Biomedical subjects

B L Randall

Publications and source records attributed to B L Randall.

6 recordsLinked to original sources

PubMed1997

Risk of end-stage renal disease in diabetes mellitus: a prospective cohort study of men screened for MRFIT. Multiple Risk Factor Intervention Trial.

CONTEXT: Diabetes is a frequent cause of end-stage renal disease (ESRD). However, the degree of risk is uncertain. OBJECTIVE: To determine the relative risk (RR) of ESRD related to diabetes in the United States. DESIGN: Nonconcurrent prospective cohort study. PARTICIPANTS: A total of 332544 men aged 35 to 57 years from 18 US cities screened in 1973 to 1975 for participation in the Multiple Risk Factor Intervention Trial (MRFIT). MAIN EXPOSURE: Diabetes mellitus defined by self-reported use of medication for diabetes at baseline. MAIN OUTCOME: Incident ESRD through 1990 assessed from a national ESRD registry and by surveillance for death from renal disease. RESULTS: Over an average follow-up of 16 years, there were 136 cases of ESRD in 5147 diabetic men and 678 cases in 327397 nondiabetic men. Age-adjusted incidence of all-cause ESRD in the diabetic men was 199.8 per 100000 person-years compared with 13.7 per 100000 person years in their nondiabetic counterparts (RR, 12.7; 95% confidence interval [CI], 10.5-15.4). Diabetic men were also at higher risk for ESRD ascribed to causes other than diabetes (RR=4.3; 95% CI, 3.2-5.9). With simultaneous adjustment for age, ethnicity, income, blood pressure, serum cholesterol level, and history of myocardial infarction, diabetic men remained at higher risk for all-cause ESRD (RR, 9.0; 95% CI, 7.4-11.0), ESRD ascribed to diabetes (RR, 92.3; 95% CI, 64.6-131.9), and ESRD ascribed to nondiabetic causes (RR, 3.0; 95% CI, 2.2-4.1). CONCLUSIONS: Diabetes mellitus is a strong independent risk factor for ESRD, even for ESRD ascribed to causes other than diabetes. Improvements in the prevention and control of diabetes should produce substantial reductions in ESRD incidence.

Adult↗

PubMed1996

Blood pressure and end-stage renal disease in men.

BACKGROUND: End-stage renal disease in the United States creates a large burden for both individuals and society as a whole. Efforts to prevent the condition require an understanding of modifiable risk factors. METHODS: We assessed the development of end-stage renal disease through 1990 in 332,544 men, 35 to 57 years of age, who were screened between 1973 and 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT). We used data from the national registry for treated end-stage renal disease of the Health Care Financing Administration and from records on death from renal disease from the National Death Index and the Social Security Administration. RESULTS: During an average of 16 years of follow-up, 814 subjects either died of end-stage renal disease or were treated for that condition (15.6 cases per 100,000 person-years of observation). A strong, graded relation between both systolic and diastolic blood pressure and end-stage renal disease was identified, independent of associations between the disease and age, race, income, use of medication for diabetes mellitus, history of myocardial infarction, serum cholesterol concentration, and cigarette smoking. As compared with men with an optimal level of blood pressure (systolic pressure < 120 mm Hg and diastolic pressure < 80 mm Hg), the relative risk of end-stage renal disease for those with stage 4 hypertension (systolic pressure > or = 210 mm Hg or diastolic pressure > or = 120 mm Hg) was 22.1 (P < 0.001). These relations were not due to end-stage renal disease that occurred soon after screening and, in the 12,866 screened men who entered the MRFIT study, were not changed by taking into account the base-line serum creatinine concentration and urinary protein excretion. The estimated risk of end-stage renal disease associated with elevations of systolic pressure was greater than that linked with elevations of diastolic pressure when both variables were considered together. CONCLUSIONS: Elevations of blood pressure are a strong independent risk factor for end-stage renal disease; interventions to prevent the disease need to emphasize the prevention and control of both high-normal and high blood pressure.

Adult↗

PubMed1993

The National Marrow Donor Program.

As the number of successful marrow transplants has increased, the lack of HLA-identical sibling donors for 60 to 70 percent of transplant candidates has become a serious problem. Pilot studies established that marrow transplantation between phenotypically HLA-identical, unrelated individuals can be accomplished successfully. Therefore, the National Marrow Donor Program was established to develop a large file of volunteer marrow donors and to serve as a center for the coordination of the donor search and donor-recipient matching processes. By November 1991, 63 months after the program was established, 457,205 potential marrow donors typed for HLA-A and -B antigens had agreed to be listed in the marrow donor registry. A donor search had been initiated for 8481 patients. At least one potential donor matched for at least three of the four HLA-A and -B antigens was located for 99.8 percent of patients. Among the 3156 searches that were completed, 940 (29.8%) resulted in a transplant. The median time in which to locate a matched donor, complete all predonation evaluations, and obtain donor consent was 208 days. The most common diagnosis in patients who underwent transplantation was chronic myelogenous leukemia (42.0%). When this analysis was completed in November 1991, the National Marrow Donor Program was operating a national network of 99 donor centers and 53 transplant centers. The donor file was increasing rapidly, and a follow-up system was in place to determine the effects of donation on the donors and the outcome in the patients who underwent transplantation. This national network of donor and transplant centers exists and is now facilitating unrelated-donor marrow transplants. The National Marrow Donor Program made it possible to locate donors for many patients in need of a transplant and helped to determine the role of unrelated-donor marrow transplants in the treatment of many diseases.

Blood Component Removal↗

PubMed1986

A long-term nutrition intervention experience: lipid responses and dietary adherence patterns in the Multiple Risk Factor Intervention Trial.

Nutrition counselors in the Multiple Risk Factor Intervention Trial (MRFIT) were able to help middle-aged men who were at high risk for coronary heart disease change their dietary habits, maintain those changes over time, and decrease their serum cholesterol levels. Most of a 7.5% mean serum cholesterol reduction achieved after 6 years of nutrition intervention occurred during the first year of the trial and was thereafter sustained. Total cholesterol and low-density lipoprotein cholesterol fraction decreases indicated improvement in terms of coronary heart disease risk. The food record rating, a numerical, semi-objective adherence technique that assesses a 3-day food record with respect to lipid-lowering potential, was used throughout the trial to measure adherence to recommended food patterns. Participants with lower food record rating scores, which indicate better adherence, demonstrated greater reductions in serum total cholesterol, plasma total cholesterol, and low-density lipoprotein fraction cholesterol determinations on a group basis. Subjective evaluations of the suitability of home and working environments, evidence of deviation from the MRFIT food patterns, and overall nutrition program motivation also showed that as ratings in each category became more favorable, lower food record rating scores and greater blood lipid reductions were consistently observed. The subgroup of participants who were non-smokers and not hypertensive demonstrated greater lipid responses and better dietary adherence. Continued smoking and antihypertensive medications appeared to adversely influence dietary adherence and/or lipid reductions. The MRFIT experience, however, demonstrated for the first time that dietary changes and blood lipid reductions can be achieved after the initial intervention effect, despite a continued emphasis on high blood pressure management and smoking cessation.

Cholesterol↗

PubMed1986

Increasing the use of meatless meals: a nutrition intervention substudy in the Multiple Risk Factor Intervention Trial (MRFIT).

Forty-seven participants from six MRFIT clinical centers were involved in a 3-month intensive dietary intervention program to determine the feasibility of increasing the use of meatless meals. The substudy was conducted late in the trial, and many dietary changes had already been made. The purpose, therefore, was to initiate ways to continue the maintenance of achieved serum cholesterol reductions and possibly effect additional decreases. The program consisted of an introductory session and three follow-up visits. Preplanning, contracting, self-monitoring, regular follow-up, and homemaker involvement were among techniques used to help participants incorporate meatless meals into routine dietary practices. Data collection included scores from a knowledge test administered at the introductory and final visits, number of meatless meals consumed per week as contracted at the first three visits and as reported at the last three visits, and serum cholesterol and weight determinations made at each visit. Knowledge related to meatless meal concepts, such as complementary proteins, appeared to improve as the majority of substudy participants scored higher on the post-test than on the pretest. Over the substudy duration, the mean number of contracted and reported weekly meatless meals in addition to breakfast was approximately four and five, respectively. Mean serum cholesterol drop was 2.6%, and mean weight loss was about 3 lb over the 3-month period. The approach was one of the intervention techniques used to maintain serum cholesterol reductions on a long-term basis, which has not been achieved in any other clinical trial with similar objectives. The described meatless meals program may prove useful to dietetic practitioners who counsel individuals in fat-modified food patterns.

Blood Pressure↗

PubMedDate not supplied

End-stage renal disease in African-American and white men. 16-year MRFIT findings.

OBJECTIVE: To determine reasons for the 4-fold higher incidence of treated end-stage renal disease (ESRD) in African-American men compared with white men. DESIGN: Prospective study. SETTING: Men screened in 1973 through 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT). PARTICIPANTS: A total of 332544 men (300645 white, 20222 African American, and 11677 other ethnic groups) aged 35 to 57 years. MAIN OUTCOME MEASURES: Incidence of ESRD assessed through 1990 using the Health Care Financing Administration national ESRD treatment registry and by surveillance for death from renal disease from data of the National Death Index and the Social Security Administration. RESULTS: Over a mean follow-up of 16 years, age-adjusted ESRD incidence was 13.90 per 100000 person-years in white men and 44.22 per 100000 person-years in African-American men. Higher blood pressure and lower socioeconomic status were associated with higher incidence of ESRD in both ethnic groups. With adjustment for baseline age, systolic blood pressure, number of cigarettes smoked, previous myocardial infarction, diabetes, income, and serum cholesterol level, relative risk of ESRD in African-American men compared with white men was reduced from 3.20 to 1.87 (95% confidence interval, 1.47-2.39). Both higher systolic blood pressure and lower income in African-American men as compared with white men were particularly related to this reduced relative risk. Results were similar when hypertensive ESRD was used as the outcome. CONCLUSION: Both higher blood pressure and lower income are associated with a higher incidence of ESRD in both white and African-American men. Disparities in blood pressure and socioeconomic status relate importantly to the excess risk of ESRD in African-American men compared with white men.

Adult↗