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Biomedical subjects

Eric B Rimm

Publications and source records attributed to Eric B Rimm.

At least 109 records · Page 6Linked to original sources
PubMed2003

Reproducibility and validity of the Diet Quality Index Revised as assessed by use of a food-frequency questionnaire.

BACKGROUND: The Diet Quality Index Revised (DQI-R) is a dietary assessment instrument based on 10 dietary recommendations reflecting dietary guidelines and policy in the United States. OBJECTIVE: The objective of this study was to assess the reproducibility and validity of the DQI-R as measured by use of food-frequency questionnaires (FFQs). DESIGN: Diet was assessed separately by two FFQs at a 1-y interval and by two 1-wk diet records. DQI-R scores were computed from each method. Venous blood specimens were collected for measurement of dietary biomarkers. Participants (n = 127) were men aged 40-75 y in a validation study of the Health Professionals Follow-up Study. RESULTS: Mean DQI-R scores were 69.5 for FFQ-1, 67.2 for FFQ-2, and 62.0 for the diet records out of a possible score of 100. The reproducibility correlation for the 2 FFQ scores was 0.72. Correlations between scores for each of the 2 FFQs and diet records were 0.66 (FFQ-1) and 0.72 (FFQ-2). DQI-R scores from FFQ-2 were directly correlated with plasma biochemical measurements of alpha-carotene (r = 0.43, P < 0.0005), beta-carotene (r = 0.35, P < 0.005), lutein (r = 0.31, P <0.005), and alpha-tocopherol (r = 0.25, P < 0.05) and were inversely correlated with plasma total cholesterol (r = -0.22, P < 0.05). CONCLUSIONS: These data indicate reasonable reproducibility and validity of the DQI-R as assessed by an FFQ. Future studies are needed to examine whether this index and other instruments of diet quality can reliably predict disease outcomes.

Adult↗
PubMed2003

Dietary fiber reduces peripheral arterial disease risk in men.

We prospectively evaluated the relationship between dietary fiber and peripheral arterial disease risk (PAD) among 46,032 men, aged 40 to 75 y, in 1986. Subjects answered a vascular disease questionnaire and completed a validated 131-item food frequency questionnaire, and were free of PAD, cardiovascular disease and diabetes. During 12 y of follow-up 308 incident PAD cases were documented. After adjusting for age, smoking, hypertension, hypercholesterolemia, family history of early coronary heart disease, alcohol consumption, BMI, physical activity and energy intake, PAD risk in each quintile of cereal fiber intake compared with the lowest quintile was 0.69, 95% CI 0.49-0.97 for quintile 2; 0.65, 95% CI 0.45-0.94 for quintile 3; 0.68, 95% CI 0.47-0.98 for quintile 4; and 0.67, 95% CI 0.47-0.97 for quintile 5. In a nonlinear model the overall inverse association (P = 0.02) and nonlinear components (P = 0.03) were significant. Fruit, vegetable and total fiber intakes were not associated with PAD risk. These results suggest an inverse association between cereal fiber intake and PAD risk in men. Increasing cereal fiber intake may prevent PAD.

Adult↗
PubMed2003

The use of B vitamin supplements and peripheral arterial disease risk in men are inversely related.

Peripheral arterial disease (PAD) causes morbidity and is associated with mortality. B vitamin intake has been inversely associated with coronary heart disease, but their effects on PAD are not known. We examined prospectively the relationships between dietary folate, vitamin B-6 and B-12 and PAD risk in 51529 male U.S. health professionals, aged 40 to 75 y, who answered a detailed 131-item questionnaire to assess diet and vitamin supplement use. The study population consisted of 46036 men free of PAD, cardiovascular disease and diabetes at baseline followed for 12 y during which we documented 308 incident PAD cases. For every 400 microg/d increment of folate intake, the multivariate adjusted PAD risk decreased by 21% [relative risk (RR) = 0.79, 95% CI 0.64-0.96]. Men in the top category of folate intake (median = 840 micro g) were at 33% lower risk of PAD than men in the bottom category (median = 244 microg) (RR = 0.67, 95% CI 0.45-0.96, P-value, test for trend = 0.03) after multivariate adjustment. There were weak inverse associations between intake of vitamin B-6 and PAD risk (RR = 0.70, 95% CI 0.48-1.02, P-value, test for trend = 0.06) and B-12 (RR = 0.77, 95% CI 0.54-1.11, P-value, test for trend = 0.12). These results suggest that higher consumption of folate may contribute to the prevention of PAD.

Adult↗
PubMed2003

Moderate alcohol intake and renal function decline in women: a prospective study.

BACKGROUND: The impact of moderate alcohol consumption on renal function has important public health implications given the high prevalence of alcohol use. Experimentally, alcohol may adversely affect renal function, but clinical data are limited and no large, prospective studies have examined this issue. METHODS: In a prospective study of 1658 nurses enrolled in the Nurses' Health Study, we sought to determine if there was an association between moderate alcohol consumption and rate of decline in renal function. Daily alcohol intake was measured in 1990, 1994 and 1998 using a detailed questionnaire. Maximum daily alcohol intake was measured in 1988. Creatinine, measured from blood samples provided in 1989 and 2000, was used to estimate glomerular filtration rate (GFR) and creatinine clearance (CCr). RESULTS: Compared to individuals with no alcohol intake, the odds ratios (ORs) for developing a >or=25% estimated GFR decline were: 0.98 (95% CI: 0.72-1.32) for 0.1-4.9 g/day, 0.83 (95% CI: 0.56-1.21) for 5-14.9 g/day and 0.81 (95% CI: 0.50-1.31) for 15-59.9 g/day. For women with hypertension (n = 726), the ORs for a >or=25% estimated GFR decline were: 0.98 (95% CI: 0.53-1.21) for 0.1-4.9 g/day, 0.62 (95% CI: 0.34-1.12) for 5-14.9 g/day and 0.53 (95% CI: 0.25-1.12) for 15-59.9 g/day. CONCLUSIONS: Moderate alcohol consumption had no substantial adverse effect on renal function in women over an 11 year follow-up period.

Alcohol Drinking↗
PubMed2003

The relationship between amalgam restorations and mercury levels in male dentists and nondental health professionals.

OBJECTIVES: The objectives of this study were: (1) to compare the mercury levels in general dentists with the mercury levels in other health professionals using toenail clippings as a biomarker, (2) to identify risk factors associated with high mercury levels, and (3) to compare practice characteristics of dentists with high and low mercury levels. METHODS: A sample of 579 men was randomly selected from the 33,737 men participating in the Health Professionals Follow-up Study who had provided toenail samples in 1987. A questionnaire was sent to these male subjects in 1991 to obtain information on fish consumption, toothbrushing frequency, number of teeth, number of amalgam restorations, general practice or specialty status, number of amalgam restorations placed and removed per week, mercury storage and handling procedures, and mercury spillage incidents. A measure of long-term mercury exposure was obtained from toenail samples using neutron activation analysis for the 410 respondents (71% response rate). The 90th percentile mercury level in toenails (0.88 ppm) was selected as the threshold for elevated toenail mercury level. RESULTS: No relationship was found between the number of dental amalgams and toenail mercury levels among general dentists, dental specialists, and nondental health professionals. General dentists were found to have more than twice the level of mercury in toenails than nondental health professionals (mean level = 0.94 vs 0.45) and 60 percent higher than dental specialists (mean = 0.59). The combined use of disposable capsules and water storage of scrap amalgam appeared to reduce the risk of elevated mercury levels. Regardless of professional status, consumption of tuna and saltwater fish were the primary exposure factors that were positively associated with toenail mercury levels. CONCLUSIONS: As shown by the associations with dental profession and fish consumption, the mercury content of toenails is a stable biomarker of cumulative long-term mercury exposure. The lack of association between nail mercury levels and number of amalgam restorations suggests that avoidance of mercury amalgam restorative materials cannot be justified by the presence of mercury released from dental amalgams.

Animals↗
PubMed2003

Periodontal disease, tooth loss, and incidence of ischemic stroke.

BACKGROUND AND PURPOSE: Periodontal and other infections have been suggested as potential risk factors for stroke. This study evaluates periodontal disease and tooth loss as risk factors for ischemic stroke. METHODS: The study population consisted of 41 380 men who were free of cardiovascular disease and diabetes at baseline. Periodontal disease history was assessed by mailed validated questionnaires. During 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. Sex and socioeconomic status were inherently controlled for by restriction. Confounding variables were updated in the analyses for each 2-year follow-up interval. RESULTS: We documented 349 ischemic stroke cases during the follow-up period. Men who had < or =24 teeth at baseline were at a higher risk of stroke compared to men with > or =25 teeth (HR=1.57; 95% CI, 1.24 to 1.98). There was little evidence of an increased risk with recent tooth loss during follow-up. A modest association was seen between baseline periodontal disease history and ischemic stroke (HR=1.33; 95% CI, 1.03 to 1.70). Addition of dietary factors to the model changed the HR only slightly. CONCLUSIONS: Our results suggest that periodontal disease and fewer teeth may be associated with increased risk of ischemic stroke.

Adult↗
PubMed2003

Alcohol for the prevention of type 2 diabetes mellitus?

While diabetes mellitus is recognized clinically as a complication of alcohol dependence, in the last 15 years several large prospective studies have demonstrated a significant reduction in risk of incident type 2 diabetes in moderate drinkers. In this article, we review prospective studies on the association between alcohol consumption and incidence of diabetes. Few prospective studies have demonstrated an unequivocal positive association between alcohol use and incidence of diabetes. A number of large prospective studies have now demonstrated an inverse association: typically a 40% risk reduction after controlling for other major risk factors. Studies based on cohorts of health professionals have not demonstrated an increased risk of diabetes with heavier consumption, but these cohorts contain few heavy drinkers. Some cohorts drawn from the general population have shown a J- or U-shaped association between level of alcohol consumption and incidence of diabetes. Frequent moderate drinking has been reported to be associated with lower risk than infrequent drinking. There have been contradictory reports on the importance of the type of alcoholic beverage and whether the effect of alcohol differs according to the bodyweight of the drinker. We conclude that like many other chronic diseases, there is a delicate balance between the harmful and beneficial effects of alcohol on the incidence of diabetes. In moderate amounts, drinking is associated with a reduced risk of diabetes, whereas in higher amounts with an increased risk.

Alcohol Drinking↗
PubMed2003

A cross-sectional study of alcohol consumption patterns and biologic markers of glycemic control among 459 women.

OBJECTIVE: Little research has explored associations of drinking patterns with glycemic control, especially among women. Our objective was to determine the relationship of patterns of alcohol consumption-including average daily consumption, weekly frequency of consumption, drinking with meals, and beverage type-with biologic markers of insulin resistance in young women. RESEARCH DESIGN AND METHODS: This study was cross-sectional in design. The subjects consisted of a stratified random subpopulation of 459 U.S. normal-weight and overweight female nurses, 33-50 years of age, drawn from the Nurses' Health Study II and sampled for distinct drinking patterns. Women provided blood samples and detailed information on dietary and lifestyle factors between 1995 and 1999. The main outcome measures were fasting insulin, C-peptide, and HbA(1c). RESULTS: Adjusting for age, smoking, physical activity, television watching, BMI, and several dietary factors, average alcohol intake was inversely associated with HbA(1c) (units in percentage of HbA(1c)): 0 g/day (reference = 5.36%), 0.1 to <5.0 g/day (-0.04%), 5.0 to <15.0 g/day (-0.09%), 15.0 to <25.0 g/day (-0.10%), and > or =25.0 g/day (-0.17%) (P value, test for trend <0.001). We found an inverse association of alcohol intake and insulin, but only for women with a BMI > or =25 kg/m(2). Specifically, insulin levels were lowest for episodic drinkers consuming > or =2 drinks per day on 0-3 days per week. Consumption with meals and type of alcoholic beverage did not further influence these results. CONCLUSIONS: Moderate alcohol consumption of 1-2 drinks per day on a few to several days of the week may have a beneficial glycemic effect, particularly among overweight women.

Adult↗
PubMed2003

A prospective study of intake of fish and marine fatty acids and prostate cancer.

Experimental studies suggest that marine fatty acids have an antitumor effect on prostate tumor cells. The aim of this study was to investigate whether high consumption of fish and marine fatty acids reduces the risk of prostate cancer in humans. We followed 47882 men participating in the Health Professionals Follow-up Study. Dietary intake was assessed in 1986, 1990, and 1994, using a validated food frequency questionnaire. During 12 years of follow-up, 2482 cases of prostate cancer were diagnosed, of which 617 were diagnosed as advanced prostate cancer including 278 metastatic prostate cancers. Eating fish more than three times per week was associated with a reduced risk of prostate cancer, and the strongest association was for metastatic cancer (multivariate relative risk, 0.56; 95% confidence interval, 0.37-0.86, compared with infrequent consumption, i.e., less than twice per month). Intake of marine fatty acids from food showed a similar but weaker association. Each additional daily intake of 0.5 g of marine fatty acid from food was associated with a 24% decreased risk of metastatic cancer. We found that men with high consumption of fish had a lower risk of prostate cancer, especially for metastatic cancer. Marine fatty acids may account for part of the effect, but other factors in fish may also play a role.

Adult↗
PubMed2003

Nutritional predictors of insulin-like growth factor I and their relationships to cancer in men.

The insulin-like growth factor (IGF) axis may play opposing roles in health and disease. The age-related declines in growth hormone and IGF-I may be associated with potentially deleterious changes in body composition and functioning, but recent studies suggest that IGF-I levels may be related to risk of prostate, colorectal, premenopausal breast, and possibly other cancers. Thus, we studied dietary influences on plasma IGF-I and IGF-I:IGF-binding protein-3 ratio in 753 men in the Health Professionals Follow-Up Study who completed a food frequency questionnaire. In this generally well-nourished population of middle-aged to elderly men, plasma IGF-I and IGF-I:IGF-binding protein-3 molar ratio tended to increase with higher intake of protein and minerals, including potassium, zinc, magnesium, calcium, and phosphorus. Men with relatively high intakes of total protein (top quintile) and minerals (top quintile of the five minerals combined) had a 25% higher mean plasma level of IGF-I compared with those in the low quintiles simultaneously. The major sources of animal protein, including milk, fish, and poultry, but not red meat, as well as total vegetable protein, were associated with an increase in IGF-I levels. Energy intake was positively related to plasma IGF-I level but only in men with body mass index <25 kg/m(2). The age-related decline in plasma IGF-I may be exacerbated by low intakes of protein and minerals. The potential role of these dietary factors on cancer risk through altering IGF-I levels requires study.

Aged↗
PubMed2003

Methylenetetrahydrofolate reductase, alcohol dehydrogenase, diet, and risk of colorectal adenomas.

An increased occurrence of colorectal cancer and its adenoma precursor is observed among individuals with low intakes or circulating levels of folate, especially if alcohol intake is high, although results have not been statistically significant in all studies. We examined folate and alcohol intake and genetic polymorphisms in methylenetetrahydrofolate reductase [MTHFR 667-->T (ala-->val) and MTHFR 1298A-->C (gln-->ala)] (associated with reduced MTHFR activity) and in alcohol dehydrogenase 3 [ADH3 (2-2) associated with decreased alcohol catabolism] in relation to risk of colorectal adenoma in the Health Professionals Follow-Up Study. Among 379 cases and 726 controls, MTHFR genotypes were not appreciably related to risk of adenoma, but a suggestive interaction (P = 0.09) was observed between MTHFR 677C-->T and alcohol intake; men with TT homozygotes who consumed 30+ g/day of alcohol had an odds ratio (OR) of 3.52 [95% confidence interval (CI), 1.41-8.78] relative to drinkers of < or =5 g/day with the CC/CT genotypes. ADH3 genotype alone was not appreciably related to risk, but its influence was modified by alcohol intake. Compared with fast alcohol catabolizers [ADH3(1-1)] with low intakes of alcohol (< or =5 g/day), high consumers of alcohol (30+ g/day) had a marked increase in risk if they had the genotype associated with slow catabolism [ADH3(2-2); OR, 2.94; 95% CI, 1.24-6.92] or intermediate catabolism [ADH3(1-2)] of alcohol (OR, 1.83; 95% CI, 1.03-3.26) but not if they were fast catabolizers [ADH3(1-1); OR = 1.27; 95% CI = 0.63-2.53). In addition, an increased risk of colorectal adenoma (OR, 17.1; 95% CI, 2.1-137) was observed for those with the ADH3(2-2) genotype and high alcohol-low folate intake compared with those with low alcohol-high folate intake and the ADH3(1-1) genotype (P for interaction = 0.006). Our results indicate that high intake of alcohol is associated with an increased risk of colorectal adenoma, particularly among MTHFR 677TT and ADH3(2-2) homozygotes. The findings that alcohol interacts with a folate-related gene (MTHFR) and that the interaction between alcohol and ADH3 is stronger among those with low folate intake support the hypothesis that the carcinogenic influence of alcohol in the large bowel is mediated through folate status.

Adenoma↗
PubMed2003

A prospective study of cruciferous vegetables and prostate cancer.

High intake of cruciferous vegetables may offer some protection against prostate cancer, but overall data are inconclusive. Thus, we examined the association between cruciferous vegetable intake and risk of prostate cancer in the Health Professionals Follow-Up Study. Between 1986 and 2000, 2,969 cases of nonstage T1a prostate cancer were diagnosed in 47,365 men who completed dietary assessments in 1986, 1990, and 1994. We calculated the multivariate relative risk (RR) and 95% confidence intervals (CIs) using Cox regression. Overall, we found no appreciable association between baseline intake of cruciferous vegetables and risk of prostate cancer (RR, 0.93; 95% CI, 0.82-1.05, for > or = 5 versus < or = 1 serving/week; P for trend = 0.30), and only a slight suggestive association for organ-confined prostate cancer (RR, 0.88; 95% CI, 0.74-1.05; P for trend = 0.06). The inverse association was stronger for men under the age of 65 years (RR, 0.81; 95% CI, 0.64-1.02; P for trend = 0.02), especially for organ-confined cancers (RR, 0.72; 95% CI, 0.54-0.97; P for trend = 0.007). In addition, this inverse association was stronger when we restricted the analysis to men with more consistent intake of vegetables over the 10 years before 1986, when we limited the analysis to men who had had a prostate-specific antigen test, and when we considered an 8-year time lag. This study does not provide compelling evidence of a protective influence of cruciferous vegetables on prostate cancer risk. However, if cruciferous vegetables are protective early in prostate carcinogenesis, as suggested by proposed mechanisms, we may expect stronger associations, as observed, for more remote diet for prostate-specific antigen-detected early stage (organ-confined) cancers in younger men. In contrast, for advanced cancers in older men, which were probably initiated decades in the past, recent dietary intakes of cruciferous vegetables may be irrelevant. These findings suggest that future studies of cruciferous vegetables should focus on early stages of prostate cancer.

Adult↗
PubMed2002

Fish consumption and risk of stroke in men.

CONTEXT: The effect of fish consumption or long-chain omega-3 polyunsaturated fatty acid (PUFA) intake on risk of stroke remains uncertain. OBJECTIVE: To examine the relation of fish consumption and long-chain omega-3 PUFA intake and risk of stroke in men. DESIGN AND SETTING: The Health Professional Follow-up Study, a US prospective cohort study with 12 years of follow-up. PARTICIPANTS: A total of 43 671 men aged 40 to 75 years who completed a detailed and validated semiquantitative food frequency questionnaire and who were free of cardiovascular disease at baseline in 1986. MAIN OUTCOME MEASURE: Relative risk (RR) of stroke by subtype based on cumulative average fish consumption or long-chain omega-3 PUFA intake, ascertained in 1986, 1990, and 1994. RESULTS: We documented 608 strokes during the 12-year follow-up period, including 377 ischemic, 106 hemorrhagic, and 125 unclassified strokes. Compared with men who consumed fish less than once per month, the multivariate RR of ischemic stroke was significantly lower among those who ate fish 1 to 3 times per month (RR, 0.57; 95% confidence interval [CI], 0.35-0.95). However, a higher frequency of fish intake was not associated with further risk reduction; the RR was 0.54 (95% CI, 0.31-0.94) for men who consumed fish 5 or more times per week. This lack of linearity was confirmed by spline analyses. By dichotomized fish intake, the multivariate RR for men who consumed fish at least once per month compared with those who ate fish less than once per month was 0.56 (95% CI, 0.38-0.83) for ischemic stroke and 1.36 (95% CI, 0.48-3.82) for hemorrhagic stroke. The inverse association between fish intake and risk of ischemic stroke was not materially modified by use of aspirin. No significant associations were found between fish or long-chain omega-3 PUFA intake and risk of hemorrhagic stroke. CONCLUSION: Our findings suggest that eating fish once per month or more can reduce the risk of ischemic stroke in men.

Adult↗
PubMed2002

Mercury and the risk of coronary heart disease in men.

BACKGROUND: A high dietary intake of mercury from consumption of fish has been hypothesized to increase the risk of coronary heart disease. METHODS: Using a nested case-control design, we investigated the association between mercury levels in toenails and the risk of coronary heart disease among male health professionals with no previous history of cardiovascular disease or cancer who were 40 to 75 years of age in 1986. Toenail clippings were collected in 1987 from 33,737 cohort members, and during five years of follow-up, we documented 470 cases of coronary heart disease (coronary-artery surgery, nonfatal myocardial infarction, and fatal coronary heart disease). Each patient was matched according to age and smoking status with a randomly selected control subject. RESULTS: The mercury level was significantly correlated with fish consumption (Spearman r=0.42, P<0.001), and the mean mercury level was higher in dentists than in nondentists (mean, 0.91 and 0.45 microg per gram, respectively; P<0.001). After age, smoking, and other risk factors for coronary heart disease had been controlled for, the mercury level was not significantly associated with the risk of coronary heart disease. When the highest and lowest quintiles of mercury level were compared, the relative risk of coronary heart disease was 0.97 in the highest level (95 percent confidence interval, 0.63 to 1.50; P value for trend=0.78). Adjustment for intake of n-3 fatty acids from fish did not appreciably change these results. CONCLUSIONS: Our findings do not support an association between total mercury exposure and the risk of coronary heart disease, but a weak relation cannot be ruled out.

Animals↗
PubMed2002

The impact of diabetes mellitus and prior myocardial infarction on mortality from all causes and from coronary heart disease in men.

OBJECTIVES: The goal of this study was to examine the impact of diabetes and prior myocardial infarction (MI) on mortality in men. BACKGROUND: Previous studies have suggested that a history of diabetes and a prior MI confer similar risk for subsequent fatal coronary heart disease (CHD). Few studies have examined duration of diabetes in relation to mortality. METHODS: We examined type 2 diabetes and prior MI in relation to mortality among 51,316 men aged 40 to 75 years in the Health Professionals Follow-up Study. RESULTS: During 10 years of follow-up, we documented 4,150 deaths from all causes, including 1,124 deaths from CHD. Compared with men without diabetes or prior MI at baseline, the multivariate relative risks (RRs) for fatal CHD were 3.84 (95% confidence interval [CI], 3.12 to 4.71) for those with diabetes only, 7.88 (95% CI, 6.86 to 9.05) for those with MI only, and 13.41 (95% CI, 10.49 to 17.16) for those with both diabetes and MI. The corresponding RRs for total mortality were 1.91 (95% CI, 1.70 to 2.15), 2.23 (95% CI, 2.03 to 2.45), and 3.13 (95% CI, 2.56 to 3.84), respectively. Duration of diabetes was an independent risk factor for total as well as CHD mortality; the multivariate RRs of CHD mortality for increasing duration of diabetes (< or = 5 years, 6 to 10 years, 11 to 15 years, 16 to 25 years, 26+ years) were 1.63, 1.93, 2.35, 2.31, and 3.87, respectively (p for trend <0.001), compared with nondiabetic participants. CONCLUSIONS: These findings support that both diabetes and MI are associated with elevated total and CHD mortality, and having both conditions is particularly hazardous. Longer duration of diabetes is a strong predictor of death among diabetic men.

Coronary Disease↗
PubMed2002

Social ties and change in social ties in relation to subsequent total and cause-specific mortality and coronary heart disease incidence in men.

The authors prospectively examined the effects of social ties and change in social ties, as measured by a well-known social network index, on total and cause-specific mortality and on coronary heart disease incidence in 28,369 US male health professionals aged 42-77 years in 1988. Over 10 years, the relative risk of total mortality for men in the lower two levels of social integration compared with more socially integrated men was 1.19 (95% confidence interval: 1.06, 1.34) after controlling for age, occupation, health behaviors, general physical condition, coronary risk factors, and dietary habits. In multivariate analysis, deaths from accidents and suicide and from other noncancer, noncardiovascular causes were significantly increased among less socially connected men. Socially isolated men also had an increased risk of fatal coronary heart disease (multivariate relative risk = 1.82, 95% confidence interval: 1.02, 3.23). An increase in the overall social network index between 1988 and 1996 was not significantly associated with subsequent 2-year mortality. In analyses of change in social network components restricted to older men, each categorical unit increase in number of close friends was significantly associated with a 29% decrease in risk of death. Increase in religious service attendance over time was also significantly predictive of decreased mortality.

Accidents↗