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Biomedical subjects

G D Friedman

Publications and source records attributed to G D Friedman.

At least 109 records · Page 6Linked to original sources
PubMed1990

Nongenetic influences of obesity on other cardiovascular disease risk factors: an analysis of identical twins.

The importance of genetic influences on obesity has been emphasized recently. We conducted matched co-twin analyses of 250 pairs of White, male, monozygotic twins from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Entirely in the absence of genetic influences, obesity was significantly associated with systolic and diastolic blood pressures; one-hour, post-load glucose; total, LDL-, and HDL-cholesterol; and triglycerides among these 42-55 year old men. Similar results were obtained in longitudinal analyses of weight change during adulthood (from mean age of 20 to mean age of 48 years) and risk factor status at middle-age. These results indicate that behaviors and environmental exposures that occur later in life are responsible, at least in part, for the associations between adult obesity and cardiovascular disease risk, supporting the appropriateness of weight reduction efforts during adulthood.

Adult↗
PubMed1989

Screening prescription drugs for possible carcinogenicity: eleven to fifteen years of follow-up.

Using computerized pharmacy records from 1969 to 1973 for a cohort of 143,574 members of the Kaiser Permanente Medical Care Program, we have been testing associations of 215 drugs or drug groups with subsequent incidence of cancer at 56 sites. This paper presents findings with follow-up through 1984. There were 227 statistically significant (P less than 0.05, two-tailed) associations: 170 positive, 57 negative. Some were undoubtedly chance findings; others were likely due to confounding by unmeasured covariables. However, several associations suggested hypotheses for further studies and/or the need for continued observation. Most notable among findings not previously reported were associations of several antibiotics, both oral and topical, with lung cancer. These associations could not be explained by indications for drug use or by differences in smoking habits between users and nonusers, and suggest a possible link between the occurrence of bacterial infections and risk for cancer. In general, our results continue to suggest that most medications used during that period did not affect cancer incidence substantially. However, for less frequently prescribed medications, our power to detect moderate increases in cancer risk was quite low.

Anti-Bacterial Agents↗
PubMed1989

Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization.

Two-hundred ninety-eight patients with gallstones accompanied by mild or nonspecific symptoms, 123 with asymptomatic gallstones, and 46 with nonfunction on cholecystogram and mild or nonspecific symptoms were followed in the setting of a health maintenance organization for up to 25 years after diagnosis. In a life-table analysis, complications (severe events) developed in about 1% per year of patients with visualized gallstones and in about 2% per year of patients with nonfunction. During each of the first 5 years after diagnosis, all events, both severe and non-severe (including surgery for continuing mild symptoms) occurred in about 6% of the patients with mild symptoms accompanying either gallstones or nonfunction, and in about 4% of patients with asymptomatic gallstones. The annual probabilities for all events tended to decrease as length of follow-up increased. Among patients with stones and mild symptoms, women were more apt to develop any event than men (p = 0.02) and more obese patients were more likely to develop severe events than those who were thinner (p = 0.05). The patients in this study are probably more representative of outpatients with gallstones seen by most primary care physicians than are most groups investigated previously for prognosis. Their event rates are sufficiently similar to those used in published decision analyses, that they should not alter previous conclusions that early elective cholecystectomy will have little positive or negative effect on average life expectancy of patients with gallstones.

Adult↗
PubMed1989

Precursors of essential hypertension. The role of body fat distribution pattern.

Progression from normotension between 1964 and 1972 to essential hypertension by age 55 years was documented in 1,031 adult members of the Kaiser Permanente Medical Care Program (Northern California region) from computerized multiphasic health checkup records and medical record review. Each case was matched to a persistently normotensive control on age, sex, race, number, and dates of multiphasics. In 609 pairs with baseline measurements of subscapular and triceps skinfolds, mean interval from baseline to the case's first hypertensive multiphasic was 5.7 years, and mean age at onset of hypertension was 47 years. Baseline measures of body mass index, subscapular skinfold, and triceps skinfold were each predictive of development of hypertension (odds ratios 3.85, 3.75, and 2.29 respectively, comparing highest with lowest quintiles, p less than 0.0001 for each). When both skinfolds were included in the same model, subscapular skinfold was highly predictive and triceps skinfold was no longer related to risk. When the authors controlled for overall obesity (body mass index), subscapular skinfold remained highly predictive (p less than 0.0001). In 330 pairs who also had skinfold measurements at the hypertensive multiphasic, weight gain was a strong predictor of hypertension. Increase in subscapular skinfold conferred a small increase in risk in women only. The authors conclude that centrally deposited body fat increases risk for developing essential hypertension independent of the overall level of obesity, while peripherally deposited fat does not.

Adipose Tissue↗
PubMed1989

Alcohol use and subsequent cerebrovascular disease hospitalizations.

We studied the relations between reported alcohol use and the incidence of hospitalization for several types of cerebrovascular disease. Daily consumption of three or more drinks, but not lighter drinking, was related to higher hospitalization rates for hemorrhagic cerebrovascular disease, especially intracerebral hemorrhage. Age, blood pressure, and black race were other independent predictors of hemorrhagic events; higher blood pressure appeared to be a partial mediator of the relation between alcohol use and hemorrhagic events. Alcohol use was associated with lower hospitalization rates for occlusive cerebrovascular disease; an inverse relation was present in both sexes, whites and blacks, and for extracranial and intracerebral occlusive lesions. Other predictors of hospitalization for occlusive disease included age, blood pressure, smoking, blood glucose and total cholesterol concentrations, and baseline disease. Our data suggest that heavier drinking increases the risk of hemorrhagic cerebrovascular events, but that alcohol use may lessen the risk of occlusive lesions.

Alcohol Drinking↗
PubMed1989

Mentholated cigarette use among multiphasic examinees, 1979-86.

Mentholated cigarette use was studied in relation to age and race in 29,037 current smokers who were Kaiser Permanente Medical Care Program members. The percentages of mentholated cigarette users were much higher in Blacks and Asians than in Whites, especially in the younger age groups. A marked inverse relationship between mentholated cigarette use and age was present in Blacks and Asians; mentholated cigarette use showed little difference with age in Whites.

Adolescent↗
PubMed1988

Epidemiologic evidence of an association between body iron stores and risk of cancer.

Biologic evidence suggests that high body iron stores could promote development of cancer. Because a previous study had shown an association between prescribed iron medication and lung cancer risk in men, we examined recent iron use as well as 2 additional indirect measures of body iron stores, anemia and the total iron-binding capacity (TIBC) of plasma, in relation to subsequent risk of cancer in a larger cohort of 174,507 persons. Women, but not men, who reported recent iron use had a lower risk of lung cancer than those who did not [RR = 0.60, 95% confidence limits (CL) 0.37, 0.97] after adjustment for age and cigarette smoking. Women who had used iron appeared to remain relatively iron-depleted. Risk for other cancers was slightly, but not significantly, lower in women who used iron. Anemia (hemoglobin less than 12 g) was also associated with lower risk of lung cancer in women (RR = 0.61, 95% CL 0.61, 0.98), but not in men. TIBC, which is inversely related to body iron stores, was inversely related to risk of lung cancer in women in a graded fashion (RR = 0.41, 95% CL 0.23, 0.73 comparing highest with lowest quartile). In men, a protective effect of higher TIBC against lung cancer was suggested, but did not reach statistical significance. These indirect measures of body iron stores appeared to reflect iron stores better in women than in men, probably because variability in iron stores is greater in women and iron deficiency more prevalent. A possible alternative explanation for our findings is incomplete adjustment for the confounding effects of cigarette smoking. This could apply to iron use and hemoglobin level which were related to smoking, but not to TIBC, which was not. These data, which indicate lower risk of cancer in iron-depleted women, lend epidemiologic support to the hypothesis that high iron stores may increase cancer risk, at least for lung cancer.

Female↗
PubMed1988

US Preventive Services Task Force. Automobile injury--selected risk factors and prevention in the health care setting.

Every year, highway crashes cause tens of thousands of deaths and millions of nonfatal injuries, many of which can be prevented. Following a mandate from the US Preventive Services Task Force, in this article we describe the magnitude of the automobile injury problem, identify injury risk factors that might be reduced by clinically based preventive programs, and review reports of interventions by health professionals to promote the use of child restraint devices, the only area in which we found published evaluations. We conclude that despite the lack of experimental evidence of the long-term effectiveness of clinically based efforts to promote occupant restraint use, such efforts may be warranted because of the enormous social and economic costs of automobile injury. In addition, physicians and other health professionals are urged to consider promoting nonclinical automobile injury prevention measures.

Accidents, Traffic↗
PubMed1988

Cataract extraction. Risk factors in a health maintenance organization population under 60 years of age.

Risk factors for cataract extraction in a young (less than 60 years of age) urban health maintenance organization population were evaluated in a case-control study. The subjects (72 case-control pairs) subscribed to the Kaiser Permanente Medical Care Program in the San Francisco Bay area and had cataract extraction between 1976 and 1980. All patients had visual acuity of at least 20/40 OU, documented before development of cataracts. Thirty-six (50%) of the 72 cataract extraction patients had at least one known risk factor for cataract formation, including trauma, intraocular inflammation, diabetes mellitus, syphilis, oral or topical steroid use, or previous eye surgery. Male patients were found to be a mean of 4.3 years younger than female patients, and diabetics were found to be a mean of 3.5 years older than nondiabetics. Variables found to be related to cataract extraction in univariate analysis included diagnosis of diabetes mellitus, a family history of cataracts, pulse rate, white blood cell count, and syphilis.

Adolescent↗
PubMed1988

Precursors of essential hypertension: body weight, alcohol and salt use, and parental history of hypertension.

Body mass index, alcohol and salt consumption, and parental history of hypertension were examined as possible predictors of the development of essential hypertension in 1,031 persons, ages 30-49 years at entry, with documented normotension followed by documented hypertension after a mean interval of 6 years. In a comparison with 1,031 matched persistently normotensive persons initial body mass index and percentage increase in body mass index were each predictive of hypertension. Consumption of three or more alcoholic drinks a day at baseline was also predictive, more so if this level of intake persisted than if it diminished. Heavy salt intake as crudely estimated at baseline by one question was also associated with the development of hypertension. Parental history of hypertension was also predictive, more so for hypertension in the mother than for hypertension in the father, and the association was apparent only in female subjects. These characteristics at baseline showed independent associations with subsequent hypertension in multivariate analysis. When follow-up data were included in the multivariate analysis, alcohol consumption at the hypertensive examination was much more strongly related than at the baseline examination, suggesting a short-term effect, and heavy salt consumption was no longer predictive, possibly because of a marked loss of subjects due to missing follow-up data. This large study confirms longitudinally the importance of obesity, weight gain during adulthood, alcohol, family history, and, to some extent, salt as predictive and possibly causal factors for essential hypertension.

Adult↗
PubMed1988

Sigmoidoscopy and mortality from colorectal cancer: the Kaiser Permanente Multiphasic Evaluation Study.

The Kaiser Permanente Multiphasic Evaluation Study is often cited as evidence from a randomized trial that screening sigmoidoscopy reduces mortality from colorectal cancer. To examine the role of sigmoidoscopy in this reduction, we reviewed the 110 incident cases of colorectal cancer occurring among the 10,713 subjects from randomization in 1964 through 1982. Tumor stage at diagnosis, location, mode of discovery, and current mortality status were determined for each. We also reanalyzed chart review data for the years 1965 through 1974 to assess the difference in exposure to sigmoidoscopy between groups. Study group subjects, who were urged to have annual multiphasic health checkups (MHC), had both a lower cumulative incidence (4.3 vs 6.7 cases per 1000 persons) and a better stage distribution (86 vs 54% Stage B or better) than nonurged control subjects for colorectal cancers arising within reach of the sigmoidoscope. The lowered incidence accounted for two-thirds of the total difference in mortality. No appreciable difference in removal of colorectal polyps was seen between groups. Only a slight excess in exposure to sigmoidoscopy was seen in the study group (30 vs 25% of subjects examined at least once between 1965 and 1974), which was unlikely to account for more than a small fraction of the study group's decrease in mortality. Although the Multiphasic Evaluation Study did find a significantly lower mortality from colorectal cancer in the study group, it did not achieve a substantial difference in exposure to sigmoidoscopy. Its results are therefore inconclusive with respect to sigmoidoscopy and should not be used as evidence either for or against sigmoidoscopic screening.

Adult↗
PubMed1988

CARDIA: study design, recruitment, and some characteristics of the examined subjects.

In 1984, a prospective cohort study, Coronary Artery Risk Development in Young Adults (CARDIA) was initiated to investigate life-style and other factors that influence, favorably and unfavorably, the evolution of coronary heart disease risk factors during young adulthood. After a year of planning and protocol development, 5,116 black and white women and men, age 18-30 years, were recruited and examined in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. The initial examination included carefully standardized measurements of major risk factors as well as assessments of psychosocial, dietary, and exercise-related characteristics that might influence them, or that might be independent risk factors. This report presents the recruitment and examination methods as well as the mean levels of blood pressure, total plasma cholesterol, height, weight and body mass index, and the prevalence of cigarette smoking by age, sex, race and educational level. Compared to recent national samples, smoking is less prevalent in CARDIA participants, and weight tends to be greater. Cholesterol levels are representative and somewhat lower blood pressures in CARDIA are probably, at least in part, due to differences in measurement methods. Especially noteworthy among several differences in risk factor levels by demographic subgroup, were a higher body mass index among black than white women and much higher prevalence of cigarette smoking among persons with no more than a high school education than among those with more education.

Adult↗
PubMed1988

The relations of alcoholic beverage use to colon and rectal cancer.

The authors prospectively studied the incidence of cancers of the colon and rectum in 106,203 men and women, both white and black, who supplied data at northern California Kaiser Permanente facilities about use of alcoholic beverages in 1978-1984. Analysis controlling for age, sex, race, body mass index, coffee use, total serum cholesterol, and education showed a positive association of alcohol use to both types of cancer, which was stronger for rectal cancer (trend test, p = 0.03) than for colon cancer (trend test, p = 0.11). When persons with a daily intake of three or more drinks were compared with abstainers, relative risk for rectal cancer was 3.17 (95% confidence interval (CI): 1.05-9.57) and relative risk for colon cancer was 1.71 (95% CI: 0.92-3.19). Women with a daily intake of three or more drinks had a relative risk for colon cancer of 2.56 (95% CI: 1.03-6.40) compared with 1.16 (95% CI: 0.46-2.90) for men. Among drinkers, preference for wine, beer, or hard liquor had no significant independent relation to either type of cancer; those who preferred beer were at slightly greater risk of rectal cancer, but those who preferred wine were more likely to develop colon cancer. These data suggest that total alcohol use, but no one specific beverage type, is associated with increased risk of rectal cancer.

Age Factors↗