Search PubMed⌕ Search

Biomedical subjects

D L Wingard

Publications and source records attributed to D L Wingard.

At least 73 records · Page 4Linked to original sources
PubMed1990

A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus.

The effect of alcohol use on risk of non-insulin-dependent diabetes mellitus was assessed in a defined population. A 24-hour recall of alcohol intake and past-week alcohol intake were obtained by separate interviewers between 1973 and 1975, and responses were coded by the Nutrition Coordinating Center, University of Minnesota. Of the 524 adults aged 30-79 years without diabetes at baseline, 31 men and 44 women were identified as diabetic by means of a glucose tolerance test (World Health Organization criteria) between 1984 and 1987. Men, but not women, who developed diabetes reported significantly more alcohol intake in the past week and in the past 24 hours. The highest rate of diabetes among alcohol users was in heavy drinkers--statistically significant only in men. Alcohol use remained a significant predictor of diabetes in men after adjustment for baseline age, body mass index (weight (kg)/height (m)2), cigarette smoking, family history of diabetes, and systolic blood pressure with a logistic regression model. The relative risk associated with past-week alcohol intake was 1.5 per 137.8 g; for past-24-hour alcohol intake, it was 1.5 per 24.5 g. Adjustment for baseline fasting plasma glucose and triglycerides did not change the results. Alcohol intake appears to be associated with risk of non-insulin-dependent diabetes mellitus in men.

Adult↗
PubMed1990

Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population.

The prevalence of ischemic heart disease (IHD) in older adults by glucose tolerance status was evaluated in 2,223 white men and women, aged 50-89 years, in the Rancho Bernardo cohort who were studied between 1984 and 1987. Impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) were classified according to World Health Organization criteria. End points of ischemic heart disease were defined by Rose Questionnaire and resting electrocardiogram (ECG) according to the Minnesota Code. IHD by electrocardiographic changes was classified as asymptomatic (without history of chest pain or overt IHD) or symptomatic (with history). IHD by all criteria combined was significantly more common in men and women with NIDDM, and in women with IGT, than in those with normal glucose tolerance. The prevalence of myocardial infarction, defined by major Q wave, Rose Questionnaire chest pain criteria, or personal history, was higher in persons with NIDDM than in persons without; the difference was highly significant in women (odds ratio, 2.08 [1.22, 3.56]; p = 0.009). Angina pectoris was not significantly related to NIDDM or IGT in either sex. Electrocardiographic evidence of asymptomatic IHD was significantly more prevalent in both men and women with NIDDM as compared with those with normal glucose tolerance (odds ratios, 1.75 [1.10, 2.81] for men and 1.80 [1.07, 3.01] for women; p less than 0.05). This significant association persisted after excluding persons on digitlis or diuretic therapy and, in women, was also independent of the effect of major known IHD risk factors. These population-based data are consistent with clinical reports suggesting an association of diabetes with silent myocardial infarction or ischemia. The presence of ischemic resting electrocardiographic abnormalities in the asymptomatic diabetic patient is likely to have prognostic and therapeutic implications.

Aged↗
PubMed1990

Nursing home utilization in adults: a prospective population-based study.

Rates of nursing home utilization between 1972 and 1986 were determined for 1,302 men and women living in an upper-middle-class community in Southern California. Leading diagnostic reasons for admission were dementia, cancer, and stroke, and the leading nondiagnostic reason for admission was an inability to carry out activities of daily living. In this cohort, rates of nursing home utilization increased with age. Women at all ages used nursing homes at a higher rate than men, although their probability of survival once admitted was greater. Admission rates were higher over time or prior to death than when observed cross-sectionally. Rates were highest in the year prior to death but declined at time of death.

Adult↗
PubMed1990

Sex-specific vs. unisex body mass indices as predictors of non-insulin dependent diabetes mellitus in older adults.

In order to examine sex differences in the association of obesity with the risk of non-insulin dependent diabetes mellitus (NIDDM) when using the body mass index (BMI), we compared unisex body mass index classifications with sex-specific categories, as defined by the Metropolitan Life Tables, based on their utility in predicting the 12-year incidence of NIDDM in men and women. The present analysis included all 747 men and 969 women from a defined older caucasian population in Rancho Bernardo, California, who were 40 years of age or older at the baseline examination in 1972-1974 and who had complete diabetes-related data available then and between 1984-1987. The 12-year age-adjusted incidence rates for NIDDM increased with increasing BMI among women (all steps significant), but was significantly increased only in the most obese category of men (relative risk (RR) = 2.3, P less than 0.05 for men; RR = 3.8, P less than 0.001 for women). Men and women had nearly identical rates of NIDDM in this obese category. When identical (unisex) BMI cutpoints were used, results were the same; (RR = 2.4, P less than 0.05 for men; RR = 3.1, P less than 0.01 for women). These data indicate that unisex and sex-specific cutpoints for BMI identify the same sex-specific patterns of association between obesity and risk of NIDDM.

Adult↗
PubMed1989

The effect of parity on the later development of non-insulin-dependent diabetes mellitus or impaired glucose tolerance.

To determine the effect of parity on the later development of non-insulin-dependent diabetes mellitus or impaired glucose tolerance, we studied a population-based sample of 1186 women at least 40 years of age; those who had been given a diagnosis of diabetes mellitus before the age of 40 or who had insulin-dependent diabetes mellitus were excluded from the study. On the basis of the World Health Organization's criteria, 714 had normal glucose tolerance, 326 had impaired glucose tolerance, and 146 had non-insulin-dependent diabetes mellitus (NIDDM). After adjustment for age, obesity, and family history of diabetes, increased parity was associated with a significantly increased risk of both NIDDM (odds ratio, 1.16 [95 percent confidence interval, 1.04 to 1.29] per pregnancy) and impaired glucose tolerance (odds ratio 1.10 [95 percent confidence interval, 1.01 to 1.19] per pregnancy). Obesity, whether estimated by means of the body-mass index or the waist-hip ratio, was significantly associated with an increased risk of both NIDDM and impaired glucose tolerance, but this factor did not explain the association between parity and diabetes or impaired glucose tolerance; neither the maximal lifetime body-mass index nor the waist-hip ratio was significantly associated with parity in this cohort. We conclude that there is a slight increase in the risk of NIDDM or impaired glucose tolerance with increasing parity many years after childbearing and that this association is not explained by obesity.

Adult↗
PubMed1989

Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited.

Postmenopausal estrogen use and risk factors for heart disease were assessed in 1057 women, aged 50 to 79 years, who were enrolled in an ongoing study of residents of an upper-middle-class community. From 1984 through 1987, thirty-one percent of the women reported current estrogen use, a rate equivalent to that determined in one survey of the same population done from 1972 through 1974. Compared with nonusers, current users did not have a more favorable cardiac risk factor profile before use, but users were more likely to have had a surgically induced menopause and to have been estrogen users during the survey done from 1972 through 1974. Similar to our earlier findings, current estrogen use was associated with lower weight, diastolic blood pressure, and fasting plasma glucose level than nonuse. Levels of low-density lipoprotein cholesterol were inversely related to estrogen dose; levels of high-density lipoprotein cholesterol were positively related to the duration of use. In this cross-sectional study, blood pressure and lipoprotein and plasma glucose levels were similar in women receiving estrogen alone and in women receiving combination estrogen and progestin therapy.

Age Factors↗
PubMed1989

Heart disease risk factors, diabetes, and prostatic cancer in an adult community.

The authors studied the association between heart disease and prostatic cancer in Rancho Bernardo, California, from August 1972 to June 1987. During a 14-year follow-up of 1,776 men aged 50-84 years, 100 cases of prostatic cancer were identified, of which 54 were incident. Systolic blood pressure, cigarette smoking, and plasma cholesterol levels in cases did not differ from those in noncases. After adjustment for age and on multivariate analysis, incident cases of prostatic cancer had a nonsignificantly higher frequency of reported heart disease at baseline. History of diabetes was inversely associated with total prostatic cancer (age-adjusted estimated relative risk = 0.2, 90% confidence interval: 0.0-0.8; multivariate-adjusted relative risk = 0.3, 90% confidence interval: 0.1-1.0). The association between heart disease and prostatic cancer is compatible with diagnostic detection bias. The inverse association between diabetes and prostatic cancer is compatible with a cancer-promoting role for endogenous testosterone, the level of which is lower in diabetics, or a risk-reducing effect of antidiabetic diet or drug therapy.

Age Factors↗
PubMed1989

Sex differentials in morbidity and mortality risks examined by age and cause in the same cohort.

Many studies indicate that women live longer than men but report more physical illness. This report is the first prospective study of sex ratios for morbidity and mortality due to a variety of causes in a single cohort: a random sample of 5,239 adults, aged 30 years or older in 1965, who have been followed through 1983 (19 years) by cause and age. For both cancer incidence and mortality there was a female excess before age 50 years, followed by a male excess peaking between ages 60 and 69 years. Sex ratios for ischemic heart disease mortality, on the other hand, indicated a male excess at virtually all ages, and that these sex ratios declined with age. However, three measures of heart disease morbidity (self-reported chest pain, heart trouble, and high blood pressure) demonstrated a female excess that did not vary by age. All four measures of functional disability (impaired self-care, impaired mobility, cessation of work, and reduction of work) demonstrated a female excess that did not vary by age (with the exception of a male excess in impaired self-care in adults aged 30 to 39 years). Further analyses of sex differences in health need to acknowledge the heterogeneity of the relation of sex to disease, and the complex age-sex interaction that varies remarkably with both cause and manifestation of outcome (morbidity vs. mortality).

Adult↗
PubMed1989

The effect of occupational, marital and parental roles on mortality: the Alameda County Study.

This study investigated the impact of combining marital, parental, and occupational roles upon 18-year risk of mortality from all causes. The respondents were 3,700 participants in the Human Population Laboratory cohort ages 35-64 who completed a comprehensive health and psychosocial questionnaire in 1965 and were followed for mortality status through 1982. Employment status and type of employment were not found to predict mortality risk among women. Contrary to the multiple roles hypothesis, there was virtually no impact upon mortality of increasing numbers of children among employed women, except possibly among single working parents. The major impact of children was felt by housewives who had significantly elevated risks when a child was present in the home or when they had four or more children. Neither the number of children nor the presence of a child in the home affected mortality risk of men. Controlling for a variety of factors thought to be related to mortality in a logistic regression analysis did not change the foregoing relation.

Adult↗
PubMed1989

The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community.

We examined the association of degree and duration overweight, dietary habits and exercise with non-insulin dependent diabetes mellitus risk in a defined population of 886 men and 1114 women who were aged 50 years and older when examined in 1984-1987. After an oral glucose tolerance test, 142 men and 142 women were classified as diabetic using WHO criteria. Compared to those with appropriate childhood weight, reported underweight as a child significantly increased the rate of diabetes as an adult (RR = 1.3, P less than 0.05). Underweight as a teenager was also associated with an increased rate (RR = 1.3, P less than 0.05). Underweight as a teenager was also associated with an increased rate (RR = 1.4, P less than 0.01). In adults with current body mass indices (weight/height2) greater than 26, the diabetes rate was significantly higher for those underweight as children (RR = 1.7, P less than 0.01). A multivariate logistic regression analysis of adult diet and weight behaviors, adjusting for age and current smoking, found that a weight gain or fluctuation between the ages of 40 and 60 of 10 lbs or more significantly increased the diabetes rate (RR = 1.4, P less than 0.05; RR = 1.7, P less than 0.01). Weight gain between age 18 and the 1984-1987 visit also significantly increased the rate (RR = 1.4 per 17.3 percent, P less than 0.001). Exercise as the only means to control weight was associated with a significantly reduced diabetes rate (RR = 0.05, P less than 0.05).

Aged↗
PubMed1988

Dietary calcium and risk of hip fracture: 14-year prospective population study.

To assess the effect of dietary calcium intake on risk of hip fracture, a geographically defined caucasian population in southern California was studied prospectively. Between 1973 and 1975, a quantified 24 hour diet recall was obtained by a dietician from 957 men and women aged 50 to 79 years at baseline. Follow-up to 1987 with mortality records and interviews showed 15 men and 18 women with hip fractures. The age-adjusted risk of hip fracture was inversely associated with dietary calcium whether considered as mg per day or as nutrient density (mg per 1000 kcal). No other nutrient was consistently associated with hip fracture in any Cox proportional hazards model that included calcium. The association between calcium and fracture persisted after adjustment for cigarette smoking, alcohol intake, exercise, and obesity. The significant independent inverse association of dietary calcium with subsequent risk of hip fracture (relative risk = 0.6 per 198 mg/1000 kcal) strongly supports the hypothesis that increased dietary calcium intake protects against hip fracture.

Aged↗
PubMed1988

Eating pattern disturbances among women medical and graduate students.

In this study, the Eating Disorder Inventory (EDI) was used to determine the incidence of disturbed eating patterns and other characteristics of anorexia nervosa and bulimia among women graduate and medical students. The EDI was given to 219 female graduate students and 132 female medical students by mail questionnaire (61% return rate). Excessive dieting concerns, as measured by the Drive for Thinness subscale, were significantly more common in medical students compared to graduate students (18.7% versus 12.9%; p less than 0.05). The incidence of bulimic eating patterns was also insignificantly higher in the medical students. The prevalence of bulimia estimated from this survey is similar to that reported in undergraduate women, but the estimated prevalence of anorexia nervosa in both medical and graduate students is lower than reported for younger students. Our data suggest that a competitive environment alone does not appear to lead to greater expression of anorexia nervosa and bulimia.

Adolescent↗
PubMed1988

Postmenopausal estrogen use and mortality. Results from a prospective study in a defined, homogeneous community.

The authors studied the association between postmenopausal estrogen use and mortality from cardiovascular disease, coronary heart disease, cancer, and all causes in a cohort of 1,868 women aged 50-79 years residing in a planned community. After 12 years, the age-adjusted all-cause mortality rate was lower in the 734 postmenopausal estrogen users (14.9/100 women) compared with the 1,134 nonusers (21.5/100 women) (relative risk (RR) = 0.69, 95% confidence interval (Cl) 0.55-0.87). After adjustment for age, systolic blood pressure, social class, fasting plasma cholesterol, fasting plasma glucose, Quetelet index (weight (lbs)/height (in)2 x 100), and cigarette smoking by the Cox model, the relative risk increased to 0.79 (95% Cl 0.62-1.01). Because a postmenopausal estrogen-smoking interaction term was significant (p = 0.025), separate Cox models were run for never, past, and current smokers. In never and current smokers, estrogen was protective for all-cause mortality, with relative risks of 0.67 (95% Cl 0.45-0.99) and 0.62 (95% Cl 0.39-0.98), respectively. However, past smokers were not protected by postmenopausal estrogen use (RR = 1.32, 95% Cl 0.84-2.08). Cause-specific models revealed differences in the association of postmenopausal estrogen use with cardiovascular disease mortality and coronary heart disease mortality that were dependent on smoking status. Postmenopausal estrogen use was strongly protective in current smokers but was associated with increased risk in past smokers. As expected, cancer mortality was increased in smokers. The confidence intervals for the relative risk estimate of postmenopausal estrogen use for cancer mortality in each smoking category included one. Finally, a separate analysis of subsequent three-year mortality in women surviving the first nine years of follow-up revealed reduced death rates only for women using estrogen at both baseline and nine years of follow-up, suggesting both a conservative bias in our data introduced by the large reduction in postmenopausal estrogen use during the study period and the possibility of a stronger protective effect for recent postmenopausal estrogen use.

Aged↗
PubMed1988

Long-term effects of exposure to diethylstilbestrol.

In 1985 nearly 1,700 persons who had exposure to diethylstilbestrol (DES)--520 mothers, 1,079 daughters, and 94 sons--responded to a mailed questionnaire about their general health status. Results were compared with responses to the 1985 National Health Interview Survey and other population-based studies. As with research findings in animals, conditions that suggest possibly impaired immune function--that is, respiratory tract infections, asthma, arthritis, and lupus--were reported more frequently among the persons with DES exposure. Conditions that may involve altered endocrine function were also more frequent among such persons. Given the biased sample, findings from this preliminary survey are seen as guidelines to areas meriting more rigorous research.

Adolescent↗