Biomedical subjects

Edward J Boyko

Publications and source records attributed to Edward J Boyko.

At least 19 recordsLinked to original sources

PubMed2003

Visceral adiposity and the prevalence of hypertension in Japanese Americans.

BACKGROUND: Visceral adiposity is generally considered to play a key role in the metabolic syndrome, including hypertension. The purpose of this study was to evaluate cross-sectionally whether visceral adiposity is associated with prevalence of hypertension independent of other adipose depots and fasting plasma insulin. METHODS AND RESULTS: Study subjects included 563 Japanese Americans with normal or impaired glucose tolerance or diabetes but not taking oral hypoglycemic medication or insulin at entry. Variables included plasma glucose and insulin measured after an overnight fast and during an oral glucose tolerance test, and abdominal, thoracic, and thigh fat areas by CT. Total fat area (TFA) was calculated as the sum of these fat areas. Hypertension was defined as having a systolic blood pressure > or =140 mm Hg, having a diastolic blood pressure > or =90 mm Hg, or taking antihypertensive medications. Intra-abdominal fat area (IAFA) was associated with a higher prevalence of hypertension. Adjusted odds ratio of hypertension by IAFA was 1.68 for a 1-SD increase (95% CI, 1.20 to 2.37) after adjusting for age, sex, fasting plasma insulin, a nonlinear transformation of 2-hour plasma glucose, and TFA. IAFA remained a significant predictor of prevalence of hypertension even after adjustment for total subcutaneous fat area, abdominal subcutaneous fat area, body mass index, or waist circumference, but no measure of regional or total adiposity was associated with the odds of prevalence of hypertension in models that contained IAFA. CONCLUSIONS: Greater visceral adiposity increases the odds of hypertension in Japanese Americans independent of other adipose depots and fasting plasma insulin.

Adipose Tissue↗

PubMed2003

A case-control study of endoscopy and mortality from adenocarcinoma of the esophagus or gastric cardia in persons with GERD.

BACKGROUND: This study assessed whether EGD reduces mortality from adenocarcinoma of the esophagus or gastric cardia for patients with gastroesophageal reflux. METHODS: A case-control study was performed. A total of 245 incident cases of death caused by adenocarcinoma of the esophagus or gastric cardia (1995-1999) in which reflux was present were identified using Veterans Health Administration databases. A total of 980 controls with reflux but no death from adenocarcinoma were frequency matched for age, gender, and race. The occurrences of EGD from 1990 onward were compared for cases and controls. Logistic regression analysis with adjustment for potential confounding factors was performed. RESULTS: All the subjects were men. Cases were significantly less likely to have had an EGD in the time period of interest as compared with controls (adjusted odds ratio 0.66: 95% CI [0.45, 0.96], p = 0.03). This negative association was as strong for any EGD performed within 1 to 8 years before diagnosis as for a more recent EGD. However, there were no controls that included esophagectomy and no controls with a nonfatal diagnosis of adenocarcinoma, raising the question of whether EGD and reduced mortality are causally linked. The risk of dying from adenocarcinoma was significantly lower for men with a diagnosis of GERD as an inpatient relative to men in whom the diagnosis was made as an outpatient (adjusted odds ratio 0.21: 95% CI [0.15, 0.31], p < 0.01). CONCLUSIONS: For patients with GERD, performing an EGD is associated with reduced mortality from adenocarcinoma of the esophagus or gastric cardia, but whether this is a causative association remains unclear.

Adenocarcinoma↗

PubMed2003

Type and location of injection drug use-related soft tissue infections predict hospitalization.

The prevalence of soft tissue infections (abscesses, cellulitides, infected ulcers) among injection drug users (IDUs) is estimated to be between 21% and 32%. Little is known regarding the health care utilization associated with these infections. This study describes IDUs seeking emergency department (ED) care for soft tissue infections, their inpatient health care utilization, including operating room procedures, and the types and locations of infections associated with increased inpatient health care utilization. This study used a medical record case series of all IDUs seeking initial care for soft tissue infections at an urban, public emergency department from November 1999 through April 2000. Initial care for IDU-related soft tissue infections was sought by 242 patients. Most were male (63.6%), Caucasian (69.4%) and without health insurance (52.0%), and most had abscesses (72.3%). All patients with only cellulitis had arm or leg infections, while most abscesses were arm, deltoid, or buttock infections (81.1%). Forty percent of the patients were hospitalized, and 44.3% of the hospitalizations were for 3 or more days. Patients with only cellulitis were more likely to be hospitalized compared to those with abscesses. Among those with abscesses, deltoid abscesses were 5.2 times more likely to receive an operating room procedure compared to other abscess locations. IDUs with cellulitis and deltoid abscesses commonly required inpatient care and operating room procedures. The morbidity associated with such infections and the intensive use of hospital services needed to treat these infections provide strong rationale for the development of preventive interventions and improved care for this neglected clinical problem.

Abscess↗

PubMed2003

Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans.

OBJECTIVE: To describe ethnic differences in the risk of amputation in diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted on a national cohort of diabetic patients who received primary care within the Veterans Affairs (VA) Health Care System. Hospitalizations for lower-limb amputations were established by ICD-9-CM procedure codes. Relative risk of amputation in diabetic patients with and without diabetic nephropathy was determined using Cox proportional hazard modeling for unadjusted and adjusted models. RESULTS: Of the 429,918 subjects identified with diabetes (mean age 64 +/- 11 years, 97.4% male), 3,289 individuals were determined to have had a lower-limb amputation during the study period. Compared with diabetic patients without amputations, amputees were on average older, more likely to belong to a minority group, and were more likely to have received treatment for more comorbid conditions. Asians were more likely to have toe amputations compared with whites or other ethnicities, while Native Americans were more likely to have below-the-knee amputations. Native Americans had the highest risk of amputation (RR 1.74, 95% CI 1.39-2.18), followed by African Americans (RR 1.41, 95% CI 1.34-1.48) and Hispanics (RR 1.28, 95% CI 1.20-1.38) compared with whites. The presence of diabetic nephropathy increased the risk of amputation threefold in all groups. Asian subjects with diabetes had the lowest adjusted relative risk of amputation (RR 0.31, 95% CI 0.19-0.50). CONCLUSIONS: Among diabetic patients, certain ethnic minority individuals have an increased risk of lower-extremity amputation compared with whites. Presence of diabetic nephropathy further increases this risk.

Adult↗

PubMed2003

Visceral adiposity and the risk of impaired glucose tolerance: a prospective study among Japanese Americans.

OBJECTIVE: Greater visceral adiposity, higher insulin resistance, and impaired insulin secretion increase the risk of type 2 diabetes. Whether visceral adiposity increases risk of impaired glucose tolerance (IGT) independent of other adipose depots, insulin resistance, and insulin secretion is not known. RESEARCH DESIGN AND METHODS: Study subjects included 128 Japanese Americans with normal glucose tolerance at entry. Baseline variables included plasma glucose and insulin measured after an overnight fast and during a 75-g oral glucose tolerance test, fat areas by computed tomography, insulin secretion (incremental insulin response [IIR] [30 min insulin - fasting insulin]/30 min glucose), and insulin resistance index (homeostasis model assessment for insulin resistance [HOMA-IR]). RESULTS: During the 10- to 11-year follow-up period, we confirmed 57 cases of IGT. Significant predictors of IGT included intra-abdominal fat area (IAFA) (odds ratio [OR] for a 1 SD increase 3.82, 95% CI 1.63-8.94 at a fasting plasma glucose [FPG] level of 4.5 mmol/l), HOMA-IR (2.41, 1.15-5.04), IIR (0.30, 0.13-0.69 at an FPG level of 4.5 mmol/l), the interactions of IAFA by FPG (P = 0.003), and IIR by FPG (P = 0.030) after adjusting for age, sex, FPG, and BMI. The multiple-adjusted OR of IAFA increased and that of IIR decreased as FPG level decreased because of these interactions. Even after adjustment for total fat area, total subcutaneous fat area, or abdominal subcutaneous fat area, all of these associations remained a significant predictor of IGT incidence. CONCLUSIONS: Greater visceral adiposity increases the risk of IGT independent of insulin resistance, insulin secretion, and other adipose depots in Japanese Americans.

Abdomen↗

PubMed2003

Comparison of a clinical model, the oral glucose tolerance test, and fasting glucose for prediction of type 2 diabetes risk in Japanese Americans.

OBJECTIVE: To test the validity of a published clinical model for predicting incident diabetes in Japanese Americans. RESEARCH DESIGN AND METHODS: A total of 465 nondiabetic Japanese Americans (243 men, 222 women), aged 34-75 years, were studied at baseline and at 5-6 years. A total of 412 subjects were studied at 10 years. The clinical model included age, sex, ethnicity, BMI, systolic blood pressure, fasting plasma glucose (FPG), HDL cholesterol, and family history of diabetes at baseline. Diabetes status at 5-6 and 10 years was determined by 75-g oral glucose tolerance test. The clinical model, 2-h glucose, and FPG were compared using receiver-operating characteristic (ROC) curves. RESULTS-The diabetes risk associated with BMI, sex, and HDL cholesterol differed by age (P <or= 0.011). At 5-6 years, the clinical model ROC curve area (0.896) was higher than that for FPG (0.776, P = 0.008), but not for 2-h glucose (0.851, P = 0.341), for subjects aged <or=55 years. For older subjects, the clinical model ROC curve area (0.599) was lower than that for 2-h glucose (0.792, P <or= 0.001), but not for FPG (0.627, P = 0.467). At 10 years, there were no significant differences between the clinical model, FPG, and 2-h glucose ROC curve areas in either age group. CONCLUSIONS: In Japanese Americans aged <or=55 years, a clinical model was better than FPG for predicting diabetes after 5-6 years but not after 10 years. The model was not useful in older Japanese Americans, whereas 2-h glucose was useful for predicting diabetes risk regardless of age.

Adult↗

PubMed2003

Predicting impaired glucose tolerance using common clinical information: data from the Third National Health and Nutrition Examination Survey.

OBJECTIVE: To develop a score to predict impaired glucose tolerance (IGT) using common clinical data. RESEARCH DESIGN AND METHODS: We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) for 2,746 individuals aged 40-74 years who completed an oral glucose tolerance test. IGT was defined as a 2-h postchallenge glucose > or =140 mg/dl (7.7 mmol/l). We performed bivariate and multivariate analyses to describe the association of IGT with commonly available clinical information. A numerical score to predict IGT was derived from the results of the multivariate logistic regression models. RESULTS: Fasting glucose levels between 101 and 109 mg/dl (5.6 and 6.0 mmol/l) or between 110 and 125 mg/dl (6.1 and 6.9 mmol/l) were associated with IGT (odds ratio 1.8 and 6.2, respectively; P < 0.05). BMI > or =25 kg/m(2), Mexican-American ethnicity, age between 60 and 74 years, hypertension, and triglyceride level > or =150 mg/dl (1.69 mmol/l) were also associated with IGT. The area under the receiver operating characteristic curve for an 8-point scale derived from the multivariate analysis was 0.74 (95% CI 0.72-0.76). Setting a low cut point of 2 on this scale resulted in high sensitivity (86%), whereas a high cut point of 6 yielded high specificity (97%) for the detection of IGT. CONCLUSIONS: A numerical score based on common clinical data can identify individuals with a low or high likelihood of having IGT.

Adult↗

PubMed2003

Racial differences in diabetic nephropathy, cardiovascular disease, and mortality in a national population of veterans.

OBJECTIVE: To determine racial differences in the prevalence of diabetic nephropathy, cardiovascular disease (CVD), and risk of mortality in a national health care system. RESEARCH DESIGN AND METHODS: A longitudinal cohort study was conducted in 429,918 veterans with diabetes. Racial minority groups were analyzed for baseline differences in prevalence of early diabetic nephropathy, diabetic end-stage renal disease (ESRD) and CVD, and longitudinal risk of mortality compared with Caucasians. RESULTS: The 429,918 patients identified with diabetes were of the following racial groups: Caucasian (56.2%), African American (15.3%), Asian (0.5%), Native American (0.4%), and unknown race (21.4%). Minority individuals were, on average, younger and less likely to have CVD but were more likely to have renal disease than Caucasians. After adjustment for age, sex, and economic status, African Americans (adjusted odds ratio [OR] = 1.3, 95% CI 1.2-1.4) and Native Americans (1.5, 1.1-2.1) were more likely to have early diabetic nephropathy than Caucasians. Diabetic ESRD was more likely to be present in African Americans (1.9, 1.9-2.0), Hispanics (1.4, 1.3-1.4), Asians (1.8, 1.5-2.1), and Native Americans (1.9, 1.5-2.3) than Caucasians. Concurrently, the adjusted OR of CVD in racial minority groups was 27-49% less than in Caucasians, whereas the 18-month risk of mortality among people from most racial minority groups was 7-12% lower than in Caucasians. CONCLUSIONS: We conclude that when access to care is comparable, microvascular complications, macrovascular disease, and subsequent death occur with different frequencies among various racial groups.

Adult↗

PubMed2003

Prevalence of rheumatoid arthritis and hepatitis C in those age 60 and older in a US population based study.

OBJECTIVE: A positive association between rheumatoid arthritis (RA) and hepatitis C virus (HCV) infection has been reported in clinic based cross sectional studies. We investigated if RA and HCV are associated in a population based survey. METHODS: Using data from the National Health and Nutrition Examination Survey III, hepatitis C and RA status were determined for subjects > or = 60 years of age. RA was defined to be present when 3 of 6 American College of Rheumatology (ACR) criteria were met. RESULTS: Of 6596 subjects, 1827 (27.7%) were excluded due to missing data. Of the remaining 4769, 196 subjects (4.1%) met our modified ACR criteria for probable RA: 63 tested positive for anti-HCV antibodies (1.3%) while 35 were HCV RNA positive (0.7%). Two subjects had both HCV antibodies and RA, while one subject was both HCV RNA positive and had RA. HCV antibody positivity was not associated with RA (OR 0.44, 95% CI 0.07-2.80). Similarly, HCV positivity by polymerase chain reaction was not associated with RA (OR 0.77, 95% CI 0.10-6.19). CONCLUSION: These results argue against a potential role for HCV in the etiology of RA in the US population aged 60 years and over.

Age Distribution↗

PubMed2002

Prospective study of autonomic neuropathy as a predictor of mortality in patients with diabetes.

OBJECTIVE: The objective of this study is to evaluate whether autonomic neuropathy predicts short term all-cause mortality in an elderly cohort of veteran patients with diabetes. RESEARCH DESIGN AND METHODS: All of the diabetic patients receiving primary care at one VA medical center were eligible for participation, between 1990 and 1997. One thousand and fifteen patients were identified, of whom 14% declined to participate, so that a total of 843 diabetic patients were enrolled. Autonomic neuropathy was evaluated by heart rate response to timed deep breathing. One hundred and fifty one patients have died since the onset of the study. RESULTS: Mean follow-up was 42.4 months. Subjects who died had greater diabetes duration compared with survivors (13.1 vs. 11.4 years, P=0.04) but were comparable with regards to type of diabetes and mean glycosylated hemoglobin level. The Cox proportional hazards analysis, adjusting for age, smoking status, creatinine, pack-years of cigarettes smoked, diabetes duration, race, history of ischemic heart disease and hypertension showed that those patients with the lowest quintile of heart rate variability had a significantly increased risk of mortality (hazard ratio=1.49, 95% confidence limits 1.01-2.19). CONCLUSIONS: This study supports the hypothesis that decreased heart rate variability is an independent risk factor for mortality in diabetic patients followed in a primary care setting.

Aged↗

PubMed2002

Race, treatment, and survival of veterans with cancer of the distal esophagus and gastric cardia.

CONTEXT: Prior studies have found racial differences in the use of invasive procedures and in cancer survival. OBJECTIVE: To assess the influence of race on the treatment and survival of patients with distal esophageal cancer. DESIGN: Retrospective cohort study. SETTING: All Veterans Affairs Medical Centers. PATIENTS: One thousand two hundred ninety white and 231 black male veterans with a new diagnosis of distal esophageal cancer during 1993 to 1997. MAIN OUTCOME MEASURES: Utilization of surgical resection, chemotherapy, radiation therapy, and survival. RESULTS: Black patients with esophageal adenocarcinoma were less likely to undergo surgery (OR, 0.54; 95% CI, 0.30-0.96) but had similar odds of undergoing chemotherapy and radiation therapy. Black patients with squamous cell carcinoma (SCC) were less likely to undergo surgical resection (OR, 0.45; 95% CI, 0.29-0.70), but were more likely to undergo radiation therapy (OR, 1.72; 95% CI, 1.21-2.47) and chemotherapy (OR, 1.74; 95% CI, 1.19-2.54). Mortality was increased for black patients with SCC (adjusted risk ratio 1.33; 95% CI, 1.10-1.61) but not adenocarcinoma. Among those veterans who underwent surgical resection (n = 502), similar results were found. CONCLUSIONS: Black veterans with distal SCC are less likely than white veterans to undergo surgical resection, whereas the use of radiation therapy and chemotherapy, as well as mortality, is increased. Black patients with distal esophageal adenocarcinoma have lower odds of undergoing surgical resection but have similar utilization of radiation therapy and chemotherapy and similar survival. Despite the presence of an equal access medical system, treatment and outcomes differ for black and white veterans with distal esophageal cancer.

Adenocarcinoma↗

PubMed2002

Outcomes of infants born to mothers with inflammatory bowel disease: a population-based cohort study.

OBJECTIVE: Limited population-based data on inflammatory bowel disease (IBD) and pregnancy outcomes exist. The purpose of this study is to determine the association between maternal IBD status and adverse pregnancy outcomes. METHODS: Using computerized birth records of infants born to mothers with Crohn's disease (CD) or ulcerative colitis (UC) and mothers without diagnoses of IBD (no-IBD) in Washington State, we performed a cross-sectional retrospective study to determine gestational age, birth weight, and congenital malformations. RESULTS: Preterm delivery was seen in 15.2% of CD births, 10.4% of UC births, and 7.2% of no-IBD births. Low birth weight was found in 16.8% of CD births, 7.6% of UC births, and 5.3% of no-IBD births. Smallness for gestational age was present in 15.2% of CD births, 10.5% of UC births, and 6.9% of no-IBD births. Only CD births were at significantly increased risk of preterm delivery (p < 0.0025), low birth weight (p < 0.001), and smallness for gestational age (p < 0.001). Congenital malformations were more commonly recorded in UC births than in controls (7.9% vs 1.7%, p < 0.001), whereas 3.4% of CD births had malformations recorded. Using multivariable logistic regression, CD births were more likely to be preterm (odds ratio [OR] = 2.3, 95% CI = 1.4-3.8) and have low birth weights (OR = 3.6, CI = 2.2-5.9) and smallness for gestational age (OR = 2.3, CI = 1.3-3.9). UC births were more likely to have congenital malformations reported (OR = 3.8, CI = 1.5-9.8). CONCLUSIONS: Maternal IBD is associated with increased odds of preterm delivery, low birth weight, smallness for gestational age (CD), and reporting of congenital malformations (UC).

Adult↗

PubMed2002

The Vietnam Era Twin Registry.

The Vietnam Era Twin (VET) Registry is composed of 7369 middle-aged male-male twin pairs both of whom served in the military during the time of the Vietnam conflict (1965-1975). The Registry is a United States Department of Veterans Affairs resource that was originally constructed from military records; the Registry has been in existence for more than 15 years. It is one of the largest national twin registries in the US and currently has subjects living in all 50 states. Initially formed to address questions about the long-term health effects of service in Vietnam the Registry has evolved into a resource for genetic epidemiologic studies of mental and physical health conditions. The management and administration of the VET Registry is described with particular attention given to the processes involved with database maintenance and study coordination. Several waves of mail and telephone surveys have collected a wealth of health-related information on Registry twins. More recent data collection efforts have focused on specific sets of twin pairs and conducted detailed clinical or laboratory testing. New Registry initiatives for the future include the construction of a web site and the development of a DNA repository.

Data Collection↗

PubMed2002

The concurrent accumulation of intra-abdominal and subcutaneous fat explains the association between insulin resistance and plasma leptin concentrations : distinct metabolic effects of two fat compartments.

Obesity is associated with insulin resistance, particularly when body fat has a central distribution. However, insulin resistance also frequently occurs in apparently lean individuals. It has been proposed that these lean insulin-resistant individuals have greater amounts of body fat than lean insulin-sensitive subjects. Alternatively, their body fat distribution may be different. Obesity is associated with elevated plasma leptin levels, but some studies have suggested that insulin sensitivity is an additional determinant of circulating leptin concentrations. To examine how body fat distribution contributes to insulin sensitivity and how these variables are related to leptin levels, we studied 174 individuals (73 men, 101 women), a priori classified as lean insulin-sensitive (LIS, n = 56), lean insulin-resistant (LIR, n = 61), and obese insulin-resistant (OIR, n = 57) based on their BMI and insulin sensitivity index (S(I)). Whereas the BMI of the two lean groups did not differ, the S(I) of the LIR subjects was less than half that of the LIS group. The subcutaneous and intra-abdominal fat areas, determined by computed tomography, were 45 and 70% greater in the LIR subjects (P < 0.001) and 2.5- and 3-fold greater in the OIR group, as compared with the LIS group. Fasting plasma leptin levels were moderately increased in LIR subjects (10.8 +/- 7.1 vs. 8.1 +/- 6.4 ng/ml in LIS subjects; P < 0.001) and doubled in OIR subjects (21.9 +/- 15.5 ng/ml; P < 0.001). Because of the confounding effect of body fat, we examined the relationships between adiposity, insulin sensitivity, and leptin concentrations by multiple regression analysis. Intra-abdominal fat was the best variable predicting insulin sensitivity in both genders and explained 54% of the variance in S(I). This inverse relationship was nonlinear (r = -0.688). On the other hand, in both genders, fasting leptin levels were strongly associated with subcutaneous fat area (r = 0.760) but not with intra-abdominal fat. In line with these analyses, when LIS and LIR subjects were matched for subcutaneous fat area, age, and gender, they had similar leptin levels, whereas their intra-abdominal fat and insulin sensitivity remained different. Thus, accumulation of intra-abdominal fat correlates with insulin resistance, whereas subcutaneous fat deposition correlates with circulating leptin levels. We conclude that the concurrent increase in these two metabolically distinct fat compartments is a major explanation for the association between insulin resistance and elevated circulating leptin concentrations in lean and obese subjects.

Abdomen↗

PubMed2002

Diet and exercise among adults with type 2 diabetes: findings from the third national health and nutrition examination survey (NHANES III).

OBJECTIVE: To describe diet and exercise practices from a nationally representative sample of U.S. adults with type 2 diabetes. METHODS: We analyzed data from 1,480 adults older than 17 years with a self-reported diagnosis of type 2 diabetes in the Third National Health and Nutrition Examination Survey (NHANES III). Fruit and vegetable consumption was obtained from a food frequency questionnaire; the percentages of total calories from fat and saturated fat were obtained from a 24-h food recall. Physical activity was based on self report during the month before the survey. RESULTS: Of individuals with type 2 diabetes, 31% reported no regular physical activity and another 38% reported less than recommended levels of physical activity. Sixty-two percent of respondents ate fewer than five servings of fruits and vegetables per day. Almost two thirds of the respondents consumed >30% of their daily calories from fat and >10% of total calories from saturated fat. Mexican Americans and individuals over the age of 65 years ate a higher number of fruits and vegetables and a lower percentage of total calories from fat. Lower income and increasing age were associated with physical inactivity. Thirty-six percent of the sample were overweight and another 46% were obese. CONCLUSIONS: The majority of individuals with type 2 diabetes were overweight, did not engage in recommended levels of physical activity, and did not follow dietary guidelines for fat and fruit and vegetable consumption. Additional measures are needed to encourage regular physical activity and improve dietary habits in this population.

Aged↗

PubMed2002

Diabetes and the risk of acute urinary tract infection among postmenopausal women.

OBJECTIVE: To examine whether the presence of diabetes alters the risk of acute urinary tract infection (UTI) in postmenopausal women. RESEARCH DESIGN AND METHODS: A case-control study of the Group Health Cooperative of Puget Sound (GHC), a staff-model nonprofit health maintenance organization in Washington State, was conducted. Subjects were women aged 55-75 years who had been members of GHC for at least 1 year and who had had an acute symptomatic UTI within the preceding month. Laboratory files were used to identify women with a urine culture that grew > or =10(5) colonies of a urinary pathogen. Medical records were reviewed to confirm the presence of acute, clinically symptomatic UTI. Control subjects were randomly selected from the GHC enrollment file, screened to remove women with recent UTI, and frequency matched to cases by age within 2 years. An interviewer ascertained self-reported clinician-diagnosed diabetes. Diagnosis of diabetes was confirmed by the GHC diabetes registry. A subsample of women underwent measurement of postvoid residual bladder volume (n = 748) and culture of vaginal flora (n = 454). RESULTS: Of the 901 case and 913 control subjects, diabetes was reported in 13.1 and 6.8%, respectively. The health plan diabetes registry confirmed the diagnosis in 92% of women who self-reported the condition. The age-adjusted odds ratio (OR) for UTI in relation to self-reported clinician-diagnosed diabetes was 2.2 (95% CI 1.6-3.0). Adjustment for frequency of sexual intercourse and history of UTI had little effect on this estimate. Compared with nondiabetic women, higher UTI odds were seen in subjects who used oral hypoglycemic agents (OR 2.9 [95% CI 1.7-5.1]) and insulin (2.6 [1.5-4.6]) but not in subjects with untreated diabetes or diabetes treated by lifestyle changes (1.3 [0.7-2.3]). No significant difference was seen in the OR for UTI in diabetic women with disease of shorter duration (<10 years, OR 1.9) or longer duration (> or =10 years, OR 2.6) or in relation to HbA(1c) level. Similar microbiologic pathogens were seen in diabetic and nondiabetic women. No significant differences were seen by diabetes status in mean postvoid residual bladder volume or vaginal flora. CONCLUSIONS: Diabetes under pharmacologic treatment is associated with increased risk of clinically apparent UTI in postmenopausal women.

Aged↗

PubMed2002

Improvement of BMI, body composition, and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance.

OBJECTIVE: To determine whether diet and endurance exercise improved adiposity-related measurements in Japanese Americans with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS: This study compared the effects of an American Heart Association (AHA) step 2 diet (<30% of total calories as fat, <7% saturated fat, 55% carbohydrate, and < 200 mg cholesterol daily) plus endurance exercise for 1 h three times a week (treatment group) with an AHA step 1 diet (30% of total calories as fat, 10% saturated fat, 50% carbohydrate, and <300 mg cholesterol) plus stretching exercise three times a week (control group) on BMI, body composition (% fat), and body fat distribution at 6 and 24 months of follow-up in 64 Japanese American men and women with IGT, 58 of whom completed the study. RESULTS: At 6 months, the treatment group showed significantly greater reduction in percent, body fat (-1.4 +/- 0.4 vs. -0.3 +/- 0.3%); BMI (-1.1 +/- 0.2 vs. -0.4 +/- 0.1 kg/m(2)); subcutaneous fat by computed tomography at the abdomen (-29.3 +/- 4.2 vs. -5.7 +/- 5.9 cm(2)), thigh (-13.2 +/- 3.6 vs. -3.6 +/- 3.0 cm(2)), and thorax (-19.6 +/- 3.6 vs. -8.9 +/- 2.6 cm(2)); and skinfold thickness at the bicep (-2.0 +/- 0.6 vs. 1.1 +/- 0.6 mm) and tricep (-3.7 +/- 0.8 vs. -0.9 +/- 0.6 mm), which continued despite moving to home-based exercise for the last 18 months. CONCLUSIONS: Diet and endurance exercise improved BMI, body composition, and body fat distribution and, thus, may delay or prevent type 2 diabetes in Japanese Americans with IGT.

Asian↗

PubMed2002

The millennium Cohort Study: a 21-year prospective cohort study of 140,000 military personnel.

Does military service, in particular operational deployment, result in a higher risk of chronic illness among military personnel and veterans? The Millennium Cohort Study, the largest Department of Defense prospective cohort study ever conducted, will attempt to answer this question. The probability-based sample of 140,000 military personnel will be surveyed every 3 years during a 21-year period. The first questionnaire, scheduled for release in summer 2001, will be sent to 30,000 veterans who have been deployed to southwest Asia, Bosnia, or Kosovo since August 1997 and 70,000 veterans who have not been deployed to these conflict areas. Twenty thousand new participants will be added to the group in each of the years 2004 and 2007 to complete the study population of 140,000. The participants will have the option of completing the study questionnaire either on the paper copy received in the mail or through the World Wide Web-based version, which is available at www.MillenniumCohort.org. This will be one of the first prospective studies ever to offer such an option. The initial survey instrument will collect data regarding demographic characteristics, self-reported medical conditions and symptoms, and health-related behaviors. Validated instruments will be incorporated to capture self-assessed physical and mental functional status (Short Form for Veterans), psychosocial assessment (Patient Health Questionnaire), and post-traumatic stress disorder (Patient Checklist-17). Information obtained from the survey responses will be linked with other military databases, including data on deployment, occupation, vaccinations, health care utilization, and disability. In addition to revealing changes in veterans' health status over time, the Millennium Cohort Study will serve as a data repository, providing a solid foundation upon which additional epidemiological studies may be constructed.

Chronic Disease↗