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Biomedical subjects

A Hofman

Publications and source records attributed to A Hofman.

At least 289 records · Page 16Linked to original sources
PubMed1996

Hyperinsulinemia and bone mineral density in an elderly population: The Rotterdam Study.

We studied the association between insulin and glucose levels and bone mineral density (BMD) in a population based study of 5931 elderly men and women. Serum insulin was measured 2 h after a nonfasting oral glucose load in subjects not using antidiabetes medication. BMD was measured by dual-energy X-ray absorptiometry in the lumbar spine and the proximal femur. In addition, the participants were asked about fractures in the preceding 5 years. Higher bone mass was associated with higher glucose and postload insulin levels at all sites, as well as with increased waist/hip ratio and body mass index. In men, the mean age-adjusted BMD at the lumbar spine (in mg/cm2) increased 4.64 per mmol/L serum glucose (95% CI 1.46-7.82) and 0.35 per mU/L postload insulin (0.17-0.53). In women, these values were 6.88 (4.37-9.39) for glucose and 0.25 (0.11-0.39) for insulin (for all analyses: p < 0.01). The relations were essentially the same with BMD measured in the femur, as well as after adjustment for waist/hip ratio. After adjustment for body mass index, the associations were reduced and lost statistical significance in women. After excluding subjects with diabetes mellitus, the results remained the same. Subjects with a history of nonvertebral fractures had a lower BMD and lower postload insulin levels than those without. The difference in insulin levels was statistically significant in men only (12.5 mU/L, p < 0.001). Excluding men with diabetes mellitus or further adjustment for waist/hip ratio, body mass index or BMD did not change this difference. These results suggest that increased insulin levels are associated with an increased BMD and might be related to a lower fracture rate.

Absorptiometry, Photon↗
PubMed1996

Primary open-angle glaucoma, intraocular pressure, and diabetes mellitus in the general elderly population. The Rotterdam Study.

PURPOSE: To investigate the association of primary open-angle glaucoma and intraocular pressure (IOP) with newly diagnosed diabetes mellitus. METHODS: Subjects participating in the Rotterdam Study (n = 4178; ages, 55 years and older) were examined according to standard protocols, including a medical history interview, perimetry, applanation tonometry, funduscopy, and a nonfasting glucose tolerance test. Glaucoma was defined by the presence of a glaucomatous visual field defect. A distinction was made between high-tension glaucoma and normal-tension glaucoma. The relation of glaucoma and IOP with newly diagnosed diabetes mellitus and blood glucose was analyzed using regression analysis. RESULTS: The presence of diabetes mellitus was associated with an overall rise in mean IOP of both eyes of 0.31 mmHg (95% confidence interval, 0.12-0.50), and with a threefold increased presence of high-tension glaucoma (odds ratio, 3.11; 95% confidence interval, 1.12-8.66). A 10-mmol/l higher random serum glucose level was borderline significantly associated with a mean IOP that was, on average, 0.41 mmHg (95% confidence interval, -0.02-0.84) higher and with an odds ratio of 2.82 (95% confidence interval, 0.92-8.58) for high-tension glaucoma. A 10-mmol/l rise in serum glucose on a glucose tolerance test was associated with an overall rise of mean IOP of 0.59 mmHg (95% confidence interval, 0.26-0.92) and with an odds ratio of 1.88 (95% confidence interval, 0.81-4.32) for high-tension glaucoma. CONCLUSION: Newly diagnosed diabetes mellitus and high levels of blood glucose are associated with elevated IOP and high-tension glaucoma.

Aged↗
PubMed1996

The association of abnormalities on physical examination of the hip and knee with locomotor disability in the Rotterdam Study.

To assess the influence of abnormalities found on physical examination of the hips and knees on disability 1156 men and 1739 women aged > or = 55 yr (the Rotterdam Study) were asked about locomotor disability (LD) using six questions of the Health Assessment Questionnaire (HAQ). The prevalence of LD was 20.2% for men and 31.9% for women. Moderately restricted range of motion of the hips and knees occurred in 34.5% of the men and 38.6% of the women. The prevalence of instability of the knees was 12.5% for men and 16.8% for women. Varus deformity in men (10.1%) and valgus deformity in women (15.0%) were the most common deformities of the knees. Restricted flexion of the hips was the strongest determinant of LD. Age-adjusted odds ratios for restricted hip flexion of LD were 4.7% (95% CI: 3.2-6.8) for men and 3.5 (2.7-4.5) for women. Valgus deformity, knee instability and obliquity were risk factors only in women. Adjustment of these odds ratios for morning stiffness and joint pain did not alter the estimates.

Activities of Daily Living↗
PubMed1996

Insulin, hypertension and antihypertensive drugs in elderly patients: the Rotterdam Study.

OBJECTIVE: To investigate the association between insulin, hypertension and antihypertensive drug use in elderly patients. DESIGN AND METHODS: Blood pressure, use of antihypertensive drugs and glucose metabolism were examined in 5453 men and women (mean age 68.8 years). This was part of the baseline examination of the Rotterdam Study, a population-based study of chronic diseases in elderly patients. Serum insulin was measured 2 h after an oral glucose load. RESULTS: Patients with hypertension had a significantly higher mean post-load insulin level than those without: 71.3 mU/l versus 59.3 mU/l (P < 0.001, adjusted for age). Systolic blood pressure increased by 0.25 mmHg per 10 mU/l insulin (95% confidence interval 0.15-0.35, adjusted for age, sex and antihypertensive drugs), whereas the increase in diastolic blood was 0.07 mmHg per 10 mU/l (0.01-0.13). Whereas insulin resistance was higher in patients with hypertension, the increase in insulin resistance with age was much more apparent in normotensive patients, resulting in similar insulin levels at high ages. Those using antihypertensive drugs, however, had higher insulin levels at all ages. CONCLUSION: The results of this study show that hyperinsulinemia is associated with raised blood pressure in elderly people, and suggest that the age-associated increase in insulin resistance is diminished in patients with raised blood pressure. The use of antihypertensive drugs, however, appears to be accompanied by an independent additional increase in insulin resistance at all ages.

Aged↗
PubMed1996

Dietary electrolyte intake and blood pressure in older subjects: the Rotterdam Study.

OBJECTIVE: To examine the relation between dietary electrolyte intake and blood pressure in older people. METHODS: The study included 3239 participants of the Rotterdam Study (41% of the total cohort) who were aged over 55 years and had not been prescribed antihypertensive drugs. Their dietary intake was assessed by a semiquantitative food frequency questionnaire. The association of energy-adjusted intakes of potassium, magnesium and calcium with blood pressure was studied in a linear regression model with adjustment for age, sex, body mass index and alcohol intake. RESULTS: An increase in potassium intake of 1 g/day was associated with a 0.9 mmHg lower systolic and a 0.8 mmHg lower diastolic blood pressure. An increase in magnesium intake of 100 mg was associated with a 1.2 mmHg lower systolic and a 1.1 mmHg lower diastolic blood pressure. Calcium intake was not independently related to blood pressure, except for a subgroup of 1360 hypertensive subjects in which a significant inverse association with diastolic blood pressure was observed. CONCLUSIONS: Our findings support the view that an increase in the intake of foods rich in potassium and magnesium could lower blood pressure at older age.

Aged↗
PubMed1996

Prevalence of epilepsy in the elderly: the Rotterdam Study.

We assessed the prevalence of epilepsy in an elderly population in The Netherlands. The study was conducted from 1991 to 1993 as part of the Rotterdam Study, a population-based door-to-door study of all elderly people living in Ommoord, a suburb of Rotterdam, and included 5,559 persons aged 55-95 years. All subjects were screened for epilepsy through direct questions regarding the existence of epilepsy and antiepileptic drug (AED) use, in addition to relevant questions from the World Health Organization (WHO) protocol for epidemiologic studies of neurologic diseases. Further evaluation of screen positives was made by a panel of 1 study physician and 4 epileptologists, who also classified all confirmed cases of epilepsy according to the classifications of the International League Against Epilepsy (ILAE). The overall prevalence of active epilepsy in our study population was 0.9% including special syndromes and 0.8% excluding special syndromes. The prevalence increased with age from 0.7% for those aged 55-64 years to 1.2% for those aged 85-94 years. The increase with age was detected among men and women both. Our study confirms other findings showing that the prevalence of active epilepsy increases with age in the elderly. The prevalence figures in our study were high as compared with those of other population-based studies. Epilepsy appears to be a major cause of morbidity in the elderly.

Age Distribution↗
PubMed1996

Clinical features and mortality in patients with early-onset Alzheimer's disease.

In a population-based study of 198 patients with probable early-onset Alzheimer's disease (AD), we studied the occurrence of extrapyramidal signs (tremors and rigidity), myoclonus, psychosis and seizures, as well as their predictive value for mortality. The presence of tremors was significantly associated with the presence of rigidity. The occurrence of myoclonus was significantly associated with the occurrence of seizures. Psychosis and seizures in AD patients were not associated with mortality. The occurrence of extrapyramidal signs and myoclonus at any point in time during the course of AD increased the risk of mortality significantly. When evaluating their relative importance, extrapyramidal signs appeared to be the most important predictor of mortality.

Adult↗
PubMed1996

Antithrombin and atherosclerosis in the Rotterdam Study.

Antithrombin is a potent inhibitor of thrombotic tendency. Whether atherosclerotic disease is associated with high or low antithrombin is unclear. Studies of the relation between antithrombin and presence of arterial disease have shown contrasting results. In the Rotterdam Study, a single-center, population-based cohort study of 7983 subjects aged 55 years and older, the association between atherosclerosis and antithrombin was evaluated. The ratio of ankle to arm blood pressure is a graded marker for atherosclerosis and provides the opportunity to investigate nonlinear associations. In the first 1427 participants of the Rotterdam Study who did not use anticoagulants, both antithrombin and the ratio of ankle to arm blood pressure were measured. In men the association between the two was quadratic: antithrombin activity was increased in men with moderate peripheral arterial atherosclerosis compared with those without, and in men with more severe atherosclerosis it was decreased. In women the association was linear: a decreased ratio of ankle to arm pressure was associated with increased antithrombin activity. These associations were independent of smoking, body mass index, serum lipids, fibrinogen, and factor VIIc. We propose that antithrombin activity rises in response to increased risk of cardiovascular disease and also in response to the presence of atherosclerosis, whereas antithrombin may decrease with increasing severity of the atherosclerotic process in men. This may explain the contrasting results found in previous studies. Changes in antithrombin over time might be useful in predicting the risk of cardiovascular disease and progression.

Aged↗
PubMed1996

Prevalence of stroke in the general population. The Rotterdam Study.

BACKGROUND AND PURPOSE: We assessed the prevalence of self-reported and medically confirmed stroke and the degree to which the event had led to hospitalization. METHODS: From all participants of the Rotterdam Study, a population-based cohort study of 7983 subjects aged 55 years and older living in a suburb of Ommoord in Rotterdam, information on stroke history was obtained by the question, "Did you ever suffer from a stroke, diagnosed by a physician?" Supplementary medical information was obtained from general practitioner or hospital discharge records. RESULTS: Prevalence of self-reported stroke was 2.5% in men aged 55 to 64 years, 5.0% in men aged 65 to 74 years, 8.9% in men aged 75 to 84 years, and 11.6% in men aged 85 years or older. Corresponding figures for women were 1.6%, 3.3%, 6.7%, and 10.5%, respectively. Of the self-reported strokes, 67% could be confirmed by medical information. In 53% (95% confidence interval, 47% to 60%) of subjects with a confirmed stroke, the event had led to hospital admission. The proportion of hospitalized patients decreased with age. CONCLUSIONS: The present study provides valid age- and sex-specific estimates of prevalence of stroke. A substantial proportion of patients with stroke is not hospitalized.

Aged↗
PubMed1996

Risk factors for Creutzfeldt-Jakob disease: a reanalysis of case-control studies.

To review the evidence for risk factors of Creutzfeldt-Jakob disease (CJD), we pooled and reanalyzed the raw data of three case-control studies. The pooled data set comprised 178 patients and 333 control subjects. The strength of association between CJD and putative risk factors was assessed by computing the odds ratio as estimate of the relative risk. The risk of CJD was statistically significantly increased for subjects with a family history of CJD (odds ratio = 19.1; 95% CI 1.1 to 348.0). Further, there was a significant association between the risk of CJD and a history of psychotic disease (odds ratio = 9.9; 95% CI 1.1 to 86.1). Although not significantly increased, there was an elevated risk of CJD for subjects with a family history of dementia, a history of poliomyelitis, subjects employed as health professionals, and subjects ever exposed to cows and sheep. No association could be shown with organ meat consumption, including brain. The negative results of this reanalysis reassures the absence of a common risk factor in all CJD patients. However, the ongoing epidemiologic surveillance of CJD in several European countries may provide more evidence to exclude any environmental exposure early in childhood.

Animals↗
PubMed1996

Plasma fibrinogen in NIDDM: the Rotterdam study.

OBJECTIVE: To compare plasma fibrinogen levels across groups of subjects with and without NIDDM with respect to diabetes therapy and to evaluate the influence of metabolic control and other selected factors. RESEARCH DESIGN AND METHODS: In a cross-sectional study, plasma fibrinogen was measured in 2,971 elderly subjects aged 55 years and older (mean age 70.8 years). This was part of the baseline examination of the Rotterdam Study, a population-based study of chronic diseases in the elderly. RESULTS: Plasma fibrinogen levels did not differ among subjects with and without NIDDM (2.84 vs. 2.81 milligrams, P = 0.5). After adjustment for age, sex, smoking, BMI, and waist-to-hip ratio, the plasma fibrinogen levels were higher in subjects receiving insulin therapy. In those without diabetes (n = 2,640), with diabetes but not taking antidiabetes medication (n = 196), taking oral medication (n = 99), and taking insulin (n = 36), the age- and sex-adjusted fibrinogen levels were 2.82 (SE 0.01), 2.79 (0.05), 2.79 (0.07), and 3.23 (0.11) milligrams, respectively (P < 0.005). Adjustment for leukocyte count or serum creatinine level did not affect the observed association, while adjustment for fructosamine decreased the differences. CONCLUSIONS: Plasma fibrinogen levels are elevated in insulin-treated NIDDM patients, which may reflect worse metabolic control in this subgroup.

Age Factors↗
PubMed1996

Physical and psychosocial disability in elderly subjects in relation to pain in the hip and/or knee.

OBJECTIVE: To determine physical and psychosocial disability in subjects aged 55 to 74 years living in the community, in relation to pain in the hip and/or knee, and to explore the relationships between pain, physical and psychosocial disability, and selected background variables. METHODS: A subsample from a community based study on pain, disability, and radiological osteoarthritis (ROA) was used to identify groups with sporadic, episodic, and chronic pain and a reference group. Disability was assessed with the Sickness Impact Profile. Data were available for 306 subjects (response 83%). RESULTS: The mean physical disability in the group with chronic (and more severe) pain (N = 59) was 5.4 times and psychosocial disability was 3.6 times higher than those of a reference group (N = 72). The body mass index, the existence of extra mobility problems, and ROA were independently positively related to physical disability. Male sex, having extra mobility problems, and moderate ROA were independently positively related to psychosocial disability. CONCLUSION: Subjects with more chronic (and severe) pain in the hip and/or knee had relatively high levels of physical as well as psychosocial disability, compared to a reference group without any signs of OA. Pain chronicity had no significant contribution to physical disability, if corrected for other factors. Both forms of disability in subjects with pain were better predicted by ROA and by problems other than pain in the hip or knee alone, than by the chronicity of the pain.

Activities of Daily Living↗
PubMed1996

The renaissance of Hippocratic epidemiology.

Epidemiology is a small but not unimportant field in medicine. It has a clear identity and special spirit. It is a science that has to avoid methodologic dogmatism. It is a science that is strongly dependent upon collaboration with medical practice and basic medical science. And it is a science that in the true spirit of Hippocrates tries to contribute to the conquering of diseases in patients and in populations.

Epidemiology↗
PubMed1996

Cardiovascular response to physical stress in offspring of hypertensive parents: Dutch Hypertension and Offspring Study.

Blood pressure (BP) regulatory mechanisms were studied in youngsters with contrasting risks for hypertension, based on parental history, during physical stress. As a static exercise, an isometric handgrip task (22% of maximal force during 5 min) was used and a dynamic exercise task was performed on a bicycle ergometer. At rest and during stress, BP and heart rate were recorded. In order to study the adaptation of the cardiovascular system to physical stress, cardiac output and total peripheral resistance were measured in addition to indices of vagal and sympathetic influences on the heart. Heart rate and cardiac output declined significantly more in offspring of hypertensive parents during static exercise (difference in heart rate: -2.5 +/- 1.2 bpm, P = 0.04; difference in cardiac output: -9.0 +/- 4.6%, P = 0.05). This is most likely the result of a larger increase in the total peripheral resistance in youngsters at risk (difference: 13.2 +/- 6.8%, P = 0.06). No differences between the two groups were found in reactivity of BP or in the indices of sympathetic activation or vagal inhibition of the heart. The offspring of hypertensive parents showed an attenuated increase in stroke volume during the dynamic exercise task (difference at the first cycling level: -11.5 +/- 5.4%, P = 0.04), while no difference in neural activity or heart rate was found. Youngsters with a parental history of hypertension show an enhanced reactivity of total peripheral resistance during static exercise. This does not lead to a higher BP response in this group, most probably because of a larger decrease of the cardiac output. During dynamic exercise the physiological increase in stroke volume is blunted in offspring of hypertensive parents.

Adolescent↗
PubMed1995

Aneurysms of the abdominal aorta in older adults. The Rotterdam Study.

To assess the age- and sex-specific prevalence and risk factors for aneurysms of the abdominal aorta, the authors performed a population-based study in 5,419 subjects (42% men, 58% women) aged 55 years and over. The proximal and distal diameter of the abdominal aorta were measured by ultrasound. An aneurysm was defined as a distal aortic diameter of 35 mm or more or a dilatation of the distal part of the the abdominal aorta of 50% or more. The mean distal and proximal aortic diameter increased 0.7 mm and 0.3 mm, respectively, with every 10 years of age. In 2.1% (95% confidence interval (CI) 1.7-2.5) of the study population, an aneurysm was present, or in 4.1% (95% CI 3.2-4.9) of the men and 0.7% (95% CI 0.4-1.0) of the women. Subjects with an abdominal aneurysm were more likely to be smokers and they had higher serum cholesterol levels and higher prevalence of cardiovascular disease compared with subjects without an aneurysm. The authors conclude that the ultrasound diameter of the abdominal aorta clearly increases with age in both men and women and that the prevalence of aneurysms of the abdominal aorta in older adults in relatively high, especially in men.

Age Distribution↗
PubMed1995

Risk of dementia in patients with Parkinson's disease, epilepsy, and severe head trauma: a register-based follow-up study.

The authors investigated the risk of developing dementia for persons aged 50-75 years who suffered from Parkinson's disease, epilepsy, or severe head trauma. They compared the risk in this patient group with the risk in a reference group in a follow-up study based on the linked databases of three Dutch nationwide morbidity registers over the years 1980-1989. The overall relative risk of developing dementia within 8 years in patients with Parkinson's disease who were initially free of dementia was 3.0 (95% confidence interval (CI) 2.9-3.1). Risk was especially increased in younger Parkinson's disease patients (relative risk (RR) = 13.2, 95% CI 6.2-28.6). For patients with epilepsy, the overall relative risk was 1.5 (95% CI 1.4-1.7). Severe head trauma was not associated with an increased risk of dementia (RR = 1.0, 95% CI 0.9-1.1). These findings suggest that Parkinson's disease is an important risk factor for dementia, with a particularly high risk in young patients with Parkinson's disease. Patients with epilepsy may bear a moderately increased risk of developing dementia. This study does not support earlier findings in retrospective case-control studies of an increased risk of dementia in head trauma patients.

Age Distribution↗
PubMed1995

[Vertebral deformities and bone density in the elderly; the ERGO Study (Erasmus Rotterdam Health and the Elderly). ERGO Study Group].

OBJECTIVE: To assess the prevalence of vertebral deformities in men and women aged 55 years and over. DESIGN: Cross-sectional study. SETTING: A quarter in Rotterdam, The Netherlands. METHODS: As part of the 'Rotterdam elderly study', 750 responding men and 750 women underwent lateral radiography of the spine and subsequent morphometry of the vertebrae to detect presence of vertebral deformities. Grade 1 and grade 2 deformities were scored on the basis of the results of the morphometry. The entire vertebral column was classified as normal (no deformities), moderate spinal deformity (grade 1 deformities) or severe spinal deformity (grade 2 deformities). Dual Energy X-ray Absorptiometry (DXA) was used to assess the bone mineral density (BMD) at the femoral neck. RESULTS: The prevalence of moderate or severe spinal deformity was estimated to be 18% in men (12% moderate and 6% severe) and 22% in women (11% moderate and 11% severe) after adjustment for the present age distribution of the Dutch population. The prevalence of deformities increased with age, in particular for severe deformities in women aged 70 years and over. A decreasing BMD was observed with increasing severity of vertebral deformities. Men with severe spinal deformity had a 4% lower BMD whereas women with severe spinal deformity had a 6% lower BMD. CONCLUSION: Vertebral deformities are frequently present in the general population, mostly in the higher age groups. There was an association with decreased BMD. In view of the ongoing aging of the population, a future increase in the prevalence of vertebral deformities is to be expected.

Absorptiometry, Photon↗