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Biomedical subjects

S E Moss

Publications and source records attributed to S E Moss.

At least 127 records · Page 7Linked to original sources
PubMed1992

Lack of association between lipoprotein (a) concentrations and coronary heart disease mortality in diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

Recently, considerable data have suggested that lipoprotein (a) [Lp(a)] is a strong independent risk factor for coronary heart disease. Since Lp(a) is increased in both insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), this study examined the relationship of Lp(a) concentrations to coronary heart disease (CHD) mortality in the 4-year follow-up of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Twenty-four older-onset subjects and 11 younger-onset subjects who died of CHD (cases) before the age of 70 were matched by age, gender, and type of diabetes to subjects who remained alive (controls). The distribution and mean levels of Lp(a) in the cases and controls were very similar, suggesting a lack of association between Lp(a) concentrations and CHD mortality. Although the number of subjects was small, caution should be used in extrapolating results on Lp(a) relationships in nondiabetic subjects to diabetic subjects.

Biomarkers↗
PubMed1992

Change in glycemia in a four-year interval in younger-onset insulin-dependent diabetes.

Hyperglycemia is an important risk factor for the development of retinopathy and nephropathy in people with diabetes mellitus. There are few population-based data on changes in glycemia over time. The purpose of this study was to examine changes in glycemia, as measured by glycosylated hemoglobin in 1980 to 1982 and in 1984 to 1986, in a large population-based study of people who were diagnosed to have diabetes before the age of 30 years and who used insulin (n = 697). Glycosylated hemoglobin was measured by a microcolumn technique at both examinations. There was a significant (P < .001) fall in the mean glycosylated hemoglobin from 10.8 to 10.1% over the 4-year interval of the study. In contrast, there was no change in the glycosylated hemoglobin (6.2%) in a similarly aged nondiabetic comparison group over the same period. The decrease in mean glycosylated hemoglobin over the 4-year period in the diabetic group was associated with several characteristics of diabetes management. These include changes in the insulin regimen (going from intermediate- or long-acting insulin only to combinations with short-acting insulin), an increase in the number of doses of insulin per day, and a higher frequency of self-monitoring of blood glucose level. It was also associated with an increased number of reported insulin reactions. These data suggest that recent changes in treatment and management of diabetes may be related to a significant decrease in glycemia.

Adult↗
PubMed1992

Detection of drusen and early signs of age-related maculopathy using a nonmydriatic camera and a standard fundus camera.

PURPOSE: The study was designed to compare the severity of age-related maculopathy as graded from photographs taken using three different techniques. METHODS: Two methods of nonstereoscopic 45 degrees retinal photography of the macula (through a nonpharmacologically dilated pupil and through a pharmacologically dilated pupil) were compared with results from standard 30 degrees stereoscopic photographs in 112 subjects. Corresponding photographic fields were graded by a masked grader for the presence of any drusen, soft drusen, retinal pigment epithelial degeneration, increased retinal pigmentation, and early and late age-related maculopathy. RESULTS: Exact agreement between gradings of the 45 degrees photographs taken through nonpharmacologically dilated pupils and 30 degrees photographs taken through dilated pupils was 75% for any drusen, 72% for soft drusen, 72% for retinal pigment epithelial degeneration, 74% for increased retinal pigment, 85% for pure geographic atrophy, and 89% for exudative macular degeneration. The kappa scores varied from 0.33 for geographic atrophy to 0.60 for exudative macular degeneration. Slightly higher rates of agreement between gradings were found after dilation. CONCLUSION: These data suggest that 45 degrees nonstereoscopic fundus photographs, when graded according to a standard classification scheme, should be considered for detection of age-related maculopathy in situations where the pupils cannot be pharmacologically dilated and retinal specialists are not available to examine the fundus.

Fundus Oculi↗
PubMed1992

Diabetes, hyperglycemia, and age-related maculopathy. The Beaver Dam Eye Study.

PURPOSE: The purpose of this study is to examine the association among hyperglycemia, diabetes status, and age-related maculopathy in a population-based study of people between the ages of 43 and 86 years who lived in Beaver Dam, Wisconsin between 1988 and 1990. METHODS: Age-related maculopathy was determined from stereoscopic fundus photographs. RESULTS: In the nondiabetic group (n = 4291), no relationship was found between glycosylated hemoglobin and any signs of age-related maculopathy. Diabetes status was not associated with early age-related maculopathy. People 75 years of age or older with diabetes (n = 85) had a higher frequency of exudative macular degeneration (9.4%) than those without (4.7%) but had similar frequencies of pure geographic atrophy (3.8% for those with diabetes and 3.4% for those without diabetes). The relative risk of exudative macular degeneration in men with diabetes who were 75 years of age or older compared with those who did not have diabetes was 10.2 (95% confidence interval [CI]: 2.4, 43.7); for females it was 1.1 (95% CI: 0.4, 3.0). CONCLUSION: These data suggest that diabetes is not related to early age-related maculopathy or geographic atrophy. The relationship of exudative macular degeneration to diabetes in older men, but not women, may be a result of chance. Further longitudinal study of this observation is needed.

Adult↗
PubMed1992

Alcohol consumption and the prevalence of diabetic retinopathy.

OBJECTIVE: To determine if alcohol consumption is associated with the prevalence of diabetic retinopathy. PARTICIPANTS: This study surveyed a population-based sample (n = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (n = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations completed by 996 and 891 (730 by persons age 21 or older) younger-onset persons, respectively, and 1370 and 987 older-onset persons, respectively. Data analyzed are from the 4-year follow-up examination. Questionnaires concerning consumption were completed at follow-up. MAIN OUTCOME MEASURE: Diabetic retinopathy as determined from stereographic fundus photography. RESULTS: After controlling for known risk factors in the adult younger-onset group, average alcohol consumption, as determined by questionnaire, was inversely associated with prevalence of proliferative diabetic retinopathy (PDR), odds ratio, 0.49; 95% confidence interval, 0.27 to 0.92. The trend was similar for recent consumption, odds ratio, 0.63; confidence interval, 0.37 to 1.09. In the older-onset groups taking or not taking insulin, average or recent alcohol consumption or usage history were not significantly associated with the prevalence of any retinopathy or PDR. CONCLUSIONS: Alcohol consumption does not appear to increase the risk of retinopathy and may have a beneficial effect in younger-onset persons, although further study is needed.

Adolescent↗
PubMed1992

The Beaver Dam Eye Study. Retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus.

The prevalence of diabetic retinopathy was examined in people with newly discovered noninsulin-dependent diabetes mellitus (NIDDM) (n = 50) and in those with previously diagnosed diabetes (n = 395) in a population-based study of people between the ages of 43 and 86 years who lived in Beaver Dam, Wisconsin between 1988 and 1990. Retinopathy was determined from stereoscopic fundus photographs. The prevalence of any retinopathy was 10.2% in those with newly diagnosed NIDDM, none had proliferative retinopathy, and 2.0% had macular edema. These data suggest that asymptomatic people discovered to have NIDDM during epidemiologic studies may not need immediate ophthalmoscopic examination at the time of their diagnosis because they have a relatively low risk of danger of visual loss due to diabetic retinopathy at that time.

Adult↗
PubMed1992

Use of cardiovascular disease medications and mortality in people with older onset diabetes.

Mortality follow-up for a cohort defined in 1980 with diabetes diagnosed at 30 years of age or older has been completed through 1988. History of medication use was obtained during the initial evaluation. There were 605 (44.2%) confirmed deaths; heart disease was the underlying cause in 49.9% of the deaths. Use of loop diuretics was associated with an odds ratio of death of 1.8 (95% CI = 1.4, 2.2). Although a causal relationship cannot be inferred, it is reasonable to suggest that blood chemistries be monitored regularly in persons on these drugs since electrolyte imbalance may be related to death.

Adult↗
PubMed1992

Genetic marker associations with proliferative retinopathy in persons diagnosed with diabetes before 30 yr of age.

It has been suggested that HLA-DR4 is a marker of genetic predisposition to proliferative retinopathy. To investigate this relationship and potential associations between other polymorphic genes and proliferative retinopathy, a sample (n = 428) of participants in the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy was selected for typing for HLA-A, -B, -C, and -DR and a panel of other polymorphic genes. The presence of proliferative retinopathy was determined from grading of stereoscopic color fundus photographs taken at 2 examinations, 4 yr apart. In logistic regression models with repeated measures, persons with HLA-DR4 who were negative for DR3 were five times more likely to have proliferative retinopathy than those negative for both antigens after adjusting for other potential risk factors (Odds ratio = 5.43, 95% Confidence Interval (Cl) = 1.04, 28.30). HLA-C2, AK-2, and MNSs-S also were associated positively with proliferative retinopathy, and HLA-DR8 was associated inversely with this complication of diabetes in each case before adjusting for the number of comparisons. These data suggest that the genetically determined immunopathic mechanisms leading to diabetes, and in linkage disequilibrium with DR4, may independently contribute to the development of proliferative retinopathy.

Adolescent↗
PubMed1992

Physical activity and proliferative retinopathy in people diagnosed with diabetes before age 30 yr.

OBJECTIVE--To examine the relationships of past and current physical activity to the prevalence of PDR. RESEARCH DESIGN AND METHODS--Individuals diagnosed with diabetes less than 30 yr of age (n = 818), who were participants in the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy, were examined during 1984-1986. Stereoscopic fundus photographs were graded for presence of PDR. Physical activity was assessed by an interviewer-administered standardized questionnaire. RESULTS--Women diagnosed with diabetes less than 14 yr of age who reported a history of participation in team sports in high school or college were less likely to have PDR at examination (OR 0.46, 95% CI 0.23, 0.93). Those women who reported current strenuous activity levels were less likely to have PDR (OR 0.34, 95% CI 0.13, 0.87). There were no significant associations between past or current physical activity and PDR in men. Current levels of energy expenditure were not related to PDR in either sex. CONCLUSIONS--Higher levels of physical activity may be associated with a reduced risk of having PDR in women. However, the lack of similar findings in men suggests that physical activity may be a relatively unimportant factor in the etiology of PDR.

Adolescent↗
PubMed1992

Epidemiology of proliferative diabetic retinopathy.

OBJECTIVE: This review examines recent epidemiological data about the prevalence and incidence of and risk factors for proliferative diabetic retinopathy. In addition, the relation of proliferative retinopathy to other systemic complications associated with diabetes is reviewed. RESEARCH DESIGN AND METHODS: The data come mostly from the baseline and 4-yr follow-up examinations of a large population-based study, the WESDR, which involved 996 younger-onset insulin-dependent people whose diabetes was diagnosed at < 30 yr of age and 1370 older-onset people whose diabetes was diagnosed at > or = 30 yr of age, and who were taking or not taking insulin. RESULTS: The major finding is that proliferative retinopathy is a prevalent complication (23% in the WESDR younger-onset group, 10% in the WESDR older-onset group that takes insulin, and 3% in the group that does not take insulin). Hyperglycemia, longer duration of diabetes, and more severe retinopathy at baseline were associated with an increased 4-yr risk of developing proliferative retinopathy. However, higher blood pressure at baseline was associated only with the development of proliferative retinopathy in the younger-onset group. The presence of proliferative diabetic retinopathy was associated with an increased 4-yr risk of loss of vision, cardiovascular disease, diabetic nephropathy, and mortality. In the WESDR, a significant number of diabetic people with proliferative retinopathy at risk for vision loss were not under the care of an ophthalmologist or had not undergone panretinal photocoagulation. CONCLUSIONS: These data suggest that hyperglycemia and, possibly, high blood pressure are related to proliferative retinopathy. They also suggest that once proliferative diabetic retinopathy is detected, people should have a medical evaluation, because it is a strong indicator for the presence and development of systemic disease. These data also indicate that diabetic patients and their physicians should be aware of the need for routine ophthalmological examinations to detect and treat proliferative retinopathy.

Age Factors↗
PubMed1992

Serum cholesterol in Wisconsin epidemiologic study of diabetic retinopathy.

OBJECTIVE: To describe serum total and high-density lipoprotein (HDL) cholesterol in a sample of people with diabetes. RESEARCH DESIGN AND METHODS: Subjects were those who participated in the 1984-1986 Wisconsin Epidemiologic Study of Diabetic Retinopathy. Data were from three groups of subjects: 304 younger-onset and 185 older-onset people taking insulin and 162 older-onset individuals not taking insulin. Serum lipids, duration of diabetes, glycosylated hemoglobin, diastolic blood pressure, sex, age, serum creatinine, units of insulin per kilogram per day, smoking status, serum C-peptide level, and alcohol use were analyzed statistically. RESULTS: In subjects taking insulin, glycosylated hemoglobin was correlated most strongly with total cholesterol. In those not taking insulin, C-peptide was correlated most strongly. In subjects taking insulin, the units used per day (fewer) and sex (female) were significantly associated with higher HDL cholesterol, and in both older-onset groups, serum C-peptide was significantly associated with lower HDL cholesterol. Mean total cholesterol levels were generally higher and mean HDL cholesterol levels were generally lower than those found in a nondiabetic comparison group. CONCLUSION: By the National Cholesterol Education Program guidelines, 17% of younger-onset and 30% of older-onset insulin users and 32% of older-onset subjects not taking insulin were in the high-risk range for total cholesterol. Lower levels of glycosylated hemoglobin might result in lower cholesterol levels.

Adult↗
PubMed1992

The prevalence and incidence of lower extremity amputation in a diabetic population.

OBJECTIVE: To describe the incidence of lower extremity amputations and sores or ulcers and investigate risk factors for these complications. DESIGN: Cohort. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 1210) of younger-onset diabetic persons (diagnosed before age 30 years and taking insulin) and a stratified random sample (N = 1780) of older-onset diabetic persons (diagnosed after age 30 years). Baseline and 4-year follow-up examinations were completed by 996 and 891 younger-onset persons, respectively, and by 1370 and 987 older-onset persons, respectively. MAIN OUTCOME MEASURES: Amputations and sores or ulcers of the lower extremities. RESULTS: Four-year incidence of amputations was 2.2% in both groups. Incidence of sores or ulcers was 9.5% in younger-onset and 10.5% in older-onset persons. In younger-onset persons, significant risk factors for amputation with odds ratios (and 95% confidence intervals) include age, 2.0 for 10 years (1.2 to 3.1), history of sores or ulcers, 10.5 (3.7 to 29.8), diastolic blood pressure, 2.1 for 10 mm Hg (1.3 to 3.5), and pack-years smoked, 1.3 for 10 years (1.0 to 1.6). Risk factors for sores or ulcers include glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), retinopathy, 1.3 for two steps (1.1 to 1.6), and current smoking, 2.3 (1.0 to 5.6). In older-onset persons, risk factors for amputation are history of sores or ulcers, 4.6 (1.7 to 12.2), proteinuria, 4.3 (1.6 to 11.5), glycosylated hemoglobin, 1.5 for 2% (1.0 to 2.2), sex, 2.8 for males (1.0 to 7.5), and duration of diabetes, 1.8 for 10 years (1.0 to 3.2). For sores or ulcers, risk factors are glycosylated hemoglobin, 1.6 for 2% (1.3 to 2.0), duration, 1.5 for 10 years (1.0 to 2.1), proteinuria, 2.2 (1.1 to 4.3), and diastolic blood pressure, 0.8 for 10 mm Hg (0.6 to 1.0). CONCLUSIONS: Several factors offer potential for modification for the prevention of amputations but require further study. These include blood pressure, glycosylated hemoglobin, and smoking.

Adolescent↗
PubMed1992

Microalbuminuria in a population-based study of diabetes.

The prevalence of microalbuminuria in younger-onset diabetic participants in a large population-based study of diabetic retinopathy was determined, and the relationships of microalbuminuria to blood pressure and other risk factors were investigated. Using an agglutination inhibition test (AlbuScreen), the frequency of microalbuminuria was 21.2%. To evaluate the association of several characteristics with the presence of microalbuminuria, multivariate models based on logistic regression were developed. Microalbuminuria was associated with having higher systolic or diastolic blood pressure and higher glycosylated hemoglobin. These findings give further impetus to efforts to reduce controllable risk factors in younger-onset diabetic persons.

Adult↗
PubMed1991

Expression of annexin VI (p68, 67 kDa-calelectrin) in normal human tissues: evidence for developmental regulation in B- and T-lymphocytes.

This paper describes the tissue distribution of annexin VI, a Ca(2+)-dependent phospholipid binding protein, and a member of the annexin super-gene family. In order to determine whether annexin VI expression correlated with a particular functional phenotype, an extensive series of non-pathological human tissues were examined, in which annexin VI was detected either immunohistochemically or by immunofluorescence, using a rabbit polyclonal anti(human annexin VI)-IgG of known specificity. Although most tissues investigated were found to express annexin VI, the protein was usually confined to highly specific cell types within each tissue, the staining generally appearing cytoplasmic and diffuse. There was particularly good correlation between annexin VI expression and hormone secreting cells, with positive staining in the islet cells of the pancreas, the Leydig cells of the testis and the cells of the adrenal cortex. A notable exception was the parathyroid gland, which lacked detectable annexin VI. Although the protein was absent in most epithelia, it was expressed strongly in certain secretory epithelia; e.g. the ductal epithelial cells of the salivary glands and non-lactating breast, and the sweat glands and their ducts. The observation that the epithelial cells of lactating breast failed to stain for annexin VI suggests functional regulation of protein expression in this tissue. However, the most interesting finding was that annexin VI expression appeared to be developmentally regulated in B- and T-lymphocyte differentiation, with negative staining in the proliferating B cells of the germinal centre of the lymph nodes, but strong staining in the mature small lymphocytes of the cortex, mantle zone and paracortex.

Adrenal Cortex↗
PubMed1991

The 5' insulin gene polymorphism and the genetics of vascular complications in type 1 (insulin-dependent) diabetes mellitus.

Recent data suggest genetic contributions to the microvascular complications of Type 1 (insulin-dependent) diabetes mellitus. Most research has focused on the HLA region, and the potential role of other genetic loci has not been adequately explored. We examined the possible relationship between DNA polymorphisms in the region 5' to the insulin gene on chromosome 11 and diabetic nephropathy. This was done by comparison of those diabetic patients homozygous for class 1 alleles at the 5' insulin gene polymorphism locus to 1/3 heterozygotes in a well-characterized series of 324 insulin-requiring diabetic patients from the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Proteinuria (defined as greater than or equal to 0.3 g protein/l urine), was used as suggestive evidence for diabetic nephropathy. Hypertension, a frequent associated finding in diabetic patients with nephropathy, was defined as a blood pressure greater than 140/90 or a history of previous treatment of hypertension. The two genotypically defined groups did not differ from each other in regard to sex ratio, age at diagnosis, age at examination, duration of diabetes, body mass, HbAlc or C-peptide. The 1+1 group had a higher prevalence of proteinuria, 29% as compared to 16.2% in other genotypes (p less than 0.05). There was no significant difference in the frequency of hypertension between the two genotypic groups. This finding suggests that the 5' insulin gene polymorphism may be associated with risk for nephropathy, but the pathophysiologic mechanism remains unclear.

Blood Pressure↗
PubMed1991

HLA-DR and the 5' insulin gene polymorphism in insulin-dependent diabetes.

While the human leukocyte antigen (HLA) region provides the major susceptibility for insulin-dependent (type I) diabetes mellitus (IDDM), other (non-HLA) genes must also play a role. Population studies have shown an increased frequency of small insertions (class I alleles) 5' to the insulin gene in individuals with IDDM, suggesting that this region may account for part, if not all, of the non-HLA genetic predisposition. However, no data are available as to whether the relation of the insulin gene polymorphism is to a DR-defined subset of IDDM or with all of IDDM. To test the hypothesis that specific combinations of HLA and insulin gene polymorphism alleles may interact in providing susceptibility for IDDM, HLA-DR and 5' insulin gene insertion size have been determined in 300 individuals with IDDM. The frequency of class 1 insulin gene alleles in the entire sample is 0.79 and the frequency of class 3 alleles (large inserts) is 0.20. The frequencies of class 1 alleles were equal across all DR classes: 0.79 in the DR3/X IDDM subjects, 0.80 in the DR4/X, 0.79 in the DR3/4, and 0.78 in those with DRX/X. Additionally, the frequencies of class 1/1 homozygotes and 1/3 heterozygotes were similar between HLA-DR types. These results suggest that the HLA region and the region 5' to the insulin gene provide independent and nonsynergistic genetic risks for IDDM.

Diabetes Mellitus, Type 1↗
PubMed1991

The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate.

Serum total and high-density lipoprotein (HDL) cholesterol were measured in a sample of individuals examined between 1984 and 1986 for the Wisconsin Epidemiologic Study of Diabetic Retinopathy. There was a significant trend for increasing severity of diabetic retinopathy and of retinal hard exudate with increasing cholesterol in insulin-using persons. Cholesterol levels were not related to the severity of either ocular condition in older-onset patients. High-density lipoprotein-cholesterol was unrelated to the severity of either lesion. In multiple logistic regression analyses, cholesterol was not a significant factor in describing the severity of retinopathy in any group but was a significant factor in describing the severity of retinal hard exudate. Glycosylated hemoglobin and diastolic blood pressure were significant descriptors of the severity of retinopathy in younger-onset patients in these multivariate analyses. Diastolic blood pressure added significantly to explaining the severity of hard exudate in older-onset insulin users. These data support the current management strategies for diabetes, which include control of level of glycemia, blood pressure, and blood lipids.

Adult↗