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Biomedical subjects

Alka M Kanaya

Publications and source records attributed to Alka M Kanaya.

At least 19 recordsLinked to original sources
PubMed2006

Quality-of-life impact and treatment of urinary incontinence in ethnically diverse older women.

OBJECTIVE: To identify the factors associated with greater quality-of-life impact, treatment seeking, and use of treatments for urinary incontinence in ethnically diverse older women. METHODS: Cross-sectional analysis of a population-based cohort of 2109 middle-aged and older women who were randomly selected from age and race/ethnicity strata. Data were collected by self-report questionnaires and in-person interviews. Multivariable logistic regression was used to identify predictors of high quality-of-life impact (Incontinence Impact Questionnaire [IIQ] score > or =75th percentile), treatment seeking, and use of treatments for incontinence. RESULTS: More than one fourth (n = 603) of the study participants (including 96 black [16%], 123 Latina [20%], 65 Asian [11%], and 309 white [51%] women) reported weekly incontinence. After clinical severity and other factors were adjusted for, women were more likely to experience high quality-of-life impact if they had nighttime incontinence (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3-4.9), coital incontinence (OR, 1.9; 95% CI, 1.1-3.3), or comorbid fecal incontinence (OR, 2.2; 95% CI, 1.2-4.2). Predictors of treatment seeking included older age (OR, 1.6 per 10 years; 95% CI, 1.2-2.0); higher IIQ score (OR, 4.6 for highest IIQ quartile vs lowest IIQ quartile; 95% CI, 2.5-8.4), and higher household income (OR, 2.6 for income > or = US dollars 100 000/y vs < US dollars 20 000/y; 95% CI, 1.0-2.7). CONCLUSIONS: Clinicians seeking to evaluate the impact of incontinence on women's lives should assess not only the clinical severity of their symptoms but also the specific context in which symptoms occur. The prevalence of treatment seeking for incontinence is low across all ethnic groups, even when women have clinically severe symptoms and access to a health provider.

Adaptation, Psychological↗
PubMed2006

Serum adiponectin and coronary heart disease risk in older Black and White Americans.

CONTEXT: Adiponectin may influence the risk of coronary heart disease (CHD) independently of traditional cardiovascular risk factors. OBJECTIVE: Because body composition and adiponectin levels vary by race, we examined the relationship of adiponectin with prevalent and incident CHD in a cohort of older Black and White adults. DESIGN AND SETTING: We conducted a cross-sectional and prospective cohort study at two U.S. clinical centers. PARTICIPANTS: Participants included 3075 well-functioning adults between ages 70 and 79 yr enrolled in the Health, Aging, and Body Composition study. MAIN OUTCOME MEASURES: Prevalent CHD was defined as history of myocardial infarction, coronary artery bypass graft, percutaneous coronary transluminal angioplasty, angina, or major electrocardiogram abnormalities. After excluding those with prevalent CHD, incident CHD was defined as hospitalized myocardial infarction or CHD death. RESULTS: At baseline, 602 participants (19.6%) had CHD. During 6 yr of follow-up, 262 (10.6%) incident CHD events occurred. Whites had higher median adiponectin than Blacks (12 vs. 8 microg/ml, P < 0.001). Race modified the effect of adiponectin (P for interaction was 0.002 for prevalent CHD, and P = 0.02 for incident CHD). Among Whites, an inverse association of adiponectin with CHD was explained by high-density lipoprotein and glucose. Among Blacks, a doubling of adiponectin was associated with a 40% higher risk of both prevalent CHD (odds ratio, 1.41; 95% confidence interval, 1.11-1.78) and incident CHD (hazards ratio, 1.37; 95% confidence interval, 1.01-1.87) after adjusting for explanatory variables. CONCLUSION: High circulating concentrations of adiponectin were associated with higher risk of CHD in older Blacks, even accounting for traditional CHD risk factors.

Adiponectin↗
PubMed2006

Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial.

OBJECTIVE: To determine the feasibility and acceptability of a restorative yoga intervention for the treatment of hot flushes in postmenopausal women. METHODS: A pilot trial in 14 postmenopausal women experiencing > or =4 moderate to severe hot flushes per day or > or =30 moderate to severe hot flushes per week. The intervention consisted of eight restorative yoga poses taught in a 3-h introductory session and 8 weekly 90-min sessions. Feasibility was measured by recruitment rates, subject retention and adherence. Acceptability was assessed by subject interview and questionnaires. Efficacy measures included change in frequency and severity of hot flushes as recorded on a 7-day diary. RESULTS: Recruitment was accomplished as planned. The majority of study subjects (93%) completed the trial. Of those who completed the trial, 92% attended seven or more of the eight yoga sessions. The majority of the subjects were satisfied with the study and 75% continued to practice yoga 3 months after the study. Mean number of hot flushes per week decreased by 30.8% (95% CI 15.6-45.9%) and mean hot flush score decreased 34.2% (95% CI 16.0-52.5%) from baseline to week 8. No adverse events were observed. CONCLUSIONS: This pilot trial demonstrates that it is feasible to teach restorative yoga to middle-aged women without prior yoga experience. The high rates of subject retention and satisfaction suggest that yoga is an acceptable intervention in this population. Our results indicate that a larger, randomized controlled trial to explore the efficacy of restorative yoga for treatment of menopausal symptoms would be safe and feasible.

Feasibility Studies↗
PubMed2006

Adipocytokines and incident diabetes mellitus in older adults: the independent effect of plasminogen activator inhibitor 1.

BACKGROUND: Adipose tissue produces "adipocytokines" of uncertain clinical significance. METHODS: We analyzed the relationships among adiposity, adipocytokines, glycemia, and incident diabetes mellitus in 2356 white and black adults aged 70 to 79 years in the Health, Aging, and Body Composition Study who did not have diabetes at baseline. We measured the levels of adipocytokines adiponectin, leptin, interleukin 6, tumor necrosis factor alpha, and plasminogen activator inhibitor 1. Regional fat area was determined by means of computed tomography. New diabetes was defined as a self-reported diagnosis of diabetes or as a fasting plasma glucose level of 126 mg/dL or greater (>/=7.0 mmol/L) at the second, fourth, or sixth annual examination. RESULTS: A total of 143 participants (14.1 cases per 1000 person-years) developed diabetes across 5 years. Visceral fat area (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.10-1.60 per standard deviation increase) and body mass index (white individuals: OR, 1.65; 95% CI, 1.26-2.15 per standard deviation increase; black individuals: OR, 1.22; 95% CI, 0.99-1.51 per standard deviation increase) independently predicted incident diabetes. Adiponectin, leptin, and plasminogen activator inhibitor 1 attenuated the relationship between adiposity and diabetes. After controlling for body mass index, visceral fat, fasting glucose, fasting insulin, high-density lipoprotein cholesterol, triglycerides, and hypertension at baseline, plasminogen activator inhibitor 1 was the only adipocytokine independently associated with increased odds of diabetes (OR, 1.35; 95% CI, 1.01-1.81). Fasting glucose level at baseline remained a strong predictor of incident diabetes, whereas associations with body mass index and visceral fat were attenuated. CONCLUSIONS: Adipocytokines and glycemia partially account for the relationship between adiposity and risk of type 2 diabetes due to adiposity. Plasminogen activator inhibitor 1 may be a useful predictor of diabetes in addition to measurements of body fat.

Adiponectin↗
PubMed2006

Abdominal obesity is an independent risk factor for chronic heart failure in older people.

OBJECTIVES: To examine whether total and abdominal adiposity are risk factors for the development of chronic heart failure (CHF) in older men and women. DESIGN: Prospective, longitudinal cohort: The Health, Aging and Body Composition study. SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania, metropolitan areas. PARTICIPANTS: Three thousand seventy-five well-functioning community-dwelling older adults aged 70 to 79. MEASUREMENTS: Body composition using dual energy X-ray absorptiometry, visceral adipose tissue area using computed tomography, adjudicated CHF. RESULTS: Of the remaining (640 participants excluded from original group of 3,075) 2,435 participants (1,081 men, 1,354 women) without coronary heart disease or CHF at baseline, there were 166 confirmed diagnoses of CHF during the median+/-standard deviation (SD) follow-up of 6.1+/-1.4 years. After adjustment for age, race, sex, site, education, smoking, and chronic obstructive pulmonary disorder, all adiposity variables (body mass index (BMI), adipose tissue mass, percentage body fat, waist-to-thigh ratio, waist circumference, and visceral and subcutaneous abdominal adipose tissue) were significant predictors of the development of CHF. In a model that included waist circumference and BMI, waist circumference was associated with incident CHF (hazard ratio (HR)=1.27, 95% confidence interval (CI)=1.04-1.54 per SD increase, P=.02), but BMI was not (HR=1.08, 95% CI=0.86-1.35). When waist circumference and percentage fat were included together, both variables were significant predictors of CHF (waist: HR=1.17, 95% CI=1.00-1.36 per SD increase, P=.05; percentage fat: HR=1.47, 95% CI=1.16-1.87 per SD increase, P=.002). Stepwise adjustment for inflammation, hypertension, insulin resistance, and diabetes mellitus did not decrease the relative risk of a greater waist circumference for the development of CHF (all HR=1.27-1.32, 95% CI=1.02-1.61 per SD increase). CONCLUSION: Abdominal body fat distribution may be a stronger risk factor for CHF than overall obesity.

Absorptiometry, Photon↗
PubMed2006

Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001-2002.

OBJECTIVE: Diabetes is associated with increased risk of urinary incontinence. It is unknown whether women with pre-diabetes, or impaired fasting glucose (IFG), have increased prevalence of incontinence. We determined the prevalence of, and risk factors for, incontinence among U.S. women with diabetes and IFG. RESEARCH DESIGN AND METHODS: The 2001-2002 National Health and Nutrition Examination Survey measured fasting plasma glucose and obtained information about diabetes and urinary incontinence among 1,461 nonpregnant adult women. Self-reported weekly or more frequent incontinence, both overall and by type (urge and stress), was our outcome. RESULTS: Of the 1,461 women, 17% had diabetes and 11% met criteria for IFG. Prevalence of weekly incontinence was similar among women in these two groups (35.4 and 33.4%, respectively) and significantly higher than among women with normal fasting glucose (16.8%); both urge and stress incontinence were increased. In addition to well-recognized risk factors including age, weight, and oral estrogen use, two microvascular complications caused by diabetes, specifically macroalbuminuria and peripheral neuropathic pain, were associated with incontinence. CONCLUSIONS: Physicians should be alert for incontinence, an often unrecognized and therefore undertreated disorder, among women with diabetes and IFG, in particular those with microvascular complications. The additional prospect of improvements in their incontinence may help motivate some high-risk women to undertake difficult lifestyle changes to reduce their more serious risk of diabetes and its sequelae.

Activities of Daily Living↗
PubMed2006

Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program.

OBJECTIVE: Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence. RESEARCH DESIGN AND METHODS: We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660 (34%) were randomized to intensive lifestyle therapy, 636 (32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years). RESULTS: The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P = 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence. CONCLUSIONS: Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes.

Adult↗
PubMed2006

Prevalence and correlates of cardiovascular risk factors in South Asians: population-based data from two California surveys.

OBJECTIVE: Few population-based studies report cardiovascular disease (CVD) risk factor prevalence for South Asians in the United States. We examined CVD risk for South Asians in California. DESIGN/SETTING/PARTICIPANTS: We used data from two population-based surveys with South Asian participants in California, the California Health Interview Survey (CHIS) and the Cardiovascular Health among Asian Indian (CHAI) survey. The CHIS 2001 was conducted in English; 769 South Asians aged 25-83 years participated as one of many ethnic groups. The CHAI survey was population-based but focused on ethnicity-specific characteristics in 304 South Asians aged 25-80 years in English and Punjabi in 2001-2002. MAIN OUTCOME MEASURES: A CVD risk score included smoking, hypertension, hypercholesterolemia, diabetes, myocardial infarction, and angina. Separate logistic regression models examined the association of sociodemographics, lifestyle, medical risk, acculturation, and "any CVD risk." RESULTS: In CHAI, hypertension (20%), hypercholesterolemia (24%), and diabetes (10%) were high; smoking was low (12%). In CHIS, prevalence of these conditions was lower, except smoking (21%). Approximately 35% of participants in each survey had any CVD risk. Male sex, age, higher body mass index, education less than a bachelor's degree, and alcohol use were associated with CVD risk in both studies. The CHAI subjects interviewed in English had higher odds of any CVD risk than those interviewed in Punjabi (odds ratio 10.3, 95% confidence interval 2.9-36.7). CONCLUSIONS: Data from multiple sources add crucial information about heterogeneity of risk within ethnic populations. South Asians in the CHIS had higher rates of smoking, but lower CVD risk scores than participants in the CHAI study. In CHAI, English language use was associated with increased CVD risk score. Additional research should examine if acculturation increases CVD risk.

Adult↗
PubMed2005

Impaired fasting glucose and cardiovascular outcomes in postmenopausal women with coronary artery disease.

BACKGROUND: Type 2 diabetes increases risk for cardiovascular disease. Persons with impaired fasting glucose levels may also have increased risk. OBJECTIVE: To evaluate the association between glucose status and cardiovascular outcomes and the effect of lowering the fasting glucose level criterion for impaired fasting glucose from a lower limit of 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL). DESIGN: Prospective cohort study. SETTING: 20 U.S. clinical centers. PATIENTS: 2763 postmenopausal women with established coronary heart disease (CHD) who were followed for 6.8 years. MEASUREMENTS: Any CHD event (nonfatal myocardial infarction or CHD death), stroke or transient ischemic attack (TIA), congestive heart failure (CHF) hospitalization, and any cardiovascular event. RESULTS: During follow-up, 583 women had a CHD event, 329 women had a stroke or TIA, and 348 women were hospitalized for CHF. Women with diabetes were at an approximately 75% increased risk for each outcome compared with normoglycemic women. The 218 women with impaired fasting glucose according to the 1997 definition (fasting glucose level, 6.1 to 6.9 mmol/L [110 to 125 mg/dL]) had increased risk for any CHD event (hazard ratio, 1.37 [95% CI, 1.08 to 1.74]), while the 698 women with impaired fasting glucose according to the 2003 definition (fasting glucose level, 5.6 to 6.9 mmol/L [100 to 125 mg/dL]) were not at increased risk (hazard ratio, 1.09 [CI, 0.90 to 1.34]). Most of the women (n = 480) with fasting glucose levels between 5.6 mmol/L (100 mg/dL) and 6.0 mmol/L (109 mg/dL) had no increased risk for CHD (hazard ratio, 0.90 [CI, 0.73 to 1.12]). Women with impaired fasting glucose according to either definition were not at increased risk for stroke or TIA or CHF. LIMITATIONS: These findings may not be generalizable to men or women without existing heart disease. CONCLUSIONS: Among postmenopausal women with coronary artery disease, the 2003 definition for impaired fasting glucose was not associated with increased risk for new CHD, stroke or TIA, or CHF.

Aged↗
PubMed2005

Dietary glycemic index and load, measures of glucose metabolism, and body fat distribution in older adults.

BACKGROUND: Recent evidence suggests that the rate of carbohydrate digestion and absorption may influence the development of type 2 diabetes. OBJECTIVE: The aim of this study was to examine associations of dietary glycemic index and glycemic load with predictors of type 2 diabetes in older adults. DESIGN: This study evaluated cross-sectional relations of dietary glycemic index and glycemic load with measures of glucose metabolism and body fat distribution in participants of the Health, Aging and Body Composition Study, a prospective cohort study of adults aged 70-80 y (n = 2248). RESULTS: In men, dietary glycemic index was positively associated with 2-h glucose (P for trend = 0.04) and fasting insulin (P for trend = 0.004), inversely associated with thigh intramuscular fat (P for trend = 0.02), and not significantly associated with fasting glucose, glycated hemoglobin, or visceral abdominal fat. Dietary glycemic load was inversely associated in men with visceral abdominal fat (P for trend = 0.02) and not significantly associated with fasting glucose, 2-h glucose, glycated hemoglobin, fasting insulin, or thigh intramuscular fat. In women, although dietary glycemic index and load were not significantly related to any measures of glucose metabolism or body fat distribution, the association between dietary glycemic index and 2-h glucose was nearly significant (P for trend = 0.06). CONCLUSION: The findings of this cross-sectional study indicate an association between dietary glycemic index and selected predictors of type 2 diabetes in older adults, particularly in men.

Adipose Tissue↗
PubMed2005

Predicting the development of diabetes in older adults: the derivation and validation of a prediction rule.

OBJECTIVE: To create a simple prediction rule that could perform as well as the 2-h postchallenge plasma glucose (PCPG) test to predict those at risk for diabetes. We created a prediction rule in one sample and prospectively validated it for incident diabetes in a separate cohort. RESEARCH DESIGN AND METHODS: A cross-sectional analysis with data from the Rancho Bernardo Study (age 67 +/- 11 years) to derive a rule predicting abnormal PCPG >/=140 mg/dl, using demographic, clinical, and laboratory data of nondiabetic participants with fasting plasma glucose (FPG) <126 mg/dl. Data from the Health, Aging and Body Composition study (age 74 +/- 3 years) were used to prospectively validate this rule for incident diabetes and compare it with the predictive ability of the PCPG test. RESULTS: Of 1,549 RBS participants, 514 (33%) had PCPG >/=140 mg/dl. Female sex, age, triglycerides, and FPG were most significantly associated with abnormal PCPG. Based on standardized beta-coefficients, we allotted 1 point for female sex, triglycerides >/=150 mg/dl, or FPG 95-104 mg/dl. Age >/=70 years or FPG 105-115 mg/dl were given 2 points, and FPG 116-125 mg/dl received 3 points. In the validation cohort, this simple prediction rule was as good as the 2-h PCPG test for predicting incident diabetes (C-statistic: 0.71 for both). CONCLUSIONS: Advanced age, female sex, FPG, and triglycerides were able to predict adults at risk for diabetes equally well as the 2-h PCPG test. Using this rule, clinicians may better identify older persons who should receive intensive lifestyle intervention to prevent type 2 diabetes.

Aged↗
PubMed2004

Association of visceral adipose tissue with incident myocardial infarction in older men and women: the Health, Aging and Body Composition Study.

Assessment of body fat distribution, particularly visceral adipose tissue, may be important for accurate risk evaluation for cardiovascular disease in the elderly. This 1997-1998 US study examined the association of incident myocardial infarction (MI) with total adiposity (body mass index and fat mass) and body fat distribution (waist-to-thigh ratio, waist circumference, visceral and subcutaneous adipose tissue) in well-functioning men (n = 1,116) and women (n = 1,387) aged 70-79 years enrolled in the Health, Aging and Body Composition Study. There were 116 MI events (71 in men, 45 in women) during an average follow-up time of 4.6 (standard deviation, 0.9) years. No association was found between incident MI and the adiposity or fat distribution variables for men. For women, visceral adipose tissue was an independent predictor of MI (hazard ratio = 1.67, 95% confidence interval: 1.28, 2.17 per standard-deviation increase; p < 0.001). No association was found between body mass index or total fat mass and MI events in women. The association of visceral adipose tissue with MI in women was independent of high density lipoprotein cholesterol, interleukin-6 concentration, hypertension, and diabetes (hazard ratio = 1.79, 95% confidence interval: 1.24, 2.58 per standard-deviation increase; p < 0.01). The amount of adipose tissue stored in the intraabdominal cavity is an important, independent risk factor for MI in well-functioning, elderly women.

Adipose Tissue↗
PubMed2004

Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort.

BACKGROUND: A few studies have examined change in cognitive performance by diabetes status with disparate results. We examined the 4-year change in cognitive performance among older adults according to glucose tolerance status. METHODS: Three cognitive tests (Mini-Mental State Examination, Verbal Fluency [VF] test, and Trail-Making Test B) were measured 4 years apart in 999 white men and women aged 42 to 89 years, who were enrolled in the Rancho Bernardo Study. Participants were classified with normal (NGT), impaired (IGT) or diabetic glucose tolerance. Sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E epsilon4 allele, and current estrogen use. We checked for mediation by further adjusting for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; blood pressure; glycohemoglobin level; and microalbuminuria, retinopathy, stroke, or coronary heart disease. RESULTS: At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes mellitus had a 4-fold increased risk of a major cognitive decline on the VF test after 4 years compared with nondiabetic women. After multivariate adjustment, VF test scores at follow-up for women were 15.2 +/- 0.6 for those with diabetes, 16.7 +/- 0.4 for those with IGT, and 17.2 +/- 0.2 for those with NGT (P =.007). Glycohemoglobin attenuated this effect, but lipid levels, blood pressure, and microvascular or macrovascular disease did not. Performance on Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status. CONCLUSIONS: Elderly white women with diabetes had a more rapid decline in performance on the VF test compared with women with IGT or NGT. Better glucose control might ameliorate this decline.

Adult↗
PubMed2004

Serum leptin concentrations and body adipose measures in older black and white adults.

BACKGROUND: Among US adults, serum leptin concentrations are higher in women than in men and are higher in blacks than in whites independent of anthropometric measures of body fatness. OBJECTIVE: Using radiographic measures of body fat, we determined the best correlates of leptin and whether adiposity can explain sex and race differences in leptin concentrations in older adults. DESIGN: This was a cross-sectional analysis of fasting serum leptin concentrations and body fat measured by dual-energy X-ray absorptiometry (DXA), abdominal computed tomography, and standard anthropometry in 3026 well-functioning 70-79-y-old participants (42% black, 51% women) of the Health, Aging, and Body Composition Study. RESULTS: Geometric mean (+/-SE) leptin concentrations (ng/mL) were higher in the women than in the men (16.5 +/- 0.3 and 5.7 +/- 0.1, respectively) and in the black women than in the white women (20.2 +/- 0.6 and 13.9 +/- 0.4, respectively), but did not differ significantly between the white and black men (5.8 +/- 0.2 and 5.5 +/- 0.2, respectively). Percentage fat estimated from DXA showed the highest correlation with leptin (R(2) = 0.56 for both sexes). Addition of abdominal visceral fat minimally increased the correlation. In the multivariate analysis, the association with sex was eliminated after adjustment for percentage fat and visceral fat in both whites (P = 0.051) and blacks (P = 0.34). Among women, higher leptin concentrations in blacks remained after adjustment for percentage fat and visceral fat (mean race difference = 4.95 ng/mL; P < 0.001). Among men, an association with black race emerged after adjustment for these factors (mean race difference = 1.42 ng/mL; P < 0.001). CONCLUSIONS: Among older adults, higher serum leptin concentrations in women are explained by a greater percentage of body fat. Higher leptin concentrations in blacks are not explained by percentage of body fat.

Abdomen↗
PubMed2004

Adipocytokines attenuate the association between visceral adiposity and diabetes in older adults.

OBJECTIVE: To examine whether adiponectin is independently associated with diabetes and whether adiponectin and other adipocytokines account for the relationship between fat and diabetes. RESEARCH DESIGN AND METHODS: A nested case-control study from the Health, Aging, and Body Composition (Health ABC) study. We measured four adipocytokines: adiponectin, interleukin (IL)-6, tumor necrosis factor-alpha, and plasminogen activator inhibitor 1 (PAI-1). Regional fat area was determined by computed tomography scan. The 519 case subjects had diabetes defined by fasting plasma glucose level > or =126 mg/dl or by use of diabetes medications. The 519 control subjects had normal glucose tolerance and were matched by sex, race, and study site. Sex-specific logistic models were adjusted for age, race, site, total adiposity, smoking, and physical activity. RESULTS: Higher adiponectin levels were associated with lower risk of diabetes (P < 0.001). Visceral fat was the only adiposity measure associated with diabetes after adjusting for BMI (odds ratio 3.0 [2.1-4.3] in women and 1.3 [1.0-1.6] in men, P < 0.001 between-sex comparison). Adipocytokines attenuated the association between visceral fat and diabetes for both sexes but more strongly in men (women 2.3 [1.5-3.3], men 1.1 [0.9-1.4]). In men, adiponectin, IL-6, and PAI-1 remained independently associated with diabetes after adjusting for fat depots; in women, adiponectin was the only independently associated adipocytokine. Controlling for insulin, HDL, triglycerides, and blood pressure did not change these results. CONCLUSIONS: Adiponectin is associated with lower odds of diabetes in older men and women. Whereas several adipocytokines explained the relationship between visceral adiposity and diabetes in men, only adiponectin partially mediated this association among women.

Adiponectin↗
PubMed2003

Association of total and central obesity with mortality in postmenopausal women with coronary heart disease.

Overweight and abdominal obesity increase mortality risk, although the risk may be mediated by traditional cardiac risk factors. The authors assessed the association of baseline measures, change in overall body weight and abdominal obesity (waist circumference), and weight and waist circumference cycling with total mortality among postmenopausal women with known heart disease. They used data from 2,739 US women who participated in the Heart and Estrogen/progestin Replacement Study between 1993 and 2001. Over 6.8 years of follow-up, 498 women died. In adjusted Cox models that included either baseline waist circumference or body mass index (BMI), each was associated with mortality. However, after further adjustment for diabetes, hypertension, and lipoproteins, these associations disappeared. In models including both waist circumference and BMI, larger waist circumference (hazard ratio=1.40 per standard deviation, 95% confidence interval: 1.16, 1.68) was associated with increased risk and higher BMI (hazard ratio=0.81 per standard deviation, 95% confidence interval: 0.67, 0.97) was associated with decreased risk of total mortality, independent of cardiac risk factors. Weight and waist circumference cycling were not associated with mortality. Results show that both BMI and waist circumference are associated with mortality among postmenopausal women with established heart disease, but waist circumference may be more important than BMI, and their effects may be largely mediated by other cardiac risk factors.

Aged↗
PubMed2003

Differences in medical care and disease outcomes among black and white women with heart disease.

BACKGROUND: The risk of cardiovascular mortality is higher among black women than white women, and the reasons for this disparity are largely unexplored. We sought to evaluate differences in medical care and clinical outcomes among black and white women with established coronary artery disease. METHODS AND RESULTS: Among the 2699 women enrolled in the Heart and Estrogen/progestin Replacement Study (HERS), we used Cox proportional hazards models to determine the association of race with risk of coronary heart disease (CHD) events independent of major cardiovascular risk factors or medical therapies. During an average of 4.1 years of follow-up, CHD events were twice as likely in black compared with white women (6.4 versus 3.1 per 100 person-years, hazard ratio, 2.1; 95% confidence interval, 1.5 to 2.8; P<0.001). Black women had higher rates of hypertension, diabetes, and hypercholesterolemia, yet were less likely to receive aspirin or statins. Black women less often had optimal blood pressure (56% versus 63%; P=0.01) and LDL cholesterol (30% versus 38%; P=0.04) control at baseline and during follow-up. After adjusting for these and other differences, black women still had >50% higher CHD event risk (hazard ratio, 1.52; 95% confidence interval, 1.1 to 2.1; P=0.03). CONCLUSIONS: In a large cohort of women with heart disease, black women less often received appropriate preventive therapy and adequate risk factor control despite a greater CHD event risk. Interventions to improve appropriate therapy and risk factor control in all women, and especially black women, are needed.

Black or African American↗