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Biomedical subjects

D Kritz-Silverstein

Publications and source records attributed to D Kritz-Silverstein.

At least 37 records · Page 2Linked to original sources
PubMed1997

Effect of postmenopausal hormone therapy on body weight and waist and hip girths. Postmenopausal Estrogen-Progestin Interventions Study Investigators.

Reports from cross-sectional comparisons, nonrandomized prospective studies, and relatively small clinical trials indicate that postmenopausal hormone therapy may slightly decrease the amount of weight typically gained by women during the decade following menopause. Despite this, widespread belief remains that hormone therapy may cause weight gain. We use data from the Postmenopausal Estrogen/Progestin Interventions trial to characterize the impact of postmenopausal hormone therapy on weight and fat distribution and to examine the consistency of this impact among subgroups of women defined by lifestyle, clinical, and demographic factors. The Postmenopausal Estrogen/Progestin Interventions trial was a 3-yr, placebo-controlled, randomized clinical trial of 875 women assessing the effects on cardiovascular risk factors of four hormone regimens: oral conjugated equine estrogen (CEE) therapy (0.625 mg daily alone), CEE in combination with medroxyprogesterone acetate (2.5 mg daily), CEE in combination with medroxyprogesterone acetate (10 mg daily on days 1-12), and CEE in combination with micronized progesterone (200 mg daily on days 1-12). Women randomly assigned to CEE with or without a progestational agent averaged 1.0 kg less weight gain at the end of 3 yr (P = 0.006) than those assigned to placebo. Assignment to CEE was also associated with averages of 1.2 cm less increase in waist girth (P = 0.01) and 0.3 cm less increase in hip (P = 0.07) girth. In regression models that included weight change as a covariate, none of these differences reached statistical significance. There were no significant differences in weight or girth changes among any of the four active hormone regimens. After accounting for the effects of assignment to active hormone therapy and baseline weight, older age (P 0.008) and higher physical activity level at baseline (P = 0.002) were also independently predictive of less weight gain. The impact of hormone therapy on weight gain was similar among subgroups, except for those defined by baseline smoking status (P = 0.04) and physical activity level at home (P = 0.02). Factors that were independently associated with smaller increases in girths were: for waist, greater overall activity (P = 0.005) and Hispanic ethnicity (P = 0.02); and for hip, work activity (P = 0.003) and greater alcohol consumption (P = 0.03). None of these factors significantly affected the observed overall relationships between estrogen and changes in girth.

Animals↗
PubMed1997

Hysterectomy, oophorectomy, and heart disease risk factors in older women.

OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.

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PubMed1996

Long-term postmenopausal hormone use, obesity, and fat distribution in older women.

OBJECTIVE: To determine whether long-term postmenopausal hormone replacement is associated with measures of obesity and body composition in elderly women. DESIGN: A 15-year prospective and cross-sectional cohort study. SETTING: Rancho Bernardo, a geographically defined community in Southern California. PARTICIPANTS: A total of 671 women aged 65 to 94 years, who were initially enrolled in the Rancho Bernardo Study between 1972 and 1974 and participated in a 1988 to 1991 follow-up clinic visit. These women had never used hormone replacement therapy (n = 194), used hormones intermittently (n = 331), or used hormones continuously (n = 146) for the 15 years between baseline and follow-up. MAIN OUTCOME MEASURES: Height and weight were obtained at both clinic visits; differences in body mass index (BMI) between baseline and follow-up were computed. At follow-up, waist and hip circumferences and bioelectric impedance were measured. RESULTS: Age-adjusted comparisons indicated intermittent and continuous hormone users had significantly lower mean BMIs at baseline than women who had never used hormone replacement therapy. After adjustment for potentially confounding covariates, there were no significant differences between estrogen users and nonusers in BMI at follow-up, change in weight or BMI between baseline and follow-up, or waist-hip ratio or fat mass at follow-up. CONCLUSION: Hormone replacement therapy, whether used intermittently or continuously for 15 or more years, is not associated with the weight gain and central obesity that is commonly observed in postmenopausal women.

Adipose Tissue↗
PubMed1996

Does hyperinsulinemia preserve bone?

OBJECTIVE: Obesity and NIDDM are each associated with increased bone mineral density (BMD). We therefore hypothesize that hyperinsulinemia is an osteogenic factor. RESEARCH DESIGN AND METHODS: Subjects consisted of 411 men and 559 women aged 50-89 years who were participants in the Rancho Bernardo Heart and Chronic Disease Study and were not diabetic by history or oral glucose tolerance test. Fasting and 2-h postchallenge insulin were measured by radioimmunoassay. Bone mineral density was measured at the midshaft radius with single photon absorptiometry and at the lumbar spine and hip with dual energy X-ray absorptiometry. RESULTS: Multiple regression analyses indicated that among men, a significant insulin-BMD association at the hip was no longer apparent after adjusting for covariates. Among women, fasting insulin was significantly and positively associated with bone density of the radius and spine (P < 0.05), independent of age, BMI, waist-hip ratio, postmenopausal estrogen use, age at menopause, thiazide use, family history of diabetes, current cigarette smoking, and exercise. Each 10 microU/ml increase in fasting insulin was associated with an increase of 0.33 and 0.57 g/cm2 of the radius and spine, respectively. CONCLUSIONS: Hyperinsulinemia may be responsible for part of the observed association of both diabetes and obesity with BMD in women.

Age Factors↗
PubMed1996

Factors associated with glucose and insulin levels in healthy postmenopausal women.

OBJECTIVE: Little is known about the covariates of hyperglycemia and hyperinsulinemia. We examined candidate factors in postmenopausal women. RESEARCH DESIGN AND METHODS: We determined the cross-sectional associations of sociodemographic, body-size, lifestyle, reproductive, and menopausal factors with pretrial fasting and postchallenge glucose and insulin levels in 869 postmenopausal women aged 45-65 years. Women were participants in the Postmenopausal Estrogen/Progestin Interventions study who were not taking estrogen or insulin. RESULTS: Plasma glucose levels increased significantly with age; serum insulin levels did not. BMI and waist-to-hip ratio (WHR) each showed graded positive and independent associations with glucose and insulin levels. Alcohol intake, cigarette smoking, physical activity, parity, education, and income were also associated with insulin or glucose in age-adjusted models. In multivariable models, BMI and WHR explained 18% of the variability in fasting glucose, 16% in postchallenge glucose, 28% in fasting insulin, and 17% in postchallenge insulin. Age and all other factors combined accounted for < 6% of the variance in glucose or insulin. In multiply adjusted models, African-American and Hispanic women had higher fasting and 2-h insulin levels than non-Hispanic white women. CONCLUSIONS: Most of the variance in glycemia and insulin is unexplained. Measures of obesity and fat distribution account for nearly all the explained variance.

Aged↗
PubMed1995

A community-based study of menopause symptoms and estrogen replacement in older women.

This study examines the symptoms after a natural menopause recalled by women aged 50-89 years. We determined the frequency and clustering of symptoms, the effect of age on symptoms, and the relation of symptoms to the use of estrogen therapy in a cross-sectional, community-based study of 589 Caucasian, middle- to upper-middle-class women from Rancho Bernardo, California. At the time of menopause, 55% of the women reported that they felt life was getting better and 57% were more cheerful. The most frequently recalled symptoms were hot flushes (74%), propensity to weight gain (45%), night sweats (35%), tiredness (32%), and insomnia (28%). Irritability was reported by one-fourth, depression by one-fifth. Nearly 11% reported anxiety about looking older. The recalled prevalence of hot flushes, irritability, weepiness and tiredness did not vary by current age, but younger women were significantly more likely than older women to have experienced night sweats, visible flushes, depression, anxiety about looking older and insomnia. Principal components factor analysis yielded four main independent factors: psychological symptoms (21% of the variance), vasomotor symptoms (14%), positive feelings (11%), and negative self-image (8%). The four symptom groupings suggest different causal mechanisms. Forty-two percent reported past, and 27% reported current use of estrogen therapy. Both past and current hormone users were significantly more likely to report menopause symptoms than non-users. Estrogen use was not associated with positive feelings or self-image at the time of menopause. Although three-quarters experienced symptoms, the majority of women reported positive feelings about menopause.

Aged↗
PubMed1994

Relation of pregnancy history to insulin levels in older, nondiabetic women.

Pregnancy has been associated with increased risk for diabetes, but an association independent of obesity has been questioned. The hypothesis that the repeated demands of pregnancy lead to reduced sensitivity to insulin and hyperinsulinemia was tested by examining the relation of pregnancy history to fasting and postchallenge insulin levels and insulin sensitivity in 764 Caucasian, nondiabetic women aged 50-89 years from the Rancho Bernardo cohort. Between 1984 and 1987, an oral glucose tolerance test was administered, fasting and postchallenge levels of glucose and insulin were measured, and an index of insulin sensitivity was calculated. After adjustment for covariates, an increased number of pregnancies was associated with increased fasting insulin (p < 0.05) and decreased insulin sensitivity (p < 0.05). Postchallenge insulin was unrelated to pregnancy history. Obesity and fat distribution were associated with higher fasting and postchallenge insulin levels and lower insulin sensitivity (ps < 0.001), but did not explain the associations between pregnancy history and insulin or insulin sensitivity. Analyses restricted to women with normal glucose tolerance yielded similar results. Thus, there is a small, but significant increase in fasting insulin and a decrease in insulin sensitivity with increasing pregnancies many years after childbearing that is independent of obesity and present even in normoglycemic women. Confirmatory studies using insulin clamp techniques would be of interest.

Aged↗
PubMed1994

Grip strength and bone mineral density in older women.

Most previous literature on muscle strength and bone density examined the association between specific muscle groups and adjacent bones. This study examined the association of grip strength with bone density at distant sites, such as the spine and hip, as well as at the wrist and radius. Subjects were 649 postmenopausal women aged 65 years and older. Bone mineral density was measured at the ultradistal wrist and midshaft radius in the nondominant arm using single-photon absorptiometry and at the lumbar spine and hip using dual-energy x-ray absorptiometry. Grip strength was measured in both the dominant and nondominant hands using a dynamometer. Overweight women had significantly stronger grip strength in both hands (p < 0.01 for dominant hand, p < 0.05 for nondominant hand grip strengths). Exercises had significantly stronger grip strength in the nondominant hand than nonexercisers (p < 0.05). Women reporting arthritis had significantly weaker grip strength in both hands than women not reporting arthritis (p < 0.001). There were no significant differences in grip strength by estrogen use, cigarette smoking, or thiazide use. Regression analyses adjusted for age, obesity, exercise, cigarette smoking, thiazide use, arthritis, years postmenopausal, and estrogen use indicated significant positive associations between grip strength and bone density at all sites. Regression analyses stratified by exercise indicated that only women who exercised had significant associations of grip strength with bone mineral density (all p < 0.05). In this cohort of older women, grip strength was an independent indicator of general bone density.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1994

Family history of osteoporosis and bone mineral density at the axial skeleton: the Rancho Bernardo Study.

To determine whether a family history of osteoporosis identifies individuals with low bone mineral density (BMD), we studied 1477 white elderly (aged 60-89 years), noninstitutionalized ambulatory men (n = 600) and women (n = 877) from the Rancho Bernardo, California cohort. Family history data on biologic parents and full sisters were obtained by questionnaire. BMD of the lumbar spine and hip was measured using dual-energy x-ray absorptiometry. After adjustment for age, body mass index, history of cigarette smoking, thiazide use, and estrogen use, men and women with a family history of osteoporosis had lower BMD than those with a negative family history. In men, a positive family history was associated with lower BMD at the hip (p = 0.01), whereas in women a significant association was observed for the spine (p = 0.02). BMD decreased in a stepwise fashion with an increasing number of family members with a history of osteoporosis. Analysis of the effect of parental history of osteoporosis on BMD showed a significant relation between paternal (but not maternal) history and lumbar spine BMD in both sexes and a significant relation between maternal (but not paternal) history and hip BMD only in men. The relative risk of having categoric osteopenia was highest in those whose fathers had a history of osteoporosis (RR 2.16, 95% CI = 1.38-3.37). A similar association was found for subjects with fractures. These results were not explained by differential awareness of family history in individuals with known osteoporosis, because the prevalence of family history was unrelated to personal history of osteoporosis in men and only weakly related in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1994

Finnmark Heart Study: employment status and parenthood as predictors of psychological health in women, 20-49 years.

This study examined the influence of employment status and presence of young children in the household on psychological health in a population-based sample of 3103 women aged 20-49 years. Women were classified by employment status and parental status, thus creating four groups for comparison. After excluding women reporting chronic diseases and women receiving sickness, rehabilitation, unemployment or disability benefits, analyses indicated that problems of coping, dissatisfaction with life, depression and loneliness were greatest among homemakers, particularly among those with young children. Analyses adjusted for age, education, marital status and place of residence yielded similar results. Stratification by marital status and place of residence revealed two exceptions to this general pattern: unmarried employed women with young children had the highest rate of coping problems--and parenthood, not employment status, was the most important factor for psychological health problems in rural areas. Discrepancies between an individual's behaviour and the norm in society regarding women's employment, may partly explain the findings.

Adaptation, Psychological↗
PubMed1993

Estrogen replacement therapy and cognitive function in older women.

OBJECTIVE: To determine whether replacement estrogen delays or prevents loss of cognitive function in elderly women. DESIGN: A 15-year prospective and cross-sectional study. SETTING: Rancho Bernardo, a geographically defined community in Southern California. PARTICIPANTS: Eight hundred women (80% of local surviving women from the original Rancho Bernardo cohort) aged 65 to 95 years. Estrogen use was evaluated at baseline between 1972 and 1974 and at follow-up between 1988 and 1991. MAIN OUTCOME MEASURES: Twelve tests of cognitive function from eight standard instruments administered at follow-up between 1988 and 1991. RESULTS: Almost half of this older, educated cohort had used estrogen at some time after menopause, and one third were current users. The age-related decrement in cognitive function was similar for women who were current, past, or never users of estrogen. Age- and education-adjusted comparisons also failed to show any consistent association between performance on tests of cognitive function and baseline, past, current, or never estrogen use; estrogen dose; or duration of use. Among 132 statistical comparisons, only five statistically significant differences were observed, less than the number expected by chance alone. Furthermore, these significant differences occurred with different tests of cognitive function, and in only one instance was the better test score associated with current estrogen use. No biases were identified that could explain these negative results. CONCLUSIONS: No compelling or internally consistent evidence for an effect of estrogen on cognitive function was found in these older women. These data do not support the hypothesis that estrogen use after the menopause preserves cognitive function in old age.

Aged↗
PubMed1993

A prospective study of dehydroepiandrosterone sulfate (DHEAS) and bone mineral density in older men and women.

The purpose of this study was to prospectively examine the relation of dehydroepiandrosterone sulfate (DHEAS) to bone mineral density in a community-based sample of 260 men and 162 women who were residents of Rancho Bernardo, California. DHEAS levels had been measured in plasma obtained in 1972-1974 when the men were 50-74 years of age and the women were 55-74. In 1988-1991, bone mineral density was measured at the lumbar spine and hip using dual x-ray absorptiometry, and at the mid-radius and ultradistal radius using single photon absorptiometry. Among men, there was a significant decrease in DHEAS levels and bone mineral density at the hip, ultradistal radius, and midshaft radius with increasing age. However, for both men and women, there was no significant association of DHEAS levels with bone mineral density at any site, both before and after adjustment for age, obesity, cigarette smoking, and use of antihypertensive medications. These data do not support the hypothesis of DHEAS having a causal role in senile osteoporosis.

Absorptiometry, Photon↗
PubMed1993

Effects of age, gender and education on selected neuropsychological tests in an elderly community cohort.

OBJECTIVE: To establish population-based data, with special emphasis on the effects of age, gender, and education, for eight, widely used neuropsychological tests in a community-dwelling cohort of normal and cognitively impaired older adults. DESIGN: A population-based observational study. SETTING: Examinations were performed in a research clinic by specially trained staff during a 1988-1992 evaluation for osteoporosis. PARTICIPANTS: 1,692 community-dwelling subjects, aged 55 to 94 years, who were members of the Rancho Bernardo Heart and Chronic Disease Study initiated in 1972. The mean age for men was 73.9 years (SD 9.3) and for women, 73.5 (SD 9.1). OUTCOME MEASURES: Eight neuropsychological tests were used to measure cognitive functions. Analysis of variance and post hoc contrasts were performed to determine the effects of age, gender, education, and their interactions on performance on these tests. RESULTS: Performance on all tests decreased progressively, without leveling off, from the youngest, age 55, to the oldest, age 94. Women performed better on verbal tasks and men on tests of visuospatial, visuoconceptual, and mental control functions. Performances of men on several tests declined more rapidly with advancing age than those of women. Both men and women with some college education performed better on most tests than men and women with high school educations, and the rate of decline with age was sometimes slower in the college-educated group. Only the savings score from the Visual Reproduction Test, which is a measure of rate of forgetting, and the scores of short-term recall derived from the Selective Reminding Test (Buschke-Fuld) were unaffected by educational attainment. CONCLUSIONS: In a community-dwelling cohort, including normal and cognitively impaired elderly men and women, advancing age is accompanied by decline in cognitive functions as measured by neuropsychological tests. This decline is slower in women and in college-educated subjects. Two cognitive indices were unaffected by education, and these may be especially useful in cross-cultural studies.

Age Factors↗
PubMed1993

Bone mineral density in postmenopausal women as determined by prior oral contraceptive use.

The long-term consequences of prior oral contraceptive use for bone mineral density were examined in 239 postmenopausal women, 35.1% of whom reported prior oral contraceptive use. Women who had used oral contraceptives for 6 or more years had significantly higher bone densities of the lumbar spine and femoral neck, but not of the ultradistal wrist or radius, than women who never used oral contraceptives.

Aged↗
PubMed1993

Early menopause, number of reproductive years, and bone mineral density in postmenopausal women.

OBJECTIVES: Previous studies have reported positive associations of age at menopause with bone density and inverse associations of age at menarche with bone density. This study examined the relationships of early age at menopause and number of reproductive years (defined as age at menopause minus age at menarche) with bone density in postmenopausal women. METHODS: The subjects were 555 women aged 60 to 89 years who had had either natural menopause (n = 391) or hysterectomy with bilateral oophorectomy (n = 164). Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine, and hip. RESULTS: Women who had had early menopause and those with the fewest reproductive years had significantly lower bone density at all sites. After adjustment for covariates, both age at menopause and number of reproductive years had significant positive associations with bone density at every site, and total number of reproductive years explained more of the variance in bone mineral density than did either age at menarche or age at menopause. CONCLUSIONS: Elderly women reporting early menopause or fewer reproductive years have more osteoporosis. The number of reproductive years may be more helpful than age at menopause in identifying women at increased risk of osteoporosis.

Age Factors↗
PubMed1992

Pregnancy and lactation as determinants of bone mineral density in postmenopausal women.

The relation of pregnancy and breast feeding to bone mineral density of the wrist, radius, hip, and spine was examined in a white, upper middle-class, homogeneous sample of 741 postmenopausal women ranging in age from 60 to 89 years. Number of pregnancies ranged from 0 to 14, with a mean of 2.0 pregnancies and 1.5 live births. Almost two thirds of the women who had had a live birth reported breast feeding. Unadjusted comparisons indicated that bone mineral density of the wrist, radius, and hip increased with increasing numbers of pregnancies, and women who had breast-fed had higher bone mineral densities at these sites. However, after adjustment for age or age and body mass index, these associations were no longer significant. Multiple regression analyses adjusted for age, age at menopause, obesity, cigarette smoking, and estrogen and thiazide use also indicated that number of pregnancies and breast feeding were not significantly associated with bone mineral density at any of the four sites measured. Results of the present study suggest that reproductive history and breast feeding are not long-term determinants of bone mineral density.

Age Factors↗
PubMed1992

The relationship between multiparity and lipoprotein levels in older women.

The relation between multiparity and lipid and lipoprotein levels was examined in a sample of 1275 Rancho Bernardo women aged 50-89. Number of pregnancies ranged from 0 to 13 with a mean of 2.1. Pregnancy was unrelated to high density lipoprotein cholesterol level in women with 4 or fewer pregnancies, but women with 5 or more pregnancies had significantly lower levels both before and after adjustment for age, obesity, diabetes, alcohol and cigarette consumption, exercise and estrogen use. After multiple regression analysis, women with 5 or more pregnancies had high density lipoprotein levels that were 4.9 mg/dl lower than women with 4 or fewer pregnancies. No differences in total cholesterol, low density lipoprotein cholesterol or triglyceride levels were observed by number of pregnancies. If confirmed by others, these results suggest that one factor mediating the previously reported relationship between multiparity and cardiovascular disease may be a decreased level of high density lipoprotein cholesterol.

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