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Biomedical subjects

D F Williamson

Publications and source records attributed to D F Williamson.

At least 19 recordsLinked to original sources
PubMed1992

Weight loss and mortality in a national cohort of adults, 1971-1987.

Although obesity is a risk factor for mortality, evidence that weight loss improves survival is limited. The relation between self-reported previous maximum weight, weight loss, and subsequent mortality was examined in 2,140 men and 2,550 women aged 45-74 years who participated in the First National Health and Nutrition Examination Survey (1971-1975) and survived the next 5 years. Vital status was determined through 1987. Among men and women whose maximum body mass index (weight (kg)/height (m)2) was between 26 and 29, risk of death increased with increasing weight loss, after adjustment for age, race, smoking, parity, preexisting illnesses, and maximum body mass index. Subjects who lost 15% or more of their maximum weight had over twice the mortality risk of those who lost less than 5%. At maximum body mass indices of 29 or higher, mortality risk increased with the amount of weight lost in women, but weight loss of 5% to < 15% appeared to lessen mortality risk in men. Generalization from these results is limited by the older age range of the sample and the inability to adequately distinguish voluntary from involuntary weight loss in this study. However, these findings suggest that prevention of severe overweight may be more generally effective than weight loss in reducing obesity-related mortality in the US population.

Aged↗
PubMed1992

Characteristics related to elderly persons' not eating for 1 or more days: implications for meal programs.

We examined how social, economic, location, health, and food need characteristics are related to elderly persons' not eating for 1 or more days. The following variables were positively related to not eating: ethnicity, location, receipt of Medicaid, living alone, health problems, mobility, age less than 80 years, cancer, nausea, difficulty swallowing, diarrhea, loss of appetite, and receipt of food from a food pantry. These results have implications for allocating meal program funds, screening clients, and monitoring whether clients eat regularly.

Activities of Daily Living↗
PubMed1992

Education, race, and high-density lipoprotein cholesterol among US adults.

OBJECTIVES: Although educational achievement is positively related to levels of high-density lipoprotein cholesterol (HDL-C) among White adults, there is an inverse association among Blacks. We assessed whether this interaction could be attributed to differences in the relation of education to correlates of HDL-C. METHODS: Cross-sectional analyses were based on data from 8391 White and 995 Black adults who participated in the Second National Health and Nutrition Examination Survey. RESULTS: Associations between education and HDL-C levels varied from negative (Black men), to nearly nonexistent (White men and Black women), to positive (White women). Mean HDL-C levels were higher among Blacks than among Whites, but differences varied according to educational achievement. Among adults with less than 9 years of education, mean levels were 6 to 10 mg/dL higher among Blacks, but the radical difference was less than 1 mg/dL among adults with at least 16 years of education. About 20% to 40% of these differences could be accounted for by obesity, alcohol consumption, and other characteristics. CONCLUSIONS: Because of the implications for coronary heart disease risk, consideration should be given to behavioral characteristics associated with the interaction between race and educational achievement.

Adult↗
PubMed1992

Weight loss attempts in adults: goals, duration, and rate of weight loss.

OBJECTIVES: Although attempted weight loss is common, little is known about the goals and durations of weight loss attempts and the rates of achieved weight loss in the general population. METHODS: Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14,915 women who reported currently trying to lose weight. RESULTS: Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. CONCLUSIONS: Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States.

Adolescent↗
PubMed1992

Depressive symptoms and weight change in a national cohort of adults.

To assess the influence of depressive symptoms (defined using the CES-D) on weight change, we analysed data from 1794 adults, aged 25-74 years, who participated in the first National Health and Nutrition Examination Survey in 1971-1975 and the National Health Epidemiologic Follow-up Study in 1982-1984. After adjusting for baseline covariates using multiple linear regression, the data show that younger men (< 55 years) who were depressed at baseline gained nearly 3 kg more over the follow-up period than those who were not depressed. Among these younger men, however, education modified the effect of depression on weight change; those with < 12 years of education gained more weight with depression than those with more education (6.2 vs. 1.2 kg, respectively; P < or = 0.01). In contrast, depressed younger women gained slightly less weight than those who were not depressed. Among younger women, education also modified the effects of depression on weight change; those with < 12 years of education gained less weight with depression than those with more education (-3.2 vs. 0.6 kg, respectively; P < or = 0.01). Among older people (> or = 55 years), both men and women who were depressed lost more weight than those who were not depressed. Depression may play a substantial role in the patterns of weight change among adults in the United States. These patterns of weight change may contribute to the adverse health effects associated with depression.

Adult↗
PubMed1992

Self-perceived stress and the risk of peptic ulcer disease. A longitudinal study of US adults.

BACKGROUND: Although many physicians and laypersons believe that stress plays a role in the occurrence of peptic ulcer disease, the importance of stress in the pathogenesis of peptic ulcers remains controversial. METHODS: To investigate the relationship between perceived stress and peptic ulcer disease we used data from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study--a nationally representative cohort study of US adults. This analysis included 4511 persons who had not previously been diagnosed with peptic ulcer disease. RESULTS: At baseline, 68% of the cohort perceived themselves as stressed. During 13 years of follow-up, 208 persons developed ulcers; the cumulative incidence of ulcers was 7.2% for persons who were stressed and 4.0% for persons who were not. After we adjusted for age, sex, education, smoking status, and regular aspirin use, persons who perceived themselves as stressed were 1.8 times more likely to develop ulcers than those who did not (95% confidence interval, 1.3 to 2.5). We also found a graded relationship between the perceived amount of stress and the incidence of peptic ulcers; relative to nonstressed persons, the relative risk of developing an ulcer was 1.4, 1.9, 2.3, 2.4, and 2.9 at five increasing levels of stress. CONCLUSIONS: These findings suggest that persons who perceive their lives as stressful may be at increased risk for the development of peptic ulcer disease.

Adult↗
PubMed1991

Smoking cessation and severity of weight gain in a national cohort.

BACKGROUND: Many believe that the prospect of weight gain discourages smokers from quitting. Accurate estimates of the weight gain related to the cessation of smoking in the general population are not available, however. METHODS: We related changes in body weight to changes in smoking status in adults 25 to 74 years of age who were weighed in the First National Health and Nutrition Examination Survey (NHANES I, 1971 to 1975) and then weighed a second time in the NHANES I Epidemiologic Follow-up Study (1982 to 1984). The cohort included continuing smokers (748 men and 1137 women) and those who had quit smoking for a year or more (409 men and 359 women). RESULTS: The mean weight gain attributable to the cessation of smoking, as adjusted for age, race, level of education, alcohol use, illnesses related to change in weight, base-line weight, and physical activity, was 2.8 kg in men and 3.8 kg in women. Major weight gain (greater than 13 kg) occurred in 9.8 percent of the men and 13.4 percent of the women who quit smoking. The relative risk of major weight gain in those who quit smoking (as compared with those who continued to smoke) was 8.1 (95 percent confidence interval, 4.4 to 14.9) in men and 5.8 (95 percent confidence interval, 3.7 to 9.1) in women, and it remained high regardless of the duration of cessation. For both sexes, blacks, people under the age of 55, and people who smoked 15 cigarettes or more per day were at higher risk of major weight gain after quitting smoking. Although at base line the smokers weighed less than those who had never smoked, they weighed nearly the same at follow-up. CONCLUSIONS: Major weight gain is strongly related to smoking cessation, but it occurs in only a minority of those who stop smoking. Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit. Effective methods of weight control are therefore needed for smokers trying to quit.

Adult↗
PubMed1991

Trends in alcohol consumption by pregnant women. 1985 through 1988.

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.

Adolescent↗
PubMed1991

The 10-y incidence of obesity and major weight gain in black and white US women aged 30-55 y.

Although the prevalence of obesity in US women is well-described, data are limited on the incidence of major weight gain and obesity. We used data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study to estimate the 10-y incidence of major weight gain (greater than or equal to 10 kg) and obesity [body mass index (BMI, in kg/m2) greater than or equal to 29] in a cohort of US women aged 30-55 y (n = 535 blacks and 2976 whites). In women not obese at baseline, blacks were 60% more likely to become obese than whites [incidence in blacks = 15.5%, 95% confidence interval (CI) = 11.2-19.7; incidence in whites = 9.7%, 95% CI = 8.6-10.8]. This higher incidence of obesity in blacks was largely due to their higher average BMI at baseline. The incidence of major weight gain was 50% higher in blacks than in whites (in blacks, 17.3%; 95% CI = 13.6-21.0; in whites, 11.7%; 95% CI = 10.3-13.1). We estimate that in black and white women, respectively, 16% and 12% of coronary heart disease is attributed to major weight gain whereas 35% and 21% is attributed to being obese.

Adult↗
PubMed1991

Is race associated with weight change in US adults after adjustment for income, education, and marital factors?

We examined the 10-y change in body mass index (BMI, in kg/m2) of black and white adults who entered the First National Health and Nutrition Examination Survey Epidemiologic Followup Study at ages 25-44 y. In women the mean change in BMI was greater for blacks than for whites despite multiple adjustments. However, the risk of major weight gain (MWG; BMI change greater than or equal to + 5) was nearly identical in black and white women. Womens' MWG was independently associated with low income [odds ratio (OR) = 1.7] and with becoming married (OR = 1.8). The risk of major weight loss (MWL; BMI change less than or equal to -2.5) was lower in black women than in white women (OR = 0.6). In men mean BMI change, MWG (BMI change greater than or equal to + 4) and MWL (BMI change greater than or equal to -2) were not associated with race, but there were effects associated with low income, low education, and marital changes. Black race does not increase the risk of weight gain; in women it may be associated with a reduced likelihood of weight loss.

Adult↗
PubMed1991

Race and weight change in US women: the roles of socioeconomic and marital status.

BACKGROUND: The prevalence of overweight among Black women in the US is higher than among White women, but the causes are unknown. METHODS: We examined the weight change for 514 Black and 2,770 White women who entered the first Health and Nutrtion Examination Survey (1971-75) at ages 25-44 years and were weighed again a decade later. We used multivariate analyses to estimate the weight-change effectgs associated with race, family income, education, and marital change. RESULTS: After multiple adjustments, Black race, education below college level, and becoming married during the follow-up interval were each independently associated with an increased mean weight change. Using multivariate logistic analyses, Black race was not independently associated with an increased risk of major weight gain (change greater than or equal to +13 kg), but it was associated with a reduced likelihood of major weight loss (change less than or equal to -7 kg) (odds ratio - 0.64 [95% CI -0.41, 0.97])]. Very low family income was independently associated with the likelihood of both major weight gain (OR - 1.71 [95% CI - 1.15, 2.55]) and major weight loss (OR - 1.86 [95% CI - 1.18, 2.95]). CONCLUSIONS: Amont US women, Black race is independently associated with a reduced likelihood of major weight loss, but not with major weight gain. Women at greatest risk of weight gain are those with education below college level, those entering marriage, and those with very low family income.

Adult↗
PubMed1991

Correlates of breast-feeding in a low-income population of whites, blacks, and southeast Asians.

Infant feeding was examined in 492 children in a population-based survey conducted in a low-income, urban county of St Paul, Minn. Of 41 Southeast Asian infants who were foreign born, 93% (38) had been breast-fed compared with 10% (12) of Southeast Asian infants born in the United States (n = 116). Among non-Southeast Asian infants, 73% (173) of whites (n = 237), 63% (27) of blacks (n = 43) and 65% (36) of other ethnic groups (n = 55) had been breast-fed. Among the non-Southeast Asian infants, the initiation of breast-feeding was associated with higher parental education and with being married. Ethnic group, level of poverty, and participation in the Supplemental Food Program for Women, Infants, and Children during pregnancy did not appear to influence the initiation of breast-feeding. The findings indicate a higher incidence of breast-feeding than in previous surveys of low-income black and white women; however, this may reflect the higher educational level of the non-Southeast Asian study population. In contrast, the sharp decline in the incidence of breast-feeding among Southeast Asian infants who were born in the United States compared with those who were foreign born indicates the need for public health approaches to strengthen traditional breast-feeding practices.

Black or African American↗
PubMed1990

Depression and the dynamics of smoking. A national perspective.

Data from multiple studies suggest that depression plays a role in cigarette smoking. To obtain a national perspective on the role of depression in the dynamics of smoking, we analyzed data from the first National Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. We used the Center for Epidemiologic Studies Depression Scale to assess symptoms of depression and used the standard cutoff (score, greater than or equal to 16) for defining persons as depressed. The cross-sectional analysis of the first National Health and Nutrition Examination Survey showed that the prevalence of current smokers increased as the Center for Epidemiologic Studies Depression Scale score increased, whereas the quit ratio (former smokers/ever smokers) decreased as the Center for Epidemiologic Studies Depression Scale score increased. Among the cohort of smokers in the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the estimated incidence of quitting after 9 years of follow-up was 9.9% for depressed smokers and 17.7% for nondepressed smokers. When we adjusted for amount smoked, sex, age, and educational attainment by means of a Cox proportional hazards model, we found that depressed smokers were 40% less likely to have quit compared with nondepressed smokers (relative risk, 0.6). These findings suggest that depression plays an important role in the dynamics of cigarette smoking in the United States.

Adult↗
PubMed1990

The effect of known risk factors on the excess mortality of black adults in the United States.

We compared the mortality rate ratios, before and after adjustment for different risk factors, of black vs white adults in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. For persons 35 to 54 years old, the rate ratio of mortality for blacks vs whites decreased from 2.3 (unadjusted) to 1.9 when adjusted simultaneously for six well-established risk factors (smoking, systolic blood pressure, cholesterol level, body-mass index, alcohol intake, and diabetes) and decreased from 1.9 to 1.4 when adjusted for the six risk factors plus family income. Thus, approximately 31% of the excess mortality can be accounted for by six well-established risk factors and a further 38% by family income. This leaves 31% unexplained. Broader social and health system changes and research targeted at the causes of the mortality gap, coupled with increased efforts aimed at modifiable risk factors, may all be needed for egalitarian goals in health to be realized.

Adult↗
PubMed1990

Identifying the malnourished within Peru: regional variation in the performance of a nutrition indicator.

Malnourished children may also have siblings at increased risk of poor health. Early identification of siblings at risk could lead to timely intervention to prevent the development of malnutrition or other potentially life-threatening events. In a nationwide survey conducted in Peru in 1984, stunting in an older sibling (defined as height/age less than or equal to 3.00 SD of the NCHS/CDC reference median) was evaluated as an indicator for stunting in a target sibling (next youngest) sibling) (n = 3284). The prevalence of stunting was much higher in target siblings who had an older sibling with stunting compared to those whose older sibling was not stunted, with prevalence ratios of 8.5 in Lima, 4.7 in urban areas, and 2.5 in rural areas. Screening indices (sensitivity, specificity, and predictive value positive) also showed marked variation across regions. The variation in this indicator's performance across regions demonstrates the importance of evaluating screening tools within the populations where they will be applied. Regional variations in the performance of malnutrition indicators should be anticipated because malnutrition is the result of a complex, multifactorial process.

Anthropometry↗
PubMed1990

A comparison of alcohol sales data with survey data on self-reported alcohol use in 21 states.

We used data from 21 states that participated in the 1985 Behavioral Risk Factor Surveillance System to compare state-specific per capita self-reported alcohol consumption and the prevalence of three drinking behaviors with state-specific per capita sales. The correlation coefficient for per capita sales and per capita self-reported consumption for the 21 states was 0.81. Per capita sales were also significantly correlated with the prevalence of self-reported heavier drinking, binge drinking, and drinking and driving; the corresponding correlation coefficients were 0.74, 0.59, and 0.51. These findings suggest that states with higher per capita sales of alcohol also have higher rates of self-reported consumption and drinking patterns suggestive of high-risk behavior.

Alcohol Drinking↗
PubMed1990

The contributions of income, education and changing marital status to weight change among US men.

The prevalence of overweight in men varies with socioeconomic and marital status. To explore the origin of these associations, we studied the effects of family income, education, and changing marital status on change in body mass index (BMI, kg/m2) over 10 years in a representative sample of US men. The subjects were 1552 white and black US men who entered the Health and Nutrition Examination Survey-I (in 1971-75) at ages 25-44 and were re-evaluated a decade later (in 1982-84). After adjusting for socio-demographic factors, baseline BMI, smoking and physical activity, the mean 10-year change in BMI was greater for men with 12 years of education (difference = 0.31 BMI units (95 percent CI 0.04-0.59) ) or with less than 12 years (difference 0.58 (0.22-0.94) ) compared with men who studied beyond 12th grade. Ten-year weight changes were also defined categorically as major weight gain (BMI change greater than or equal to +4 units) or major weight loss (BMI change less than or equal to -2 units). By multiple logistic regression analysis, the odds of experiencing major weight gain were independently associated with low family income (odds ratio (OR) = 1.8 (95 percent CI, 1.0-3.3) ) compared with favorable income, and with becoming married (OR = 3.3 (1.7-6.3) ) or remaining unmarried (OR = 2.1 (1.1-4.2) ) compared with men who were consistently married. The risk of major weight loss was independently associated with marriage ending (OR = 1.8 (1.0-3.3) ) or with remaining unmarried (OR = 2.5 (1.3-4.7) ). A US public health strategy for the prevention of men's weight gain should focus on men with little education or low family incomes and those who are unmarried. There may also be a benefit to preventive weight-gain counseling for men as they enter marriage.

Adult↗