Search PubMed⌕ Search

Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 127 records · Page 7Linked to original sources
PubMed1997

Given diabetes, is fat better than thin?

OBJECTIVE: To evaluate the association between BMI and mortality in women and men with type II diabetes. RESEARCH DESIGN AND METHODS: Fasting plasma glucose (FPG), height and weight measurements, and medical history were obtained from 4,483 community-dwelling adults, aged 40-79 years, in 1972-1974. A total of 373 persons with either a history of diabetes or FPG > or = 7.77 mmol/l were studied. Subjects were grouped into four sex-specific weight categories based on U.S. population data. Vital status after 14 years was known for 99.9% of the patients studied. Cox models were used to assess relative survival by weight category. RESULTS: Diabetic men and women of average weight had the lowest mortality. A J-shaped relative risk curve by weight category was found, with a poorer survival rate for those who were thin, overweight, or obese. This effect was not explained by early mortality or cigarette smoking. CONCLUSIONS: Being thin may not provide a mortality benefit for diabetic men and women. Average weight appears to be desirable.

Adult↗
PubMed1997

A population-based analysis of qualitative features of the neuropsychological test performance of individuals with dementia of the Alzheimer type: implications for individuals with questionable dementia.

Qualitative features of the neuropsychological test performance of individuals with dementia of the Alzheimer type (DAT) were examined in a population-based study. Qualitative error scores were derived from measures of verbal and figural memory, verbal fluency and confrontation naming for 38 patients with clinically diagnosed DAT, 236 normal elderly (NE) individuals, and 72 others who were questionably demented and at risk (AR) for DAT. Persons with DAT made a greater proportion of intrusion and perseverative errors, and more lexical and semantic naming errors, than the NE participants. These measures provided fair specificity but poor sensitivity for the diagnosis of DAT, and a logistic model based on these measures correctly classified 98% of the NE participants, but only 29% of the DAT participants. The AR participants demonstrated a pattern of errors that was highly similar to that of the DAT patients, and when their scores were subjected to the logistic model, 90% were classified as NE and 10% as DAT. These results indicate that specific error types that have been associated with DAT in self-referred or clinic-based samples also occur in the general population to a greater degree in individuals with DAT or questionable dementia than in NE individuals. Furthermore, these qualitative features may have some diagnostic usefulness in that their presence provides reasonable specificity for DAT or questionable dementia.

Aged↗
PubMed1996

The postwar hospitalization experience of U.S. veterans of the Persian Gulf War.

BACKGROUND: Since the Persian Gulf War ended in 1991, many veterans of that conflict have reported diverse, unexplained symptoms. To evaluate the health of Gulf War veterans, we studied their postwar hospitalization experience and compared it with that of other military personnel serving at the same time who did not go to the Persian Gulf. METHODS: Using a retrospective cohort approach and data from Department of Defense hospitals, we studied hospitalizations of 547,076 veterans of the Gulf War who were serving in the Army, Navy, Marine Corps, and Air Force and 618,335 other veterans from the same era who did not serve in the Persian Gulf. Using multivariate logistic-regression models, we analyzed risk factors for hospitalization both overall and in 14 broad diagnostic categories during three periods from August 1991 through September 1993 (a total of 45 specific comparisons). RESULTS: After the war, the overall odds ratio for hospitalization of the Gulf War veterans was not higher than that of the other veterans, even after adjustment for selection effects related to deployment. In 16 of the 42 comparisons involving specific diagnoses, the risk of hospitalization among Gulf War veterans differed significantly from that among other veterans. Among these 16 comparisons, Gulf War veterans were at higher risk in 5: neoplasms (largely benign) during 1991, diseases of the genitourinary system during 1991, diseases of the blood and blood-forming organs (mostly forms of anemia) during 1992, and mental disorders during both 1992 and 1993. The differences were not consistent over time and could be accounted for by deferred care, postwar pregnancies, and postwar stress. CONCLUSIONS: During the two years after the Persian Gulf War, there was no excess of unexplained hospitalization among Americans who remained on active duty after serving in that conflict.

Adult↗
PubMed1996

Caffeine intake and endogenous sex steroid levels in postmenopausal women. The Rancho Bernardo Study.

Caffeine intake has been associated with risk of osteoporosis, breast cancer, endometriosis, and fibrocystic breast disease and has been hypothesized to exert its effects through alteration of endogenous hormone levels. This study examined the cross-sectional association of caffeine intake with endogenous androgens, estrogens, and sex hormone-binding globulin in 728 white postmenopausal women aged 42-90 years in the Rancho Bernardo community-based study in 1984-1987. Caffeine intake was inversely associated with age and waist/hip ratio and positively associated with alcohol consumption. Significant inverse associations were noted between caffeine intake and bioavailable testosterone, which persisted after adjustment for age, waist/hip ratio, body mass index, alcohol intake, cigarette smoking, and physical activity (r = -0.10, p = 0.02). At high doses (equivalent to more than 2 cups of coffee or four cans of caffeinated soda daily), caffeine intake was positively associated with plasma estrone before and after adjustment for confounders (r = 0.26, p = 0.05). Sex hormone-binding globulin levels were positively associated with increasing caffeine intake (adjusted r = 0.09, p = 0.03). The positive association of caffeine with estrone and its inverse association with bioavailable testosterone suggest that caffeine's reported association with several chronic conditions may be mediated by an effect on endogenous sex steroids.

Adult↗
PubMed1996

Sex differences in measures of body fat and body fat distribution in the elderly.

This study describes sex differences in obesity and body fat distribution using commonly used assessment methods in 140 men and 245 women age 65-96 years from Rancho Bernardo, California. Significant correlations were shown among all obesity measures. The waist/hip ratio was more strongly correlated with the truncal fat/leg fat ratio in women than in men. The waist/hip ratio correlated significantly with the subscapular/ triceps skinfold ration in women only. In both sexes, waist circumference was more strongly correlated with body mass index and the percentage of body fat by bioelectric impedance analysis and dual-energy X-ray absorptiometry than with the waist/hip ratio. In those aged over 80 years, age stratification showed that the waist/hip ration was not correlated with any other measurement of obesity or fat distribution in men and correlated only with subscapular skinfolds in women. Waist circumference, however, correlated significantly with almost all other measures of central obesity in older and younger men and women. Estimates of upper body (central) fat distribution appear to be age specific. After age 80, the waist/hip ratio is a poor method of assessing central or visceral adiposity, and waist circumference is a better measure of body fat distribution.

Absorptiometry, Photon↗
PubMed1996

Effect of active and passive smoking on ventilatory function in elderly men and women.

Although it is well known that pulmonary function declines with age and that this decline is accelerated by cigarette smoking, the effects of such factors are not well established in elderly individuals. Tha authors examined the effect of active and passive smoking on ventilatory function assessed by spirometry in 1,397 community-dwelling men and women aged 51-95 years and observed that active smoking affected ventilatory function into advanced old age. Smokers who quit before age 40 had an age- and height-adjusted forced expiratory volume in 1 second (FEV1)(in liters) that did not differ from that of never smokers in either men (3.06 (standard deviation (SD) = 0.58) vs. 3.06 (SD = 0.60), p = 0.99) or women (2.09 (SD = 0.51) vs. 2.13 (SD = 0.46), p = 0.51). In smokers who quit between ages 40 and 60, FEV1 was lower than that of never smokers and higher than that of current smokers in both men and women. Male and female smokers who quit after age 60 had a FEV1 similar to current smokers. FEV1 correlated significantly with the duration since quitting smoking (r = 0.24, p = 0.0001 in men; and r = 0.26,p = 0.0001 in women) and with the duration of smoking (r = -0.30, p = 0.0001 in both men and women). FEV1 and forced midexpiratory rate in 25-75 seconds were not lower in either male or female nonsmokers passively exposed to cigarette smoke at home. These results confirm the deleterious effect of active smoking and demonstrate a beneficial effect of quitting smoking before age 40, with an apparent lack of benefit on pulmonary function if cessation is delayed to age 60.

Aged↗
PubMed1996

Leisure, home, and occupational physical activity and cardiovascular risk factors in postmenopausal women. The Postmenopausal Estrogens/Progestins Intervention (PEPI) Study.

OBJECTIVE: To examine the associations between self-reported leisure, home, and occupational physical activity and selected cardiovascular risk factors. METHODS: A cross-sectional analysis of baseline data from the Postmenopausal Estrogen/Progestins Intervention Trial was performed in 851 women aged 45 to 64 years. Outcomes were levels of high-density lipoprotein cholesterol, insulin (2 hours after challenge), fibrinogen, systolic blood pressure. Race-stratified models were adjusted for age, smoking, alcohol, and previous noncontraceptive estrogen use. Models were also run with body mass index as an additional covariate. RESULTS: In white women, leisure physical activity was positively associated with levels of high-density lipoprotein cholesterol (P = .001) and inversely associated with levels of insulin (P = .04) and fibrinogen (P = .02). Compared with high-density lipoprotein cholesterol levels in the inactive and light leisure physical activity groups, moderate (P < .001) and heavy (P = .004) leisure activities were associated with higher high-density lipoprotein cholesterol levels. High-density lipoprotein cholesterol levels in the heavy leisure physical activity group were significantly higher than those in the moderate group (P = .01). Compared with lesser levels of leisure physical activity, significantly lower mean values of fibrinogen (P = .02) and insulin (P = .01) were associated with the highest-intensity leisure physical activity. Home physical activity was positively related to high-density lipoprotein cholesterol level (P = .01); relative to lower levels of home physical activity, the heavy home physical activity group demonstrated significantly higher mean high-density lipoprotein cholesterol levels. The effects of leisure and home physical activities were independent of each other. systolic blood pressure did not vary by leisure, occupational, or home physical activity. CONCLUSION: The unique relationships between type of physical activity and cardiac risk factors underscore the necessity of including multiple domains of activity in epidemiologic studies of epidemiologic studies of physical activity in women.

Cardiovascular Diseases↗
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

Factors associated with bone mineral density in middle-aged men.

This cross-sectional population-based study examined the association of anthropometric and lifestyle risk factors with bone mineral density (BMD) in 218 white ambulatory men aged 50-64 from the Rancho Bernardo, California cohort. BMD was measured at the lumbar spine and hip using dual-energy X-ray absorptiometry and at the ultradistal wrist and midshaft radius of the forearm using single-photon absorptiometry. Body mass index (BMI) was significantly correlated with BMD at all four skeletal sites. Overall, 17.0% of men aged 55-64 were osteopenic (BMD > or = 2 SD below the distribution for ages 50-54) at one skeletal site, 16.5% were osteopenic at two sites, and 13.6% were osteopenic at three or more sites. Men who reported regular exercise had significantly higher BMD levels at the spine and hip. Men meeting the recommended daily allowance (RDA) for calcium intake (> or = 800 g/day) had significantly higher BMD levels at the spine and wrist. Alcohol intake and smoking were associated with differences of borderline significance in BMD at the spine. In analyses adjusted for BMI, weight change, exercise, smoking, drinking, and calcium intake, there was a significant independent age-related decline in BMD at the hip (0.008 g/cm2/year; p = 0.001), at the wrist (0.004 g/cm2; p < 0.01), at the forearm (0.006 g/cm2; p < 0.01), but not at the spine (0.005 g/cm2). These data, although cross-sectional, strongly suggest that age-related bone loss occurs in middle-aged men and that both physical activity and an adequate calcium intake are associated with better bone density.

Ambulatory Care↗
PubMed1996

Depressive symptoms in overweight and obese older adults: a test of the "jolly fat" hypothesis.

The association between body weight and depressive symptoms in older adults was examined in a population-based study of 2,245 noninstitutionalized men and women aged 50 to 89 years living in Rancho Bernardo, California, U.S.A. The prevalence of Beck Depression Inventory scores > or = 13 was inversely associated with body weight in men, but not in women. Overweight and obese 50- to 69-yr-old women were more depressed than women with a body mass index below 25 kg/m2, but the difference was only marginally significant (p = 0.09). When age, health status and medication use were controlled, the odds of being depressed were 0.34 (p = 0.004) in overweight men and 0.28 (p = 0.09) in obese men, compared to men with a body mass index below 25 kg/m2. In this cohort, depression in men was inversely associated with body weight, supporting the "Jolly Fat" hypothesis. The likelihood that more stigma is attached to excessive weight in women than men may account for the lack of an inverse association between weight and depression in women.

Adult↗
PubMed1996

An Epstein Barr virus-related cross reactive autoimmune response in multiple sclerosis in Norway.

In studies of patients in Norway with multiple sclerosis (MS), we have found cross reactive autoantibodies related to the Epstein Barr virus nuclear antigen-1 (EBNA-1). The MS patients had elevated IgG antibody to EBNA-1, as measured by reactivity with a synthetic glycine/alanine peptide, P62, which represents the glycine/alanine repeat in EBNA-1. The mean titer of anti-P62 in patients with acute relapse at the time of assay was significantly higher than in the remaining patients. Patients with remitting/relapsing MS also had elevated autoantibody to a lymphocyte protein, p542, cross reactive with EBNA-1 through a glycine/serine epitope. High titered anti-EBNA-1 antibodies from some MS, as well as from some SLE sera, were shown to cross react with 80-82 kDa and 60 kDa proteins in neuroglial cells.

Amino Acid Sequence↗
PubMed1996

Reasons for changing caffeinated coffee consumption: the Rancho Bernardo Study.

OBJECTIVE: To determine patterns of lifetime caffeinated and decaffeinated coffee use, focusing on frequency and determinants for curtailing caffeinated coffee. METHODS: Residents of Rancho Bernardo, a white, upper-middle class Southern California community, were surveyed about their lifetime coffee-drinking behavior; completed questionnaires were received from 69% (n = 2955; mean age was 64 years, age range: 30-105 years). Chi-square tests of differences between proportions in categorical data and t-tests for continuous data were used. Due to the large number of comparisons, statistical significance was defined as p or=5 cups/day only in those who curtailed caffeinated coffee on advice of a physician or for heart/circulatory problems. CONCLUSIONS: Curtailing of caffeinated coffee in this adult cohort was primarily due to health concerns, but few of those who curtailed caffeinated coffee attribute the change to the advice of a physician.

Adult↗
PubMed1996

Weight loss precedes dementia in community-dwelling older adults.

OBJECTIVE: To determine whether the weight loss associated with Alzheimer's disease precedes or follows the dementia. DESIGN: Older community-dwelling men (n = 134) and women (n = 165) were followed for 20 years before they were diagnosed as cognitively intact or demented. A repeated measures analysis was used to compare weight change in those who developed Alzheimer's Disease (AD) with those who remained cognitively intact. MEASUREMENTS: Weight was measured at three clinic visits between 1972-74, 1984-87, and 1990-93. Participants were classified as having probable or possible AD or being cognitively intact at the 1990-93 evaluation. Diagnoses were made by two neurologists and a neuropsychometrist, based on neuropsychological tests and physical examination, using NINCDS-ADRDA criteria. RESULTS: There were 36 men and 24 women diagnosed with probable or possible AD; they were considered to have mild to moderate dementia based on their test scores and community-dwelling status. Those who developed dementia were older than those diagnosed as cognitively intact. In age-adjusted analyses, both men and women who were later diagnosed with AD had a significant decrease in weight after the baseline visit (P < .001 and P < .003, respectively), but there was no significant weight loss in the men and women who remained cognitively intact. These differences were not explained by lifestyle, depression, or other illness. CONCLUSION: Weight loss precedes mild to moderate dementia; early weight loss is, therefore, unlikely to be a consequence of AD patients being unable or unwilling to eat.

Aged↗
PubMed1996

Cognitive and functional status of the oldest old.

OBJECTIVE: To compare the cognitive performance and functional status of the normal oldest old (85 + years) with that of normal older persons aged 65 to 84 years to identify age-associated changes in cognition in individuals considered clinically normal. BACKGROUND: Advancing age appears to be a risk factor for dementia. DESIGN/METHODS: Analysis of performance on an extensive neuropsychological battery and the Pfeffer Outpatient Disability Scale in 243 normal individuals age 65 to 99 years. RESULTS: Fifty-two normal subjects who were 85 years of age and older (mean age 88.2 +/- 3.1) and 191 normal subjects aged 65-84 years (mean age 75.8 +/- 5.0) were compared. Mean education for both groups was not statistically different. No significant differences in functional disability were found between the two groups. Normal subjects aged 85 years and older performed significantly less well than their younger counterparts on verbal and nonverbal memory, psychomotor/executive tasks, and category verbal fluency. CONCLUSIONS: Advancing age in normal subjects is accompanied by a decrease in cognitive function, measured by various neuropsychological tests, but is not accompanied by functional impairment.

Activities of Daily Living↗
PubMed1996

Effects of sequential neuropsychological testing of an elderly community-based sample.

The magnitude and importance of changes in scores of neuropsychological tests on retest in the elderly, especially over long time periods, is not well established. Three neuropsychological tests and one mental status test were initially administered to screen for potential dementia and were readministered to 380 of the surviving individuals 2.4 years later who either failed the screening examination or were an age matched control. Of the 380 women and men aged 65 and older, 56 were diagnosed as having Alzheimer disease (AD), 82 as at risk for developing AD, and 242 as having normal cognition. The present report focuses on changes in test scores between the two visits. In the normal and at risk groups, significant improvements were seen on retest of the Visual Reproduction Test (VRT), the Trails B test, and the Mini-Mental Status examination; verbal fluency decreased, and savings score of the VRT showed small variations. On most tests, scores of the AD group decreased. Practice effects, biases, and other variables may have played a role in the improvements seen in those labeled normal and at risk. If these results are confirmed, savings score of the VRT (which remained stable over time in normals and individuals at risk and decreased in patients with dementia) and verbal fluency (which decreased in all groups) may be better measures of true cognitive performance than the other tests that we evaluated.

Aged↗
PubMed1996

Dehydroepiandrosterone, dehydroepiandrosterone sulfate, obesity, waist-hip ratio, and noninsulin-dependent diabetes in postmenopausal women: the Rancho Bernardo Study.

Dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) levels were determined in morning specimens from 659 fasting postmenopausal women who were not using estrogen therapy or antidiabetic medication. All women had concurrent oral glucose tolerance tests and measurements of body mass index (BMI) and waist-hip ratio (WHR). DHEA levels were weakly and inversely associated with BMI but not with WHR or glucose tolerance status. DHEAS levels were not associated with BMI but were positively associated with WHR, diabetes, and impaired glucose tolerance. In analyses adjusted for or stratified by WHR, the DHEAS association with abnormal carbohydrate tolerance was reduced but still independent of fat distribution. Because this was a cross-sectional study, it was not possible to determine whether DHEAS levels were raised by central obesity or vice versa. At a minimum, these data strongly suggest that the positive association of DHEAS with both central obesity and abnormal glucose tolerance does not support the thesis that DHEAS protect against diabetes or obesity in older women as had been suggested by animal studies.

Aged↗