Biomedical subjects

C F Finch

Publications and source records attributed to C F Finch.

66 records · Page 4Linked to original sources

PubMed1992

Hemodynamic and liver function predictors of serum hyaluronan in alcoholic liver disease.

To define hepatic predictors of serum hyaluronan in patients with chronic liver disease, 62 patients with alcoholic liver disease were evaluated. In group 1, 30 patients had concurrent assessment of serum hyaluronan, liver function tests, Pugh grade and hemodynamic indices. A second, overlapping group of 42 patients (group 2) also had antipyrine clearance measured but without hemodynamic assessment. All but six patients had elevated serum hyaluronan levels. In both groups, serum hyaluronan levels differed between Pugh grades and, in each group, was significantly greater in Pugh grade C compared with those in Pugh grade A (p less than 0.05, Kruskal-Wallis test). When analyzed by correlation, serum hyaluronan was significantly associated with several indices in group 1, but on multivariate linear regression only three statistically independent predictors of serum hyaluronan were identified: serum albumin (p = 0.008), indocyanine green clearance (p = 0.024) and indocyanine green extraction (p = 0.036). The overall R2 for these correlates was 65%. In the second group, antipyrine clearance was not significantly associated with serum hyaluronan (r = 0.29, p = 0.06), but other associations were similar to the first group. On multivariate analysis, only serum albumin predicted serum hyaluronan (p less than 0.001; R2 = 43%). In conclusion, indices of hepatocyte synthetic function, sinusoidal blood flow and degree of intrahepatic shunting are independent predictors of serum hyaluronan in alcoholic liver disease. These data show the unique nature of serum hyaluronan and suggest its potential application to the assessment of acute hemodynamic changes in patients with liver disease.

Adult↗

PubMed1992

Neoplasia and hyperplasia of large bowel: focal lesions in an abnormal epithelium.

Expression of brush border hydrolases can reflect the state of differentiation of an epithelium. To determine if expression of these enzymes is disordered in patients with neoplastic or hyperplastic lesions, the activities of alkaline phosphatase, maltase, and dipeptidyl peptidase IV were measured spectrophotometrically in colonoscopic biopsies from the proximal and distal colon and rectum in 50 controls, 17 patients with large bowel adenomas, 29 with carcinoma, and 9 with hyperplastic polyps. In normal controls, a descending cecorectal gradient of alkaline phosphatase activities and an ascending gradient of maltase activities were seen (P < 0.001). Though regional patterns of expression were generally preserved in disease groups, there were significant differences of activities across patient groups for alkaline phosphatase (greater in cancer, adenoma, and hyperplastic groups than in normals; P < 0.05) and for dipeptidyl peptidase IV (greater in hyperplastic polyp group than normals, greater in adenoma than cancer group; P < 0.05). Compared with normal controls, abnormalities of site-specific activities were confined to the rectum in patients with adenoma (maltase decreased, P = 0.02; dipeptidyl peptidase IV increased, P < 0.01) or with carcinoma (alkaline phosphatase increased, P = 0.03) but dipeptidyl peptidase IV activities were increased in all regions in bowels bearing hyperplastic polyps (P < 0.01). These data suggest that neoplastic and hyperplastic lesions, while focal in nature, occur in large bowel epithelium, which is diffusely abnormal in terms of its expression of these enzymes.

Adenoma↗

PubMed1991

Decline in incidence of epidemic glucose intolerance in Nauruans: implications for the "thrifty genotype".

Trends in the prevalence and incidence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance were studied in Micronesian Nauruans aged 20 years and above, by linking glucose tolerance data collected during population surveys performed in 1975/1976, 1982, and 1987. Based on World Health Organization criteria, the age-standardized prevalence of non-insulin-dependent diabetes mellitus has remained relatively constant (24.0% in 1987), but the prevalence of impaired glucose tolerance has decreased significantly from 21.1% (95% confidence interval (CI) 17.0-25.3) in 1975/1976 to 8.7% (95% CI 7.1-10.3) in 1987. Between the periods 1975/1976-1982 and 1982-1987, the incidence of progression from normal glucose tolerance to either impaired glucose tolerance (incidence rate ratio (IRR) = 0.55, p less than 0.01) or non-insulin-dependent diabetes (IRR = 0.46, p less than 0.05) has decreased dramatically, while progression from impaired glucose tolerance to non-insulin-dependent diabetes has increased (IRR = 1.23). The overall age-standardized incidence of non-insulin-dependent diabetes has declined from 26.2 cases/1,000 person-years in 1975/1976-1982 to 22.5 cases/1,000 person-years in 1982-1987. As there were no changes in the frequency of recognized risk factors, the decline in incidence of glucose intolerance is probably due to the intensity of the epidemic in Nauru, which has already removed a high proportion of the genetically susceptible individuals from the pool with normal glucose tolerance. Coupled with the observations that mortality is higher and fertility lower in diabetic Nauruans across the age range, the observed decline in the incidence and prevalence of non-insulin-dependent diabetes mellitus and impaired glucose tolerance may presage a fall in the population frequency of the diabetic genotype, at least in its more severe form, as might be predicted on the basis of Neel's "thrifty genotype" hypothesis.

Adult↗

PubMed1991

An overview of retrospective case-control studies investigating the relationship between prone sleeping position and SIDS.

A critical overview of 19 case-control studies that have investigated the relationship between prone sleeping position and sudden infant death syndrome (SIDS) is presented. Issues relating to the non-comparability of the studies are described in terms of: (i) case definition; (ii) selection of controls; (iii) quality of the sleeping position data; (iv) recall bias; and (v) adjustment for confounding factors. All studies showed a positive association (2 out of the 19 studies were not significant) between prone sleeping position and SIDS. Meta-analysis techniques applied to six of these studies, based on 'usual' sleeping position in cases and population representative controls, has confirmed an overall higher risk of SIDS in infants who usually sleep prone. The most common odds ratio for an association between prone sleeping position and SIDS was 2.72 (95% confidence interval 2.27-3.26). The extent to which the methodological problems of retrospective case-control studies interfere with our interpretations of this association are discussed.

Bias↗

PubMed1991

Abdominal obesity and physical inactivity as risk factors for NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians.

OBJECTIVE: We wanted to determine whether obesity, abdominal fat distribution, and physical inactivity act similarly and independently as risk factors for noninsulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) in Hindu and Muslim Asian Indians, African-origin Creoles, and Chinese Mauritians. RESEARCH DESIGN AND METHODS: We examined a population-based random cluster sample of 5080 adult subjects from the Indian Ocean island of Mauritius. Glucose tolerance was assessed with a 75-g oral glucose tolerance test and World Health Organization criteria. RESULTS: Univariate data and multiple logistic regression models indicated that age, family history of diabetes, body mass index (BMI), waist-hip ratio (WHR), and physical inactivity conveyed similar risk for NIDDM (and IGT) in each ethnic group. After adjusting for all other factors, Hindu ethnicity conferred additional risk for NIDDM (but not IGT) in men, but in women there were no clear ethnic differences. Although BMI and WHR were independently significant risk factors, WHR conveyed relatively stronger risk for NIDDM than BMI in women, whereas the converse was true in men. For ethnic groups combined, the independent odds ratios for IGT associated with moderate and low physical activity scores (relative to high) were 1.56 and 1.71 (P less than 0.05), respectively, in men and 1.32 and 1.69 (P less than 0.05) in women. In subjects with asymptomatic NIDDM diagnosed during the survey, the independent odds ratios were 1.96 and 2.00 (P less than 0.05) in men and 1.73 and 2.70 (P less than 0.05) in women. CONCLUSIONS: These data indicate that BMI, abdominally distributed fat, and physical inactivity are important independent risk factors for both IGT and NIDDM in diverse ethnic groups. Attributable risk fractions for Mauritius suggest that populationwide modification of levels of these risk factors could potentially result in substantially lower occurrence of NIDDM (and IGT). Such interventions should be attempted in high-risk populations.

Activities of Daily Living↗

PubMed1990

Quantifying the extent to which random plasma glucose underestimates diabetes prevalence in the Nauruan population.

The extent to which random plasma glucose levels underestimate the true prevalence of diabetes has been determined in Micronesian Nauruans. In 337 individuals who were screened on the basis of their random plasma glucose levels, the age-standardised prevalence based on a cut-off of 11.1 mmol/l underestimated the population prevalence based on a complete oral glucose tolerance test by 42% in males and 63% in females. At a cut-off level of 7.8 mmol/l the true age-standardised prevalence was underestimated by 16 and 38%, in males and females, respectively. The use of random plasma glucose concentrations to determine the prevalence of diabetes, as currently defined, seems inappropriate. Performing oral glucose tolerance tests on smaller representative population samples should provide more accurate data at less expense than through large-scale screening utilizing random glucose levels.

Adult↗

PubMed1990

An inconsistent relationship between insulin and blood pressure in three Pacific island populations.

The evidence linking insulin to blood pressure is controversial, and results for groups similarly categorized by body mass, glucose tolerance and hypertensive status are often contradictory. We have investigated the relationship in three population-based samples of Micronesian (Nauru), Polynesian (Western Samoa) and Melanesian (New Caledonia) Pacific islanders, who are known to be susceptible to obesity, non-insulin-dependent diabetes mellitus (NIDDM), hyperinsulinaemia and hypertension. After controlling for age and body mass index (BMI), mean fasting and 2-hr (post 75 g glucose) insulin levels were not significantly different between hypertensive and non-hypertensive subjects, in any population or glucose tolerance sub-group, excepting 2-hr insulin in New Caledonians with normal glucose tolerance. Similarly, there were no strong trends for a higher prevalence of hypertension amongst those with insulin levels in the upper quartile of the distribution of each population, although it was apparent in some BMI/glucose tolerance sub-groups of two populations. Multiple linear regression analyses also showed an inconsistent and where present, weak, independent association between insulin and blood pressure in models predicting both systolic and diastolic blood pressure. We therefore conclude that the hypothesis implicating insulin as a major determinant of blood pressure and as the pathophysiological link between obesity, NIDDM and hypertension is not strongly supported either by the literature or the present data.

Adult↗

PubMed1990

Determining diabetes prevalence: a rational basis for the use of fasting plasma glucose concentrations?

The World Health Organization and the National Diabetes Data Group each recommend a diagnostic cut-off point for diabetes of 7.8 mmol l-1 for fasting plasma glucose concentrations as part of the diagnostic criteria for epidemiological studies. However, this cut-off has been shown to be insensitive compared with a screening test based on 2-h plasma glucose levels. In thirteen Pacific populations, from four ethnic groups (Asian Indian, Melanesian, Micronesian, and Polynesian), we have examined whether a different cut-off point for fasting plasma glucose would be more accurate for obtaining an estimate of the prevalence of diabetes when compared with 2-h levels. A fasting plasma glucose diagnostic cut-off of 7.0 mmol l-1 gave an estimate of prevalence not significantly different from that based on the 2-h plasma glucose in 12 of the 13 populations (mean difference 0.27, range -1.51 to +2.44,%). On the other hand, when a cut-off of 7.8 mmol l-1 for fasting plasma glucose was used, the resulting prevalence over-estimated the 2-h glucose prevalence in all populations (mean difference 1.91, range 0.14-5.80,%). Thus for Pacific populations, a fasting plasma glucose cut-off of 7.0 mmol l-1 provides estimates of prevalence that are equivalent to those based on 2-h plasma glucose levels. In epidemiological studies designed to estimate diabetes prevalence, we recommend use of a fasting plasma glucose cut-off of 7.0 mmol l-1 in preference to a detection level of 7.8 mmol l-1, if glucose loading is not possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

High prevalence of NIDDM and impaired glucose tolerance in Indian, Creole, and Chinese Mauritians. Mauritius Noncommunicable Disease Study Group.

Mauritius, a multiethnic island nation in the southwestern Indian Ocean, has one of the world's highest diabetes mortality rates. The prevalence of both impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) was investigated in 5080 Muslim and Hindu Indian, Creole (mixed African, European, and Indian origin), and Chinese Mauritian adults aged 25-74 yr who were selected by random cluster sampling. Based on a 75-g oral glucose tolerance test and World Health Organization criteria, the age-standardized prevalence of IGT was significantly greater in women (19.7%, 95% confidence interval [CI] 18.1-21.2) than in men (11.7%, CI 10.5-12.8). By contrast, the prevalence of NIDDM was similar in men (12.1%, CI 10.9-13.4) and women (11.7%, CI 10.5-12.8) for all ethnic groups combined. The sex difference in IGT prevalence was seen in all ethnic groups, but for NIDDM, the sex difference was not consistent across ethnic groups. However, age- and sex-standardized prevalence of IGT and NIDDM was remarkably similar across ethnic groups (16.2 and 12.4% in Hindu Indians, 15.3 and 13.3% in Muslim Indians, 17.5 and 10.4% in Creoles, and 16.6 and 11.9% in Chinese, respectively). Three new cases of diabetes were diagnosed for every two known cases. The high prevalence of abnormal glucose tolerance in Indian subjects is consistent with studies of other migrant Indian communities, but the findings in Creole and, in particular, Chinese subjects are unexpected. Potent environmental factors shared between ethnic groups in Mauritius may be responsible for the epidemic of glucose intolerance.

Adult↗

PubMed1989

Performance of 'Micro-Bumintest' tablets for detection of microalbuminuria in Nauruans.

Subclinical elevation of urinary albumin excretion (microalbuminuria) is useful for the detection of individuals at high risk of developing nephropathy in both insulin-dependent and non-insulin-dependent diabetes mellitus. We have evaluated the performance of Micro-Bumintest, a semi-quantitative test for the rapid detection of microalbuminuria. A total of 1186 samples from a population-based survey of the high diabetes prevalence community of Nauru were studied. Compared with a radioimmunoassay method, the Micro-Bumintest had a sensitivity of 97.6%, specificity of 93.2% and overall efficiency of 94.8%, when 40 micrograms/ml was used as the discriminating albumin concentration defining microalbuminuria. Significant differences in radioimmunoassay results between categories of the Micro-Bumintest were found, indicating its usefulness as a semi-quantitative test. Compared with subjects with normal glucose tolerance, there was a statistically significant progressive increase in the prevalence of microalbuminuria as detected by Micro-Bumintest in subjects with impaired glucose tolerance and diabetes mellitus. Micro-Bumintest performs well as a screening test for detection of microalbuminuria not only in the clinical situation, but also in population-based epidemiological studies.

Adult↗

PubMed1989

Prevalence and risk factors for micro- and macroalbuminuria in diabetic subjects and entire population of Nauru.

Rates of elevated urinary albumin concentration, defined as microalbuminuria (30-299 micrograms/ml) and macroalbuminuria (greater than or equal to 300 micrograms/ml), were determined on random morning urine specimens in the population of Nauru, which has a high prevalence of non-insulin-dependent diabetes mellitus. The prevalence of elevated urinary albumin levels in the total Nauruan population was very high: 26 and 30% of men and women, respectively, had microalbuminuria, whereas 13% of both sexes had macroalbuminuria. Of the subjects with macroalbuminuria, 66% had diabetes. The prevalence increased with worsening glucose tolerance; 26% of subjects with normal glucose tolerance had either micro- or macroalbuminuria, increasing to 43% of subjects with impaired glucose tolerance, 63% of newly diagnosed diabetic subjects, and 75% of previously diagnosed diabetic subjects. Associations between elevated urinary albumin concentration and putative risk factors were assessed for both the total population (n = 1184) and the diabetic subgroup alone (n = 318). Fasting plasma glucose and hypertension were the most important independent correlates for the whole population, whereas plasma creatinine was also important in diabetic subjects. Age at onset and duration of diabetes were not found to be significantly associated with elevated albumin concentration. In subjects with normal glucose tolerance, hypertension and hyperuricemia were the most important associated factors. These results suggest that blood glucose, blood pressure, and possibly obesity and plasma uric acid are important modifiable risk factors for both micro- and macroalbuminuria in this population.

Adult↗

PubMed1988

Mortality from diabetes in Nauru. Results of 4-yr follow-up.

A population survey in 1982 confirmed that Nauruan adults suffer from an extremely high prevalence (24%) of non-insulin-dependent diabetes mellitus. A follow-up study of the survey subjects was conducted in 1986. The aim was to assess the burden of diabetes to Nauruans in terms of premature mortality. Age-adjusted mortality rates for diabetic subjects were significantly increased when compared with normal subjects (relative risks for 4-yr mortality were 4.53 in men, P less than .01, and 3.96 in women, P less than .05). Although there was an excess number of deaths among diabetic subjects compared with normal subjects and subjects with impaired glucose tolerance, there was no significant association between cause of death and diabetes.

Adult↗