Albuminuria in people at least 40 years old: effect of alcohol consumption, regular exercise, and cigarette smoking

We investigated the relation between albuminuria and life-style factors in 5670 people, ages 40 years and over, who participated in a health screening survey of a local workforce. The degree of albuminuria showed piecewise log-linear relationships with alcohol consumption and cigarette smoking, with changes in slope (and 95% confidence interval) corresponding with 5 (2, 8) g of alcohol/day and 10 (6, 14) cigarettes/day. After adjusting for age, gender, ethnicity, and other life-style variables, relative risks (95% confidence interval) of slight albuminuria for people consuming > 32 g of alcohol/day compared with nondrinkers, and for cigarette smokers compared with nonsmokers, were 1.74 (1.02, 2.98) and 1.37 (1.01, 1.88), respectively. However, there was no significant effect of exercise. We conclude that slight albuminuria is significantly associated with cigarette smoking and heavy alcohol consumption, consistent with its role as an index of risk of cardiovascular disease.

Fermi Surface of Metallic V_{2}O_{3} from Angle-Resolved Photoemission: Mid-level Filling of e_{g}^{π} Bands

Using angle resolved photoemission spectroscopy, we report the first band dispersions and distinct features of the bulk Fermi surface (FS) in the paramagnetic metallic phase of the prototypical metal-insulator transition material V_{2}O_{3}. Along the c axis we observe both an electron pocket and a triangular holelike FS topology, showing that both V 3d a_{1g} and e_{g}^{π} states contribute to the FS. These results challenge the existing correlation-enhanced crystal field splitting theoretical explanation for the transition mechanism and pave the way for the solution of this mystery.

Dietary intakes of Pacific ethnic groups and European people

OBJECTIVE

To compare dietary intakes, food servings, and cooking practices of Pacific ethnic groups with New Zealand Europeans.

METHODS

Daily nutrient intakes were calculated from a self-administered food frequency questionnaire from a cross-sectional health screening study. Participants were Pacific (n=954) and New Zealand European (n=1.745) people aged 35 to 74 years.

RESULTS

Total energy intakes in Samoan and Niuean men were higher than European men, while for women, total energy intakes were significantly higher in all Pacific ethnic groups compared to New Zealand European women. Pacific men and women had lower alcohol and calcium intakes compared to New Zealand Europeans, and Pacific men had higher protein and cholesterol intakes. Pacific adults reported eating more servings of fish, chicken and bread, fewer servings of cheese and breakfast cereal per month, and boiled their meat more often than European adults.

CONCLUSIONS

Substantial differences in dietary habits and cooking practices exist between European and the different Pacific adult groups mainly related to the frequency of consumption of certain food/nutrient groups and greater serving sizes in Pacific compared to New Zealand European adults. Implications Strategies targeting serving sizes and frequency of consumption of specific food groups may help address the major ethnic disparities in nutrition-related health problems in New Zealand.

Antiferromagnetic-paramagnetic insulating transition in Cr-doped V(2)O(3) investigated by EXAFS analysis

We have performed extended x-ray absorption fine-structure (EXAFS) spectroscopy on a 2.8% Cr-doped V(2)O(3) sample, with the aim of studying its structural evolution in a wide temperature range across the paramagnetic-antiferromagnetic insulating phase transition at T(c). The data were registered with two different set-ups in fluorescence and transmission geometries, for polarized and unpolarized spectra, respectively. Our idea, based on previous experiments reported in the literature, is that extended structural modifications of the nominal trigonal symmetry are present in the paramagnetic insulating phase for several tens of degrees above T(c), involving further-nearest-neighbor vanadium ions. Our data confirm that the paramagnetic insulating phase is not structurally homogeneous in a temperature range of about 30 K around T(c), where local distortions of monoclinic symmetry involving further-nearest neighbors are present. Moreover, the analysis of the absorption profile at Cr K-edge suggests that Cr ions enter the lattice randomly. We finally analyze our findings in light of current theoretical models.

Design effects associated with dietary nutrient intakes from a clustered design of 1 to 14-year-old children

OBJECTIVE

To calculate intra-cluster and intra-household design effects and intra-class correlation coefficients for dietary nutrients obtained from a 24 h record-assisted recall.

DESIGN

Children were recruited using clustered probability sampling. Randomly selected starting-point addresses were obtained with probability proportional to mesh block size.

SETTING

Children aged 1-14 years in New Zealand.

SUBJECTS

There were 125 children in 50 clusters, giving an average of 2.498 children per cluster. In 15 homes, there were two children for the calculation of intra-household statistics.

RESULTS

Intra-cluster design effects ranged from 1.0 for cholesterol, beta-carotene, vitamin A, vitamin D, vitamin E, selenium, fructose and both carbohydrate and protein expressed as their contribution to total energy intakes to 1.552 for saturated fat, with a median design effect of 1.148. Their corresponding intra-cluster correlations ranged from 0 to 0.37, respectively. Intra-household design effects ranged from 1.0 for height to 1.839 for vitamin B(6), corresponding to intra-household correlations of 0 and 0.839. The median intra-household design effect was 1.550. Using a sampling design of two to three households per cluster for estimating dietary nutrient intakes would need, on average, a 15% increase in sample size compared with simple random sampling with a maximum increase of 55% to cover all nutrients.

CONCLUSIONS

These data enable sample sizes for dietary nutrients to be estimated for both cluster and non-cluster sampling for children aged 1-14 years. The larger design effects found within households suggest that little extra information may be obtained by sampling more than one child per household.

Short-term repeatability of a food frequency questionnaire in New Zealand children aged 1–14 y

OBJECTIVE

To evaluate the repeatability of a children's food frequency questionnaire (FFQ) by gender, ethnicity, and age group.

DESIGN

A 117-item FFQ asking about food intake patterns over the past 4 weeks was developed using food records from 428 children (204 boys and 224 girls) and the reproducibility on average 13 days apart was tested in 130 children (78 boys and 52 girls). Children were recruited using clustered probability sampling (n=103), and a convenience sample of 25 Maori children.

SETTING

Children aged 1-14 y from Auckland, Feilding and Shannon, New Zealand.

SUBJECTS

There were 71 Maori, 20 Pacific, and 39 Other children.

RESULTS

Spearman correlations between the two FFQs ranged from 0.50 for bread to 0.82 for fruit, with a median of 0.76 for spreads and nonmilk drinks, and Cronbach's coefficient alpha's ranged from 0.59 for bread to 0.92 for nonmilk drinks, with a median of 0.85 for mixed meat dishes. There were no significant differences between the two administrations, apart from reporting higher intakes of vegetables and snacks & sweets in the first FFQ. Correlation coefficients tended to be slightly higher in boys than in girls, and in Other ethnic groups compared to Maori and Pacific children. Correlations were slightly higher for the 1-4 y age group, intermediate in the 10-14 y age group, and lowest in the 5-9 y-old age group.

CONCLUSIONS

Overall, the FFQ described here shows similar or better repeatability in New Zealand children of all major ethnic groups compared to other child or adolescent FFQs.

Factors associated with changes in serum total cholesterol levels over 7 years in middle-aged New Zealand men and women: a prospective study

BACKGROUND AND AIM

The aim of this study was to determine the factors associated with changes in serum total cholesterol levels over a period of seven years.

METHODS AND RESULTS

The baseline Workforce Diabetes Survey was carried out between 1988 and 1990 and involved workers predominantly aged > or = 40 years; a follow-up survey of 4,053 participants was carried out between 1995 and 1997. Both surveys measured serum lipid levels by means of enzymatic methods. The overall age- and gender-adjusted mean serum cholesterol levels decreased by 4.6% between the two surveys. The two-thirds of participants who experienced a decrease in total serum cholesterol formed a higher risk group at baseline insofar as they were older, more inactive and more likely to be male, and had higher blood pressure (BP), higher serum cholesterol and triglyceride levels, and a higher body mass index (BMI) and waist/hip ratio than the one-third whose serum cholesterol levels increased (all p < 0.05). The decrease in serum cholesterol was associated with improvements or less deterioration in risk factors (fasting glucose, BP, BMI and the waist/hip ratio, the low-density/high-density lipoprotein (LDL/HDL) ratio, triglyceride concentrations and level of physical activity) and an increase in the use of lipid lowering drugs.

CONCLUSION

Serum cholesterol levels decreased over the seven years between the surveys, principally among the individuals at highest risk. The use of lipid lowering drugs contributed to this decline but lifestyle factors, such as increased exercise levels, may also have played a role because other risk factors also improved.

Long-term (5-year) effects of a reduced-fat diet intervention in individuals with glucose intolerance

OBJECTIVE

To determine whether reducing dietary fat would reduce body weight and improve long-term glycemia in people with glucose intolerance.

RESEARCH DESIGN AND METHODS

A 5-year Follow-up of a 1-year randomized controlled trial of a reduced-fat ad libitum diet versus a usual diet. Participants with glucose intolerance (2-h blood glucose 7.0-11.0 mmol/l) were recruited from a Workforce Diabetes Survey. The group that was randomized to a reduced-fat diet participated in monthly small-group education sessions on reduced-fat eating for 1 year. Body weight and glucose tolerance were measured in 136 participants at baseline 6 months, and 1 year (end of intervention), with follow-up at 2 years (n = l04), 3 years (n = 99), and 5 years (n = 103).

RESULTS

Compared with the control group, weight decreased in the reduced-fat-diet group (P < 0.0001); the greatest difference was noted at 1 year (-3.3 kg), diminished at subsequent follow-up (-3.2 kg at 2 years and -1.6 kg at 3 years), and was no longer present by 5 years (1.1 kg). Glucose tolerance also improved in patients on the reduced-fat diet; a lower proportion had type 2 diabetes or impaired glucose tolerance at 1 year (47 vs. 67%, P < 0.05), but in subsequent years, there were no differences between groups. However, the more compliant 50% of the intervention group maintained lower fasting and 2-h glucose at 5 years (P = 0.041 and P = 0.026 respectively) compared with control subjects.

CONCLUSIONS

The natural history for people at high risk of developing type 2 diabetes is weight gain and deterioration in glucose tolerance. This process may be ameliorated through adherence to a reduced fat intake

First observation of nonreciprocal X-Ray gyrotropy

We report the first observation of a nonreciprocal x-ray linear dichroism caused by the time-reversal odd, real part zeta of the complex gyrotropy tensor zeta(*) which is dominated by electric dipole-electric quadrupole E1E2 interference terms. A nonreciprocal transverse anisotropy was observed in the low temperature insulating phase of a Cr doped V2O3 Mott crystal when a single antiferromagnetic domain was grown by magnetoelectric annealing along the hexagonal c axis. This new element (edge) specific spectroscopy could nicely complement x-ray magnetic circular dichroism which is silent for antiferromagnetic materials.

Comparison of WHO and ADA criteria for diagnosis of glucose status in adults

The aim was to compare the 1997 American Diabetes Association (ADA) and 1985 and 1998 World Health Organisation (WHO) criteria for the diagnosis of diabetes and impaired glucose tolerance (IGT) by ethnicity and cardiovascular risk factors. We analysed the oral glucose tolerance tests carried out in a cross-sectional survey of 5816 New Zealand workers aged 22-78 years (4211 men, 1605 women) carried out between 1988 and 1990. Prevalence of diabetes was similar using ADA (3.1%) compared with the 1998 WHO criteria (3.0%). The overall prevalence rate of diabetes using the 1985 WHO criteria was only 1.5%. The prevalence rate of impaired fasting glucose (IFG) was the lowest in Europeans (7.3%) and highest in Asians (15.0%). The overall weighted kappa for agreement between the 1997 ADA and 1998 WHO criteria was moderate (0.59), but varied between ethnic groups. Cardiovascular disease (CVD) risk factors were approximately more adverse across groups with IFG, normal (ADA)/IGT (WHO), IFG/IGT and diabetes compared with normal subjects. Compared to those with IFG, participants with the normal (ADA)/IGT (WHO) criteria differed in fasting and 2-h glucose, diastolic blood pressure, and urinary albumin levels, and the proportions of males and number with hypertension, but had a significantly adverse pattern of CVD risk factors compared to those with normal glycaemia. The 1988 WHO criteria using the OGTT provides additional information for classifying various categories of glucose intolerance that is not captured using the 1997 ADA fasting glucose criteria alone.

Ethnic differences in perceptions of body size in middle-aged European, Maori and Pacific people living in New Zealand

OBJECTIVES

The aim of this study was to compare perceptions of body size in European, Maori and Pacific Islands people with measured body mass index (BMI), waist-to-hip ratio and change in BMI since age 21 y. Socio-demographic factors that influenced perceptions of body size were also investigated.

DESIGN

Cross-sectional survey.

METHODS

Participants were 5554 workers, aged > or =40 y, recruited from companies in New Zealand during 1988-1990.

RESULTS

Prevalences of BMI>25 kg/m2 were: Europeans, 64.7% men, 47.2% women; Maori, 93.2% men, 80.6% women; and Pacific Islanders, 94.1% men, 92.9% women. Similarly, prevalences of BMI >30 kg/m2 were: Europeans, 14.4% men, 14.6% women; Maori, 55.0% men, 41.9% women; and Pacific Islanders, 55.1% men, 71.7% women. At each perception of body size category, Maori and Pacific Islands men and women had a higher BMI than European men and women, respectively. BMI increased with increasing perception of body size in all gender and ethnic groups. Since age 21, increases in BMI were highest in Pacific Islands people and increased with increasing perceptions of body size category in all ethnic and gender groups. BMI adjusted odds (95% CI) of being in a lower perception category for body size were 1.70 (1.38-2.12) in Maori and 8.99 (7.30-11.09) in Pacific people compared to Europeans, 1.27 (1.13-1.42) times higher for people with no tertiary education, 1.41 (1.25-1.59) times higher in people with low socioeconomic status, and 0.94 (0.92- 0.95) for change in BMI since age 21.

CONCLUSION

Nutritional programs aimed at reducing levels of obesity should be ethnic-specific, addressing food and health in the context of their culture, and also take into account the socioeconomic status of the group. On the population level, obesity reduction programs may be more beneficial if they are aimed at the maintenance of weight at age 21.

Haemostasis and carotid artery wall thickness in non-insulin dependent diabetes mellitus

The purpose of this study was to examine the associations of carotid artery intima-media wall thickness (IMT) with hemostatic proteins and cardiovascular risk factors (CVRFs) in participants with and without non-insulin dependent diabetes mellitus (NIDDM). IMT measurements were determined by high resolution B-mode ultrasound imaging of the carotid arteries in 921 participants with NIDDM and 11,964 non-diabetic participants aged 45-64 years. Fasting glucose, serum lipids and activated partial thromboplastin time, factor VIII fibrinogen, factor VII, antithrombin III, protein C, and von Willebrand factor measurements were made. Compared to non-diabetic participants, participants with NIDDM had a more adverse pattern of CVRFs and a more procoagulatory profile. Participants with NIDDM had 0.06 mm (8.1%) higher mean IMT compared to non-diabetic participants after adjusting for age and gender (P < 0.001). However, only plasma fibrinogen concentrations showed statistically significant positive associations with IMT in both groups. After adjusting for CVRFs and fibrinogen, mean IMT remained 0.04 mm (5.4%) higher in diabetic compared to non-diabetic participants. Despite the more procoagulatory profile in participants with NIDDM, only plasma fibrinogen concentrations were independently associated with mean IMT. The association of NIDDM with mean IMT was only partly explained by CVRFs.

Modifiable risk factor levels of coronary heart disease survivors in a middle-aged workforce

BACKGROUND AND AIM

Coronary heart disease (CHD) is common in New Zealand. Risk factors for CHD are modifiable or non-modifiable. Modifiable risk factor levels of CHD survivors were compared with those without such a history (non-CHD).

METHODS AND RESULTS

Participants were from a cross-sectional survey of 5,656 workers aged > or = 40. CHD survivors were 73 general practitioner (GP)-confirmed participants with a history of hospitalisation for CHD. There were no significant differences in mean blood pressure levels between CHD survivors and non-CHD workers after adjusting for age, gender and ethnicity, but current use of antihypertensive medications was higher in CHD survivors (34.2%) than non-CHD workers (8.1%); p < 0.001. CHD survivors had higher, similarly adjusted, mean serum total cholesterol, triglyceride and lower HDL-cholesterol levels, and their reported carbohydrate, fibre, polyunsaturated fat intakes and ratio of polyunsaturated to saturated fat intakes were higher and total fat, saturated fat and monounsaturated fat intakes were lower. CHD survivors ate fewer servings of red meats per month and more servings of fruit, and cereal, and number of cups of milk. Salt added to meals was lower and margarine use higher in CHD survivors. There were no significant differences in the proportions of those who exercised regularly, or were current cigarette smokers. However, more CHD survivors (57.5%) than non-CHD workers (33.1%) were ex-smokers p < 0.001, who had stopped smoking at a higher mean (se) age (41.1 (1.36) vs 37.6 (0.20) years respectively; p = 0.012).

CONCLUSIONS

A large proportion of CHD survivors were dyslipidaemic, despite consuming a lower fat, higher fibre and carbohydrate diet. More than 50% of CHD survivors were ex-cigarette smokers, who had given up smoking at a later age than non-CHD workers. These high-risk CHD survivors would benefit from more aggressive measures aimed at correcting their dyslipidaemias.

African American-white differences in lipids, lipoproteins, and apolipoproteins, by educational attainment, among middle-aged adults: the Atherosclerosis Risk in Communities Study

Measures of socioeconomic status have been shown to be related positively to levels of high density lipoprotein (HDL) cholesterol in white men and women and negatively in African American men. However, there is little information regarding the association between educational attainment and HDL fractions or apolipoproteins. The authors examined these associations in 9,407 white and 2,664 African American men and women aged 45-64 years who participated in the Atherosclerosis Risk in Communities Study baseline survey, and they found racial differences. A positive association for HDL cholesterol, its fractions HDL2 and HDL3 cholesterol, and its associated apolipoprotein A-I was found in white men and white women, but a negative association was found in African American men, and there was no association in African American women. In whites, there was also an inverse association of low density lipoprotein (LDL) cholesterol and apolipoprotein B with educational attainment. With the exception of African American men, advanced education was associated with a more favorable cardiovascular lipid profile, which was strongest in white women. Racial differences in total cholesterol (women only), plasma triglycerides, LDL cholesterol, apolipoprotein B (women only), HDL cholesterol, HDL2 and HDL3 cholesterol, and apolipoprotein A-I were reduced at higher levels of educational attainment. Apart from triglycerides in men and HDL3 cholesterol in women, these African American-white lipid differences associated with educational attainment remained statistically significant after multivariable adjustment for lifestyle factors. Lipoprotein(a) showed no association with educational attainment. These findings confirm African American-white differences in lipids, lipoproteins, and apolipoproteins across levels of educational attainment that were not explained by conventional nondietary lifestyle variables. Understanding these differences associated with educational attainment will assist in identifying measures aimed at prevention of cardiovascular disease.

Dietary intakes of middle-aged European, Maori and Pacific Islands people living in New Zealand

AIM

To compare dietary intakes of Maori, Pacific Islands and European men and women in New Zealand.

METHODS

A food frequency questionnaire was used to calculate nutrient intakes of 5523 New Zealand workers aged 40 years and over (3997 men, 1524 women) from a cross-sectional survey carried out between 1988 to 1990.

RESULTS

Compared with European men and women, Maori women and Pacific Islands men and women consumed larger amounts of total energy per day. Age-adjusted nutrients expressed as percentage contribution to total energy intakes showed that Maori and Pacific Islands men and women consumed less carbohydrate, fibre and calcium, and more protein, fat, saturated fat and cholesterol than European men and women, respectively. These results were consistent with fewer servings of cereal and cheese per month, and more servings of red meats, fish and eggs in Maori and Pacific Islands participants compared with Europeans, after adjusting for age and total energy intakes. Pacific Islands men and women also consumed more servings of chicken, fewer cups of milk and fewer servings of fruit per month compared to Europeans. Maori men and women consumed more slices of bread and fewer servings of vegetables per month compared to European men and women.

CONCLUSIONS

There were striking differences in dietary habits, food selections and cooking practices between European, Maori and Pacific Islands participants. Dietary intakes of Maori workers were closer to those of Europeans than those of Pacific Islands participants. Ethnic differences were due to larger portion sizes and increased frequency of most foods in Maori and Pacific Islands participants.

Associations between body morphology and microalbuminuria in healthy middle-aged European, Maori and Pacific Island New Zealanders

OBJECTIVE

To examine the relationship between albuminuria and measures of body morphology.

DESIGN

Cross-sectional study of European, Maori and Pacific Island workers aged 40 y and over.

SUBJECTS

3960 non-diabetic, non-hypertensive, non-lipidaemic, non-proteinuric middle-aged men and women.

MEASUREMENTS

Height, weight, waist, hip, fasting and 2 h glucose, systolic and diastolic blood pressure, urinary creatinine and urinary albumin measurements.

RESULTS

After adjusting for age and gender, the relative risks (95% confidence interval) of microalbuminuria were 4.87-fold (3.10-7.64) higher in Maori, and 4.96-fold (3.40-7.24) higher in Pacific Islanders compared to European New Zealanders. In contrast, age and gender adjusted relative risks (95% confidence interval) for high albumin:creatinine ratios were 6.38 (4.27, 9.53) in Maori and 5.14 (3.54, 7.48) in Pacific Islanders compared to European workers. Workers with microalbuminuria had higher urinary creatinine concentrations than those with urinary albumin in the normal range. Age and gender adjusted partial correlation coefficients between urinary albumin concentrations and the inverse of urinary creatinine concentrations were highest in European and Maori workers. Apart from Pacific islanders, urinary creatinine concentrations accounted for over 20% of the variation in urinary albumin concentrations in healthy individuals. Other independent predictors of urinary albumin concentrations were waist measurements, short stature and body mass index in Europeans and Pacific Islanders, and systolic blood pressure levels and gender in Europeans. After adjusting for age, gender, waist, height, 2 h glucose, urinary creatinine, systolic blood pressure and body mass index Maori and Pacific Islanders still had significantly higher urinary albumin concentrations than Europeans.

CONCLUSION

Urinary creatinine concentrations were significantly associated with urinary albumin concentrations in all ethnic groups, and, with the exception of Pacific Islanders, accounted for a large proportion of the variation in urinary albumin concentrations in healthy individuals. Urinary albumin concentrations were associated with measures of obesity and short stature in Europeans and Pacific Islanders, and systolic blood pressure levels and gender in Europeans. However, measures of body morphology did not completely explain the higher urinary albumin concentrations in Maori or Pacific Islanders.

Patterns of aspirin use in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study

To determine correlates of and recent trends in aspirin use in middle-age men and women, we analyzed data from population-based samples selected in four U.S. communities. Aspirin use (during a 2-week period preceding the study examination) was more prevalent in whites than in blacks (30% vs 11%; p < 0.001) and in men than in women among whites (31% vs 28%; p < 0.002) but not blacks (10% in both sexes). In all four race and sex groups, there was a graded positive relation between estimated coronary heart disease (CHD) risk and age-adjusted prevalence of aspirin use. For example, 33% of CHD-free white men who reported diagnoses of hypercholesterolemia and hypertension and had ever smoked reported aspirin use as compared with 25% of their risk factor-free counterparts (p < 0.001). Among men with symptomatic CHD or at high risk for CHD, aspirin use increased by four percentage points between 1987 and 1989 in conjunction with the publication of results from the aspirin primary prevention trials. However, nearly 50% of participants reporting a history of myocardial infarction apparently did not take aspirin regularly.

Reproducibility of extracranial carotid atherosclerotic lesions assessed by B-mode ultrasound: the Atherosclerosis Risk in Communities Study

The reproducibility in the identification of carotid artery lesions using B-mode ultrasound was studied in a large random sample selected from the Atherosclerosis Risk in Communities (ARIC) Study. Carotid lesions were defined as plaque with or without acoustic shadowing (indicative of mineralization). A weighted kappa (kappa w) statistic was used as a chance-adjusted measure of repeatability. In the ARIC baseline survey, the kappa w values for the assessment of lesions on repeat reading were 0.47, 0.60 and 0.69 in the left common carotid artery, the carotid bifurcation and the internal carotid artery, respectively. In a repeat scanning, the kappa w values ranged from 0.59 to 0.79 in the left carotid segments. The results were similar in the left and right carotid arteries. Covariates (age, race, gender, body mass index, study center) did not influence the reproducibility. Similar results were also found in both the baseline survey and the first follow-up examination. In conclusion, reproducibility in the assessment of carotid lesions by B-mode ultrasound can be achieved in multicenter studies at fair to good levels of agreement.

Stress at Work: An Evaluation of Occupational Stressors as Reported by a Multicultural New Zealand Workforce

Occupational stress is a cause of considerable morbidity, but research on work stressors has comparatively neglected the moderating effects of gender, age, ethnicity, and occupation. A workforce of 5,467 European, Maori, Pacific Islander, and Asian employees, 40 years old or older, working for 41 companies, completed a questionnaire giving details of total stressors and subcategories of stressors. Relative risks were estimated using numbers above and below median scores. There were significant associations between increased stressors and the following [with category showing highest relative risk, and corresponding relative risk (95% confidence interval)]: male gender [job scope, 1.50(1.37,1.63)]; young age [rapport with management, 1.34(11.23,1.46)]; administrative goup [job pressure, 1.85(1.69,2.03)]; and a negative association with Pacific Islander ethnicity [rapport with management, 0.59(0.52,0.66)]. These findings indicate areas in a workforce to which stress-reduction interventions can be directed.

Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. Atherosclerosis Risk in Communities Study

The objective of this study was to examine the relationships of serum and dietary magnesium (Mg) with prevalent cardiovascular disease (CVD), hypertension, diabetes mellitus, fasting insulin, and average carotid intimal-medial wall thickness measured by B-mode ultrasound. A cross-sectional design was used. The setting was the Atherosclerosis Risk in Communities (ARIC) Study in four US communities. A total of 15,248 participants took part, male and female, black and white, aged 45-64 years. Fasting serum Mg, lipids, fasting glucose and insulin were measured; as was usual dietary intake by food frequency questionnaire and carotid intima-media thickness by standardized B-mode ultrasound methods. The results showed that serum Mg levels and dietary Mg intake were both lower in blacks than whites. Mean serum Mg levels were significantly lower in participants with prevalent CVD, hypertension, and diabetes than in those free of these diseases. In participants without CVD, serum Mg levels were also inversely associated with fasting serum insulin, glucose, systolic blood pressure and smoking. Dietary Mg intake was inversely associated with fasting serum insulin, plasma high density lipoprotein-cholesterol, systolic and diastolic blood pressure. Adjusted for age, race, body mass index, smoking, hypertension, Low density lipoprotein-cholesterol, and field center, mean carotid wall thickness increased in women by 0.0118 mm (p = 0.006) in diuretic users and 0.0048 mm (p = 0.017) in nonusers for each 0.1 mmol/l decrease in serum Mg level; the multivariate association in men was not significant. In conclusion, low serum and dietary Mg may be related to the etiologies of CVD, hypertension, diabetes, and atherosclerosis.

Low serum albumin. Association with diabetes mellitus and other cardiovascular risk factors but not with prevalent cardiovascular disease or carotid artery intima-media thickness. The Atherosclerosis Risk in Communities (ARIC) Study Investigators

We examined the association of serum albumin concentration with diabetes mellitus and other cardiovascular risk factors, prevalent cardiovascular disease, and ultrasonographically assessed carotid artery intima-media thickness using data from 45- to 64-year-old adults in the Atherosclerosis Risk in Communities (ARIC) Study. The mean albumin concentration was 0.04 to 0.12 g/L lower in participants with diabetes and 0.02 to 0.06 g/L lower in those with cardiovascular disease, compared to participants without these conditions. However, lower serum albumin level was also correlated with most traditional risk factors and hemostatic variables. On adjustment for these, there was essentially no association between serum albumin and prevalent cardiovascular disease. Likewise, there was no association between albumin and carotid intima-media thickness (a marker of atherosclerosis). While hypoalbuminemia may be a marker for chronic disease and perhaps renal loss of albumin, it seems unlikely that it is an important cause of atherosclerosis.

Differences in intake of specific food plants by Polynesians may explain their lower incidence of colorectal cancer compared with Europeans in New Zealand

Epidemiological studies have implicated obesity; high intakes of alcohol, fat, and energy; and low intakes of food plants as risk factors for colorectal cancer. In New Zealand, Polynesians (including Maoris and people from several Pacific Islands) are more likely to be overweight and have higher intakes of fat and energy than Europeans, and they are likely to have similar total intakes of food plants. Yet, in New Zealand, Polynesians have a significantly lower incidence of colorectal cancer than the Europeans. It is possible that the difference in incidence of colorectal cancer is due to differences in consumption of specific food plants by Polynesians and Europeans in New Zealand. Here we have compared the consumption of specific food plants by 429 Maoris, 643 Pacific Islanders, and 4,451 Europeans in paid employment in New Zealand. Of the 51 food plants eaten by New Zealanders, 6 were eaten significantly more frequently and 17 significantly less frequently by the two Polynesian groups than by Europeans. The quantity of any protective chemical components (or other as yet unknown protective factors) in food plants is likely to be related to their botanical classification. Differences in the intake of specific food plants may at least partly explain differences in the incidence of colorectal cancer between Polynesians and Europeans.

B-mode-detected carotid artery plaque in a general population. Atherosclerosis Risk in Communities (ARIC) Study Investigators

BACKGROUND AND PURPOSE

There is little information on the distribution of atherosclerotic lesions of the extracranial carotid artery wall in free-living populations. The purpose of the present study was to describe the prevalence from 1987 through 1989 of extracranial carotid artery plaque and plaque with acoustic attenuation (shadowing) lesions in a general population of white and black adults from four US communities.

METHODS

B-mode ultrasound was used to characterize wall lesions in the common and internal carotid arteries and at the carotid artery bifurcation in 14,046 men and women 45 to 64 years old who participated in the Atherosclerosis Risk in Communities Study baseline survey.

RESULTS

Thirty-four percent of participants had plaque and 6.4% had plaque with acoustic shadowing. The prevalence of plaque with acoustic shadowing increased steadily with age from 2.5% at ages 45 to 49 to 12.4% at ages 60 to 64. Overall, whites had more plaque with acoustic shadowing lesions than blacks (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.02 to 1.46), and men had more than women (OR, 1.42; 95% CI, 1.22 to 1.63). However, plaque lesions in the common carotid artery were less common among whites than among blacks, and no racial difference was observed in the prevalence of plaque with acoustic shadowing at this segment.

CONCLUSIONS

Although these prevalence rates are likely to be underestimated because of the emphasis on arterial boundary visualization of the scanning protocol, they show a large, mostly asymptomatic burden of atherosclerosis in these populations, especially among older individuals. Site-specific frequency rates of plaque varied between blacks and whites. Among those with plaque, however, whites had more lesions with acoustic shadowing attenuation.

Epidemiology of microalbuminuria in the general population

Microalbuminuria in the general population is associated with recognized risk factors for cardiovascular disease such as hypertension, hyperglycemia, hyperinsulinemia, and hyperlipidemia; and it is an independent predictor of subsequent cardiovascular mortality in hypertensive, diabetic, and elderly populations. Although different methods have been used for measuring and expressing urinary albumin excretion and a variety of cutoff levels have been used for defining microalbuminuria, prevalence of microalbuminuria appears to be higher in non-Europeans (8%-28%) than in Europeans (2%-10%). However, because of the large within-individual variability of urinary albumin excretion and the relatively low prevalence of microalbuminuria, large studies are required to detect statistically significant associations between albuminuria and cardiovascular risk factors. Evidence presented here supports the proposition that microalbuminuria represents a marker of cardiovascular disease risk in nondiabetic individuals as well as diabetic individuals. Moreover, because of a high sensitivity of the test and because albuminuria is a concomitant of many forms of renal disease, microalbuminuria also has a role in detecting patients with renal involvement associated with essential hypertension, lupus erythematosus, women with pre-eclampsia, and subjects with unsuspected primary and secondary nephropathies.

Microalbuminuria in a middle-aged workforce. Effect of hyperglycemia and ethnicity

OBJECTIVE

To determine the prevalence of microalbuminuria in a mixed, ethnic population and to find the extent that ethnic variation in microalbuminuria can be explained by abnormal glucose metabolism, obesity, hypertension, hypertriglyceridemia, and life-style factors.

RESEARCH DESIGN AND METHODS

Urinary albumin concentrations were measured in 5467 middle-aged Maori, Pacific Islander, and European workers who participated in a health-screening survey of 46 New Zealand companies. Participants provided a first-voided, morning urine sample; had a 75-g oral glucose tolerance test; had weight, height, and blood pressure measured; and completed a self-administered questionnaire about past medical history and sociodemographic status.

RESULTS

A significantly higher prevalence of microalbuminuria was found in individuals with new cases of diabetes mellitus (24.1%), in cases of diabetes mellitus previously diagnosed (20.6%), and in those with impaired glucose tolerance (16.1%) compared with nondiabetic individuals (4.0%). Moreover, in the general population, a piecewise linear relationship was detected between albuminuria and plasma glucose with significant changes of slope corresponding with 2 h plasma glucose concentrations (95% confidence interval) of 6.7 (6.4-7.0) and 9.2 (8.6-9.8) mM, respectively. After adjusting for sex, obesity, hypertension, hypertriglyceridemia, cigarette smoking, and heavy alcohol consumption in a multivariate model, glycemia was the most significant determinant of urinary albumin concentrations in all three ethnic groups. However, blood glucose concentrations did not completely explain the higher relative risk (95% confidence interval) of microalbuminuria in Maori (5.97; 4.48-7.78) and Pacific Islander (5.33; 4.13-6.87) workers compared with European workers.

CONCLUSIONS

Of the variables investigated, hyperglycemia was the most important factor explaining the high prevalence of microalbuminuria in Maori and Pacific Islander workers compared with the European workers. However, only 14.9% of the variation in urinary albumin concentrations was found in our multivariate model, and we have speculated on the contribution of other factors such as diet and coexisting renal diseases.

Dietary nutrient intakes and slight albuminuria in people at least 40 years old

We studied the relation between diet and slight albuminuria in 5416 people, ages 40 years and over, who participated in a health screening survey of a local workforce. Degree of albuminuria showed log-linear univariate relations with dietary protein, cholesterol, and sodium intakes, and negative log-linear univariate relations with dietary fiber and polyunsaturated to saturated fat (P/S) ratio. After adjusting for age, gender, and ethnicity, the relative risk (95% confidence interval) for slight albuminuria was significantly increased in people reporting dietary cholesterol consumption &gt; 226 mg/day compared with people reporting consumption &lt; or = 226 mg/day [1.32 (1.02, 1.70)], and significantly reduced in people reporting dietary fiber consumption &gt; 26 g/day compared with people reporting consumption &lt; or = 26 g/day [0.74 (0.58, 0.95)]. There was no significant effect of dietary protein, P/S ratio, or salt intake. We conclude that risk of slight albuminuria is increased by consumption of dietary cholesterol and reduced by consumption of dietary fiber.

Dietary nutrient intakes and slight albuminuria in people at least 40 years old

We studied the relation between diet and slight albuminuria in 5416 people, ages 40 years and over, who participated in a health screening survey of a local workforce. Degree of albuminuria showed log-linear univariate relations with dietary protein, cholesterol, and sodium intakes, and negative log-linear univariate relations with dietary fiber and polyunsaturated to saturated fat (P/S) ratio. After adjusting for age, gender, and ethnicity, the relative risk (95% confidence interval) for slight albuminuria was significantly increased in people reporting dietary cholesterol consumption > 226 mg/day compared with people reporting consumption < or = 226 mg/day [1.32 (1.02, 1.70)], and significantly reduced in people reporting dietary fiber consumption > 26 g/day compared with people reporting consumption < or = 26 g/day [0.74 (0.58, 0.95)]. There was no significant effect of dietary protein, P/S ratio, or salt intake. We conclude that risk of slight albuminuria is increased by consumption of dietary cholesterol and reduced by consumption of dietary fiber.

Albuminuria in people at least 40 years old: effect of alcohol consumption, regular exercise, and cigarette smoking

We investigated the relation between albuminuria and life-style factors in 5670 people, ages 40 years and over, who participated in a health screening survey of a local workforce. The degree of albuminuria showed piecewise log-linear relationships with alcohol consumption and cigarette smoking, with changes in slope (and 95% confidence interval) corresponding with 5 (2, 8) g of alcohol/day and 10 (6, 14) cigarettes/day. After adjusting for age, gender, ethnicity, and other life-style variables, relative risks (95% confidence interval) of slight albuminuria for people consuming > 32 g of alcohol/day compared with nondrinkers, and for cigarette smokers compared with nonsmokers, were 1.74 (1.02, 2.98) and 1.37 (1.01, 1.88), respectively. However, there was no significant effect of exercise. We conclude that slight albuminuria is significantly associated with cigarette smoking and heavy alcohol consumption, consistent with its role as an index of risk of cardiovascular disease.

Relationship between albumin and fructosamine concentration in diabetic and non-diabetic sera

We investigated the contribution of albumin to serum fructosamine activity. On gel exclusion chromatography, pooled diabetic and pooled non-diabetic sera before and after incubation with [14C]glucose differed in fructosamine activity and radioactivity mainly in the albumin-containing fractions. We confirmed the major contribution of glycated albumin to serum fructosamine concentration using affinity chromatography on Blue Sepharose. The importance of high molecular mass species was further demonstrated by the recovery of reducing activity following dialysis and charcoal treatment. Fructosamine measurements in diabetic patients were not correlated with serum albumin concentration in individuals with urinary albumin less than 1 g/l. We conclude that fructosamine activity is a convenient measure of glycosylprotein concentration and that the index responds mainly to glycation of albumin. However, routine correction for serum albumin concentration is inappropriate.

Use of protein-based standards in automated colorimetric determinations of fructosamine in serum

We have developed an automated colorimetric assay for glycated serum proteins (or fructosamines), measuring the reducing activity of serum in alkaline solution (pH 10.35) at 37 degrees C. The calibrants were prepared from a synthetic fructosamine (1-deoxy-1-morpholinofructose), although secondary standards of glycated bovine albumin were more robust in routine application. Interference was appreciable only with icteric specimens (bilirubin greater than 60 mumol/L), and between-batch imprecision (CV) was less than 2%. The range of fructosamine concentrations measured in 502 healthy (nondiabetic) blood donors was 1.87-2.87 mmol/L. There were no significant (p greater than 0.05) age- or sex-related differences in this population sample. Fructosamine accurately reflected blood glucose control as evidenced by the significant correlation with glucose concentrations in fasting plasma (r = 0.82, p less than 0.001) and with glycated hemoglobin (HbA1c) (r = 0.87, p less than 0.01) in 115 patients with type 2 (non-insulin-dependent) diabetes mellitus. The test is simple and rapid to perform (75 samples per hour) and provides an alternative to HbA1c determinations for monitoring blood glucose control and assessing the effects of changes in diabetes management.

Use of protein-based standards in automated colorimetric determinations of fructosamine in serum

We have developed an automated colorimetric assay for glycated serum proteins (or fructosamines), measuring the reducing activity of serum in alkaline solution (pH 10.35) at 37 degrees C. The calibrants were prepared from a synthetic fructosamine (1-deoxy-1-morpholinofructose), although secondary standards of glycated bovine albumin were more robust in routine application. Interference was appreciable only with icteric specimens (bilirubin greater than 60 mumol/L), and between-batch imprecision (CV) was less than 2%. The range of fructosamine concentrations measured in 502 healthy (nondiabetic) blood donors was 1.87-2.87 mmol/L. There were no significant (p greater than 0.05) age- or sex-related differences in this population sample. Fructosamine accurately reflected blood glucose control as evidenced by the significant correlation with glucose concentrations in fasting plasma (r = 0.82, p less than 0.001) and with glycated hemoglobin (HbA1c) (r = 0.87, p less than 0.01) in 115 patients with type 2 (non-insulin-dependent) diabetes mellitus. The test is simple and rapid to perform (75 samples per hour) and provides an alternative to HbA1c determinations for monitoring blood glucose control and assessing the effects of changes in diabetes management.

Serum fructosamine concentration as measure of blood glucose control in type I (insulin dependent) diabetes mellitus

Serum fructosamine activity was studied in 42 patients with type I (insulin dependent) diabetes mellitus and 30 non-diabetic volunteers as an index of blood glucose control. There was a significant correlation both between fructosamine and glycosylated haemoglobin values (r = 0.82) and between fructosamine and the fasting C peptide concentration (r = -0.81). Test results in 14 of the diabetics reflected the mean plasma glucose concentration calculated from 25 serial estimations in a single 24 hour period (r = 0.75; p less than 0.01) but not the mean amplitude of glycaemic excursion (r = 0.23; p greater than 0.05). Fructosamine concentrations measured in these multiple blood specimens did not change significantly throughout the day (mean coefficient of variation 4.1%) despite wide variability of the respective plasma glucose concentrations (mean coefficient of variation 36.2%). It is concluded that a single random serum sample analysed for fructosamine concentration provides a simple and reliable assessment of glucose homoeostasis in patients with type I diabetes mellitus.

Clinical usefulness of estimation of serum fructosamine concentration as a screening test for diabetes mellitus

Fructosamine, a putative measure of serum glycosylated proteins, was measured in 74 subjects referred for oral glucose tolerance tests. A normal range (mean (2 SD] of 1.6 (0.4) mmol/l (40(10) mg/100 ml) derive from results obtained in 83 healthy non-diabetic volunteers permitted the detection of 15 out of 17 (88%) subjects with proved diabetes and yielded only five (9%) false positive diagnoses. Fructosamine concentrations correlated significantly (p less than 0.001) with fasting plasma glucose concentrations (r = 0.76) and glycosylated haemoglobin concentrations (r = 0.70). A longitudinal study suggested that fructosamine concentration was an index of intermediate term (one to three weeks) blood glucose control. Fructosamine concentration was not related to uraemia and did not depend on albumin or total protein concentrations, provided that serum albumin concentrations remained above 30 g/l. Estimation of fructosamine concentrations is a fully automated procedure and may provide a simple means of screening for diabetes mellitus.

Fructosamine: a new approach to the estimation of serum glycosylprotein. An index of diabetic control

The development of a novel manual method designed to measure serum glycosylprotein as an index of diabetic control is described. The method relies on the ability of ketoamines (fructosamines) to act as reducing agents in alkaline solution. Conditions are described for a simple colorimetric procedure which permits assay of both a synthetic fructosamine and purified albumin while severely limiting the contribution of interfering substances. Applied to whole sera, the measurement is linear with volume of serum assayed. It allows clear discrimination of normal and diabetic populations (p less than 0.001), and is significantly correlated with fasting blood glucose concentration (r = 0.72) and with a thiobarbituric acid procedure for measuring glycosylprotein-derived hydroxymethylfurfural (r = 0.58). The method is rapid (at least 12 samples per hour) and demands only simple equipment.