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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 163 records · Page 9Linked to original sources
PubMed1995

Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study.

OBJECTIVE: To examine the associations between osteoporotic fractures and difficulty performing selected physical and functional activities. DESIGN: Cross sectional analysis of a cohort study. SETTING: Geographically defined cohort located in Rancho Bernardo, California. PARTICIPANTS: Community-dwelling women aged 55 and older who participated in a study of osteoporosis between 1988-1991. Eighty percent of eligible women participated in the study. MAIN OUTCOME MEASURES: Self-reported difficulty performing seven physical activities and four functional tasks. RESULTS: The mean age of the 1010 women was 72.6 years. A total of 160 first minimal trauma fractures occurred between 1972 and 1991, including 62 wrist, 29 rib, 25 hip, and 23 spine fractures. The mean time since fracture was 6.7 years (range, 1 to 17 years). In multiply adjusted analyses, having experienced any osteoporotic fracture was significantly associated with a 1.7 to 3.0-fold increase in difficulty bending, lifting, reaching, walking, climbing stairs, and descending stairs. Any fracture was significantly associated with 1.9 to 6.7 times more difficulty in dressing, cooking, shopping, and performing heavy housework. Compared with the relative odds of physical limitation associated with any osteoporotic fracture, hip fractures were more strongly associated with difficulty walking (OR 3.6) and descending stairs (OR 4.1), whereas spine fractures demonstrated a stronger association with difficulty bending (OR 3.1), lifting (OR 3.4), and descending stairs (OR 4.2). CONCLUSIONS: Among older women, remote osteoporotic fracture at any site is associated with an approximate doubling of the risk of physical limitations and an even higher risk of functional limitations. Although this cross-sectional analysis cannot secure the direction of the association, the specificity of the effect of particular fractures on discrete activities supports causality.

Activities of Daily Living↗
PubMed1995

Sex differences in insulin levels in older adults and the effect of body size, estrogen replacement therapy, and glucose tolerance status. The Rancho Bernardo Study, 1984-1987.

OBJECTIVE--To determine if insulin levels vary with sex, independent of estrogen replacement therapy (ERT), differences in body mass index (BMI), waist-to-hip ratio (WHR), and glycemia. RESEARCH DESIGN AND METHODS--In a population-based study of older adults, insulin levels were measured before and after a standardized oral glucose tolerance test in 673 men and 849 women, all free of known diabetes. RESULTS--Age-adjusted fasting insulin levels were highest in men, intermediate in women not taking estrogen, and lowest in estrogen-treated women (P < 0.01). Differences between men and women not taking estrogen disappeared after adjusting for age and BMI, but not glycemia; estrogen-treated women had significantly lower fasting insulin levels than did men (P < 0.01) and women not taking estrogen (P < 0.01). The association of estrogen use with lower fasting insulin levels persisted after adjusting for age and WHR (P < 0.001) and was stronger among women with abnormal glucose tolerance. Age-adjusted postchallenge insulin levels were higher in women than in men (P < 0.01). The sex difference persisted after adjusting for age and BMI or glycemia. Postchallenge insulin levels did not vary by ERT. CONCLUSIONS--Men have higher fasting insulin levels than do women, whether or not the women are using ERT. Differences between men and untreated women are explained by differences in BMI, but estrogen users have lower fasting insulin levels independent of BMI. Postchallenge insulin levels are higher in women than men and are independent of ERT, BMI, and glycemia. Clinical trials in women are needed to determine whether ERT can improve insulin and glucose metabolism.

Aged↗
PubMed1995

Total but not bioavailable testosterone is a predictor of central adiposity in postmenopausal women.

OBJECTIVE: In pre and postmenopausal women low levels of sex hormone binding globulin (SHBG) have been shown to be associated with a large waist-hip ratio (WHR), a measure of visceral adiposity. Previous studies of WHR and testosterone, however, have been inconclusive. DESIGN: We examined the prospective association between endogenous total and bioavailable testosterone and SHBG levels at baseline with WHR measured 12-15 years later in a community-based cohort of older women. SETTING: Rancho Bernardo, California. SUBJECTS: 334 postmenopausal women. MAIN OUTCOME MEASURES: Endogenous total and bioavailable testosterone and SHBG levels and WHR. RESULTS: Only age-adjusted SHBG levels and the testosterone/SHBG ratio were associated with BMI. Age-adjusted SHBG levels and total testosterone decreased with increasing WHR. Neither measured nor estimated (testosterone/SHBG ratio) bioavailable testosterone was associated with WHR before or after adjustment for age, BMI, and cigarette smoking. CONCLUSION: These prospective data confirm the reported cross-sectional association between SHBG and WHR, but show no association with measured bioavailable testosterone or the testosterone/SHBG ratio. These findings do not support the premise that androgens cause visceral adiposity in postmenopausal women.

Adipose Tissue↗
PubMed1995

Postmenopausal estrogen and heart disease.

A protective effect of estrogen is the most obvious reason for the substantial and consistent favored status of women vs. men with regard to coronary heart disease (CHD). This paper briefly reviews the history of studies of the estrogen-heart disease hypothesis, the reason why clinical trials of postmenopausal estrogen are necessary (despite the strength, consistency, and plausibility of the 'protection' seen in observational studies), and the status of the 'Postmenopausal Estrogen/Progestin Interventions' (PEPI) trial results and ongoing trials. The potential for nonhormonal primary prevention is emphasized.

Estrogen Replacement Therapy↗
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

Low blood pressure and depression in older men: a population based study.

OBJECTIVE: To determine if an association exists between low blood pressure and depressive symptoms in older men living in the community. DESIGN: Cross sectional, population based study. SETTING: Town of Rancho Bernardo, California, United States. SUBJECTS: 846 men aged 60-89 years. Comparisons between hypotensive, normotensive, and hypertensive groups were limited to 594 men not taking drugs for hypertension. MAIN OUTCOME MEASURES: Mean scores on Beck depression inventory and prevalence of scores > or = 13. RESULTS: Men with diastolic blood pressure < 75 mm Hg had significantly higher depression scores (mean scores 6.35 v 4.96; P < 0.001) and more categorical depression (7.6% v 1.8% with scores > or = 13; P < 0.01) than men with diastolic blood pressure levels between 75 and 85 mm Hg. Men with diastolic blood pressure levels > 85 mm Hg had higher depression scores than men with intermediate blood pressure levels (mean scores 5.85 v 4.96; P < 0.05). Men with diastolic hypotension scored significantly higher on both affective and somatic item subscales of the Beck depression inventory and on individual measures of fatigue, pessimism, sadness, loss of appetite, weight loss, and preoccupation with health. Low diastolic blood pressure was a significant predictor of both mean depression score and prevalence of categorical depression, independent of age and change in weight since the baseline visit. The presence of several chronic diseases was associated with depressed mood and higher blood pressure but not with low blood pressure. CONCLUSION: The association of relatively low diastolic blood pressure with higher depressive symptom scores and rates of categorical depression was independent of age or weight loss. Since fatigue is a prominent symptom of depression, any association of low blood pressure with fatigue could reflect depressive disorders or clinically important depression.

Aged↗
PubMed1994

Coffee-associated osteoporosis offset by daily milk consumption. The Rancho Bernardo Study.

OBJECTIVE: To describe the association of lifetime intake of caffeinated coffee, in cup-years, to bone mineral density (BMD) of the hip and spine in postmenopausal women; and to determine the effect of regular milk intake on this association. DESIGN: Women from an established epidemiologic cohort had measures of BMD and gave a medical and behavioral history that included caffeinated coffee and daily milk intake between the ages of 12 and 18 years, 20 and 50 years, and 50 years of age and older. SETTING: A community-based population of older women, Rancho Bernardo, Calif. PARTICIPANTS: All 980 postmenopausal women aged 50 to 98 years (mean age, 72.7 years) who participated between 1988 and 1991. MAIN OUTCOME MEASURES: Bone density at the hip and lumbar spine measured by dual energy x-ray absorptiometry. MAIN RESULTS: There was a statistically significant graded association between increasing lifetime intake of caffeinated coffee and decreasing BMD at both the hip and spine, independent of age, obesity, parity, years since menopause, and the use of tobacco, alcohol, estrogen, thiazides, and calcium supplements. Bone density did not vary by lifetime coffee intake in women who reported drinking at least one glass of milk per day during most of their adult lives. CONCLUSIONS: Lifetime caffeinated coffee intake equivalent to two cups per day is associated with decreased bone density in older women who do not drink milk on a daily basis.

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

The association between health beliefs and health behavior change in older adults.

BACKGROUND: Previous studies have reported weak relationships between health beliefs and behavior change; few studied elderly populations. METHODS: We examined the relation between self-reported behavior change and health-related beliefs among an educated, upper-middle-class population age 50 to 89 years. RESULTS: More women reported decreasing dietary salt and fat, changing diet, and reading self-help materials than men. Younger respondents (age 50 to 69 years) reported more positive health behavior changes in diet and exercise than did older respondents (age 70 to 89 years). Respondents who agreed that diet and exercise were important for optimal health and/or spent money on healthful items reported more positive behavior change than those who disagreed. Those who reported confusion about how to stay healthy or a lack of motivation to engage in healthful behaviors were less likely to make positive lifestyle changes. Older respondents reported a higher rate of confusion regarding which foods to eat (53% vs 39%) and how to stay healthy (29% vs 19%) than younger respondents, while younger respondents were more likely to report a problem with motivation (40% vs 34%). CONCLUSIONS: These results suggest that increasing age does not diminish the relation between health beliefs and health behaviors. Health promotion campaigns aimed at older adults should strive to reduce confusion to improve health behavior.

Age Factors↗
PubMed1994

Dietary sodium and bone mineral density: results of a 16-year follow-up study.

BACKGROUND AND PURPOSE: It has been proposed that high dietary sodium intake, resulting in a sodium-mediated increase in renal calcium excretion, is a risk factor for osteoporosis. To evaluate the relationship between dietary sodium intake and bone mineral density (BMD), a prospective study of the Rancho Bernardo cohort was performed. METHOD: A 24-hour diet recall was done for the period 1973 through 1975; follow-up bone mineral density of the ultradistal radius, midradius, total hip, and spine was measured between 1988 and 1991. Covariates were ascertained by self-report and examination at baseline. Multivariable analysis of the sodium-BMD association was performed using gender and menopause-specific linear regressions. RESULTS: All subjects were white. At the bone evaluation, there were 258 women (average age 73.3 years) and 169 men (average age 72.4 years). In both men and women, higher levels of sodium intake were strongly associated with higher levels of calcium intake and total calories. Body mass index increased with sodium quartile in women, while a modest negative association was seen in men. In women, after age adjustment, positive associations between dietary sodium and bone density were found at the ultradistal radius (beta = 0.01, P = 0.03) and the total hip (beta = 0.019, P = 0.02). BMD increased by 0.01 to 0.02 g/cm2 per gram increase in sodium ingested. After adjustment for estrogen use, body mass, dietary calcium, alcohol, and total calories, these effects were no longer significant. Similar patterns were seen in pre- and postmenopausal women. In men, age and multivariate-adjusted BMD increased with higher sodium intake at the ultradistal radius only (beta = 0.013, P = 0.05). Stratification by gender-specific median calcium level did not significantly effect the results. CONCLUSIONS: After control for confounders, a small, statistically significant protective effect of sodium was found at the ultradistal radius in men only. At other sites in women and men, no effect of sodium on BMD was apparent in the multivariable models. These results do not support a detrimental effect of dietary sodium on bone mineral density. Rather, the findings suggest that sodium intake, in the range measured, is not a major osteoporosis risk factor.

Aged↗
PubMed1994

A prospective study of dehydroepiandrosterone sulfate and cognitive function in an older population: the Rancho Bernardo Study.

OBJECTIVE: To determine whether low plasma dehydroepiandrosterone sulfate (DHEAS) levels predict poor cognitive function in the elderly. DESIGN: A prospective, population-based study with periodic clinical evaluations and 100% follow-up for vital status. SETTING: Rancho Bernardo, California PATIENTS: 270 men and 167 women (80% of surviving, local, age-eligible subjects) from the Rancho Bernardo cohort who had plasma obtained for DHEAS assays in 1972 to 1974 and screening for dementia in 1988 to 1991. MEASUREMENTS: DHEAS levels were measured by radioimmunoassay. There were five interviewer-administered standard screening tests of cognitive function: Mini-Mental Status Examination, Buschke selective reminding test, Trails B, category fluency, and Heaton Visual Reproduction test. RESULTS: DHEAS levels were higher in men than women and decreased with age in both sexes. There were no significant differences in age-adjusted DHEAS levels in the percent of men or women with categorically impaired performance on any test. When analyzed as a continuous variable, DHEAS levels were significantly correlated with only one test, the Bushke, and only in women. Low baseline DHEAS levels were not associated with any mention of dementia on death certificates or with non-participation of survivors. Low levels of DHEAS predicted mortality in men more than in women such that men were more likely to have died before cognitive function testing than women. CONCLUSION: The single DHEAS-memory association, restricted to women, is most likely to be spurious, consequent to multiple comparisons. We cannot exclude a true effect of low DHEAS, restricted to women and reflecting their better survival than men.

Age Factors↗
PubMed1994

Higher risk of cardiovascular mortality among lean hypertensive individuals in Tecumseh, Michigan.

BACKGROUND: A cohort of 2181 men and women, aged 40 to 79 years, without evidence of coronary heart disease or cancer at entry to the Tecumseh Study was evaluated. METHODS AND RESULTS: Subjects were defined as lean if their Metropolitan Life Insurance table relative weight was < 110 (n = 584) and as obese if their relative weight was > or = 120 (n = 1024). There were 688 subjects with hypertension at study entry (systolic blood pressure > or = 160, diastolic blood pressure > or = 95, or treated). The 29-year relative risk (RR) of mortality from ischemic heart disease (IHD) or cardiovascular disease (CVD) associated with systolic blood pressure level was significant for both lean and obese subjects. Among hypertensive subjects, the RR of fatal IHD for lean versus obese hypertensive subjects was 1.87 (95% confidence interval, 1.21 to 2.88) and the RR of fatal CVD was 1.56 (95% confidence interval, 1.10 to 2.20) using a Cox proportional-hazards model to adjust for the independent effects of age and traditional CVD risk factors. The findings are consistent with other studies in men showing lean hypertensive subjects to be at greater risk of IHD or CVD mortality than obese hypertensive subjects. A similar finding is now observed in women. CONCLUSIONS: Associations do not prove causality or dictate management. Nevertheless, the unexplained higher mortality in lean versus obese hypertensive subjects has now been reported with sufficient frequency to suggest that the association is real (if unexplained). Determining the reasons for this association may improve targeted prevention and treatment strategies.

Adult↗
PubMed1994

Dyslipidemia and ischemic heart disease mortality among men and women with diabetes.

BACKGROUND: We investigated whether the greater increased risk of ischemic heart disease mortality associated with diabetes among women compared with men could be explained by their more pronounced lipoprotein abnormalities. METHODS AND RESULTS: Seventy-six men and 45 women with diabetes and 327 men and 496 women without diabetes were followed for an average of 16 years in a population-based study. Cox proportional hazards models were used to determine the relative hazard of ischemic heart disease mortality for changes in lipoprotein subfractions after adjustment for age, hypertension, obesity, smoking, exercise, alcohol consumption, and estrogen use (among women). The relative hazard of ischemic heart disease mortality among diabetic women was 1.76 (P = .10) for a 10-mg/dL decrement in high-density lipoprotein cholesterol (HDL-C) and 3.13 (P = .01) for a 1-U increment in log very-low-density lipoprotein cholesterol (VLDL-C). The risk of ischemic heart disease mortality among diabetic women relative to nondiabetic women for an HDL-C level of 50 mg/dL and a log(e) VLDL-C of 3 (about 20 mg/dL) were 4.1 and 3.4, respectively (P < .05). These lipoprotein changes were not associated with ischemic heart disease mortality among men or among nondiabetic women. CONCLUSIONS: Excess ischemic heart disease mortality among diabetic women is partially explained by deleterious levels of HDL-C and VLDL-C. HDL-C levels of < or = 50 mg/dL and VLDL-C levels of > or = 20 mg/dL appear to predict ischemic heart disease mortality among these women and may help identify women who would benefit most from intervention.

California↗
PubMed1994

Lifetime milk consumption and bone mineral density in older women.

This study examined the relationship between lifetime milk consumption both axial and appendicular bone mineral density in 581 postmenopausal White women. Positive significant, graded associations between milk consumption in adulthood and bone mineral density at the spine, total hip, trochanter, intertrochanter, and midradius, but not the ultradistal wrist or femoral neck, were observed. Adolescent milk consumption showed similar, statistically significant associations (spine and midradius). Associations were independent of age, body mass index, years postmenopausal, thiazide, estrogen and alcohol use, smoking, and exercise. Regular milk consumption in youth and adulthood is associated with better bone mineral density at cortical and trabecular sites in elderly women.

Adolescent↗
PubMed1994

Heart disease in women.

OBJECTIVE: To consider why women have less heart disease than men and to review the relation of heart disease risk factors, menopause, and estrogen to the risk for heart disease in women. DESIGN: A review of illustrative publications. RESULTS: Women have less heart disease than men at any given level of every major risk factor, with the possible exception of diabetes, even when the relative risk associated with that risk factor is similar for both sexes. Endogenous estrogen is a plausible explanatory variable, but no studies have shown that it is protective. Estrogen treatment after the menopause appears to reduce women's risk for heart disease, but no clinical trials have been reported that prove the benefit of this or any other intervention, except blood pressure control, in women. CONCLUSIONS: Prevention programs can safely recommend nonpharmacologic interventions that reflect the evolutionary norm, such as better diet, more exercise, and not smoking. Pharmacologic interventions to prevent disease require clinical trials.

Cholesterol, HDL↗