Bone health in women with premature ovarian insufficiency/early menopause: a 23-year longitudinal analysis

STUDY QUESTION

What is the frequency of, and predictors for, osteoporosis, fractures, and osteoporosis management (investigation, treatment) in women with premature ovarian insufficiency (POI; menopause <40 years) and early menopause (EM; menopause 40-44years)?

SUMMARY ANSWER

Over the 23-year follow-up duration, at a mean age of 68 years, women with POI/EM had higher osteoporosis/fracture risk and prevalence, higher osteoporosis screening and anti-osteoporosis medication use compared to women with usual age menopause; increasing age was predictive of increased risk of osteoporosis/fracture and menopause hormone therapy (MHT) prior to or at study entry (aged 45-50 years) was protective.

WHAT IS KNOWN ALREADY

Women with POI/EM have increased risk of osteoporosis and fractures with limited data regarding risk factors for reduced bone density and fractures. Clinical guidelines recommend screening with dual X-ray absorptiometry (DXA) and treatment with MHT for most women with POI/EM to reduce osteoporosis and fracture risk; however, studies indicate gaps in osteoporosis knowledge, guideline uptake, and management adherence by clinicians and women.

STUDY DESIGN, SIZE, DURATION

The Australian Longitudinal Study on Women's Health is a prospective longitudinal study of Australian women. This study uses the cohort of women born between 1946 and 1951, surveyed nine times between 1996 and 2019. Data from the Australian administrative health records, including hospital admissions data (fractures, osteoporosis), Medicare Benefits Schedule (DXA), and the Pharmaceutical Benefits Scheme (PBS; MHT, anti-osteoporosis medication, available only from 2002) were linked to survey data.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Survey respondents with self-reported age of menopause were included. POI/EM was defined as menopause <45 years. T-test or chi-square were used for comparisons at baseline (P < 0.05 indicates significance). Generalized estimating equations for panel data explored predictors for the longitudinal outcomes of osteoporosis, fractures, DXA rates, MHT use, and anti-osteoporosis medication (in women with osteoporosis/fracture, from Survey 4 onwards only). Univariable regression was performed, and variables retained where P < 0.2, to form the multivariable model, and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robustness of results.

MAIN RESULTS AND THE ROLE OF CHANCE

Eight thousand six hundred and three women were included: 610 (7.1%) with POI/EM. Mean (SD) baseline age was 47.6 (1.45) years in the entire cohort and mean (SD) age of menopause was 38.2 (7.95) and 51.3 (3.04) years in women with POI/EM and usual age menopause, respectively (P < 0.001). Over the 23 years, of women with POI/EM, 303 (49.7%) had osteoporosis/fractures, 421 (69.0%) had DXA screening, 474 ever used MHT (77.7%), and 116 (39.1%) of those with osteoporosis/fractures used anti-osteoporosis medication. Of women with usual age menopause, 2929 (36.6%) had osteoporosis/fractures, 4920 (61.6%) had DXA screening, 4014 (50.2%) used MHT, and 964 (33.0%) of those with osteoporosis/fractures used anti-osteoporosis medication. Compared to women with menopause at age ≥45 years and after adjusting for other risk factors, women with POI/EM had increased risk of osteoporosis (odds ratio [OR] 1.37; 95% CI 1.07-1.77), fractures (OR 1.45; 1.15-1.81), DXA testing (OR 1.64; 1.42-1.90), MHT use (OR 6.87; 5.68-8.30), and anti-osteoporosis medication use (OR 1.50; 1.14-1.98). In women with POI/EM women, increasing age was associated with greater risk of osteoporosis/fracture (OR 1.09; 1.08-1.11), and MHT prior to or at study entry (aged 45-50 years), was protective (OR 0.65, 0.45-0.96). In women with POI/EM, age (OR 1.11; 1.10-1.12), fractures (OR 1.80, 1.38-2.34), current smoking (OR 0.60; 0.43-0.86), and inner (OR 0.68; 0.53-0.88) or outer regional (OR 0.63; 0.46-0.87) residential location were associated with DXA screening. In women with POI/EM, increasing age (OR 1.02; 1.01-1.02), and currently consuming alcohol (OR 1.17; 1.06-1.28), was associated with having ever used MHT. In the 299 women with POI/EM and osteoporosis/fractures, only 39.1% ever received treatment with an anti-osteoporosis medication. Increasing age (OR 1.07; 1.04-1.09) and lower BMI (OR 0.95; 0.92-0.98) were associated with greater likelihood of treatment with anti-osteoporosis medication.

LIMITATIONS, REASONS FOR CAUTION

Survey data including age of menopause were self-reported by participants; fracture questions were not included in the 2001 survey, and location or level of trauma of self-reported fractures was not asked. Additional risk/protective factors such as vitamin D status, calcium intake, and exercise were not able to be included. Due to sample size, POI and EM were combined for all analyses, and we were unable to differentiate between causes of POI/EM. PBS data were only available from 2004, and hospital admissions data were state-based, with all of Australia were only available from 2007.

WIDER IMPLICATIONS OF THE FINDINGS

This study supports previous literature indicating increased risk of osteoporosis and fractures in women with POI, and adds evidence for women with POI/EM, where there was a relative paucity of data. This is the first study to analyse a variety of clinical and demographic risk factors for osteoporosis and fractures in women with POI/EM, as well as analysing investigation and treatment rates. In these women, using MHT prior to or at study entry, aged 45-50 years, was protective for osteoporosis/fractures; however, having ever used MHT was not, highlighting the importance of early treatment with MHT in these women to preserve bone strength. Although women with POI/EM and osteoporosis or fractures were more likely to use anti-osteoporosis medications than those with usual age menopause, overall treatment rates are low at <40%, demonstrating a significant treatment gap that should be addressed to reduce future fracture risk.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by The Australian NHMRC Centre of Research Excellence Women's Health in Reproductive Life (CRE-WHIRL, project number APP1171592). A.R.J. is the recipient of a National Health and Medical Research Council post-graduate research scholarship (grant number 1169192). P.R.E. is supported by a National Health and Medical Research Council grant 1197958. P.R.E. reports grants paid to their institution from Amgen, Sanofi, and Alexion, honoraria from Amgen paid to their institution, and honoraria from Alexion and Kyowa-Kirin.

TRIAL REGISTRATION NUMBER

N/A.

Levels of physical activity and sitting time in women with infants, toddlers and preschoolers: a population-based cross-sectional study

OBJECTIVES

Insufficient physical activity (PA) and prolonged sitting time (ST) increase the risk of chronic disease and mortality. Caring for young children can potentially impact maternal PA and sedentary behaviours. The aims of this study were to explore the levels of PA and ST in women with young children (infants, toddlers and preschoolers) and sociodemographic and behavioural factors associated with these.

STUDY DESIGN

This was a population-based cross-sectional study.

METHODS

Survey 5 data collected in 2009 (n = 4290) of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health were used. Multiple linear and logistic regression models were used to examine associations.

RESULTS

In adjusted models, compared with women with preschoolers, women whose youngest child was an infant aged 0-6 months, aged >6-12 months or toddler had lower PA (-321.3 MET.min/week [95% confidence interval (CI) -416.2, -226.4], -147.9 MET.min/week [95% CI -237.6, -58.1] and -106.4 MET.min/week [95% CI -172.3, -40.5]). ST was higher in women whose youngest child was an infant aged 0-6 months (0.48 h/day; 95% CI 0.19, 0.77) but lower with infants aged >6-12 months (-0.33 h/day; 95% CI -0.60, -0.05) and toddlers (-0.40 h/day; 95% CI -0.60, -0.20) than in those with preschoolers. The findings were similar in the logistic model. Sociodemographic and behavioural factors such as occupation and marital status also influenced PA and ST.

CONCLUSIONS

Women with infants and toddlers have lower PA than women with preschoolers. Women are more likely to sit more in the first 6 months after childbirth. These findings can inform resources and intervention development to improve activity levels in women with young children through consideration of the age of the youngest child, sociodemographic and behavioural factors.

Delayed diagnosis of endometriosis disadvantages women in ART: a retrospective population linked data study

STUDY QUESTION

Do the outcomes and use of ART differ between women with and without endometriosis?

SUMMARY ANSWER

ART use and outcome do not appear to differ for women with and without endometriosis, as long as endometriosis is diagnosed prior to commencing ART.

WHAT IS KNOWN ALREADY

Approximately 40% of women with endometriosis have infertility and ART is the recommended treatment option for these women. However, diagnosis of endometriosis can be complex and lengthy, and a delay in diagnosis can reduce the likelihood of achieving a live birth.

STUDY DESIGN, SIZE, DURATION

This retrospective national cohort study used longitudinal self-report data (collected 1996-2018) from women born in 1973-1978 who are participants in the Australian Longitudinal Study on Women's Health (ALSWH). The study also used linked administrative data on Endometriosis (1970-2018), ART (1996-2020) and births (1996-2018).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The outcome measures were: age at first ART cycle; use of ART treatments (IVF only; IUI only/and IVF); number of ART cycles (1-3; 4-10; 11-36); and births after first ART (no; yes) (note that births could not be tied to ART).

MAIN RESULTS AND THE ROLE OF CHANCE

One in three (34.7%, n = 459/1322) women using ART had endometriosis, with 65.6% of these diagnosed before first ART and 34.4% after. Adjusted regression analyses showed women with endometriosis diagnosed before first ART were not significantly different to women without endometriosis on any outcome. However, women with endometriosis diagnosed after first ART were more likely to use IUI (adjusted odds ratio (aOR) 2.14, 95% CI 1.48, 3.09) and do more cycles (11-36 cycles: aOR 4.09, 95% CI 2.41, 6.95), and less likely to report a birth (aOR 0.67, 95% CI 0.45, 0.99), compared to women without endometriosis, despite no significant difference in starting age (coefficient = -0.62, 95% CI -1.36, 0.13).

LIMITATIONS, REASONS FOR CAUTION

We did not have information on the severity of endometriosis, or the reasons for using ART, which can influence treatment and outcomes. We were not able to reliably link births with ART treatment. Finally, it is possible that some of the women in our 'no endometriosis' group did have endometriosis and were unaware of it, although prevalence rates match population estimates.

WIDER IMPLICATIONS OF THE FINDINGS

These findings support previous studies that have found no difference in outcome of ART for women with endometriosis, but add the new insight that this is only true if endometriosis is diagnosed prior to commencing ART. A delayed diagnosis can create disadvantage during ART treatment. Early recourse to IVF may be advantageous for pregnancy prospects for women with endometriosis.

STUDY FUNDING/COMPETING INTEREST(S)

The ALSWH is funded by the Australian Government Department of Health. G.D.M. is supported by an NHMRC Principal Research Fellowship (APP11218449). The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Longitudinal changes in employment following a diagnosis of endometriosis: Findings from an Australian cohort study

PURPOSE

Endometriosis is a chronic inflammatory disease affecting the reproductive, gastrointestinal and urinary systems. We examined changes in labour force participation among women with endometriosis following diagnosis.

METHODS

We analysed data from 4494 women born in 1973-78 from the Australian Longitudinal Study on Women's Health. We used multinomial logistic regression models with generalised estimating equations to examine changes in labour force participation among 468 women with surgically confirmed endometriosis, and 375 women with clinically suspected endometriosis, relative to a comparison group of 4151 women without endometriosis.

RESULTS

At diagnosis, women with surgically confirmed endometriosis were somewhat more likely to be working part-time (OR 1.26, 95% CI 0.94-1.68) or unemployed (OR 1.46, 95% CI 0.96-2.23) than before diagnosis. After diagnosis, women with surgically confirmed endometriosis remained somewhat more likely to be working part-time (OR 1.26, 95% CI 0.88-1.80) but were significantly more likely to be unemployed (OR 1.85, 95% CI 1.16-2.96) than before diagnosis. Labour force participation for women with clinically suspected endometriosis did not differ from women without endometriosis at diagnosis and did not change over time.

CONCLUSIONS

Women with surgically confirmed endometriosis transitioned out the labour force following diagnosis. Supportive workplace practices may help women remain in the labour force.

Asthma severity and impact on perinatal outcomes: an updated systematic review and meta-analysis

BACKGROUND

Large-scale studies exploring the associations of asthma severity, exacerbations and medication use with adverse perinatal outcomes have been published in recent years.

OBJECTIVES

To update evidence on the associations of asthma severity, exacerbations and medication use with the adverse perinatal outcomes of preterm delivery (PD), low birthweight (LBW) and small-for-gestational-age (SGA).

SEARCH STRATEGY

PubMed, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI) from inception to 1 January 2021.

SELECTION CRITERIA

Cohort studies comparing the likelihood of adverse perinatal outcomes in groups of asthmatic women stratified by asthma severity, asthma exacerbations or medication use, or comparing the likelihood of adverse perinatal outcomes between non-asthmatic women and asthmatics of various levels of severity and exacerbation.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias. Random-effects models were used to meta-analyse the results.

MAIN RESULTS

Twenty studies met the inclusion criteria. The odds of delivering SGA babies increased with maternal asthma severity. Pregnant women with an asthma exacerbation had higher odds of delivering LBW babies and SGA babies, compared with pregnant women with asthma but without an exacerbation (pooled adjusted odds ratio [OR] 1.15, 95% CI 1.02-1.29 for LBW; number of studies with adjusted OR 3; I²  = 0%) (pooled adjusted OR 1.13, 95% CI 1.04-1.23 for SGA; number of studies with adjusted OR 4; I²  = 0%) and compared to pregnant women without asthma. Oral corticosteroids use during pregnancy was associated with increased odds of LBW, but not PD.

CONCLUSIONS

The available data suggest that maternal asthma severity and exacerbations are associated with increased odds of LBW and SGA babies.

TWEETABLE ABSTRACT

A systematic review and meta-analysis found that maternal asthma severity and exacerbations are associated with increased odds of delivering low birthweight and small-for-gestational-age babies.

The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study

This study evaluated mediators of fracture risk in postmenopausal women with type 1 (T1D) and type 2 diabetes (T2D), over a 15-year follow-up period. This study provides evidence that the increased fracture risk in women with T1D or T2D is partially explained by falls. Furthermore, a shorter reproductive lifespan in women with T1D contributes modestly to fracture risk in this cohort.

PURPOSE

Skeletal fragility is associated with diabetes mellitus, while limited estrogen exposure during the reproductive years also predisposes to lower bone mass and higher fracture risk. We aimed to determine osteoporosis diagnosis, fall and fracture rates in women with type 1 (T1D) and type 2 (T2D) diabetes mellitus, and explore mediators of the diabetes-fracture relationship.

METHODS

Prospective observational data drawn from the Australian Longitudinal Study in Women's Health (ALSWH) from 1996 to 2010. Women were randomly selected from the national health insurance database. Standardized data collection occurred at six survey time points, with main outcome measures being self-reported osteoporosis, incident fracture, falls, and reproductive lifespan. Mediation analyses were performed to elucidate relevant intermediaries in the diabetes-fracture relationship.

RESULTS

Exactly 11,313 women were included at baseline (T1D, n = 107; T2D, n = 333; controls, n = 10,873). A total of 885 new cases of osteoporosis and 1099 incident fractures were reported over 15 years. Women with T1D or T2D reported more falls and fall-related injuries; additionally, women with T1D had a shorter reproductive lifespan. While fracture risk was increased in women with diabetes (T1D: OR 2.28, 95% CI 1.53-3.40; T2D: OR 2.40, 95% CI 1.90-3.03), compared with controls, adjustment for falls attenuated the risk of fracture by 10% and 6% in T1D and T2D, respectively. In women with T1D, reproductive lifespan modestly attenuated fracture risk by 4%.

CONCLUSION

Women with T1D and T2D have an increased risk of fracture, which may be partially explained by increased falls, and to a lesser extent by shorter reproductive lifespan, in T1D.

Duration of estrogen exposure during reproductive years, age at menarche and age at menopause, and risk of cardiovascular disease events, all-cause and cardiovascular mortality: a systematic review and meta-analysis

BACKGROUND

Little is known about the estrogen exposure measurement and mutual effect of age at menarche and age at menopause in the risk of cardiovascular disease (CVD) events.

OBJECTIVES

To evaluate estrogen exposure measurement and describe mutual effect of age at menarche and age at menopause in the risk of CVD events.

SEARCH STRATEGY

Systematic review of literature in PubMed, Embase and Web of Science for studies published up to 28 June 2020.

SELECTION CRITERIA

Observational studies related to estrogen exposure measurement, including mutual effect of age at menarche and age at menopause and risk of CVD events.

DATA COLLECTION AND ANALYSIS

Synthesis of evidence was conducted by reviewing individual estimates, followed by meta-analysis. The study received no external funding.

MAIN RESULTS

A total of 75 studies were included in synthesis of evidence, of which 17 studies were included in meta-analysis. Reproductive lifespan (age at menopause - age at menarche), endogenous estrogen exposure and total estrogen exposure were used for estrogen exposure measurement. Reproductive lifespan was by far the most commonly used method for estrogen exposure measurement. A shorter reproductive lifespan was associated with a higher risk of CVD events; the pooled relative risk (95% CI) was 1.31 (1.25-1.36) for stroke events. Robust epidemiological studies with measurement of estrogen exposure and associated health risk would strengthen the evidence.

CONCLUSIONS

Reproductive lifespan was the most commonly used method for estrogen exposure measurement in epidemiological studies. A shorter reproductive lifespan was associated with a higher risk of CVD events, particularly stroke.

TWEETABLE ABSTRACT

A systematic review and meta-analysis found that women with a shorter reproductive lifespan have a higher risk of stroke events.

Prevalence and incidence of endometriosis in Australian women: a data linkage cohort study

OBJECTIVE

To estimate the prevalence and incidence of endometriosis among Australian women.

DESIGN

Population-based cohort study linked to administrative health records.

SETTING

Secondary analysis of seven surveys collected between 2000 and 2018 from a population-based cohort study.

POPULATION

A total of 13 508 Australian women, born 1973-78, from a prospective cohort study of 14 247 women conducted between 1996 and 2018.

METHODS

During 2000 and 2018, self-reported longitudinal survey data were linked to three administrative health databases to separately identify women with clinically confirmed or suspected endometriosis across the multiple data sources.

MAIN OUTCOME MEASURES

Prevalence and incidence of clinically confirmed endometriosis in the cohort were first estimated using national hospital data. Data were then combined with other administrative health databases and the survey data to capture all clinically confirmed and suspected diagnoses of endometriosis.

RESULTS

The cumulative prevalence of clinically confirmed endometriosis was 6.0% (95% CI 5.8-6.2%) by age 40-44 years. The cumulative prevalence increased to 11.4% (95% CI 11.1-11.7%) when adding diagnoses of clinically suspected endometriosis. Age-specific incidence estimates peaked to 6 per 1000 person-years at age 30-34 years.

CONCLUSIONS

Among 13 508 Australian women followed for 20 years, one in nine women had clinically confirmed or suspected endometriosis by the age of 44, with most diagnosed during their early thirties. Endometriosis is a significant public health issue requiring increased surveillance, clinical awareness and management. Efforts to expand knowledge on the aetiology of the disease and optimal methods for disease management are crucial to women's health.

TWEETABLE ABSTRACT

In a national study of 13 508 Australian women, one in nine women were diagnosed with endometriosis by age 44.

Socioeconomic Position and Reproduction: Findings from the Australian Longitudinal Study on Women's Health

OBJECTIVE

To investigate the association of socioeconomic position (SEP) with reproductive outcomes among Australian women.

METHODS

Data from the Australian Longitudinal Study on Women's Health's (population-based cohort study) 1973-1978 cohort were used (N = 6899, aged 37-42 years in 2015). The association of SEP (childhood and own, multiple indicators) with age at first birth, birth-to-pregnancy (BTP) intervals and total number of children was analysed using multinomial logistic regression.

RESULTS

14% of women had their first birth aged < 24 years. 29% of multiparous women had a BTP interval within the WHO recommendation (18-27 months). Women with a low SEP had increased odds of a first birth < 24 years: low (OR 7.0: 95% C.I. 5.3, 9.3) or intermediate education (OR 3.8: 2.8, 5.1); living in rural (OR 1.8: 1.5, 2.2) or remote (OR 2.1: 1.7, 2.7) areas; who found it sometimes (OR 1.8: 1.5, 2.2) or always difficult (OR 2.0: 1.6, 2.7) to manage on their income; and did not know their parent's education (OR 4.5: 3.2, 6.4). Low SEP was associated with having a much longer than recommended BTP interval.

CONCLUSION

As the first Australian study describing social differences in reproductive characteristics, these findings provide a base for reducing social inequalities in reproduction. Assisting adequate BTP spacing is important, particularly for women with existing elevated risks due to social disadvantage; including having a first birth < 24 years of age and a longer than recommended BTP interval. This includes reviewing services/access to postnatal support, free family planning/contraception clinics, and improved family policies.

A pro-inflammatory diet is associated with increased risk of developing hypertension among middle-aged women

BACKGROUND AND AIMS

A pro-inflammatory diet is thought to lead to hypertension through oxidative stress and vessel wall inflammation. We therefore investigated the association between the dietary inflammatory index (DII) and developing hypertension in a population-based cohort of middle-aged women.

METHODS AND RESULTS

The Australian Longitudinal Study on Women's Health included 7169 Australian women, aged 52 years (SD 1 year) at baseline in 2001, who were followed up through 4 surveys until 2013. The DII, a literature-derived dietary index that has been validated against several inflammatory markers, was calculated based on data collected via a validated food-frequency questionnaire administered at baseline. Hypertension was defined as new onset of doctor-diagnosed hypertension, ascertained through self-report between 2001 and 2013. Generalised Estimating Equation analyses were used to investigate the association between the DII and incident hypertension. The analyses were adjusted for demographic and hypertension risk factors. During 12-years follow-up we identified 1680 incident cases of hypertension. A more pro-inflammatory diet was associated with higher risk of hypertension in dichotomised analyses with an OR_{fully adjusted} of 1.24, 95% CI: 1.06-1.45.

CONCLUSION

A pro-inflammatory diet might lead to a higher risk of developing hypertension. These results need to be replicated in other studies.

Protective effect of hormone therapy among women with hysterectomy/oophorectomy

Study question

Does exposure to menopausal hormone therapy (MHT) in mid-aged women alter their risk of cardiovascular disease (CVD) mortality and all-cause mortality?

Summary answer

MHT soon after menopause is unlikely to increase the risk of CVD mortality or all-cause mortality and may have a protective effect for women with hysterectomy/oophorectomy.

What is known already

The balance of benefits and risks of MHT are currently unclear and may differ according to when treatment starts and whether women have an intact uterus.

Study design size, duration

A total of 13 715 participants from the mid-aged population-based cohort (born 1946-1951) of the Australian Longitudinal Study on Women's Health (ALSWH) were followed from 1998 to 2013.

Participants/materials setting methods

The measures included cardiovascular and all-cause mortality, exposure to MHT and menopausal status (based on 3-yearly self-reports). Electronic prescriptions data on MHT were also available from mid-2002 onwards. At each follow-up survey wave, participants were classified as: an existing user of MHT, an initiator of MHT or a non-initiator of MHT.

Main results and the role of chance

After adjusting for confounding variables, existing users of MHT had a reduced risk (hazard ratio 0.63; 95% CI, 0.43-0.92) of CVD mortality compared with non-initiators. Insufficient evidence of an association was identified for initiators of MHT (0.66; 0.35-1.24). For all-cause mortality, risks were reduced for both initiators (0.69; 0.55-0.87) and existing users (0.80; 0.70-0.91). In a subgroup analysis, women with hysterectomy/oophorectomy had lower risks of CVD mortality for both initiators (0.14; 0.02-0.98) and existing users (0.55; 0.34-0.90), but no evidence of an association was found for women whose MHT commenced during or after menopause. Similarly for all-cause mortality, only the women with hysterectomy/oophorectomy had lower risks for both initiators (0.47; 0.31-0.70) and existing users (0.69; 0.58-0.82).

Limitations, reasons for caution

Limitations include the observational nature of the study, the small number of deaths, MHT use being self-reported and the classification of menopausal status also being based on self-reported information.

Wider implications of the findings

Women considering MHT soon after menopause can be reassured that the treatment is unlikely to increase their risk of CVD mortality or all-cause mortality.

Study funding/competing interest(s)

The Australian Longitudinal Study on Women's Health is funded by the Australian Department of Health. G.D.M. is funded by the Australian Research Council Future Fellowship. L.C. was funded by a China scholarship council (CSC) graduate scholarship. All authors report no conflict of interest.

Trial registration number

N/A.

Young women's psychological distress after a diagnosis of polycystic ovary syndrome or endometriosis

STUDY QUESTION

Do young women with polycystic ovary syndrome (PCOS) or endometriosis report more psychological distress than their peers without a history of these conditions?

SUMMARY ANSWER

Young women (aged 18-23 years) with PCOS or endometriosis had a greater risk of moderate to severe psychological distress than women without a history of these conditions.

WHAT IS KNOWN ALREADY

Psychological distress appears common among women with PCOS and endometriosis. However, population-based studies that examine the psychological outcomes for adolescents and young women are generally absent from the literature.

STUDY DESIGN, SIZE, DURATION

This is a secondary analysis of data collected from 17 015 young, Australian women participating in a national, longitudinal cohort study. Women were first surveyed in 2012-2013 when they were aged 18-23 years. In 2014, women completed the second survey when they were aged 19-24 years and 11324 (67%) women responded.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We analysed data from 11 238 women who participated in both Surveys 1 and 2 and who responded to questions about PCOS and endometriosis. Using logistic regression, we compared the odds of moderate to severe psychological distress at Surveys 1 and 2 for women reporting a recent diagnosis (within the last 12 months) of PCOS or endometriosis and women with a pre-existing diagnosis, with that for women without a history of these conditions.

MAIN RESULTS AND THE ROLE OF CHANCE

At Survey 2, around 60% of women reporting a diagnosis of PCOS or endometriosis had moderate to severe levels of psychological distress. Compared to women without a history of these conditions, the odds of moderate to severe psychological distress at Survey 2 were significantly higher for women recently diagnosed with PCOS [Adjusted Odds Ratio (AOR) = 1.62, 95% CI = 1.21-2.18] or endometriosis (AOR= 1.77; 95% CI = 1.20-2.63) and for women with a pre-existing diagnosis of PCOS (AOR = 1.57, 95% CI = 1.30-1.89) or endometriosis (AOR = 1.61; 95% CI = 1.26-2.06). Women recently diagnosed with PCOS or endometriosis also had a greater likelihood of moderate to severe distress in the year prior to their diagnosis. The association between PCOS and psychological distress was attenuated when adjusting for BMI, but hormonal contraceptive use did not attenuate the risk of distress among the women with PCOS or endometriosis.

LIMITATIONS, REASONS FOR CAUTION

All data were self-reported and, therefore, the diagnoses of PCOS or endometriosis were not confirmed by a medical practitioner.

WIDER IMPLICATIONS OF THE FINDINGS

Health professionals should be aware of the potential psychosocial and healthcare needs among young women with these conditions, particularly women with PCOS who are obese. While hormonal contraceptives may help to regulate the hormonal aspects of these conditions, they do not appear to reduce women's psychological distress. Because psychological distress among the young women in this study remained elevated even after diagnosis, this supports the need for multidisciplinary health care to help women adjust to their diagnosis and treatment regimens and facilitate positive, long-term mental health outcomes. Future research that examines medical and psychosocial sources of distress for young women with PCOS and endometriosis is needed.

STUDY FUNDING/COMPETING INTERESTS

I.J.R. was supported by an Australian National Health and Medical Research Council Centre for Research Excellence (grant number: APP1000986). G.D.M. is funded by the Australian Research Council Future Fellowship (FT120100812). The Australian Longitudinal Study on Women's Health is funded by the Australian Government Department of Health. H.T. is supported by an Australian National Health and Medical Research Council Practitioner Fellowship. The authors declare that no competing interests exist.

TRIAL REGISTRATION NUMBER

N/A.

Developmental trajectories of adiposity from birth until early adulthood and association with cardiometabolic risk factors

OBJECTIVE

To identify developmental trajectories of adiposity from birth until early adulthood, and to investigate how they relate with cardiometabolic risk factors at 21 years of age.

METHODS

Participants' weight and height measurements were obtained using the EPITeen cohort protocol at 13, 17 and 21 years of age, and extracted from child health books as recorded during health routine evaluations since birth. Blood pressure, triglycerides, cholesterol and insulin resistance (HOMA-IR) were assessed at 21 years. Trajectories were defined using 719 participants contributing 11 459 measurements. The individual growth curves were modelled using mixed-effects fractional polynomial, and the trajectories were estimated using normal mixture modelling for model-based clustering. Differences in cardiometabolic risk factors at 21 years according to adiposity trajectories were estimated through analysis of covariance (ANCOVA), and adjusted means are presented.

RESULTS

Two trajectories-'Average body mass index (BMI) growth' (80.7%) and 'Higher BMI growth' (19.3%)-were identified. Compared with those in 'Average BMI growth', 'Higher BMI growth' participants were more frequently delivered by caesarean section, mothers were younger and had higher BMI, and parental education was lower; and at 21 years showed higher adjusted mean systolic (111.6 vs 108.3 mm Hg, P<0.001) and diastolic blood pressure (71.9 vs 68.4 mm Hg, P<0.001), and lower high-density lipoprotein cholesterol (53.3 vs 57.0 mg dl(-1), P=0.001). As there was a significant interaction between trajectories and sex, triglycerides and HOMA-IR were stratified by sex and we found significantly higher triglycerides, in males, and higher HOMA-IR in both sexes in 'Higher BMI growth' trajectory. All the differences were attenuated after adjustment for BMI at 21 years.

CONCLUSIONS

In this long-term follow-up, we were able to identify two adiposity trajectories, statistically related to the BMI and cardiometabolic profile in adulthood. Our results also suggest that the impact of the adiposity trajectory on cardiometabolic profile is mediated by current BMI.

The influence of long-term exposure and timing of physical activity on new joint pain and stiffness in mid-age women

OBJECTIVE

To examine the influence of long-term exposure and timing of physical activity (PA) on new joint pain/stiffness in mid-age women.

METHODS

Data were from 5105 participants (born 1946-51) in the Australian Longitudinal Study on Women's Health (ALSWH) who completed survey items on PA (1998, 2001 and 2004) and joint pain/stiffness (2007 and 2010). PA was categorized in five levels at each survey and summed into a cumulative PA score (CPA, range 0-12). Associations were analysed using logistic regression, with separate models for the cumulative model (using CPA), the sensitive periods model (i.e., PA measured at each survey in one regression model) and the critical periods model (i.e., separate regression models for PA at each survey).

RESULTS

951 (18.6%) participants reported new-onset joint pain/stiffness. In the cumulative model, CPA was associated joint pain/stiffness when included as a continuous variable (adjusted odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95-0.99), but not when included as a categorical variable. In both the sensitive periods and critical periods models, low to high levels of PA in 2001 and 2004 had stronger inverse associations with joint pain/stiffness than PA levels in 1998. The model fit was better for the sensitive periods than the cumulative or critical periods models.

CONCLUSIONS

In mid-age women, PA between the ages 47 and 58 was associated with a lower risk of joint pain/stiffness 9 years later. Associations were stronger for PA in the last 6 years than for earlier PA.

Hot flushes and night sweats are associated with coronary heart disease risk in midlife: a longitudinal study

OBJECTIVE

The purpose of this study was to investigate associations between vasomotor menopausal symptoms (VMS), i.e. hot flushes and night sweats, and the incidence of coronary heart disease (CHD).

DESIGN

A prospective cohort study.

SETTING AND POPULATION

11 725 women, aged 45-50 years at baseline in 1996, were followed up at 3-year intervals for 14 years.

METHODS

Self-reported VMS and incident CHD were measured at each survey.

MAIN OUTCOME MEASURE

We determined the association between VMS and CHD at the subsequent survey, using generalised estimating equation analysis, adjusting for time-varying covariates.

RESULTS

At baseline, 14% reported rarely, 17% reported sometimes, and 7% reported often having night sweats. During follow-up, 187 CHD events occurred. In the age-adjusted analysis, women who reported their frequency of experiencing hot flushes and night sweats as 'often' had a greater than two-fold increased odds of CHD (OR hot flushes 2.18, 95% CI 1.49-3.18; OR night sweats 2.38, 95% CI 1.62-3.50) compared with women with no symptoms (P trend < 0.001 for frequency of symptoms). Adjustment for menopausal status, lifestyle factors, body mass index, diabetes, and hypertension attenuated the associations (OR hot flushes 1.70, 95% CI 1.16-2.51, P trend = 0.01; OR night sweats 1.84, 95% CI 1.24-2.73), P trend = 0.004).

CONCLUSIONS

Women who report having hot flushes or night sweats 'often' have an increased risk of developing CHD over a period of 14 years, even after taking the effects of age, menopause status, lifestyle, and other chronic disease risk factors into account.

Bidirectional association between weight change and depression in mid-aged women: a population-based longitudinal study

BACKGROUND

There is some evidence for a bidirectional association between obesity and depression. However, studies examining weight change and depression are scarce and report inconsistent findings.

OBJECTIVE

The objective was to investigate the relationship between average annual percentage weight change and depression in mid-aged women.

DESIGN

This was a prospective cohort study.

SUBJECTS

A total of 8246 women aged 45-50 years at baseline participating in the Australian Longitudinal Study on Women's Health were surveyed every 3 years over a 12-year period. Information on body mass index and depression was collected at each survey. We used regression models to investigate the effect of weight change predicting depression and vice versa, by calculating odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Weight gain was associated with an increased risk of prevalence (OR 1.39, 95% CI 1.25-1.56) and incidence (OR 1.30, 95% CI 1.14-1.49) of depression. However, in time-lagged analyses, where weight change between the two preceding surveys was used to predict incidence of depression at the current survey, no statistically significant associations with depression were found. Compared with women without depression, women with prevalent and incident depression had an increased risk of weight gain (OR 1.29, 95% CI 1.19-1.40 and OR 1.20, 95% CI 1.05-1.38, respectively). When incidence of depression was lagged with respect to weight change between the two subsequent surveys, depression remained associated with an increased risk (OR 1.19, 95% CI 1.00-1.41) of gaining weight.

CONCLUSION

These findings suggest that depression may cause weight gain over the next 3 years, but that weight change (loss or gain) may not lead to depression. Further research at shorter intervals, perhaps 6 monthly or yearly is needed to ascertain whether weight change is an independent predictor of depression in the shorter term.

Validity of self-reported osteoporosis in mid-age and older women

The validity of self-reported osteoporosis is often questioned, but validation studies are lacking. We validated self-reported prevalence and incidence of osteoporosis against self-reported and administrative data on medications. The concurrent validity was moderate to good for self-reported prevalent osteoporosis, but only poor to moderate for self-reported incident osteoporosis in mid-age and older women, respectively. Construct validity was acceptable for self-reported prevalent but not for incident osteoporosis.

INTRODUCTION

The validity of self-reported osteoporosis is often questioned, but validation studies are lacking. The aim was to examine the validity of self-reported prevalence and incidence of osteoporosis against self-reported and administrative data on medications.

METHODS

Data were from mid-age (56-61 years in 2007) and older (79-84 years in 2005) participants in the Australian Longitudinal Study on Women's Health. Self-reported diagnosis was compared with medication information from (1) self-report (n(mid) = 10,509 and n(old) = 7,072), and (2) pharmaceutical prescription reimbursement claims (n(mid) = 6,632 and n(old) = 4,668). Concurrent validity of self-report was examined by calculating agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Construct validity was tested by examining associations of self-reported diagnosis with osteoporosis-related characteristics (fracture, weight, bodily pain, back pain, and physical functioning).

RESULTS

Agreement, sensitivity and PPV of self-reported prevalent diagnosis were higher when compared with medication claims (mid-age women: kappa = 0.51, 95% confidence interval [CI] = 0.46-0.56; older women: kappa = 0.65, 95% CI = 0.63-0.68) than with self-reported medication (mid-age women: kappa = 0.41, 95% CI = 0.37-0.45; older women: kappa = 0.57, 95% CI = 0.55-0.59). Sensitivity, PPV and agreement were lower for self-reported incident diagnosis (mid-age women: kappa = 0.39, 95% CI = 0.32-0.47; older women: kappa = 0.55, 95% CI = 0.51-0.61). Statistically significant associations between self-reported diagnosis and at least four of five characteristics were found for prevalent diagnosis in both age groups and for incident diagnosis in older women.

CONCLUSIONS

The concurrent validity was moderate to good for self-reported prevalent osteoporosis, but only poor to moderate for self-reported incident osteoporosis in mid-age and older women, respectively. Construct validity was acceptable for self-reported prevalent but not for incident osteoporosis.

A study of relationships between bone-related vitamins and minerals, related risk markers, and subsequent mortality in older British people: the National Diet and Nutrition Survey of People Aged 65 Years and Over

SUMMARY

Follow-up of a British national survey of older people found that in men, all-cause mortality was predicted by baseline plasma concentrations of phosphorus, albumin, creatinine and α1-antichymotrypsin, and food energy intake and in women by plasma alkaline phosphatase, creatinine, α1-antichymotrypsin, 25-hydroxy-vitamin D (marginally), and phosphorus intake.

INTRODUCTION

Predictive power, for all-cause mortality, of bone-related vitamin and mineral indices and intakes, measured at baseline (primary objective), was studied in the British National Diet and Nutrition Survey (community-living subset) of People Aged 65 Years and Over. A secondary objective was to identify cross-sectional relationships between indices at baseline to help explain mortality predictions.

METHODS

Mortality status was recorded for 1,054 (mean age 76.6 ± 7.4 years, 49.0% female) participants from baseline survey in 1994/1995 until September 2008. Seventy-four per cent of male and 62% of female participants died. Cox proportional hazards models were used to relate baseline nutrient and risk marker estimates to subsequent survival. Results below 1.0 signified lower risk at greater nutrient (status or intake) values and vice versa.

RESULTS

In both sexes, all-cause mortality was significantly predicted by body weight and mid-upper arm circumference. In men, it was predicted by baseline plasma concentrations (per SD) of: phosphorus (hazard ratio 1.18, 95% confidence interval (CI) = 1.06-1.30), albumin (hazard ratio 0.84, 95% CI = 0.74-0.94), creatinine (hazard ratio 1.20, 95% CI = 1.08-1.33) and α(1)-antichymotrypsin (hazard ratio 1.21, 95% CI = 1.11-1.33). In women, it was predicted by plasma albumin (hazard ratio 0.83, 95% CI = 0.72-0.96), alkaline phosphatase (hazard ratio 1.08, 95% CI = 1.01-1.16), creatinine (hazard ratio 1.37, 95% CI = 1.13-1.66), α(1)-antichymotrypsin (hazard ratio 1.27, 95% CI = 1.11-1.45) and marginally by 25-hydroxy-vitamin D (hazard ratio 0.87, 95% CI = 0.75-1.00). In men, it was predicted by dietary intake (per SD) of food energy; in women, by intake of phosphorus. Adjustment for plasma α(1)-antichymotrypsin or plasma creatinine reduced the significance of plasma phosphorus in men.

CONCLUSION

Mortality prediction by higher plasma phosphorus in older British men may imply impaired renal function and/or acute phase status. Further studies are needed on which associations are causal and modifiable.

Early adulthood television viewing and cardiometabolic risk profiles in early middle age: results from a population, prospective cohort study

AIMS/HYPOTHESIS

Little research has been done on the long-term longitudinal associations between markers of sedentary behaviour and health risks. We hypothesised that television (TV) viewing in early to mid-adulthood predicts an adverse cardiometabolic risk factor profile in middle age independently of participation in physical activity.

METHODS

We used prospective data from 5,972 (2,947 men) participants of the 1958 British Birth Cohort study. TV viewing and exercise frequency were obtained at age 23 years. Daily TV viewing and weekly moderate to vigorous physical activity were assessed at age 44 years, as well as HbA(1c), triacylglycerol, total and HDL-cholesterol, systolic and diastolic blood pressure, and waist circumference. We used generalised linear models and multiple linear regression to examine the associations between TV viewing at age 23 years and the cardiometabolic risk markers (including a clustered cardiometabolic risk score) at 44 years, while adjusting for sex, exercise participation and TV viewing at age 44 years, and other potential confounders.

RESULTS

In the multivariable models, TV viewing frequency at age 23 years showed positive associations with C-reactive protein (generalised linear model change 12.6%, 95% CI 3.5, 22.8; p = 0.005), fibrinogen (change 1.8%, 95% CI 0.3, 3.3; p = 0.020), waist circumference (coefficient 1.17, 95% CI 0.32, 2.01; p = 0.004), systolic (coefficient 1.44, 95% CI 0.33, 2.54; p = 0.019) and diastolic (coefficient 0.75, 95% CI -0.01, 1.51; p = 0.053) blood pressure, and clustered cardiometabolic risk score (men only, coefficient 0.06, 95% CI 0.01, 0.11; p = 0.038). Adjustments for baseline (age 23 years) BMI attenuated these associations towards null.

CONCLUSIONS/INTERPRETATION

TV viewing habits in early adulthood are associated with adverse cardiometabolic profiles in early middle adulthood that are independent of TV viewing habits and physical activity in middle age, but not independent of BMI in early adulthood.

Dietary patterns and cardiovascular risk markers in the UK Low Income Diet and Nutrition Survey

BACKGROUND AND AIM

Dietary patterns have been associated with various disease risk markers. There is presently little representative data about the dietary patterns of adults on low income. The objective was therefore to identify dietary patterns and how they relate to cardiovascular (CVD) risk markers in this specific population.

METHODS AND RESULTS

Exploratory factor analysis was performed to examine dietary patterns in participants from the UK Low Income Diet and Nutrition Survey (n=2931, aged 49.4+/-20.2 years, 65% female). Dietary intake was assessed from three 24h dietary recalls and blood was drawn for the assessment of CVD risk markers (C-reactive protein [CRP], total and high density lipoprotein [HDL] cholesterol, triglycerides, homocysteine). Results of the factor analysis revealed four interpretable principle components accounting for approximately 16.5% of the total variance, with similar patterns across gender. A 'fast food' diet pattern explained the greatest proportion of the variance (5.5%), followed by 'health aware' (4.1%), 'traditional' (3.6%), and 'sweet' (3.3%) factors. Participants consuming more items from the fast food pattern were younger, more likely to be smokers and employed, but not partnered. The 'health aware' diet pattern was inversely associated with concentrations of CRP and homocysteine, and positively with HDL-cholesterol.

CONCLUSIONS

A fast food dietary pattern, high in saturated fat, explained the greatest proportion of the variance in a representative sample of adults on low income from the UK. There was, however, considerable heterogeneity in dietary intake among this socially deprived group and healthy eating was associated with lower CVD risk markers.

Dietary patterns, assessed from a weighed food record, and survival among elderly participants from the United Kingdom

BACKGROUND/OBJECTIVES

There is variability in the association between dietary intake and health outcomes across different countries, especially among the elderly. We used the gold standard dietary assessment method, a weighed food record, to examine the association between dietary pattern and mortality in a representative sample of community dwelling participants from Great Britain aged 65 years and older.

SUBJECTS/METHODS

Dietary intake was recorded at baseline in 1017 elderly participants (520 men, 497 women, mean age 76.3+/-7.4 years). Exploratory factor analysis was performed to examine dietary patterns and participants were followed up over an average of 9.2 years for mortality.

RESULTS

The factor analysis revealed four interpretable principal components accounting for approximately 9.8% of the total variance, with similar patterns across sex. A 'Mediterranean-style' dietary pattern explained the greatest proportion of the variance (3.7%), followed by 'health-aware' (2.2%), 'traditional' (2.0%) and 'sweet and fat' (1.9%) factors. There were a total of 683 deaths through follow-up. After adjustment for potential confounders, only the Mediterranean-style dietary pattern remained associated with mortality (highest vs lowest tertile; hazard ratio=0.82, 95% CI, 0.68-1.00). The benefits of the Mediterranean-style diet were only observed among women (hazard ratio=0.71, 95% CI 0.52-0.96) although in men the traditional diet was a risk factor for mortality (hazard ratio=1.30, 95% CI 1.00-1.71).

CONCLUSIONS

Using a gold standard approach, our results confirm previous evidence that dietary patterns are important in longevity among the elderly.

Patterns in trouble sleeping among women at mid-life: results from a British prospective cohort study

BACKGROUND

Although trouble sleeping is a common problem among women at mid-life, patterns in trouble sleeping relating to social and health-related risk factors are unclear. This analysis describes the dynamics of trouble sleeping among women at mid-life.

METHODS

The National Survey of Health and Development is a nationally representative study of births in 1946 in England, Scotland, and Wales followed up through mid-life. Multistate life table analysis utilised 893 women interviewed annually between ages 48 to 54 years.

RESULTS

Women spent an average of 2.6 years with trouble sleeping, and the average length of a continuous episode of trouble sleeping was 2.4 years. Among women who reported at least one episode, the average number of episodes was 1.5. Health-related risk factors at age 43 of number of physical conditions, anxiety and depression symptoms, use of prescription medication, and current or past trouble sleeping were related to increased total and per episode duration of trouble sleeping over the 7-year study interval and increased duration per episode. Differences associated with these risk factors ranged from 1.2 to 1.8 years for duration over the study interval and 0.5 to 0.8 years per episode. There was no association between average number of episodes per woman reporting at least one episode and these health-related risk factors at age 43.

CONCLUSIONS

This study provides support for association between increased duration of trouble sleeping, in total and per episode, and health risk factors at age 43, suggesting a long-term relationship between risk factors and sleep.

Age at birth of first child and coronary heart disease risk factors at age 53 years in men and women: British birth cohort study

OBJECTIVE

To assess the associations between parental age at birth of first child and coronary heart disease (CHD) risk factors in men and women. To investigate whether the associations are explained by childhood predictors of age at parenthood or adult lifestyle factors related to child rearing.

METHODS

Data from 2540 men and women, with CHD risk factors measured at age 53 years, from a birth cohort study of individuals born in Britain in 1946 (Medical Research Council National Survey of Health and Development) and followed up regularly throughout life, were analysed.

RESULTS

Younger age at birth of first child in both men and women was associated with poorer mean body mass index (BMI), waist-hip ratio, blood pressure (BP), high-density lipoprotein cholesterol, triglyceride and glycated haemoglobin levels. Mean BMI decreased from 28.0 kg/m(2) (95% CI 27.2 to 28.8) in the teenage motherhood group to 26.8 kg/m(2) (25.9 to 27.7) in the oldest motherhood group (> or =30 years). For men, the equivalent mean values were 28.5 kg/m(2) (27.3 to 29.8) and 27.1 kg/m(2) (26.7 to 27.6). Associations with adiposity, lipid measures and glycated haemoglobin were largely explained by childhood antecedents and adult social and lifestyle variables. Associations with BP remained robust to adjustment: systolic blood pressure remained highest in teenage parents (7.5 mmHg (1.0 to 13.9) difference in women and 8.6 mmHg (0.4 to 16.8) difference in men between the youngest and the oldest parenthood groups)

CONCLUSIONS

Lifestyle factors, rather than the biological impact of pregnancy, explain the relationship between age at motherhood and CHD risk factors. Family-based lifestyle interventions targeted at young parents may improve their future CHD risk.

Body weight through adult life and risk of urinary incontinence in middle-aged women: results from a British prospective cohort

OBJECTIVES

To determine whether the onset and duration of being overweight or obese are associated with symptoms of urinary incontinence.

DESIGN

Nationally representative cohort study.

SUBJECTS

A total of 1201 women followed-up since their birth in 1946 and annually from 48 to 54 years.

MEASUREMENTS

The body mass index (BMI) at the age of 20, 26, 36 and 43, and symptoms of stress, urge and severe incontinence at seven consecutive years from age 48 to 54.

RESULTS

In each year from age 48 to 54, almost half (46-49%) reported symptoms of stress incontinence, urge incontinence rose from 22 to 25% and severe incontinence from 8 to 11%. At the age of 20, 26, 36 and 43, BMI was positively associated with stress symptoms and severe incontinence in midlife. BMI transition was found to have accumulation effects on symptoms of severe incontinence; women who were overweight/obese since age 20 years were more likely to report severe incontinence than women whose BMI remained below 25 kg/m(2) (odds ratio (95% confidence interval): 2.30 (1.36-3.93)) or who became overweight or obese at 43 years (1.85 (0.97-3.51)). These relationships existed beyond the effects of aging, childhood enuresis, kidney infection, childbirth characteristics, menopause, educational attainment, general practitioner consultations and smoking status. BMI was not associated with symptoms of urge incontinence.

CONCLUSIONS

Across adult life, higher BMI for women was linked with subsequent symptoms of stress and severe incontinence in midlife; those who were overweight or obese since early in adult life more than doubled their risk of severe incontinence. Women, and especially young women, should be encouraged to keep their weight in a normal range throughout adult life.

Offspring birth weight, gestational age and maternal characteristics in relation to glucose status at age 53 years: evidence from a national birth cohort

AIMS

We investigated pathways linking offspring birth weight to maternal diabetes risk in later life by taking into account a range of prospective early-life and adult maternal factors.

METHODS

In a national birth cohort study, we examined the relationship between offspring birth weight and maternal glycated haemoglobin (HbA1c) at age 53 years in 581 mothers who had a first birth between age 19 and 25 years, and had data on potential confounders or mediators.

RESULTS

Mean age at first birth was 21.5 years. After adjustment for maternal body mass index (BMI), mean percentage change in maternal HbA1c per kilogram increase in offspring birth weight was -1.8%[95% confidence interval (CI) -3.5, -0.1; P = 0.03]. This relationship was mostly accounted for by gestational age that was inversely related to maternal HbA1c (-0.9%; 95% CI -1.5, -0.4; P = 0.001). Other risk factors for high HbA1c were smoking and high BMI at 53 years. There was a significant interaction between offspring birth weight and maternal childhood social class (P = 0.01). Mothers from a manual background with higher birth weight offspring had lower HbA1c (BMI adjusted: -3.1%; 95% CI -5.0, -1.1); this was not observed for mothers from a non-manual background (BMI adjusted: 1.9%; 95% CI -1.3, 5.0).

CONCLUSIONS

Short gestational age and low offspring birth weight may be part of a pathway linking impaired early maternal growth to diabetes risk in later life. A second possible pathway linking higher offspring birth weight to later maternal glucose status was also identified. These potential pathways require further investigation in cohorts with a wider maternal age range so that the early targeting of public health initiatives can be assessed.

Characterisation of smoking behaviour across the life course and its impact on decline in lung function and all-cause mortality: evidence from a British birth cohort

OBJECTIVES

To describe smoking trajectories from early adolescence into mid-life and to examine the effects of these trajectories on health and all-cause mortality.

METHODS

A nationally representative birth cohort study including 3387 men and women followed up since their birth in 1946 in England, Scotland and Wales. The main outcome measure is all-cause mortality by age 60 years and rate of decline in forced expiratory volume in 1 second (FEV(1)).

RESULTS

Eighteen per cent of the sample were categorised as lifelong smokers (smokers at all six waves at ages 20, 25, 31, 36, 43, 53 years), of whom 90% had begun smoking by age 18 years. By age 60 years, 10% of all lifelong smokers had died. They had a threefold increase in mortality rate compared with never smokers (hazard ratio (HR) 3.2, 95% confidence interval (CI) 2.1 to 4.8). For predominantly smokers (smokers for at least four of the six data collections), mortality rate remained higher than never smokers (HR 1.6, 95% CI 1.0 to 2.5). Predominantly non-smokers did not differ from those who never smoked (HR 1.3, 95% CI 0.9 to 2.0). Using the most recent smoking status available, current smokers had more than double the risk of mortality compared with never smokers (HR 2.4, 95% CI 1.6 to 3.5). Lifelong smokers and predominantly smokers had a greater rate of decline in lung function than never smokers (regression coefficients -18 ml/year, 95% CI -22 to -13; -6, 95% CI -10.3 to -1.7 respectively). For current smokers, the decline was 8.4 ml/year (95% CI -12.0 to -5.0) faster than never smokers.

CONCLUSIONS

The strength and differentiation of adverse effects identified by using simplified smoking behaviours has highlighted the advantages of obtaining further information on lifelong smoking behaviour from former smokers, rather than just current smoking status.

γ-Tocopherol as a possible marker for nutrition-related risk: results from four National Diet and Nutrition Surveys in Britain

Relationships between vitamin E status (α and γ-tocopherol and their ratio in plasma), anthropometric and biochemical indices, and food and nutrient intakes, were studied in four British National Diet and Nutrition Surveys: children aged 1·5–4·5 years, young people aged 4·0–18·0 years, adults 19·0–64·0 years and adults aged ≥65·0 years. γ-Tocopherol:α-tocopherol ratio declined with age. In older women γ-tocopherol and γ-tocopherol:α-tocopherol ratios were directly related to indices of obesity. In young men α- and γ-tocopherols were directly correlated with obesity, but γ-tocopherol:α-tocopherol ratio was not. For young people and toddlers, fewer obesity indices were available and relationships were weaker. Other fat- and water-soluble vitamin indices correlated directly with α-tocopherol and inversely with γ-tocopherol and γ-tocopherol:α-tocopherol ratio. Whereas α-tocopherol correlated directly with ‘healthy’ nutrient choices (such as intrinsic sugars, dietary fibre, vitamins and potassium) and inversely with ‘unhealthy’ choices (extrinsic sugars and monounsaturated fats, i.e. avoidance of polyunsaturated fat), γ-tocopherol and the γ-tocopherol:α-tocopherol ratio related inversely with ‘healthy’ choices. Food groups had analogous relationships; thus, α-tocopherol related directly to use of polyunsaturated fats, fresh fruits and fruit juices, and inversely to non-polyunsaturated fats and extrinsic sugar. The reverse was true for γ-tocopherol and γ-tocopherol:α-tocopherol ratio. Although the mechanisms underlying these relationships are obscure, the γ-tocopherol:α-tocopherol ratio may reveal poor dietary choices, status predictors and a propensity for obesity in later life, especially in women.

The impact of inter-generational social and regional circumstances on dietary intake patterns of British adults: results from the 1946 British Birth Cohort

Objectives:

(1) To determine the extent to which an individual's childhood social circumstances and region of residence influence their dietary pattern at age 43 years and (2) to establish the extent to which an individual adopts the dietary pattern of their social and regional circumstances at age 43 years.

Design:

Longitudinal study of a social class stratified, random sample of all legitimate, singleton births in the week of 3–9 March 1946.

Settings:

England, Scotland and Wales.

Subjects:

The 3187 survey members who provided sociodemographic information at age 4 years in 1950 and sociodemographic and dietary data (48-hour dietary recall) at 43 years in 1989.

Results:

People who remained in the non-manual social class consumed significantly higher amounts of food items correlated with the factor health aware (items include high-fibre breakfast cereals, wholemeal breads, apples and bananas) than those who remained in the manual social class. Those who made the transition from manual social class in childhood to non-manual social class at age 43 years partly adopted the distinctive dietary patterns of the non-manual social classes. Consumption of items in the factors refined (items include whole-fat milk, white bread, sugar and butter) and sandwich (items include tomatoes, lettuce, onions, bacon and ham) did not differ by social class or regional mobility.

Conclusions:

This work suggests that although adult dietary patterns are developed as a result of childhood influences, these patterns can be modified as a result of social and regional transitions. Such changes in dietary patterns may influence susceptibility to disease.

The impact of long chain n-3 polyunsaturated fatty acid supplementation on inflammation, insulin sensitivity and CVD risk in a group of overweight women with an inflammatory phenotype

BACKGROUND

Inflammation is strongly related to obesity and the risk of cardiovascular disease (CVD). The metabolic benefits of long chain (LC) n-3 polyunsaturated fatty acid (PUFA) may be attributable to its anti-inflammatory properties.

OBJECTIVE

To investigate whether an individual's habitual inflammatory status influences the impact of a LC n-3 PUFA intervention on CVD risk.

DESIGN

The study was a randomized crossover design. Subjects received LC n-3 PUFA capsules or a placebo for 12 weeks, with 4-week washout between phases. Thirty women, in the top and bottom tertiles of baseline sialic acid concentration, formed raised inflammatory status (top, n = 12) and reference (bottom, n = 18) groups. Baseline data were analysed using one-way anova, differences between treatment phases were calculated at each timepoint and analysed using a random effects model.

RESULTS

At baseline, the raised inflammatory status group had significantly higher body mass index and area under the curve (AUC) insulin than the reference group. With LC n-3 PUFA supplementation, both groups showed significantly higher plasma eicosapentaenoic acid and docosahexaenoic acid at 4 and 12 weeks (p < 0.001), and lower triacylglycerols (4 weeks p < 0.01 and 12 weeks p < 0.05). The difference in AUC insulin between the two treatment phases at 12 weeks was significantly greater in the raised inflammatory status group compared to the reference group (p < 0.05). Inflammatory markers were significantly lower after 12 weeks LC n-3 PUFA supplementation compared to baseline (C-reactive protein p < 0.05 and interleukin-6 p < 0.01), but there was no significant group effect.

CONCLUSIONS

Habitual inflammatory status influences the impact of LC n-3 PUFA supplementation, but it is not clear whether the effect of LC n-3 PUFA on AUC insulin is mediated through inflammatory mechanisms.

Longitudinal changes in dietary patterns during adult life

Despite the growing interest in dietary patterns, there have been few longitudinal investigations. The objective of the present study was to extend an earlier method of dietary pattern assessment to longitudinal binary data and to assess changes in patterns over time and in relation to socio-demographic covariates. A prospective national cohort of 1265 participants completed a 5 d food diary at three time-points during their adult life (at age 36 years in 1982, 43 years in 1989 and 53 years in 1999). Factor analysis identified three dietary patterns for women (fruit, vegetables and dairy; ethnic foods and alcohol; meat, potatoes and sweet foods) and two patterns in men (ethnic foods and alcohol; mixed). Trends in dietary pattern scores were calculated using random effects models. Marked changes were found in scores for all patterns between 1989 and 1999, with only the meat, potatoes and sweet foods pattern in women recording a decline. In a multiple variable model that included the three time-points, socio-demographic variables and BMI time-dependent covariates, both non-manual social class and higher education level were also strongly associated with the consumption of more items from the ethnic foods and alcohol pattern and the mixed pattern for men (P < 0.0001) and the fruit, vegetables and dairy pattern and the ethnic foods and alcohol pattern for women (P < 0.01). In conclusion, longitudinal changes in dietary patterns and across socio-economic groups can assist with targeting public health initiatives by identifying stages during adult life when interventions to improve diet would be most beneficial to health.

Additive benefits of long-chain n-3 polyunsaturated fatty acids and weight-loss in the management of cardiovascular disease risk in overweight hyperinsulinaemic women

BACKGROUND

Obesity, inflammation, insulin resistance and cardiovascular disease (CVD) risk are inter-related. Both weight-loss and long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) are independently known to reduce metabolic risk, but the combined effects are unclear.

OBJECTIVE

This study examines whether addition of LC n-3 PUFA to a low fat/high carbohydrate weight-loss programme results in greater improvements in inflammation, insulin sensitivity and CVD risk, than weight-loss alone.

DESIGN

One hundred and sixteen overweight insulin-resistant women entered a 24-week randomised intervention study. Thirty-nine women were randomised to a weight-loss programme, with LC n-3 PUFA (WLFO), 38 to a weight-loss programme with placebo oil (WLPO), and 39 to receive placebo oil, with no weight-loss programme (control).

RESULTS

Ninety-three women completed the study (35 WLFO, 32 WLPO and 26 control), with significant weight-loss in WLFO (10.8+/-1.0%) and WLPO (12.4+/-1.0%) compared to the control group (P<0.0001). The WLFO, but not WLPO or control group, showed significant increases in adipose tissue LC n-3 PUFA (0.34+/-0.20 vs 0.17+/-0.10 and 0.16+/-0.10 %DHA, P<0.0001). Weight-loss showed significant improvements in insulin sensitivity (P<0.001), lipid profile (triglycerides P<0.05) and inflammation (sialic acid P<0.05). Time*group effects showed significant decreases in triglycerides (P<0.05) and increases in adiponectin (P<0.01) with LC n-3 PUFA, in the WLFO vs WLPO groups.

CONCLUSIONS

Weight-loss improved risk factors associated with CVD, with some additional benefits of LC n-3 PUFA on triglycerides and adiponectin. Given the current low dietary intake of LC n-3 PUFA, greater attention should be given to increase these fatty acids in the treatment of obesity.

Dietary silicon intake in post-menopausal women

Si has been suggested as an essential element, and may be important in optimal bone, skin and cardiovascular health. However, there are few estimates of dietary Si intakes in man, especially in a UK population. Following the development of a UK food composition database for Si, the aim of the present study was to investigate dietary intakes of Si amongst healthy women aged over 60 years and to identify important food sources of Si in their diet. Healthy, post-menopausal female subjects (>60 years of age; n 209) were recruited from the general population around Dundee, Scotland as part of an unrelated randomised controlled intervention study where dietary intake was assessed using a self-administered, semi-quantitative food-frequency questionnaire at five time-points over a 2-year period. Food composition data on the Si content of UK foods was used to determine the Si content of food items on the food-frequency questionnaire. Mean Si intake was 18.6 (sd 4.6) mg and did not vary significantly across the 2 years of investigation. Cereals provided the greatest amount of Si in the diet (about 30 %), followed by fruit, beverages (hot, cold and alcoholic beverages combined) and vegetables; together these foods provided over 75 % about Si intake. Si intakes in the UK appear consistent with those reported previously for elderly women in Western populations, but lower than those reported for younger women or for men.

Changes in intake of key nutrients over 17 years during adult life of a British birth cohort

An investigation was carried out to determine whether there were significant changes in nutrient intake over 17 years of adult life. The Medical Research Council National Survey of Health and Development is a longitudinal study of a nationally representative cohort of singleton births in the UK in 1946. Of this cohort, 1253 survey members provided information on diet recorded in a 5 d diary at age 36 years in 1982, 43 years in 1989 and 53 years in 1999. The outcome measures were mean intakes of energy, macronutrients, minerals and vitamins. There were significant changes in the intake of most nutrients in 1999 compared with previous years. Intakes of fat, Na, Fe and Cu have fallen, but there was a rising trend in the intakes of Ca, P, carotene, thiamin, pyridoxine, folic acid and vitamins C, D and E in both men and women. Additionally, intakes of K, Mg and vitamin K1 have risen in women. There were significant gender differences, women showing a higher percentage rise in the intakes of carotene, riboflavin, folic acid, vitamin C and vitamin E. These changes were related to changes in the consumption of certain key foods, such as the increased consumption of fruit and vegetables and a shift away from whole milk, butter and red meat. Most of these trends are in line with accepted nutritional guidelines. How far these changes are due to consumer choice and real changes in food composition or are due to artefacts inherent in the methodology is discussed.

Comparability of dietary patterns assessed by multiple dietary assessment methods: results from the 1946 British Birth Cohort

OBJECTIVE

The aim of this study is to evaluate the consistency of dietary patterns assessed through the use of a dietary recall and a 5-day food diary.

DESIGN

Participants (n = 2265) of a longitudinal study of health and development completed 48-h dietary recall at interview, followed by a 5-day food diary and with the 24 h immediately preceding the interview analysed separately as a 24-h recall. Mean intakes of foods and nutrients were calculated and dietary patterns were assessed using exploratory factor analysis, using the method of principal components. Paired t-tests and correlation coefficients were used to compare the three dietary assessment methods.

RESULTS

Five distinct dietary patterns were identified using the food diary and the 48-h recall but were less consistent on the 24-h recall. Correlations between factor scores on the 48-h recall and the food diary (r = 0.13-0.67) were higher than those between the 24-h recall and food diary (r = -0.01-0.59). The recall methods were effective at ranking subjects according to food and nutrient intakes, with the 48-h recall and food diary showing higher correlations in both males and females.

CONCLUSIONS

This study indicates that a 48-h recall effectively characterises dietary patterns in British adults when compared to a food diary and ranks participants appropriately with respect to most nutrients and foods and is superior to a single 24-h recall. These results have implications for longitudinal studies where maximising response rates to repeat dietary assessment tools is essential.

Elevated sialic acid, but not CRP, predicts features of the metabolic syndrome independently of BMI in women

AIMS

C-reactive protein (CRP) is a predictor of many diseases including type II diabetes and cardiovascular disease. Fewer studies have similarly shown sialic acid (SA) to be a predictor of obesity-related diseases, but importantly SA shows less intra-individual variability than CRP and acts as an integrated marker of the activity of a number of acute-phase proteins. This study examines the association between both CRP and SA with individual and combined features of the metabolic syndrome.

SUBJECTS

In all, 257 women with a body mass index (BMI) ranging from 25.1 to 54.5 kg/m2 (geometric mean 33.1+/-5.8 kg/m2) and aged 19-71 y (mean 45.6+/-12.1 y) were studied. Subjects had no symptoms of intercurrent infection, known diabetes, treated dyslipidaemia, a chronic inflammatory condition, liver disease or malignancy.

RESULTS

Linear regression demonstrates that both CRP and SA were positively associated with weight, BMI, insulin resistance, dyslipidaemia and hypertension. There was a highly significant (P<0.0001) positive association of both SA and CRP with none, one, two, three or four features of the metabolic syndrome. For a 1 s.d. (4.0 mg/l) increase in CRP, there was a significant increased risk when comparing the odds of having metabolic syndrome (defined as three or more individual features) compared with the remainder of the population (odds ratio=1.7, P<0.0001), but this was not significant after adjustment for BMI. However, for a 1 s.d. (0.34 mmol/l) increase in SA, the odds of having metabolic syndrome compared with those without metabolic syndrome was 2.5 (P<0.0001), and persisted after additional adjustment for BMI (adjusted odds ratio=1.9, P<0.0001).

CONCLUSIONS

While SA and CRP are both univariately associated with individual features of the metabolic syndrome, SA, but not CRP, is significantly associated with the metabolic syndrome, independent of BMI. We conclude that SA identifies a subgroup of overweight individuals with an inflammatory phenotype, who are at the greatest risk of metabolic syndrome.

Tomato consumption and plasma lycopene concentration in people aged 65 y and over in a British national survey

OBJECTIVE

Assessment of consumption of raw and processed tomatoes, plasma lycopene concentration and their interrelationship in a nationally representative sample of elderly British people.

SETTING

: A 1994-1995 National Diet and Nutrition Survey: a nationwide cross-sectional sample of people aged 65 y and over living in mainland Britain, either in the community ("free-living", n=1275) or in institutions such as nursing homes (n=412).

METHODS

Consumption of raw and processed tomatoes (including those in tomato-containing composite foods) was recorded by a 4-day dietary record for each participant. Plasma lycopene concentration was assayed by HPLC. Sociodemographic and lifestyle information was recorded by trained interviewers.

RESULTS

In all, 29% of free-living people and 24% of those living in institutions did not consume any raw or processed tomatoes during the 4-day recording period. Free-living participants were more likely to consume raw tomatoes (26 vs 16%). Plasma lycopene concentration was positively associated with the weight of raw and processed tomatoes consumed, especially with processed tomatoes and their products, alcohol consumption and with plasma total (as well as HDL and non-HDL) cholesterol concentrations. Among free-living participants, increased age, cigarette smoking habit and manual occupational social class were all associated with lower plasma lycopene concentration.

CONCLUSIONS

In the current population, consumption of raw and processed tomatoes varied by sociodemographic and lifestyle characteristics, and made a significant contribution to plasma lycopene concentration. Determinants of plasma lycopene concentration were age, plasma cholesterol concentration and smoking habit.

Childhood and adult dietary vitamin E intake and cardiovascular risk factors in mid-life in the 1946 British Birth Cohort

OBJECTIVES

To determine whether dietary vitamin E intake in childhood or mid-life was predictive of adult hypertension and high waist circumference, as two important risk factors for cardiovascular disease.

DESIGN

Longitudinal study of a social class stratified random sample of all the legitimate, singleton births in the week of 3-9 March 1946.

SETTINGS

England, Scotland and Wales.

SUBJECTS

The 2980 survey members who provided information on diet, health and sociodemographic information at two time points; age 4 y in 1950 (24-h dietary recall) and 43 y in 1989 (48-h dietary recall).

MAIN OUTCOME MEASURES

Outcomes were adjusted odds ratios (ORs) for hypertension and high waist circumference at age 43 y by thirds of vitamin E intake, relative to the highest intake thirds at both ages.

RESULTS

The lowest consumers of vitamin E in both childhood and adulthood were more likely to be hypertensive (OR 1.8, 95% confidence interval (CI): 1.03-3.08) and have high waist circumference (OR 1.6, 95% CI: 1.02-2.43) than those consuming high levels at both ages. A low intake of vitamin E at just one time point was not associated with a statistically significant increased risk of hypertension or high waist circumference. Social class was also an independent and equally strong predictor of these coronary risk factors, indicating that the relation between social class and cardiovascular risks was not mediated solely by the current measures of diet and lifestyle.

CONCLUSIONS

Unique data on vitamin E intake from foods in both childhood and adulthood have indicated that relatively low intake of vitamin E at both ages predicted hypertension and high waist circumference at age 43 y.

In a population study, can parathyroid hormone aid the definition of adequate vitamin D status? A study of people aged 65 years and over from the British National Diet and Nutrition Survey

The British National Diet and Nutrition Survey of people aged 65 years and over in 1994-5 provided nationally representative estimates of food and nutrient intakes and biochemical status indices. In a further analysis study, parathyroid hormone (PTH) concentrations were measured in plasma samples from 773 subjects and were analyzed with the existing data on vitamin D intake, plasma 25-hydroxyvitamin D (25OHD), total plasma calcium and albumin. As predicted, a strong inverse relationship was observed between PTH and 25OHD. In the free-living respondents aged 65-84 years (n=507) there was a continuous decline in PTH with increasing 25OHD and no plateau, whereas in free-living people aged 85+ years (n=86) there was a significant deviation from a simple inverse relationship, with unexpectedly high PTH values in some people with satisfactory 25OHD status. There was a relationship between both PTH (inverse) and plasma 25OHD (direct) with calcium intake. A direct relationship between 25OHD and total plasma calcium was not significant when calcium was corrected for albumin. Geographically, 25OHD, and to a lesser extent PTH, exhibited a north-south gradient, and 25OHD was associated with self-reported health status. Both 25OHD and PTH were associated with self-reported physical activity. Low calcium intake and 25OHD was associated with receipt of state benefits. The relationship between plasma 25OHD and vitamin D intake revealed a striking seasonal cycle. 25OHD was strongly influenced by vitamin D intake in the winter in free-living subjects, but this was not observed in the summer. In people living in institutions such as nursing homes, who are less likely to be exposed to sunlight throughout the year, plasma 25OHD levels were lower throughout the year.

Social factors and obesity: an investigation of the role of health behaviours

OBJECTIVES

This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control).

METHODS

A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status.

RESULTS

Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours.

CONCLUSIONS

These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Sociodemographic inequalities in the diet of young children in the 1946 British birth cohort

OBJECTIVE

To evaluate whether there was food and nutrient equality across occupational social classes and geographical region for members of the 1946 British birth cohort at age 4 years.

DESIGN

Cross-sectional analysis of selected food groups, energy and nutrients from one-day recall diet records.

SETTING

England, Scotland and Wales in 1950.

SUBJECTS

Nationally representative sample of 4419 children aged 4 years in 1950 from the MRC National Survey of Health and Development (NSHD) (1946 Birth Cohort).

RESULTS

Significant food and nutrient inequalities occurred by region and occupational social class of the father. Disparity in fruit and vegetable consumption primarily led to the nutrient differences, especially with respect to lower vitamin C and carotene intakes in children from Scotland and from a manual social class background. Lower energy intake in Scottish children was attributable to inequality in the consumption of foods providing fat, and also to the retention of the traditional Scottish diet that included porridge and soups. Consumption of some rationed foods -- bacon, orange juice and tea -- was inequitably distributed by father's social class, but others, in particular meat and spreading fats, were consumed more uniformly. In contrast to fruits and vegetables, which showed marked sociodemographic disparities, other non-rationed foods such as bread and potatoes were consumed universally.

CONCLUSION

Local cultural norms may have played as strong a part in sociodemographic differences in the diet of children in the early 1950s as did the strict, post-war food rationing that prevailed. In consequence, nutritional equality was not achieved, and the relatively low intake of antioxidant vitamins during early childhood in certain population groups may have compromised health in the long term.

Changes in risk factors for cardiovascular disease with body fat loss in obese women

BACKGROUND

Current guidelines for obesity management emphasize the improvements in health risks associated with weight losses of 5-10% initial weight. However, most of the data is derived from periods of acute weight loss and may not represent the true effect in the longer term or in obese but otherwise healthy individuals. This study examines the temporal changes in risk factors for cardiovascular disease with weight change over 52 weeks.

METHODS

In total, 57 overweight women (age 43.7 +/- 9.1 years, mean BMI of 31.7 kg/m2, range 27.2-38.5 kg/m2) with no other significant medical history, entered a milk-based, low-energy weight loss programme for 12 weeks and were then monitored without further intervention until 52 weeks. Weight, fat mass, fasting plasma insulin, lipids and blood pressure were measured at 0, 12, 24 and 52 weeks.

RESULTS

The mean weight change in sequential periods was -11.6% (p < 0.0001), +1.1% (p = 0.02) and +5.2% (p < 0.0001). The change from baseline to 1 year being -6.0% (p < 0.0001) an 11% (p < 0.0001) reduction in initial body fat mass. Initial weight loss (0-12 weeks) was positively correlated with greater longer term weight loss (0-52 weeks, r = 0.75, p < 0.0001) and not with weight regain (12-52 weeks, r = 0.14, p = 0.28). Despite significant improvements in insulin sensitivity, lipid profile and blood pressure (BP) with acute weight loss, in the group overall, only benefits in BP were maintained after 52 weeks. However, improvements in insulin sensitivity were sustained in those who maintained more than 5% weight loss, and those with higher baseline metabolic risk had greater benefits with weight loss. Change in waist circumference was better than BMI or fat mass in predicting improvements in metabolic risk in these obese women.

CONCLUSIONS

This study suggests, in otherwise apparently healthy obese women, the rationale of targeting individuals most likely to benefit from weight management. Most importantly it highlights the need to focus on achieving initial weight losses of greater than 10% to maintain longer term losses of at least 5% and the associated health benefits.

Cigarette smoking, menstrual symptoms and miscarriage among young women

OBJECTIVE

To examine associations between cigarette smoking and menstrual symptoms and miscarriage among young women.

METHOD

The study sample consists of 14,779 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self reported menstrual symptoms and miscarriages.

RESULTS

Current smokers and ex-smokers had an increased risk of menstrual symptoms and miscarriages compared with women who had never smoked, with the highest risk occurring in heavy smokers (adjusted odds ratios for those smoking > or = 20 cigarettes per day: premenstrual tension 1.5 (95% confidence interval 1.3 to 1.7), irregular periods 1.5 (1.3 to 1.8), heavy periods 1.6 (1.4 to 1.9), severe period pain 1.5 (1.4 to 1.7), one or more miscarriages 2.0 (1.5 to 2.8). The odds ratios generally increased with numbers of cigarettes smoked and a younger age of starting to smoke.

CONCLUSION

This study suggests that young women who smoke are at higher risk of a range of menstrual problems and miscarriage than those who have never smoked. The immediacy of this risk (in contrast to the longer term risks of chronic disease) can be used to improve the relevance of anti-smoking campaigns targeted to young women.

Sexually transmitted infections and use of sexual health services among young Australian women: women's health Australia study

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors. The study sample comprised 14,762 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics. The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score. This study reports interesting correlates of having an STI among young Australian women aged 18-23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood.

Synergistic effects of ajoene and the microwave power density memories of water on germination inhibition of fungal spores

The synergistic effects of ajoene and the microwave power density memories of water on germination inhibition of some fungal spores are examined. The study reveals power memory varying different synergistic effects of different concentrations of ajoene on the inhibition of spore germination.