Objective: To investigate the association between resting energy expenditure (REE) and bone mineral density (BMD) in white adults. Design: Cross-sectional study. Setting: White, middle-class to upper middle-class community-dwelling adults. Participants: Women (n = 996) and men (n = 686) aged 36 to 97 years. Assessment of Risk Factors: REE calculated using the Harris-Benedict equation. Main Outcome Measures: BMD of the lumbar spine (L1 to L4), total hip, and total body measured using dual energy x-ray absorptiometry. Results: REE was lower in women than in men (1220 versus 1566 kcal/day, P < 0.0001); women also had lower BMI. After adjusting for lean body mass (LBM), REE was higher in women than men (1407 versus 1296 kcal/kg LBM/d, P < 0.0001). In stepwise multiple linear regression models, REE explained 13% of variance in spine BMD in women and 6% in men, 33% of variance in hip BMD in women and 22% in men, and 32% of variance in total body BMD in women and 22% in men. In women, weight explained 10% less of the hip BMD variance and 6% less of the total body BMD variance than REE. In men, weight explained 4% more of the spine BMD variance and 1% more of the total body BMD variance than REE. Conclusions: REE explained more of the BMD variance than weight in women, and the reverse was true in men. These sex differences were largely explained by sex differences in LBM or weight.
Journal Article THE RELATION OF REPRODUCTIVE HISTORY AND PARENTHOOD TO SUBSEQUENT HYPERTENSION Get access DONNA KRITZ-SILVERSTEIN, DONNA KRITZ-SILVERSTEIN Search for other works by this author on: Oxford Academic PubMed Google Scholar DEBORAH L. WINGARD, DEBORAH L. WINGARD Search for other works by this author on: Oxford Academic PubMed Google Scholar ELIZABETH BARRETT-CONNOR ELIZABETH BARRETT-CONNOR Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Epidemiology, Volume 130, Issue 2, August 1989, Pages 399–403, https://doi.org/10.1093/oxfordjournals.aje.a115347 Published: 01 August 1989 Article history Received: 08 August 1988 Revision received: 19 December 1988 Published: 01 August 1989
The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 3rd expert report highlights up-to-date Cancer Prevention Recommendations that may reduce burdens of many chronic diseases, including diabetes. This study examined if following a lifestyle that aligns with the recommendations - assessed via the 2018 WCRF/AICR Score - was associated with lower risk of type 2 diabetes in high-risk adults participating in the Diabetes Prevention Program Outcomes Study (DPPOS).The Diabetes Prevention Program (DPP) randomized adults at high risk for diabetes to receive a lifestyle intervention (ILS), metformin (MET) or a placebo (PLB) (mean: 3.2 years), with additional follow-up in DPPOS for 11 years (mean: 15 years total). 2018 WCRF/AICR Scores included seven components: body weight, physical activity, plant-based foods, fast foods, red and processed meat, sugar-sweetened beverages, and alcohol; the optional breastfeeding component was excluded. Scores ranged 0-7 points (with greater scores indicating greater alignment with the recommendations) and were estimated at years 0, 1, 5, 6, 9, and 15 (N=3,147). Fasting glucose and HbA1c were measured every six months and oral glucose tolerance tests were performed annually. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were used to examine the association of both Score changes from years 0-1 and time-dependent Score changes on diabetes risk through DPP and year 15.Scores improved within all groups over 15 years (p<0.001); ILS Scores improved more than MET or PLB Scores after 1 year (p<0.001). For every 1-unit improvement from years 0-1, there was a 31% and 15% lower diabetes risk in ILS (95% CI: 0.56-0.84) and PLB (95% CI: 0.72-0.97) through DPP, and no significant association in MET. Associations were greatest among American Indian participants, followed by non-Hispanic White and Hispanic participants. Score changes from years 0-1 and time-dependent Score changes in ILS and PLB remained associated with lower risk through year 15.Score improvements were associated with long-term, lower diabetes risk among high-risk adults randomized to ILS and PLB, but not MET. Future research should explore impact of the Score on cancer risk.Diabetes Prevention Program: NCT00004992 ; Diabetes Prevention Program Outcomes Study: NCT00038727.
The prevalence of cardiometabolic multimorbidity is increasing.
Objective
To estimate reductions in life expectancy associated with cardiometabolic multimorbidity.
Design, Setting, and Participants
Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128 843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499 808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates.
Exposures
A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI).
Main Outcomes and Measures
All-cause mortality and estimated reductions in life expectancy.
Results
In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy.
Conclusions and Relevance
Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.
OBJECTIVES: To test the hypothesis that sleep disturbances are independently associated with frailty status in older men. DESIGN: Cross‐sectional analysis of prospective cohort study. SETTING: Six U.S. centers. PARTICIPANTS: Three thousand one hundred thirty‐three men aged 67 and older. MEASUREMENTS: Self‐reported sleep parameters (questionnaire); objective parameters of sleep–wake patterns (actigraphy data collected for an average of 5.2 nights); and objective parameters of sleep‐disordered breathing, nocturnal hypoxemia, and periodic leg movements with arousals (PLMAs) (in‐home overnight polysomnography). Frailty status was classified as robust, intermediate stage, or frail using criteria similar to those used in the Cardiovascular Health Study frailty index. RESULTS: The prevalence of sleep disturbances, including poor sleep quality, excessive daytime sleepiness, short sleep duration, lower sleep efficiency, prolonged sleep latency, sleep fragmentation (greater nighttime wakefulness and frequent, long wake episodes), sleep‐disordered breathing, nocturnal hypoxemia, and frequent PLMAs, was lowest in robust men, intermediate in men in the intermediate‐stage group, and highest in frail men ( P ‐for‐trend ≤.002 for all sleep parameters). After adjusting for multiple potential confounders, self‐reported poor sleep quality (Pittsburgh Sleep Quality Index >5, multivariable odds ratio (MOR)=1.28, 95% confidence interval (CI)=1.09–1.50), sleep efficiency less than 70% (MOR=1.37, 95% CI=1.12–1.67), sleep latency of 60 minutes or longer (MOR=1.42, 95% CI=1.10–1.82), and sleep‐disordered breathing (respiratory disturbance index ≥15, MOR=1.38, 95% CI=1.15–1.65) were each independently associated with higher odds of greater frailty status. CONCLUSION: Sleep disturbances, including poor self‐reported sleep quality, lower sleep efficiency, prolonged sleep latency, and sleep‐disordered breathing, are independently associated with greater evidence of frailty.
Most of the research on osteoporosis has been conducted on women. Few studies have compared central and peripheral densitometry and their association with vertebral fractures in men. The present study was designed to compare peripheral bone mineral density (BMD) measurements with central BMD measurements and to examine their association with radiographic spine fracture in men. We studied 402 community-dwelling men aged 45-92 years (mean = 70 years) from the Rancho Bernardo Study cohort who attended a clinic visit between 1988 and 1992 when BMD measurements of the midshaft radius, ultradistal wrist, lumbar spine, and total hip were obtained, and who returned for lateral x-rays of the thoracic and lumbar spine an average of 4 years later. Logistic regression, t-scores, and quintiles were used to analyze BMD and its association with vertebral fractures. The prevalence of osteoporosis defined by NOF criteria (for women) was 14.2% at the spine and 13% at the hip. Because there are no validated definitions of osteoporosis based on the ability to predict fracture risk for peripheral densitometry, the frequency of overlap by bone site was calculated among men in the lowest quintile of each site. Using BMD at all four sites identified 155 men (38.6%) as osteoporotic. The radiographs showed one vertebral fracture in 5.7% and more than one fracture in an additional 2.5%. Low BMD at the spine was associated with having one or more vertebral fractures, whether using NOF T-score defined osteoporosis (OR = 3.81; CI = 1.52, 9.57) or the lowest quintile versus all others (OR = 2.53; CI = 1.03, 6.19). Neither BMD at the total hip nor at the peripheral sites was associated with spine fractures, using either NOF women-based criteria or male quintiles from this cohort. We found that different men had osteoporosis defined by quintiles at different sites, and only low BMD at the spine was associated with vertebral fracture.
Blood hemoglobin (Hb) declines with age in healthy elderly men, in whom decreasing T has been regarded as part of normal aging. However, the association between Hb and serum estradiol is incompletely known.To determine whether estradiol is associated with anemia/Hb and established determinants of Hb in elderly men without prostate cancer.The MrOS (Osteoporotic Fractures in Men) is a population-based study (n = 918; median age, 75.3 y; range, 70-81 y).We evaluated total estradiol in relation to Hb and adjusted for potential confounders (ie, age, body mass index [BMI], erythropoietin [EPO], total T, cystatin C, and iron and B-vitamin status).Estradiol correlated negatively with age (r = -0.14; P < .001). Hb correlated (age adjusted) positively with estradiol (r = 0.21; P < .001) and T (r = 0.10; P < .01). Independent predictors for Hb in multivariate analyses were estradiol, EPO, BMI, transferrin saturation, cystatin C, and free T4, but not T. After exclusion of subjects with Hb <130 g/L and/or T < 8 nmol/L (n = 99), the correlation between Hb and T was no longer significant, whereas the associations between Hb and estradiol remained. After adjusting for age, BMI, and EPO, men with lower estradiol levels were more likely to have Hb in the lowest quartile of values (odds ratio per SD decrease in estradiol = 1.61 [95% confidence interval, 1.34-1.93]). Anemic subjects (Hb < 130 g/L) had lower mean estradiol than nonanemic subjects (67.4 vs 79.4 pmol/L; P < .001).Estradiol correlated positively and independently with Hb. Decreased estradiol might partly explain the age-related Hb decline observed in healthy elderly men.
