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Li N, Liu Y, Papandonatos GD, Calafat AM, Eaton CB, Kelsey KT, Cecil KM, Kalkwarf HJ, Yolton K, Lanphear BP, Chen A, Braun JM. Gestational and childhood exposure to per- and polyfluoroalkyl substances and cardiometabolic risk at age 12 years. ENVIRONMENT INTERNATIONAL 2021; 147:106344. [PMID: 33418195 PMCID: PMC7856172 DOI: 10.1016/j.envint.2020.106344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/04/2020] [Accepted: 12/14/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) may adversely influence cardiometabolic risk. However, few studies have examined if the timing of early life PFAS exposure modifies their relation to cardiometabolic risk. We examined the influence of gestational and childhood PFAS exposure on adolescents' cardiometabolic risk. METHODS We quantified concentrations of four PFAS (perfluorooctanoate [PFOA], perfluorooctane sulfonate [PFOS], perfluorononanoate [PFNA], and perfluorohexane sulfonate [PFHxS]) in sera collected during pregnancy, at birth, and at ages 3, 8, and 12 years from 221 mother-child pairs in the HOME Study (enrolled 2003-06, Cincinnati, Ohio). We measured cardiometabolic risk factors using physical examinations, fasting serum biomarkers, and dual-energy X-ray absorptiometry scans at age 12 years. Cardiometabolic risk summary scores were calculated by summing age- and sex-standardized z-scores for individual cardiometabolic risk factors. We used multiple informant models to estimate covariate-adjusted associations of serum PFAS concentrations (log2-transformed) at each visit with cardiometabolic risk scores and their individual components, and tested for differences in associations across visits. RESULTS The associations of serum PFOA concentrations with cardiometabolic risk scores differed across visits (P for heterogeneity = 0.03). Gestational and cord serum PFOA concentrations were positively associated with cardiometabolic risk scores (βs and 95% confidence intervals [95% CIs]: gestational 0.8 [0.0, 1.6]; cord 0.9 [-0.1, 1.9] per interquartile range increase). These positive associations were primarily driven by homeostatic model assessment for insulin resistance index (β = 0.3 [0.1, 0.5]) and adiponectin to leptin ratio (β = -0.5 [-1.0, 0.0]). Other individual cardiometabolic risk factors associated with gestational PFOA included insulin and waist circumference. Gestational and cord PFHxS were also associated with higher cardiometabolic risk scores (βs: gestational 0.9 [0.2, 1.6]; cord 0.9 [0.1, 1.7]). CONCLUSION In this cohort of children with higher gestational PFOA exposure, fetal exposure to PFOA and PFHxS was associated with unfavorable cardiometabolic risk in adolescence.
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Affiliation(s)
- Nan Li
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.
| | - Yun Liu
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.
| | - George D Papandonatos
- Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, United States.
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Charles B Eaton
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States; Kent Memorial Hospital, Warwick, Rhode Island, United States.
| | - Karl T Kelsey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States; Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, United States.
| | - Kim M Cecil
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Heidi J Kalkwarf
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
| | - Kimberly Yolton
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Department of Pediatrics, Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Joseph M Braun
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.
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A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians. PLoS One 2015; 10:e0125820. [PMID: 25954817 PMCID: PMC4425648 DOI: 10.1371/journal.pone.0125820] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/17/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction One in three people will be diagnosed with diabetes by 2050, and the proportion will likely be higher among Native Americans. Diabetes control is currently suboptimal in underserved populations despite a plethora of new therapies. Patient empowerment is a key determinant of diabetes control, but such empowerment can be difficult to achieve due to resource limitation and cultural, language and health literacy barriers. We describe a home-based educational intervention using Community Health Representatives (CHRs), leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control. Methods Sixty participants with type 2 diabetes (T2D) completed a baseline evaluation including physical exam, Point of Care (POC) testing, and the Patient Activation Measure (PAM) survey. Participants then underwent a one hour group didactic session led by Community Health Representatives (CHRs) who subsequently carried out monthly home-based educational interventions to encourage healthy lifestyles, including diet, exercise, and alcohol and cigarette avoidance until follow up at 6 months, when clinical phenotyping and the PAM survey were repeated. Results PAM scores were increased by at least one level in 35 (58%) participants, while 24 participants who started at higher baseline score did not change. Six months after intervention, mean levels of A1C decreased by 0.7 ± 1.2%; fasting blood glucose decreased by 24.0 ± 38.0 mg/dl; BMI decreased by 1.5 ± 2.1 kg/m2; total cholesterol decreased by 12.0± 28.0 mg/dl; and triglycerides decreased by 52.0 ± 71.0 mg/dl. All of these changes were statistically significant (p<0.05). Conclusion This six month, CHR led and community-oriented educational intervention helps inform standards of practice for the management of diabetes, engages diabetic populations in their own care, and reduces health disparities for the underserved population of Zuni Indians. Trial Registration ClinicalTrials.gov NCT02339311
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HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. J Acquir Immune Defic Syndr 2015; 68:209-16. [PMID: 25588033 DOI: 10.1097/qai.0000000000000419] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV-infected (HIV+) participants. We assessed the association between HIV and incident AMI within CVDRF strata. METHODS Cohort-81,322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study Virtual Cohort (prospective study of HIV+ and matched HIV- veterans) participated in this study. Veterans were followed from first clinical encounter on/after April 1, 2003, until AMI/death/last follow-up date (December 31, 2009). Predictors-HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood pressure, blood pressure medication, smoking, diabetes) used to create 6 mutually exclusive profiles: all CVDRFs optimal, 1+ nonoptimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs. Outcome-Incident AMI [defined using enzyme, electrocardiogram (EKG) clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates]. Statistics-Cox models adjusted for demographics, comorbidity, and substance use. RESULTS Of note, 858 AMIs (42% HIV+) occurred over 5.9 years (median). Prevalence of optimal cardiac health was <2%. Optimal CVDRF profile was associated with the lowest adjusted AMI rates. Compared with HIV- veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared with HIV- veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0; 95% confidence interval: 1.0 to 3.9; P = 0.044). CONCLUSIONS The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared with HIV- veterans with high CVDRF burden, AMI rates were still higher in HIV+ veterans. Preventing/reducing CVDRF burden may reduce excess AMI risk among HIV+ people.
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Huang S, Hu X, Chen H, Xie D, Gan X, Wu Y, Nie S, Wu J. The positive effect of an intervention program on the hypertension knowledge and lifestyles of rural residents over the age of 35 years in an area of China. Hypertens Res 2011; 34:503-8. [PMID: 21248756 DOI: 10.1038/hr.2010.265] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hypertension (HTN) is a leading cause of cardiovascular and cerebrovascular diseases. Lifestyle modification may be the preferential approach to prevent and control HTN. The purpose of this study was to evaluate the effects of a community intervention program, which focused on improving the HTN knowledge, diets and lifestyles in a rural Chinese area. The study was carried out in a rural area of the Hubei Province from May 2003 to April 2006. A total of 1632 participants were recruited. Of the participants, 826 from the town of Xiaoxita and 806 from the town of Fenxiang were assigned to the intervention group (group I) and to the control group (group C), respectively. Group I participants underwent an intervention that included HTN education and dietary and lifestyle guidance. Group C participants were not subjected to an intervention. The outcome measures included HTN knowledge, dietary and lifestyle behaviors, and prevalence, awareness, treatment and control rates of HTN. Along with the changes in HTN education (P<0.05), the participants in group I exhibited a significantly greater improvement in dietary habits and lifestyle behaviors, including reducing salty food intake (13.6%), fat intake (22.9%) and alcohol consumption (9.6%), after 3 years in comparison with those in group C (21.7, 31.9 and 18%, respectively). The prevalence of HTN was significantly lower in group I (22.5%) than in group C (36%) after the intervention strategies. The study showed that the implementation of a community intervention program involving HTN education and lifestyle modifications for rural residents is a powerful approach to reduce HTN prevalence and improve long-term health outcomes.
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Affiliation(s)
- Shuqiong Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Huang S, Xu Y, Yue L, Wei S, Liu L, Gan X, Zhou S, Nie S. Evaluating the risk of hypertension using an artificial neural network method in rural residents over the age of 35 years in a Chinese area. Hypertens Res 2010; 33:722-6. [PMID: 20505678 DOI: 10.1038/hr.2010.73] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hypertension (HTN) has been proven to be associated with an increased risk of cardiovascular diseases. The purpose of the study was to examine risk factors for HTN and to develop a prediction model to estimate HTN risk for rural residents over the age of 35 years. This study was based on a cross-sectional survey of 3054 rural community residents (N=3054). Participants were divided into two groups: a training set (N1=2438) and a validation set (N2=616). The differences between the training set and validation set were not statistically significant. The predictors of HTN risk were identified from the training set using logistic regression analysis. Some risk factors were significantly associated with HTN, such as a high educational level (EL) (odds ratio (OR)=0.744), a predominantly sedentary job (OR=1.090), a positive family history of HTN (OR=1.614), being overweight (OR=1.525), dysarteriotony (OR=1.101), alcohol intake (OR=0.760), a salty diet (OR=1.146), more vegetable and fruit intake (OR=0.882), meat consumption (OR=0.787) and regular physical exercise (OR=0.866). We established the predictive models using logistic regression model (LRM) and artificial neural network (ANN). The accuracy of the models was compared by receiver operating characteristic (ROC) when the models were applied to the validation set. The ANN model (area under the curve (AUC)=0.900+/-0.014) proved better than the LRM (AUC=0.732+/-0.026) in terms of evaluating the HTN risk because it had a larger area under the ROC curve.
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Affiliation(s)
- Shuqiong Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Barengo NC, Katoh S, Moltchanov V, Tajima N, Tuomilehto J. The diabetes-cardiovascular risk paradox: results from a Finnish population-based prospective study. Eur Heart J 2008; 29:1889-95. [PMID: 18559404 DOI: 10.1093/eurheartj/ehn250] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess changes in coronary heart disease (CHD) event rates and CHD mortality rates among diabetic and non-diabetic individuals between two large study cohorts with baseline assessments 10 years apart and followed up for 10 years. METHODS AND RESULTS Four population surveys were carried out in 1972, 1977, 1982, and 1987 in a randomly selected independent population in Finland. For the analyses, we combined the 1972 and 1977 cohorts (cohort 1) and similarly also the 1982 and 1987 cohorts (cohort 2). A total of 16 779 men and 18 235 women were followed up for 10 years. Whereas the risk of first cardiovascular disease event in women did not change between the two cohorts, the risk in diabetic men aged 25-49 years and men of all age groups with incidence diabetes during the follow-up decreased compared with the earlier cohort. The relative risk of CHD mortality in men with baseline diabetes or incident diabetes compared with non-diabetic individuals increased (from 1.67 to 1.75 and 1.00 to 1.92, respectively). CHD event rates and CHD mortality rates decreased among non-diabetic individuals between the two study cohorts. CONCLUSION Special attention should be given to prevent the onset of diabetes in the population and to intensify the management of patients with diabetes.
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Affiliation(s)
- Noël C Barengo
- Department of Public Health, University of Helsinki, Helsinki, Finland.
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Englert HS, Diehl HA, Greenlaw RL, Willich SN, Aldana S. The effect of a community-based coronary risk reduction: the Rockford CHIP. Prev Med 2007; 44:513-9. [PMID: 17383717 DOI: 10.1016/j.ypmed.2007.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 01/05/2007] [Accepted: 01/26/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the clinical effects of a community-based lifestyle intervention program in reducing coronary risk, especially in a high risk group. METHOD The 40-hour educational curriculum of the Coronary Health Improvement Project (CHIP) delivered over a 30-day period with clinical and nutritional assessments before and after was offered in the spring and fall of 2000 to 2002 through the Center for Complementary Medicine of the Swedish American Health System in Rockford, Illinois to its employees and the general public. The participants were instructed to optimize their diet, quit smoking and exercise daily (walking 30 min/day). RESULTS The data of the 5 CHIP programs were pooled and analyzed. 544 men and 973 women (almost all Caucasian; mean age 55 years) were eligible for analysis. At the end of the 30-day intervention period, stratified analyses of total cholesterol, LDL, triglycerides, blood glucose, blood pressure and weight showed highly significant reductions with the greatest improvements among those at highest risk. CONCLUSION Well-designed community-based intervention programs can improve lifestyle choices and health habits. They can also markedly and rather quickly reduce the level of coronary risk factors in a non-randomized population.
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Chang M, Hahn RA, Teutsch SM, Hutwagner LC. Multiple risk factors and population attributable risk for ischemic heart disease mortality in the United States, 1971–1992. J Clin Epidemiol 2001; 54:634-44. [PMID: 11377125 DOI: 10.1016/s0895-4356(00)00343-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objective of this study was to assess the associations and population attributable risks (PAR) of risk factor combinations and ischemic heart disease (IHD) mortality in the United States. We used logistic regression models to assess the association of risk factors with IHD in the First National Health and Nutrition Examination Survey (1971-1974) and Epidemiologic Follow-up Study (1982-1992) among white and black men and women. We examined eight modifiable risk factors: hypertension, elevated serum cholesterol, diabetes, overweight, current smoking, physical inactivity, depression, and nonuse of replacement hormones. Risk factors associated with IHD mortality were the same among white and black men (i.e., age, education, smoking, diabetes, hypertension, and serum cholesterol). Age, education, smoking, diabetes, and hypertension were the risk factors among white and black women. Physical inactivity, nonuse of replacement hormones, serum cholesterol, and overweight were the additional risk factors among white women. Adjusted for demographic risk factors, overall PARs for study risk factors were 41.2% for white men, 60.5% for white women (with five risk factors only), 49.2% for black men, and 71.2% for black women. Much IHD mortality attributable to individual risk factors is caused by those factors in combination with other risk factors; relatively little mortality is attributable to each risk factor in isolation. Analysis that does not examine risk factor combinations may greatly overestimate PARs associated with individual risk factors.
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Affiliation(s)
- M Chang
- Division of Public Health Surveillance and Informatics, Epidemiology Program Office, Centers for Disease Control and Prevention, 4770 Buford Highway, MS K-74, Atlanta, GA 30341, USA.
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Hasegawa T, Oshima M. Non-Linear trends in the blood pressure of Japanese adults. Hypertens Res 2001; 24:215-9. [PMID: 11409643 DOI: 10.1291/hypres.24.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertension is one of the risk factors for the development of coronary artery disease as well as stroke. The National Nutrition Survey shows that the systolic and diastolic blood pressures of Japanese adults have decreased over time. These trends have plateaued during the last decade. We investigated national trends in blood pressure (BP) levels during these 10 years by plotting the relation between the mean BP levels during year t, BP(t), and those of the following year, BP(t+1). When we plotted the systolic BP levels of Japanese men and women aged 15 to 80 years, the trace revolved clockwise, with cycles of 4 to 5 years. The approximate center of the circular trace corresponding to data for 1985 through 1990 was at 134 mmHg in men and 129 mmHg in women, and the approximate center of a smaller circle was at 135 mmHg in men and 130 mmHg in women, respectively. In addition, with respect to the data for Japanese men in their 60s, the mean systolic BP level decreased linearly from 1982 to 1986, whereas it seemed to generate 4 circles after 1986. The approximate center of the first circle was 146 mmHg in the men. The center of the second circle was 145 mmHg and that of the third circle was 144 mmHg. Plotting of the data for Japanese women of the same age group yielded the same number of circles as the data for men. Our method of documenting changes in the mean BP levels in Japanese adults provided information about a chaotic oscillation that occurred in the populations we studied. The centers of Lorenz-plotted circles may thus provide essential information about trends in the BP levels in these populations.
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Affiliation(s)
- T Hasegawa
- Senju Public Health Center, Ichikawa, Japan
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O'Loughlin JL, Paradis G, Gray-Donald K, Renaud L. The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood. Am J Public Health 1999; 89:1819-26. [PMID: 10589309 PMCID: PMC1509008 DOI: 10.2105/ajph.89.12.1819] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, innercity neighborhood in Montreal, Quebec. METHODS Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey. RESULTS Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups. CONCLUSIONS Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact.
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Affiliation(s)
- J L O'Loughlin
- Department of Public Health, Régie régionale de la santé et des services sociaux de Montréal-Centre, Montreal, Quebec, Canada.
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Whaley MH, Kampert JB, Kohl HW, Blair SN. Physical fitness and clustering of risk factors associated with the metabolic syndrome. Med Sci Sports Exerc 1999; 31:287-93. [PMID: 10063819 DOI: 10.1097/00005768-199902000-00013] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The purposes of this study were to 1) assess the prevalence of clustering of metabolic markers of the MS in a defined population and 2) determine the association between CRF and such clustering in a large group of adult men (N = 15,537) and women (N = 3,899). METHODS Metabolic markers of the MS included systolic blood pressure (BP) > or = 140 mm Hg, serum triglycerides > or = 150 mg x dL(-1), fasting blood glucose > or = 110 mg x dL(-1), and elevated central adiposity (waist circumference > 100 cm). Cardiorespiratory fitness was defined as total time on a maximal treadmill exercise test. The cohort was grouped by the number of metabolic abnormalities and level of CRF. Associations between CRF and the number of metabolic abnormalities were assessed using proportional odds logit models. RESULTS Among men, the age-adjusted cumulative odds ratio for abnormal markers of the MS was 3.0 (95% C.I. 2.7-3.4; P < 0.001) for the least-fit men when compared with moderately-fit ones, and 10.1 (95% C.I. 9.1-11.2; P < 0.001) when compared with the most-fit men. Among women, the age-adjusted cumulative odds ratio was 2.7 (95% C.I. 2.1-3.5; P < 0.001) for the least-fit women when compared with moderately-fit ones, and 4.9 (95% C.I. 3.8-6.3; P < 0.001) when compared with the most-fit women. CONCLUSIONS These cross-sectional results suggest that low CRF is associated with an increased clustering of the metabolic abnormalities associated with the MS in both adult men and women and support the need for future prospective analyses.
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Affiliation(s)
- M H Whaley
- Adult Physical Fitness Programs, Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA.
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Abstract
OBJECTIVE To describe the prevalence of cigarette smoking and its association with other risk factors for chronic diseases among active workers of communication and data processing centers of a Bank. METHODS Cross-sectional study in a simple random sample of 647 active workers of the bank. The data were collected in the work environment, through self-administered questionnaires. RESULTS The prevalence of cigarette smoking was 29.5% (95% Confidence Interval (CI): 27.5%-31.5%), 31.1% (95% CI: 26.2%-35.8%) among men and 27.8% (95% CI: 22.6%-32.9%) among women. On average, males started smoking at the age of 17.6 years and women at the age of 19.4. High prevalence of heavy smokers was observed among men and women (53% and 42%, respectively, smoked more than 20 cigarettes per day). Smokers were older, more likely to be divorced, separated and widowed, to have high blood pressure, to drink alcoholic beverages more often, and to exercise less often than to non-smokers. Those who gave up smoking were older, drank more alcoholic beverages, and were more often overweight. CONCLUSION The considerable frequency of smoking and other risk factors for chronic diseases among those workers may be an indication of the need for new strategies for health interventions. Opportunities for preventive actions, which are more effective and less costly, may have been lost.
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Affiliation(s)
- R H Griep
- Departamento de Enfermagem em Saúde Pública, Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro, Brasil
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Schooler C, Farquhar JW, Fortmann SP, Flora JA. Synthesis of findings and issues from community prevention trials. Ann Epidemiol 1997. [DOI: 10.1016/s1047-2797(97)80008-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liese AD, Mayer-Davis EJ, Tyroler HA, Davis CE, Keil U, Duncan BB, Heiss G. Development of the multiple metabolic syndrome in the ARIC cohort: joint contribution of insulin, BMI, and WHR. Atherosclerosis risk in communities. Ann Epidemiol 1997; 7:407-16. [PMID: 9279450 DOI: 10.1016/s1047-2797(97)00047-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE The natural history of the multiple metabolic syndrome (MMS) and its predictors has rarely been addressed in population samples. This study evaluated the predictive role of fasting serum insulin, body mass index (BMI), and waist-to-hip ratio (WHR) on the development of incident MMS components (diabetes, hypertension, and dyslipidemias) over the course of three years. METHODS The study population comprised the cohort of middle-aged African American and European American men and women of the Atherosclerosis Risk in Communities Study (1987-1992). RESULTS Among 6113 individuals free of MMS components at baseline, high insulin (> 14 microU/ ml) was independently predictive of the development of one or more MMS components (OR:1.5, 95% CI:1.2-1.8), as was a BMI > or = 30 (OR:1.7, 95% CI:1.4-2.0), and a high WHR (> 0.98) (OR:1.5, 95% CI:1.3-1.8) adjusting statistically for age, gender, and ethnicity/center. These associations were markedly stronger for combinations of MMS components (two or more) than for isolated components. CONCLUSIONS The findings confirm earlier reports on the predictive role of insulin, BMI, and WHR, and suggest that these antecedent factors may be integral to the development of combinations of disorders, i.e., the particular clustering identified as the MMS.
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Affiliation(s)
- A D Liese
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
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Lukkarinen H, Hentinen M. Self-care agency and factors related to this agency among patients with coronary heart disease. Int J Nurs Stud 1997; 34:295-304. [PMID: 9306164 DOI: 10.1016/s0020-7489(97)00017-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to assess the self-care agency and factors related to this agency among patients with coronary heart disease (N = 250) measured with a self-care inventory (Self-as-Carer Inventory, SCI). A secondary aim was to analyze the ability of the SCI inventory based on Orem's self-care deficit theory to measure the self-care agency of patients with coronary heart disease. Factor analysis yielded four factors which represent the key aspects of self-care, such as evaluation, implementation, decision-making, significance of knowledge, attitudes, motivation and physical prerequisites of self-care. The most important precondition for self-care in our study was 'appreciation and motivation to self-care'. This factor had numerous correlations with the background factors. Age, sex, socioeconomic status, employment status, health behavior, such as alcohol use and smoking, other diseases, such as diabetes, and satisfaction with sex life were related to the patients' self-care agency. It can be concluded that the self-care agency of our patients was moderate and many background factors were related to it. The SCI inventory seems to cover the self-care requirements of these patients, but the clinical use of SCI is precarious. The items are still too abstract and the questionnaire is therefore too difficult to fill in for many patients.
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Affiliation(s)
- H Lukkarinen
- Department of Nursing, Faculty of Medicine, University of Oulu, Finland
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Morabia A, Bernstein M, Héritier S, Ylli A. Community-based surveillance of cardiovascular risk factors in Geneva: methods, resulting distributions, and comparisons with other populations. Prev Med 1997; 26:311-9. [PMID: 9144755 DOI: 10.1006/pmed.1997.0146] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This paper presents the results of an ongoing community-based surveillance program of cardiovascular risk factors in Geneva, Switzerland, using percentiles with their associated 95% confidence intervals and compares the Genevan results with published data from international surveys reporting percentiles. METHODS A random survey of adults ages 35 to 74 years was conducted from 1993 to 1994. Confidence intervals for percentiles based on parametric and non-parametric methods are given. RESULTS The distribution of total cholesterol was shifted upward with increasing age. The median reached a maximum at 55-64 years among men (5.7 mmol/L) and at 65-74 years among women (5.9 mmol/L), and remained relatively stable thereafter. In both genders, systolic and, less so, diastolic blood pressure increased progressively with advancing age. The median daily energy intake among men declined from 2,390 kcal at age 35-44 years to 2,169 kcal at age 65-74 years, while among women it remained stable at about 1,900 kcal. In both males and females, the relative intake of saturated fat was stable throughout life (14 to 13%). The median body mass index (BMI) was about 25 kg/m2 across all age groups among men, but increased with age among women, with a peak of 23.6 kg/m2 occurring at ages 65-74 years. Compared with U.S. and western European surveys, Genevan men and women had lower total plasma cholesterol and Genevan women tended to have lower BMIs. CONCLUSIONS Percentiles with their associated precision appear particularly well suited for international comparison of surveillance data. They could be used in the future to monitor shifts in distributions resulting from mass prevention strategies.
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Affiliation(s)
- A Morabia
- Clinical Epidemiology Division, University Hospital, Geneva, Switzerland.
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