Igl Wilmar, Johansson Asa, Gyllensten Ulf
Rudbeck Laboratory, Department of Genetics and Pathology, University of Uppsala, Uppsala, Sweden.
Rural Remote Health. 2010 Apr-Jun;10(2):1363. Epub 2010 Jun 18.
Health care and research in rural populations are often limited due to poor infrastructure and small sample sizes. However, such populations have a need for medical care and can be of great value when studying the health effects of lifestyle and genetic factors. The Northern Sweden Population Health Study (NSPHS) is a paradigmatic study that combines a survey of the health status and specific needs of the community with basic research into the environmental and genetic determinants of non-communicable diseases. This article presents the NSPHS results on lifestyle, subclinical, and clinical measures and gives a review of the past contributions of this study to our understanding of the genetic determinants of disease in international collaborations.
A population-representative, cross-sectional sample (n=656) was examined from the Karesuando parish in Northern Sweden north of the Arctic Circle. The population consists of individuals living a traditional, subsistence-based lifestyle (TLS, n=96), mainly based on reindeer herding, hunting and fishing, and others following a modern, more industrialized lifestyle (MLS, n=560), similar to other western European countries. Subgroups with a modern versus traditional lifestyle were compared separately in men and women, highlighting differences in lifestyle (eg diet, physical activity), subclinical (eg blood circulation, blood lipids, lung function) and clinical measures (eg disorders of the cardiovascular, metabolic, and musculoskeletal system).
TLS men and women consumed much more game meat (Men: 71 vs 194 g/day, p=0.0011; Women: 56 vs 140 g/day, p=0.0020) and less non-game meat (Men: 88 vs 42 g/day, p=1.4x10(-7); Women: 81 vs 42 g/day, p=0.026) compared with the respective MLS group. TLS men consumed less milk (p=4.2x10(-4)), and TLS women less vegetables (p=0.042). TLS men reported more physical activity at work (p=0.042) and TLS women less physical activity at leisure (p=0.0023). Total cholesterol (Men: 220 vs 244 mg/dl, p=0.0031; Women: 225 vs 246 mg/dl, (p=0.049) and LDL cholesterol levels (Men: 134 vs 153 mg/dl, p=0.012; Women: 133 vs 146 mg/dl, p>0.05) were higher in the blood serum of TLS men and women than in the MLS comparison group. While TLS women showed a higher rate of myocardial infarction (5% vs 16%, p=0.024), TLS men reported a dramatically higher frequency of body pain consistently, for example in the lower back (0% vs 25%; p>0.05).
A consistent pattern was found of differences between individuals living a traditional versus modern lifestyle and between the sexes, identifying specific health risks for each group. Women with a traditional lifestyle were exposed to a greater risk for cardiovascular disease (especially myocardial infarction) and men with a traditional lifestyle reported higher rates of orthopedic symptoms (eg body pain). We also show that studies of rural populations can make a substantial contribution to basic research into understanding the environmental and genetic determinants of disease. The European Special Populations Research Network (EUROSPAN) provided an excellent example of a platform combining studies of rural populations from different parts of Europe that can leverage these for collaboration with large international consortia.
由于基础设施薄弱和样本量小，农村人口的医疗保健和研究往往受到限制。然而，这类人群有医疗需求，并且在研究生活方式和遗传因素对健康的影响时可能具有重要价值。瑞典北部人口健康研究（NSPHS）是一项典型研究，它将对社区健康状况和特定需求的调查与对非传染性疾病的环境和遗传决定因素的基础研究相结合。本文介绍了NSPHS在生活方式、亚临床和临床指标方面的结果，并回顾了该研究过去在国际合作中对我们理解疾病遗传决定因素所做的贡献。
从北极圈以北瑞典北部的卡雷苏安多教区选取了一个具有人群代表性的横断面样本（n = 656）。该人群包括过着传统的、以自给自足为基础生活方式（TLS，n = 96）的个体，主要以驯鹿放牧、狩猎和捕鱼为生，以及其他过着现代、更工业化生活方式（MLS，n = 560）的个体，类似于其他西欧国家。分别对男性和女性中具有现代与传统生活方式的亚组进行比较，突出生活方式（如饮食、身体活动）、亚临床指标（如血液循环、血脂、肺功能）和临床指标（如心血管、代谢和肌肉骨骼系统疾病）方面的差异。
与各自的MLS组相比，TLS男性和女性食用的野味更多（男性：71克/天对194克/天，p = 0.0011；女性：56克/天对140克/天），食用的非野味肉类更少（男性：88克/天对42克/天，p = 1.4×10⁻⁷；女性：81克/天对42克/天，p = 0.026）。TLS男性饮用的牛奶较少（p = 4.2×10⁻⁴），TLS女性食用的蔬菜较少（p = 0.042）。TLS男性报告工作时的身体活动更多（p = 0.042），TLS女性休闲时的身体活动较少（p = 0.0023）。TLS男性和女性血清中的总胆固醇（男性：220毫克/分升对244毫克/分升，p = 0.0031；女性：225毫克/分升对246毫克/分升，p = 0.049）和低密度脂蛋白胆固醇水平（男性：134毫克/分升对153毫克/分升，p = 0.012；女性：133毫克/分升对146毫克/分升，p>0.05）高于MLS对照组。虽然TLS女性心肌梗死发生率较高（5%对16%，p = 0.024），但TLS男性报告身体疼痛的频率一直显著更高，例如下背部疼痛（0%对25%；p>0.05）。
发现了一种一致的模式，即过传统生活方式与现代生活方式的个体之间以及不同性别之间存在差异，确定了每组特定的健康风险。具有传统生活方式的女性面临更大的心血管疾病风险（尤其是心肌梗死），具有传统生活方式的男性报告的骨科症状发生率较高（如身体疼痛）。我们还表明，对农村人口的研究可为理解疾病的环境和遗传决定因素的基础研究做出重大贡献。欧洲特殊人群研究网络（EUROSPAN）提供了一个很好范例，它是一个将来自欧洲不同地区农村人口研究结合起来的平台，可利用这些研究与大型国际财团开展合作。
