Plasma retinol and tocopherol levels in Greek elderly population from an urban and a rural area: Associations with the dietary habits M. Leotsinidis, A. Alexopoulos, V. Schinas, M. Kardara & X. Kondakis Laboratory of Public Health, Medical School, University of Patras, Greece Accepted in revised form 21 December 2000 Abstract. Data on plasma concentrations of retinol and a-tocopherol in elderly (over 65 years) living in the Mediterranean countries are sparse. In the cur- rent study, plasma retinol and a-tocopherol concen- trations were determined in 200 healthy subjects (82 men and 112 women) residing in an urban and in a ruralareainSouthWesternGreece.Highprevalence oflowplasmaretinolconcentrationwasobservedfor bothsexesineacharea.The16.7%ofmalesinurban and 25.4% in rural area had plasma retinol levels below 0.3 mg/l. The corresponding values for female subjects were 26% and 20.3%. Plasma a-tocopherol wasfoundtobewithinnormalrangeintheruralarea (onlyonemalehadplasma a-tocopherolbelow5 mg/l) while in the urban area 68.3% of men and 62% of womenhadplasma a-tocopherolvaluesbelow5mg/l. Dierences in dietary habits between subjects living in the rural and in the urban area were revealed through a weekly food frequency questionnaire. This could partly explain the dierence in a-tocopherol concentrations between the two areas. The results of this study revealed high risk of vitamin A and E de- ®ciency and suggests that the health care system in Greece should pay more attention on the social and health status of its elderly population. Key words: Dietary habits, Elderly, Retinol, Tocopherol Introduction Antioxidant vitamin A and E have been associated withareducedriskofsomechronicdiseasesandthus may contribute to healthy aging [1±6]. Many studies regarding vitamin E and A plasma levels in the adults have been published. It has also been reported that dietary and life style factors may aectplasmaretinoland a-tocopherolconcentrations [7, 8]. Recent data, to our knowledge, on plasma concentrationofretinoland a-tocopherolinthefree- livingelderlyinMediterraneancountriesdonotexist. Previous studies, from this area suggest that only a small proportion of the elderly population is at high riskofvitaminAandEde®ciency[9,10].Theaimof this study was to assess the retinol and a-tocopherol plasma levels in free living, healthy elderly individu- als, residing in an urban and in a rural area respec- tively. The dierence in the subjects' diet pattern betweentheruralandurbanareaanditseectonthe plasma retinol and a-tocopherol were examined. Materials and methods Subjects This study was conducted in the city of Patras (154,000 residents), in SW Greece and in the sur- rounding rural area during the years 1997±1998. In thecityofPatrassystematicallyrandomsampleswere drawn based on the electricity counters of the Hel- lenic Public Electricity Board. Only one (if any) household member aged over 65 years old was ran- domlyselectedtoparticipateinthestudy.Intherural areatherandomsamplingwasbasedonapopulation registries of 15 communities with the population ranging less than 2000 inhabitants each. While visiting homes, a clinical questionnaire was ®lled in and a summary clinical examination was performed by a physician. Subjects with metabolic diseases (diabetes mellitus, thyroid disease etc.) were excluded from the study. The ®rst 100 subjects ful- ®llingbothcriteriaofageandphysicalconditionwere included in the study in each area. Dietary questions ascertained the frequency of weekly consumption of 20fooditems:meat,®sh,poultry,eggs,milk,cheese, yogurt, bread, pasta, rice, potatoes, boiled and fresh vegetables,legumes,fruit,butter,margarine,oliveoil, nuts, sweets±sugar. None of the subjects stated, was using vitamin supplements. Analysis of micronutrients Venous blood was drawn in heparinized Vacutainer tubes after an overnight fast. The tubes were placed in containers so as to be protected from light, and plasmawasseparatedaftercentrifugationofbloodat European Journal of Epidemiology 16: 1009±1016, 2000. Ó 2001 Kluwer Academic Publishers. Printed in the Netherlands.