Biomedical subjects

D L Wingard

Publications and source records attributed to D L Wingard.

At least 55 records · Page 3Linked to original sources

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.

Aged↗

PubMed1992

Psychosocial and economic factors associated with infant feeding intentions of adolescent mothers.

The infant feeding intentions of 64 primiparous, adolescent females, ages 14-18 years, were studied to assess factors which differentiated those who chose breastfeeding from those who did not. The study population consisted of 43 Hispanic, 9 black, 7 non-Hispanic white, and 5 Filipino or Southeast Asian subjects interviewed after delivery. Among the Hispanics, 31 primarily spoke Spanish, and 12 primarily spoke English. A total of 72% intended to breastfeed, and 22% planned to exclusively formula feed. Those teens who intended to breastfeed were significantly older, more often married, more likely to be Hispanic and Spanish speaking, and less likely to have been in school during the pregnancy. In addition, teens were more likely to choose breastfeeding if they had been breastfed themselves or exposed to other women who breastfed. These data suggest that the younger, non-Hispanic, single teen who is enrolled in school and lacking exposure to breastfeeding is the most in need of breastfeeding-promotion programs.

Adolescent↗

PubMed1992

Increased meal frequency associated with decreased cholesterol concentrations; Rancho Bernardo, CA, 1984-1987.

The hypothesis that meal frequency is associated with plasma cholesterol was tested in a population-based sample of 2034 white men and women aged 50-89 y. Total, low-density-lipoprotein (LDL) and high-density-lipoprotein (HDL) cholesterol and triglycerides were measured after a 12-h fast in a Lipid Research Clinic laboratory and meal frequency was obtained by questionnaire. The age-adjusted total cholesterol concentrations for men and women reporting greater than or equal to 4 meals/d averaged 0.23 mmol/L lower than for those who reported 1-2 meals/d (P = 0.01). Similarly, LDL concentrations were lower in those reporting higher meal frequency (0.16 mmol/L, P = 0.06). These associations persisted after adjustment for smoking, alcohol, waist-to-hip ratio, systolic blood pressure, body mass index, and dietary nutrients. These results suggest that cholesterol reductions might be achieved by modest increases in meal frequency without an increase in caloric intake.

Aged↗

PubMed1992

Employment status and heart disease risk factors in middle-aged women: the Rancho Bernardo Study.

BACKGROUND: In recent years, an increasing number of women have been entering the labor force. It is known that in men, employment is related to heart disease risk, but there are few studies examining this association among women. METHODS: The relation between employment status and heart disease risk factors including lipid and lipoprotein levels, systolic and diastolic blood pressure, fasting and postchallenge plasma glucose and insulin levels, was examined in 242 women aged 40 to 59 years, who were participants in the Rancho Bernardo Heart and Chronic Disease Survey. At the time of a follow-up clinic visit between 1984 and 1987, 46.7% were employed, primarily in managerial positions. RESULTS: Employed women smoked fewer cigarettes, drank less alcohol, and exercised more than unemployed women, but these differences were not statistically significant. After adjustment for covariates, employed women had significantly lower total cholesterol and fasting plasma glucose levels than unemployed women. Differences on other biological variables, although not statistically significant, also favored the employed women. CONCLUSIONS: Results of this study suggest that middle-aged women employed in managerial positions are healthier than unemployed women.

Adult↗

PubMed1991

Sex differences in fasting glycemia as a risk factor for ischemic heart disease death.

The relation between fasting plasma glucose and mortality from ischemic heart disease was examined in a population of 3,458 nondiabetics (aged 40-79 years) in Rancho Bernardo, California, who were free of heart disease at baseline and were followed for an average of 14 years, from 1972 to 1987. A linear increase of age-adjusted ischemic heart disease mortality rates with fasting glucose was observed in men, and a threshold relation at 110 mg/100 ml plasma glucose was observed in women. On the basis of Cox proportional hazards analysis, the observed sex differential in the association between plasma glucose and ischemic heart disease mortality proved to be statistically significant and independent of the effects of age, systolic blood pressure, body mass index, plasma cholesterol, plasma triglyceride, and, in women, estrogen use. In sex-specific multivariate models, interaction terms representing a threshold effect at glucose levels greater than or equal to 110 mg/100 ml were statistically significant in women (p = 0.007), but not in men, and interaction between sex and the glucose threshold term was observed in multivariate analysis of men and women combined (p = 0.07). The authors conclude that sex differences in the effect of fasting glycemia on ischemic heart disease mortality among nondiabetics exist and are unexplained. Elucidation may hold a key to the sex difference in heart disease and the relatively greater importance of diabetes and impaired glucose tolerance as risk factors for ischemic heart disease in women compared with men.

Adult↗

PubMed1991

Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study.

We report here the 14-year sex-specific effect of non-insulin-dependent diabetes mellitus on the risk of fatal ischemic heart disease in a geographically defined population of men and women aged 40 through 79 years. There were 207 men and 127 women who had diabetes at baseline based on medical history or fasting hyperglycemia. They were compared with 2137 adults who had fasting euglycemia and a negative personal and family history of diabetes. The relative hazard of ischemic heart disease death in diabetics vs nondiabetics was 1.8 in men and 3.3 in women, after adjusting for age, and 1.9 and 3.3, respectively, after adjusting for age, systolic blood pressure, cholesterol, body mass index, and cigarette smoking using the Cox regression model. The sex difference in the independent contribution of diabetes to fatal heart disease was largely explained by the persistently more favorable survival rate of women (than men) without diabetes.

Adult↗

PubMed1991

Are insulin and hypertension independently related?

Hyperinsulinemia has been proposed as the common pathogenetic mechanism of obesity, non-insulin-dependent diabetes mellitus, and hypertension. We examined the cross-sectional relationship between fasting and postchallenge insulin levels and hypertensive status in a population-based study of 653 men and 784 women, aged 50 to 93 years, in Rancho Bernardo, California. Hypertensive subjects had slightly but not significantly higher fasting plasma insulin levels than did normotensive subjects, but significantly higher postchallenge insulin levels. After stratification for obesity and glucose intolerance, there was no significant difference between the mean age-adjusted fasting or postchallenge insulin levels of those with and those without hypertension in 12 possible subgroups. Analysis of variance of both fasting and postchallenge insulin levels also failed to reveal a significant relationship between insulin and hypertensive status after adjusting for age, sex, body mass index, and diabetes. The current study does not support the hypothesis that insulin is independently associated with hypertension.

Age Factors↗

PubMed1991

Gender differences in health-related quality of life.

In 1986 the life expectancy at birth was 71.3 years for males and 78.3 years for females--providing a 7-year advantage for women. Although women live longer, it has been reported that they paradoxically experience more physical and psychological illnesses. In this article, we estimate the expected well-years or quality-adjusted life years for men and women in the general population. The data were obtained in a random sample of 1,034 residents of San Diego. The well-life expectancy uses standard life expectancies with adjustments for quality of life. The well-life expectancy for men was 59.8 years; for women, it was 62.7 years. Thus, the quality adjustment had significantly more impact on women (15.6 years) than on men (11.5 years). Age-specific estimates of health-related quality of life suggested a male advantage before age 45 and a female advantage after age 45. The benefits of well-years of life as a public health statistic are discussed.

Adult↗

PubMed1991

Type 2 diabetes and depressive symptoms in older adults: a population-based study.

The prevalence of depressive symptoms and its association with Type 2 (non-insulin-dependent) diabetes was examined in a population-based study of 1586 men and women aged 50 years or older. Men and women with previously diagnosed diabetes had significantly higher mean Beck Depression Inventory total, somatic subscale, and affective subscale scores than normal men and women and individuals with newly diagnosed diabetes. The age- and sex-adjusted rates of Inventory scores of 13 or greater among individuals with previously diagnosed diabetes was 3.7 times greater than the rates among individuals with newly diagnosed diabetes (p less than 0.05). Medication use and fasting plasma glucose were unrelated to symptom score. The number of other chronic conditions and age were significant independent predictors of depressive symptoms in all diabetic men and women. Results suggest that depressive symptoms in individuals with Type 2 diabetes may be related to awareness of diabetic condition in addition to poor health.

Adult↗

PubMed1991

Visual impairment and retinopathy in people with normal glucose tolerance, impaired glucose tolerance, and newly diagnosed NIDDM.

OBJECTIVE: Prevalence rates of visual impairment and retinopathy were compared in 1992 people with normal glucose tolerance, impaired glucose tolerance (IGT), or newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Glucose tolerance status was based on an oral glucose tolerance test after exclusion of those with a history of diabetes and/or diabetes medication use in an upper middle-class community of older white adults in southern California between 1984 and 1987. RESULTS: Although many sex-specific comparisons were made between glucose tolerance groups, only a few emerged as statistically significant. Among those, women with IGT had significantly higher age-adjusted rates of visual impairment (10.8%) than women with normal glucose tolerance (4.4%). Among men, those with IGT had significantly higher age-adjusted rates of visual impairment (7.9%) than men with newly diagnosed NIDDM (4.0%). CONCLUSIONS: Low frequencies of retinopathy were found in all three glucose tolerance groups.

Age Factors↗

PubMed1991

Evaluation of fasting plasma glucose as screening test for NIDDM in older adults. Rancho Bernardo Study.

OBJECTIVE: To examine the efficiency of fasting plasma glucose (FPG) as a screening test for non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH AND METHODS DESIGN: A population-based evaluation was made of FPG as screening test for NIDDM in an upper middle-class white community of Rancho Bernardo, California. NIDDM was defined by 2-h postchallenge plasma glucose (PCPG) level greater than or equal to 11.1 mM, the cutoff point recommended by the World Health Organization. Participants comprised a population-based sample of 1851 men and women 50-79 yr of age that represented 80% of surviving participants surveyed between 1972 and 1974 for the Lipid Research Clinic Prevalence Study. Those with insulin-dependent diabetes were excluded. RESULTS: Analyses were stratified by age after logistic regression indicated that FPG and age (but not gender) were significantly related to probability of disease. As FPG cutoff points increased, sensitivity and percentage of the population to be recalled for confirmation decreased, whereas specificity and positive predictive value increased. Negative predictive value was consistently in the 90% range. Specificity did not change with age. In contrast, at virtually every FPG cutoff point, sensitivity decreased with increasing age. For example, at FPG greater than or equal to 6.7 mM, sensitivity was 65.6% for those 50-64 yr of age and 40.0% for those 65-79 yr of age. At FPG greater than or equal to 7.2 mM, these sensitivities were 46.9 and 28.5%, respectively. Positive predictive value increased with increasing age, reflecting the increasing prevalence of NIDDM with age. CONCLUSIONS: Poorer sensitivity with increasing age reflects the fact that the numerator of the sensitivity equation is not affected by age (mean FPG did not vary significantly between age-groups), whereas the denominator increases with age (mean PCPG increased from 6.6 mM for subjects 50-64 yr of age to 8.2 mM for subjects 65-79 yr of age). Nevertheless, because the clinical significance of increasing PCPG with age in older adults is unknown, age-specific screening criteria probably are not warranted.

Age Factors↗

PubMed1990

A prospective, population-based study of androstenedione, estrogens, and prostatic cancer.

Endogenous androgens have been suggested as determinants of risk of prostatic cancer. To examine this possibility, baseline sex hormone levels were measured in 1008 men ages 40-79 years who had been followed for 14 years. There were 31 incident cases of prostatic cancer and 26 identified from death certificates with unknown dates of diagnosis. In this study, total testosterone, estrone, estradiol, and sex hormone-binding globulin were not related to prostate cancer, but plasma androstenedione showed a positive dose-response gradient. Age-adjusted relative risks of prostatic cancer for low (0-2.2 nM), middle (2.3-3.1 nM), and high (3.2+ nM) tertiles of androstenedione were 1.00, 1.34, and 1.98, respectively (P trend less than 0.05). The linear gradient of risk persisted after adjustment for age and body mass index. If confirmed, these data suggest that androstenedione might increase the occurrence of clinically manifest prostatic cancer.

Adult↗

PubMed1990

Self-reported arthritis among men and women in an adult community.

In the Rancho Bernardo, California population of older adults, the age-adjusted prevalence rate of self-reported arthritis was higher in women than men for all types combined (38.6 vs. 22.3%, p less than 0.05), and for osteoarthritis (18.1 vs 12.9%). Men and women with osteoarthritis and disabling arthritis were significantly more likely to report co-morbid conditions. Women with osteoarthritis were significantly less likely to drink alcohol and more likely to be taking estrogen replacement therapy. At 15 years of follow up, mortality rates were not significantly increased in men or women with arthritis or osteoarthritis compared to those without arthritis.

Activities of Daily Living↗

PubMed1990

The biocultural context of social networks and depression among the elderly.

The association between the size and structure of social networks and the prevalence of depressive symptoms was examined in a population-based study of 1615 men and women age 65 years and older. Age was significantly associated with marital status, social network index quartile, and the social relationship to the primary source of support. Women and men differed with respect to current marital status, number of close friends and relatives, frequency of face-to-face contact, and participation in voluntary associations and religious institutions. Regardless of their marital status, women were also less likely than men to point to a spouse as their primary source of support. Beck Depression Inventory mean scores and rates of depressive symptoms were inversely associated with social network index and participation in voluntary associations and religious institutions for both men and women. Individuals with no primary source of support or who depended on a relative had significantly higher than expected mean scores and rates of depressive symptoms. Both social network index and social distance to primary source of support were independently associated with depression after controlling for age, sex, and number of chronic conditions. Participation in voluntary associations, social distance from primary source of support, church membership, and number of close friends were also significant independent predictors of depressive symptoms. Results indicate that depressive symptoms are inversely associated with the size of social networks. The structure of these networks, in turn, is influenced by biological factors such as age, physical disability, and mortality of network members, and by culturally-determined rules that define the individuals and institutions available for support. However, these rules appear to differ for men and women.

Aged↗

PubMed1990

Chronic illness and depressive symptoms in the elderly: a population-based study.

A cross-sectional study of the distribution of depressive symptoms and association between depressed mood and chronic illness was conducted in a geographically defined population in southern California of 1617 men and women aged 65 years and older. The prevalence of depressed mood for the total population was 5.2%. Women exhibited a significantly higher mean depressive symptom score and a prevalence rate almost twice that of men. Depressive symptoms were associated with several risk factors in both sexes, including age, self-perception of current health status, number of reported chronic diseases and medications and amount of exercise. However, the relationship between physical illness and depressive symptoms appeared to differ by sex with respect to the nature of the disease or disability and the type of medication currently used. These findings indicate that the risk of depression does not diminish with age among the elderly as other studies have suggested.

Age Factors↗

PubMed1990

The relationship between reproductive history and cholecystectomy in older women.

We examined the relationship of reproductive history to cholecystectomy in a population-based sample of 1093 women aged 50 years and older. Number of pregnancies ranged from 0 to 13. Age and obesity were each significantly and independently associated with an increased risk of cholecystectomy. When adjusted for differences in age and obesity, those who had had five or more pregnancies had a significantly increased risk of cholecystectomy. We conclude that an increased risk of gallbladder disease may follow either obesity or multiple pregnancies. One possibly unifying hypothesis for the obesity and pregnancy association is sustained hyperestrogenemia.

Aged↗

PubMed1990

Sex differences in time from self-reported heart trouble to heart disease death in the Alameda County Study. Significance of time dependence of risk variable effects.

In a previous analysis from the Alameda County Study, it was observed that although men had higher heart disease mortality rates than women, there was no male excess in the prevalence of self-reported heart disease morbidity at baseline or in new reports of morbidity 9 years past baseline. This apparent contradiction might occur because women report less severe heart disease than men. In the present study, this hypothesis was evaluated by examining whether self-reported heart trouble was more strongly associated with subsequent heart disease mortality for men than for women in a representative sample of the population of Alameda County, California, selected in 1965 and followed for mortality for 19 years (n = 3,742). In a time-dependent Cox model, self-reported heart trouble was a stronger predictor of heart disease mortality for men, but only during the early years of follow-up (p = 0.00). This effect was due to a shorter time to death for men who reported heart trouble. The relative hazard for men reporting heart trouble was 6.6 (95% confidence interval (CI) 3.7-11.6) at baseline, declining to 3.2 (95% CI 2.2-4.5) by 5 years past baseline and 1.5 (95% CI 0.9-2.5) by 10 years past baseline. Self-reported heart trouble was a consistent predictor of subsequent heart disease mortality for women over the 19-year follow-up period (relative hazard = 2.0, 95% CI 1.4-2.8). Sex differences in the prognosis of self-reported heart trouble were masked in non-time-dependent analyses. These results illustrate that consideration of time dependence may be required for meaningful analysis of long-term cohort studies. Possible explanations of the shorter time to death for men who reported heart trouble are discussed.

Adult↗

PubMed1990

Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a community of older adults.

Cardiovascular disease risk factors were measured 10-15 years (mean, 11.9 years) prior to the diagnosis of impaired glucose tolerance and non-insulin-dependent diabetes mellitus in Rancho Bernardo, California. There were 1,847 men and women aged 40-79 years who had no known diabetes or fasting hyperglycemia at baseline (1972-1974). At the follow-up examination (1984-1987), 1,115 men and women (60.4%) had normal glucose tolerance, 513 (27.8%) had impaired glucose tolerance, and 219 (11.9%) had non-insulin-dependent diabetes mellitus as defined by World Health Organization criteria. Rates of impaired glucose tolerance and non-insulin-dependent diabetes mellitus increased with age, and impaired glucose tolerance was approximately twice as common as non-insulin-dependent diabetes mellitus. Those with non-insulin-dependent diabetes mellitus were older and more overweight and had higher levels of blood pressure, fasting plasma glucose, and triglyceride at baseline than those whose glucose tolerance remained normal; those with impaired glucose tolerance generally had intermediate levels of the same risk factors. When it was examined in a prospective fashion, in general, the age-adjusted risk of non-insulin-dependent diabetes mellitus increased with increasing quartile of each risk factor, and the risk of non-insulin-dependent diabetes mellitus in a given quartile was greater than that for impaired glucose tolerance. Logistic regression analyses showed these factors to be positively associated with a subsequent diagnosis of impaired glucose tolerance as well as non-insulin-dependent diabetes mellitus in women, and to a lesser degree in men, independent of baseline age and body mass index (weight (kg)/height (m)2). These data illustrate that a less favorable cardiovascular risk factor profile precedes the diagnosis of both non-insulin-dependent diabetes mellitus and impaired glucose tolerance.

Adult↗