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Biomedical subjects

B E Klein

Publications and source records attributed to B E Klein.

At least 163 records · Page 9Linked to original sources
PubMed1994

Self-rated health and mortality in people with diabetes.

OBJECTIVES: This study examined whether self-rated health is an independent and significant predictor of mortality in people with diabetes, using data collected in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. METHODS: Participants were asked to rate their health in comparison with others their age. A proportional hazards model was used to regress survival time on self-rated health and a number of covariates measuring physical health. RESULTS: People with younger onset diabetes (n = 891) who rated their health relative to their peers as "worse" or "don't know" were no more likely to die than those rating their health as "the same" or "better" when physical health status was controlled. In contrast, those with older onset diabetes (n = 987) who rated their health as "worse" or "don't know" were almost twice as likely to die as those rating their health as "the same" or "better" when physical health status was controlled. CONCLUSIONS: Self-rated health is a significant predictor of mortality in people with older onset diabetes but not in those with younger onset diabetes when physical health status is controlled.

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PubMed1994

Refractive status in the Beaver Dam Eye Study.

PURPOSE: To describe the prevalence of refractive errors in a population of adult Americans. METHODS: From 1988 to 1990, 4926 adults who were 43 to 84 years of age and living in Beaver Dam, Wisconsin at the time of the 1987-1988 census were examined. Refractions were performed according to a modification of the Early Treatment Diabetic Retinopathy Study protocol. Included in this study were 4533 people who had not undergone cataract surgery and who had a best corrected visual acuity better than 20/40 in at least one eye. Myopia was defined as a refractive error less than -0.50 diopters; hyperopia was defined as a refractive error greater than +0.50 diopters. RESULTS: Hyperopia was more frequent than myopia in the study group (age-adjusted of 49.0% and 26.2% in right eyes, respectively, P = 0.0001). The prevalence of hyperopia in the right eye increased with increasing age from 22.1% in those 43 to 54 years of age to 68.5% in those 75 years of age or older. The prevalence of myopia in the right eye decreased from 43.0% in those 43 to 54 years of age to 14.4% in those 75 years of age or older. There was significant relationship between education level and refractive error (age adjusted r = -0.32, P = 0.0001). Neither household income nor occupation was associated with refractive error in our data. CONCLUSION: These cross-sectional data indicate age-related differences in refractive status in an adult population and suggest that education is associated with myopia independent of age.

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PubMed1993

Genetic etiology of nuclear cataract: evidence for a major gene.

Sibling correlations and segregation analysis were used to examine the familial distribution of age-sex-adjusted measures of nuclear sclerosis in 1,247 individuals from 564 sibships in the Beaver Dam Eye Study. There are highly significant sibling correlations for all sibs, and separately for sister-sister, sister-brother, and brother-brother pairs. Two transformed normal distributions give the best fit to the data. The hypothesis of mendelian transmission of a major effect cannot be rejected, but the hypothesis of a random environmental major effect is rejected. The parameters of the tau AB free model showed close similarity to the values expected under a mendelian hypothesis. Our results suggest that a single major gene can account for 35% of the total variability of age-sex-adjusted measures of nuclear sclerosis.

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PubMed1993

The Beaver Dam Eye Study: the relation of age-related maculopathy to smoking.

There are conflicting reports regarding the relation of cigarette smoking to age-related maculopathy, a major cause of blindness in the United States. In this report, the authors examined this association in people aged 43-86 years (n = 4,771) who participated in the Beaver Dam Eye Study, Beaver Dam, Wisconsin (1988-1990). Exposure data on cigarette smoking were derived from questions about present and past smoking, duration of smoking, and the number of cigarettes smoked per day. Age-related maculopathy status was determined by grading stereoscopic color fundus photographs using the Wisconsin Age-related Maculopathy Grading System. Smoking status, pack-years smoked, and current exposure to passive smoking were not associated with drusen characteristics (type, area, and confluence) or signs of early age-related maculopathy in any age-sex group studied, except for a higher frequency of increased retinal pigment in males who had ever smoked compared with those who had never smoked. The relative odds for exudative macular degeneration, one form of late age-related maculopathy, in females who were current smokers was 2.50 (95% confidence interval 1.01-6.20) compared with those who were ex-smokers or never smokers; for males, it was 3.29 (95% confidence interval 1.03-10.50). There was no significant relation between smoking status and pure geographic atrophy, another form of late age-related maculopathy. These results suggest that exudative macular degeneration is associated with cigarette smoking and that different forms of macular degeneration may have different etiologies.

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PubMed1993

Alcohol use and lens opacities in the Beaver Dam Eye Study.

The relationship between alcohol use and lens opacities was examined in a large (N = 4926) population-based study of adults aged 43 to 86 years in Beaver Dam, Wis. These data were collected from 1988 to 1990. Alcohol history was determined by a standardized questionnaire. Prevalence and severity of cataract were determined by masked grading of photographs obtained using a slit-lamp camera and retroillumination. A history of heavy drinking was related to more severe nuclear sclerotic, cortical, and posterior subcapsular opacities (odds ratios, 1.34, 1.38, and 1.57, respectively). These relationships remained after adjusting for other risk factors such as smoking. Moderate liquor consumption was associated with less severe nuclear sclerosis (odds ratio, 0.81). Participants who drank wine had less severe nuclear sclerosis (odds ratio, 0.84) and cortical opacities (odds ratio, 0.84) than those who did not. Increased consumption of beer was related to increased risk of cortical opacities.

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PubMed1993

Sunlight and age-related macular degeneration. The Beaver Dam Eye Study.

OBJECTIVE: To investigate the relationship of sunlight exposure with age-related maculopathy. This was investigated in the population-based Beaver Dam Eye Study. DESIGN: In this cross-sectional population-based study, questionnaire data about sunlight exposure were obtained. Stereoscopic color fundus photographs were graded to determine the presence of age-related maculopathy. PARTICIPANTS: People aged 43 through 84 years who resided in Beaver Dam, Wis, between 1987 and 1988 were examined between 1988 and 1990. RESULTS: Light exposure was not associated with early age-related maculopathy in women. In men, after adjusting for age, the amount of time spent outdoors in summer was associated with increased retinal pigment (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.01 to 2.04). Wearing eyeglasses was inversely associated with increased retinal pigment (OR, 0.75; 95% CI, 0.58 to 0.97), and the use of hats and sunglasses was inversely associated with soft indistinct drusen (OR, 0.61; 95% CI, 0.38 to 0.98). The amount of leisure time spent outdoors in summer was significantly associated with exudative macular degeneration (OR, 2.26; 95% CI, 1.06 to 4.81) and late maculopathy (OR, 2.19; 95% CI, 1.12 to 4.25). There were no associations between estimated ambient UV-B exposure and age-related maculopathy. CONCLUSIONS: These data suggest that exposure to sunlight may be associated with age-related maculopathy. However, longitudinal studies of these associations are needed.

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PubMed1993

Sex hormones and the incidence of severe retinopathy in male subjects with type I diabetes.

BACKGROUND: Diabetic retinopathy rarely occurs before puberty, suggesting that changes in sex hormones may influence the development of this condition. METHODS: The authors measured total testosterone, free testosterone, sex hormone-binding globulin, estradiol, and dehydroepiandrosterone-sulfate levels in 44 men with type I diabetes participating in the 1984 to 1986 re-examination phase of the Wisconsin Epidemiologic Study of Diabetic Retinopathy, a population-based study of diabetic complications. The mean age was 32.7 years, and the mean duration of diabetes was 15.4 years. Subjects who progressed to proliferative or preproliferative retinopathy 6 years later (cases, n = 22) were compared with subjects who had little or no progression (controls, n = 22). Both groups were matched on initial level of retinopathy. Seven stereoscopic retinal photographs of each eye were obtained at both examinations, and the photographs were read by the University of Wisconsin Reading Center. RESULTS: Sex hormone-binding globulin concentrations (nmol/l) were significantly lower (reflecting increased androgenicity) in cases than in controls (22.4 +/- 11.4 versus 32.5 +/- 19.8; P = 0.04). No other statistically significant differences in hormone levels were observed. CONCLUSION: Neither serum testosterone nor other sex hormones were related to the incidence of severe retinopathy. The relationship to low-serum sex hormone-binding globulin suggests that increased androgenicity may be associated with the progression of retinopathy in male subjects with type I diabetes.

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PubMed1993

Relationship of drinking alcohol and smoking to prevalence of open-angle glaucoma. The Beaver Dam Eye Study.

PURPOSE: To evaluate a possible association of glaucoma with alcohol ingestion and cigarette-smoking behavior. METHODS: A population-based survey was performed of persons 43 to 84 years of age in Beaver Dam, Wisconsin (n = 4926). The diagnosis of glaucoma was based on visual field testing, measurement of intraocular pressure, and cup-to-disc ratios based on detailed protocols for examination, measurement, and gradings of photographs. Alcohol intake and smoking history were based on questionnaire responses. The prevalence of glaucoma in "heavy drinkers," whether current or past, was contrasted with the prevalence in those not reporting heavy drinking. Prevalences in never, past, and current smokers were compared. RESULTS: There was no difference in frequency of glaucoma by drinking status. Similarly, there was no difference in the frequency of glaucoma by cigarette-smoking status. CONCLUSION: In these prevalence data, neither heavy drinking nor cigarette-smoking behavior was related to the prevalence of open-angle glaucoma. This finding may reflect a real absence of a pathologic effect.

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PubMed1993

Is gross proteinuria a risk factor for the incidence of proliferative diabetic retinopathy?

PURPOSE: To examine the relationship between gross proteinuria, measured at the initial examination, and the 4-year incidence of proliferative diabetic retinopathy (PDR) in a population-based study in Wisconsin. METHODS: Gross proteinuria was measured by reagent strip. Diabetic retinopathy was determined from stereoscopic fundus photographs in a masked fashion using the modified Airlie House classification scheme. RESULTS: In the younger-onset group taking insulin (n = 693), the relative risk of proliferative retinopathy developing in those with gross proteinuria at baseline was 2.32 (95% confidence interval [CI]: 1.40,3.83) compared with those without gross proteinuria. For the older-onset group taking insulin, the relative risk was 2.02 (95% CI: 0.91,4.44), and for those not taking insulin it was 1.13 (95% CI: 0.15,8.50). After controlling for other risk variables, the relationship was of borderline statistical significance (P = 0.052) in the younger-onset group with no or early nonproliferative retinopathy at baseline. CONCLUSION: These data suggest that gross proteinuria is a risk indicator for proliferative retinopathy in younger-onset patients with diabetes. These patients might benefit from having regular ophthalmologic evaluation.

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PubMed1993

The relationship of cardiovascular disease and its risk factors to age-related maculopathy. The Beaver Dam Eye Study.

PURPOSE: To examine the association between cardiovascular disease and its risk factors to age-related maculopathy in a population-based study of people between the ages of 43 and 86 years (n = 4926) between 1988 and 1990. METHODS: Population-based prevalence study using standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy. Standard univariate and multivariate analyses were performed. RESULTS: After controlling for age, early age-related maculopathy was related to low total serum cholesterol levels in women and a high high-density lipoprotein (HDL) cholesterol level and a low total cholesterol/HDL-cholesterol ratio in men. After controlling for age and sex, age-related exudative macular degeneration was associated with higher hematocrit values (odds ratio, 1.09; 95% confidence interval, 1.00, 1.19) and higher leukocyte count (odds ratio, 1.10; 95% confidence interval, 1.00, 1.19). There was no statistically significant relationship between blood pressure, hypertension, or history of cardiovascular disease and exudative macular degeneration or geographic atrophy. CONCLUSION: With the exception of relationships between serum lipids and early age-related maculopathy, and hematocrit values, leukocyte counts, and exudative macular degeneration, these data suggest that most cardiovascular disease risk factors are not related to age-related maculopathy. Further longitudinal study is needed.

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PubMed1993

Glycosylated hemoglobin concentrations and vitamin E, vitamin C, and beta-carotene intake in diabetic and nondiabetic older adults.

Studies indicate that large doses of all-rac-alpha-tocopherol in people with diabetes or ascorbic acid in nondiabetic subjects reduces protein glycosylation. The mechanisms by which these nutrients influence glycosylation are poorly understood but may be related to their ability to function as antioxidants. We examined the relationship between glycosylated hemoglobin (GHb) and intake of vitamins E and C and beta-carotene in a population-based sample of middle-aged and older adults participating in the Beaver Dam Eye Study. In people with diabetes, no significant associations were observed between GHb and intake of vitamins E and C and beta-carotene. In people without diabetes, energy-adjusted vitamin C intake was negatively associated with GHb after age and sex were controlled for (dietary, P = 0.02; total, P = 0.04). No significant relationships between GHb and intake of vitamin E and beta-carotene were observed.

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PubMed1993

Nutrient supplements contribute to the dietary intake of middle- and older-aged adult residents of Beaver Dam, Wisconsin.

Intake of macronutrients and micronutrients was estimated from a diet history questionnaire in a population-based sample of persons (n = 2152), 43-86 y of age. Men and women 65 y of age or older consumed less protein, fat, cholesterol, niacin, riboflavin, calcium, iron, zinc and lycopene than their middle-aged counterparts. After including nutrient intake from supplements, age differences in intake were no longer significant for zinc in women or for niacin and iron in men. After further adjusting for energy intake, only protein, cholesterol, and lycopene mean intakes were lower in older compared with middle-aged men and women. Regular use of supplements was most prevalent among older men and women (40 and 48%, respectively). Supplement use was greater in the current time period compared with retrospective reports of supplement use 10 y before interview. The impact of supplement intake on median values of intake was greatest in women, particularly for vitamins A, C and E, riboflavin and calcium. The high prevalence of supplement use emphasizes the importance of considering this source of nutrients in future investigations in which dietary intake is measured.

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PubMed1993

A diet history questionnaire ranks nutrient intakes in middle-aged and older men and women similarly to multiple food records.

We evaluated the reproducibility of a modified version of the National Cancer Institute diet history questionnaire and also studied comparability of nutrient estimates from this questionnaire to those from four 2-d food records. Subjects (n = 211) were from a population-based sample of middle-aged and older adults participating in the Beaver Dam Eye Study in south-central Wisconsin. Median age-specific correlation coefficients between the questionnaire, administered twice at a 3-mo interval, were 0.8 in men and 0.7 in women (range = 0.5 to 0.9). Questionnaire estimates of protein, cholesterol, thiamin, niacin, iron and zinc were consistently lower than food record estimates whereas estimates of fat were higher. Correlation coefficients between estimates from the questionnaire and records were generally > 0.5, indicating overall good agreement in ranking. However, the range in correlation coefficients was wide [ranging from 0.06 for iron (without supplements) in middle-aged women to 0.8 for alcohol in middle-aged men and women]. Questionnaire estimates similarly classified persons into the lowest two food record quintiles of intake 50 to 93% of the time depending on nutrient. These results suggest that the questionnaire produces nutrient estimates that rank individuals on the basis of intake of most nutrients similarly to estimates from multiple food records.

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PubMed1993

Diagnostic x-ray exposure and lens opacities: the Beaver Dam Eye Study.

The Beaver Dam Eye Study is a population-based study of common age-related eye diseases. During the standardized medical history, the 4926 subjects were asked whether they had ever had a chest x-ray, computerized axial tomography (CAT) scan of the head, other x-rays of the head, x-rays of the abdomen, or other diagnostic x-rays. The eye examination included photographs of the lenses of the eyes, which were subsequently graded according to protocol. Nuclear sclerosis and posterior subcapsular opacity were significantly associated with CAT scans. If these relationships are causal, it would highlight the importance of minimizing such exposure to the lens of the eye.

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PubMed1993

Incidence of gross proteinuria in older-onset diabetes. A population-based perspective.

A few population-based studies describe the incidence of gross proteinuria in people with diabetes. We performed a population-based study in southern Wisconsin of diabetic individuals diagnosed at > or = 30 yr of age either taking insulin (n = 398) or not taking insulin (n = 441). The presence of gross proteinuria (> or = 0.3 g/L) was determined by means of a reagent strip. The incidence of proteinuria in the 4-yr interval was 17.3% (95% CI 13.6-21.0) in those taking insulin and 10.7% (95% CI 7.8-13.6) in those not taking insulin. The relative risk of developing proteinuria for those in the highest level of total pack-yr smoked compared with those who had never smoked was 2.0 (95% CI 1.2-3.3) for those taking insulin and 2.5 (95% CI 1.3-4.5) for those not taking insulin. After controlling for other risk variables, the incidence of gross proteinuria was also associated with higher GHb. These data suggest that smoking and glycemic control, both potentially modifiable factors, are significant risk factors for the development of gross proteinuria.

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