 3. 12

4. 1 < 30 < 10 10 10 15 50 60 10 20 < 300 mg/d 6 KAP LPL-Pvu II LPL-Pvu II 1. DNA 4 CTAB K DNA TE DNA 2. LPL-Pvu II (1) PCR [61] P 1 5 -ATGGCACCCATGTTGAAGGTG-3 P 2 5 -GTTAACTTCTGATAACAATCTC-3 13

PCR 50µl 5µl 10 MgCl 2 2.5mmol/L 50pmol dntps 200µmol/L Taq DNA 3U DNA 1µl, 50µl 94 C 4 94 C 30 60 C 1 30 60 C 2 PCR ERICOMP Power Block Taq DNA 2% 440bp PCR 2 RFLP PCR 15µl 12U PvuII 37 C 4 2% 1. 1 KAP 2 EPInfo 6.04 2. SPSS for Windows 10.0 t t LPL-Pvu II 14

15 n=623 n=428 n=195 n=240 n=188 6 1 * n=94 n=120 *KAP *KAP KAP KAP

428, 6, KAP 345 2 3 57.85 7.38 57.20 58.05 19.4 4-6 2 40 2 0 1 2 5 41 8 32 14 20 74 51 21 73 12 60 166 61 22 79 16 58 175 71 2 1 1 4 8 55 185 44 144 428 3 40 2 0 1 1 4 41 6 26 8 17 57 51 19 64 9 42 134 61 18 67 13 46 144 71 1 0 1 4 6 46 157 32 110 345 4 χ 2 p 46 157 9 28 0.049 0.852 32 110 12 34 0.244 0.621 16