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Biomedical subjects

D R Jacobs

Publications and source records attributed to D R Jacobs.

At least 109 records · Page 6Linked to original sources
PubMed1996

Seven-year trends in plasma low-density-lipoprotein-cholesterol in young adults: the CARDIA Study.

To identify determinants of recent secular trends in lipids and characterize their influence on age-related increases in LDL-cholesterol, we examined a cohort of black and white men and women aged 18-30 in 1985-1986. Secular trends were determined by comparing participants aged 25-30 at baseline with those aged 25-30 at year 7 (2788 and 1395 participants, respectively). LDL-cholesterol was lower among those 25-30 at year 7 (5.9 to 10.2 mg/dL, depending on race-sex group; P < 0.001); weight was higher (8.3 to 12.5 lb; P < 0.001); Keys score was lower (-4.2 to -7.3 units; P < 0.001); and use of oral contraceptives was greater (white women only, P < 0.01). Among 4086 participants followed for 7 years, LDL-cholesterol changed little or decreased, despite substantial weight increases in all groups (11.6 to 19.0 lb; P < 0.001). Keys scores decreased by 6.1 to 8.0 units, and use of oral contraceptives decreased (P < 0.001). Declining secular trends in LDL-cholesterol occurred despite upward trends in weight; the decline was associated with lower dietary fat and cholesterol and offset expected age-related increases in LDL-cholesterol.

Adult↗
PubMed1996

A food frequency questionnaire can detect pregnancy-related changes in diet.

OBJECTIVE: To determine whether a food frequency questionnaire (FFQ) can detect changes in dietary intake before pregnancy to mid-pregnancy relative to a 4-day food record. DESIGN: FFQs and 4-day, weighed food records (4DRs) were completed during similar time intervals before pregnancy and again near mid-pregnancy by women served by a large health maintenance organization in the Minneapolis-St Paul, Minn, area. The outcome of interest was change in the intake of energy and 16 nutrients. Participants were members of the Diana Project, a prospective study of relationships among prepregnancy and pregnancy nutritional and other exposures and reproductive outcomes. Fifty-six (51%) of the eligible women completed the study. SUBJECTS: Well-educated, healthy, white women. STATISTICAL ANALYSES PERFORMED: Spearman rank order correlations. RESULTS: Mean energy and nutrient intake levels estimated using the 4DR were generally higher than those estimated using the FFQ. Correlations between change in energy and nutrient intakes measured by the 4DR and FFQ ranged from .75 for vitamin C to .02 for cholesterol and averaged .48. APPLICATIONS: Comparisons with 4DRs indicate that the FFQ used in this study is appropriate for obtaining reliable estimates of prepregnancy to mid-pregnancy changes in intake of energy and a number of nutrients in similar groups of women.

Adult↗
PubMed1996

Maternal waist-to-hip ratio as a predictor of newborn size: Results of the Diana Project.

Location of body fat stores, as indicated by waist-to-hip circumference ratio (WHR), affects a variety of metabolic processes in women, and some of these changes could affect fetal growth during pregnancy. We tested the hypothesis that WHR affects fetal growth among 702 participants of the Diana Project, a prospective study designed to identify preconceptual exposures related to reproductive outcomes. We tested the effect of maternal WHR on the outcomes of infant birthweight, length, and head circumference in regressional models that included 16 variables such as maternal body mass index, duration of gestation, and pregnancy weight gain previously related to birthweight. Maternal WHR was related to each measure of newborn size. A 0.1-unit increase in WHR predicts a 120-gm greater birthweight, a 0.2-inch greater length, and a 0.3-cm greater head circumference. We conclude that WHR is related to fetal growth and that the effect of WHR on fetal growth may be mediated by metabolic alterations associated with a preponderance of central body fat stores or to other factors closely aligned with WHR. The common finding of an independent effect of pregnancy BMI on birthweight may be largely attributable to maternal WHR.

Adult↗
PubMed1996

Relationships between depressive symptoms, anxiety, alcohol consumption, and blood pressure: results from the CARDIA Study. Coronary Artery Risk Development in Young Adults Study.

OBJECTIVES: We examined cross-sectional relationships among depressive symptoms, anxiety, alcohol intake, and blood pressure. Test hypotheses were that: (1) alcohol intake, depressive symptoms, and anxiety would be positively related to blood pressure; (2) depressive symptoms and anxiety would have a stronger association with alcohol intake in Blacks than in Whites; and (3) adjustment for differences in depressive symptoms, anxiety, and alcohol intake would reduce Black-White blood pressure differences. METHODS: Study hypotheses were tested in a sample of 4,352 Black and White adults, participating in the CARDIA study. Hypotheses were tested using multiple linear regression. RESULTS: Alcohol intake was positively related to systolic (p = 0.0001) and diastolic (p = 0.0004) blood pressure in men, but not in women. Depressive symptoms and anxiety were unrelated to blood pressure. The relationship between alcohol intake and depressive symptoms differed by race/ethnicity in men (p = 0.0719) and in women (p = 0.0002). Alcohol intake increased with increasing levels of depressive symptoms, but the increase was greater in Blacks than in Whites. After accounting for alcohol intake, body mass index, and other variables, Black-White blood pressure differences were reduced in men, but not in women; most of the reduction was caused by body mass index. CONCLUSIONS: Blacks may respond differently than Whites to psychological distress.

Adolescent↗
PubMed1996

Community-based education classes for hypertension control. A 1.5-year randomized controlled trial.

Community-based hypertension control is important for primary prevention of cardiovascular disease. In this study, untreated men and women aged 35 to 69 years were randomly assigned to an intervention (n=56) or control (n=55) group in a 1.5-year community-based education program. Subjects had no evidence of hypertensive end-organ defects and had screening blood pressures of 140 to 179 mm Hg systolic and/or 90 to 109 mm Hg diastolic, with no difference in mean blood pressure between groups (148 to 150 mm Hg for mean systolic and 83 to 84 mm Hg for mean diastolic pressures). The intervention group took four education classes in the first 6 months and four classes during the next year, and the control group took two classes. Health education focused on reduced dietary sodium and increased milk intake, brisk walking, and, if necessary, reduction of alcohol and sugar intakes. Antihypertensive medication was started less often in the intervention than in the control group at 1.5 years (9% versus 24%, P <.05). Mean systolic pressure was 5 to 6 mm Hg less in the intervention than in the control group at both 6 months and 1.5 years (P <.05), with or without inclusion of those subjects who began antihypertensive medication. Diastolic pressure and body mass index did not change significantly between groups. Urinary sodium excretion declined in the intervention but not in the control group (differences between groups: P=.04 at 6 months and P=.07 at 1.5 years). According to a behavioral questionnaire, sodium reduction and milk increase were greater in the intervention than the control group (sodium: P <.01 at 6 months and P=.08 at 1.5 years; milk: P <.001 at 6 months and P <.01 at 1.5 years). Mean ethanol intake was reduced in the intervention but not the control group (P=.04 at 1.5 years). This community-based hypertension control program was effective in reducing systolic pressure levels by nonpharmacological means during the first 6 months and maintaining the reduction for 1.5 years.

Aged↗
PubMed1996

Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program.

BACKGROUND AND PURPOSE: Epidemiological studies indicate a higher incidence of intracerebral (but not subarachnoid) hemorrhagic stroke among persons with low total serum cholesterol levels. This report further examines the prospective relationship of total serum cholesterol with subsequent intracerebral hemorrhage in a large, well-defined population. METHODS: The cohort included 61756 enrollees in a health plan from the San Francisco-Oakland metropolitan area (46% men, 63% white), aged 40 to 89 years and free of cardiovascular disease at baseline. Sixteen-year incidence of combined nonfatal and fatal intracerebral hemorrhagic stroke (International Classification of Diseases [ICD], 8th revision, code 431, or ICD, 9th revision, codes 431 and 432) was investigated in relation to serum cholesterol measured in multiphasic health checkups made in 1977 through 1985. Intracerebral hemorrhagic events were ascertained using hospital discharge records and as underlying cause of death by the California Mortality Linkage Information System. RESULTS: From 1978 through 1993 (average of 10.7 years), there were 386 events (201 in men, 29% fatal; 185 in women, 42% fatal). By multivariate proportional hazards life-table regression analysis, serum cholesterol level below the sex-specific 10th percentile (< 4.62 mmol/L [178 mg/dL] in men), compared with higher cholesterol level, was associated with a significantly increased risk of intracerebral hemorrhage in men aged 65 years or older (relative risk, 2.7; 95% confidence interval, 1.4 to 5.0). An excess risk was also observed among elderly women at the lowest cholesterol range, but a chance finding could not be ruled out. No relationship was seen among men or women aged 40 to 64, and no statistical interaction of low serum cholesterol with hypertension was found in either sex. CONCLUSIONS: In these data, the association between low serum cholesterol level and intracerebral hemorrhage was confined to elderly men.

Adult↗
PubMed1996

Twenty-five-year prediction of stroke deaths in the seven countries study: the role of blood pressure and its changes.

BACKGROUND AND PURPOSE: This report explores the prediction of long-term stroke mortality in cohorts of the Seven Countries Study. METHODS: Sixteen cohorts of men aged 40 to 59 years at entry were examined at years 0, 5, and 10, with mortality follow-up through 25 years. RESULTS: Stroke death rates in 25 years were high in rural Serbia, Croatia, and Japan; intermediate in Italy, Greece, and urban Serbia; and low in Finland, the Netherlands, and the United States. Age and blood pressure were powerful predictors of 25-year stroke mortality in almost all cohorts and countries. Proportional hazards regression coefficients were .0232 increase in stroke death hazard per millimeter of mercury (t=14.60) for systolic blood pressure and .0409 (t=13.41) for diastolic blood pressure. Moderate blood pressure increases from low usual levels were associated with lower stroke mortality rates in years 10 to 25. Increases of blood pressure starting from high usual levels were associated with increased rates of stroke mortality. Systolic blood pressure was associated with stroke mortality at given levels of diastolic pressure, but diastolic blood pressure was not predictive of stroke mortality at given levels of systolic blood pressure. CONCLUSIONS: Associations of systolic and diastolic blood pressure with stroke mortality were similar in cultures with different stroke mortality rates. Increases in blood pressure were associated with subsequent excess stroke mortality only in those who started from high usual levels; this study finds lower stroke risk in those men whose blood pressure increased moderately from low usual levels. Diastolic blood pressure is not independently associated with stroke risk in these populations.

Adult↗
PubMed1996

Relationship of lipoproteins, apolipoproteins, triglycerides and lipid ratios to plasma total cholesterol in young adults: the CARDIA Study. Coronary Artery Risk Development in Young Adults.

OBJECTIVE: To characterize the association of carrier lipoproteins, apolipoproteins, triglycerides and various lipid ratios with total cholesterol in young adults. DESIGN: Cross-sectional data from the baseline examination (1985-1986) of The Coronary Artery Risk Development In Young Adults (CARDIA) Study, a multicenter investigation of a biracial cohort of 4941 men and women aged 18-30 years. METHODS: Multiple linear regression models to estimate mean levels of lipids and lipoproteins for each category of total cholesterol, stratified by race and sex and adjusted for age and education level. RESULTS: As expected, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1) and triglycerides increased linearly with the level of total cholesterol in all race-sex subgroups. The LDL-C/HDL-C, ApoB/ApoA-1 and LDL-C/ApoB ratio also increased with total cholesterol in all race-sex subgroups. The HDL-C/ApoA-1 ratio, indicative of cholesterol content per HDL particle, did not vary with total cholesterol except in white men, in whom it was slightly lower for those with high total cholesterol than those with low total cholesterol concentrations. White men showed higher triglyceride concentrations and lower HDL-C for any given total cholesterol strata. All these associations of lipoproteins, apolipoproteins and lipid ratios with total cholesterol were independent of body mass index, smoking status, fitness level and Keys score. CONCLUSIONS: Young adults with low total cholesterol have lipoprotein profiles characterized by low atherogenic potential. White men with high total cholesterol levels, compared with other groups, showed a lipid profile more conductive to atherogenesis.

Adolescent↗
PubMed1996

Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations.

OBJECTIVES: This study compared prevalence rates of health-compromising behaviors among boys and girls from different ethnic backgrounds in early, middle, and late adolescence and compared co-occurrences of such behaviors across gender and ethnic groups. METHODS: The study population included 123 132 adolescents in grades 6, 9, and 12. Adolescents completed a classroom-administered statewide survey focusing on high-risk behaviors, including unhealthy weight loss, substance abuse, suicide risk, delinquency, and sexual activity. RESULTS: Prevalence rates of most health-compromising behaviors differed by gender, increased with age, and tended to be highest among American Indian youth and lowest among Asian Americans. Strong associations were found between substance abuse and delinquency across all ethnic groups. Substance abuse and delinquency were associated with suicide risk across most ethnic groups. Covariations with sexual activity and unhealthy weight loss behaviors showed more ethnic variation. CONCLUSIONS: Prevention interventions should take into account the tendency for health-compromising behaviors to co-occur and should be sensitive to demographic and socioeconomic differences in behavior patterns.

Adolescent↗
PubMed1995

Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study.

OBJECTIVE: To compare the relationship between serum total cholesterol and long-term mortality from coronary heart disease (CHD) in different cultures. DESIGN: Total cholesterol was measured at baseline (1958 through 1964) and at 5- and 10-year follow-up in 12,467 men aged 40 through 59 years in 16 cohorts located in seven countries: five European countries, the United States, and Japan. To increase statistical power six cohorts were formed, based on similarities in culture and cholesterol changes during the first 10 years of follow-up. MAIN OUTCOME MEASURES: Relative risks (RRs), estimated with Cox proportional hazards (survival) analysis, for 25-year CHD mortality for cholesterol quartiles and per 0.50-mmol/L (20-mg/dL) cholesterol increase. Adjustment was made for age, smoking, and systolic blood pressure. RESULTS: The age-standardized CHD mortality rates in the six cohorts ranged from 3% to 20%. The RRs for the highest compared with the lowest cholesterol quartile ranged from 1.5 to 2.3, except for Japan's RR of 1.1. For a cholesterol level of around 5.45 mmol/L (210 mg/dL), CHD mortality rates varied from 4% to 5% in Japan and Mediterranean Southern Europe to about 15% in Northern Europe. However, the relative increase in CHD mortality due to a given cholesterol increase was similar in all cultures except Japan. Using a linear approximation, a 0.50-mmol/L (20-mg/dL) increase in total cholesterol corresponded to an increase in CHD mortality risk of 12%, which became an increase in mortality risk of 17% when adjusted for regression dilution bias. CONCLUSION: Across cultures, cholesterol is linearly related to CHD mortality, and the relative increase in CHD mortality rates with a given cholesterol increase is the same. The large difference in absolute CHD mortality rates at a given cholesterol level, however, indicates that other factors, such as diet, that are typical for cultures with a low CHD risk are also important with respect to primary prevention.

Adult↗
PubMed1995

Assessment of ability to recall physical activity of several years ago.

In this study we assessed the reliability of recall of physical activity. Study participants were members of the Coronary Artery Risk Development in Young Adult Study (CARDIA) cohort who reported physical activity at each CARDIA examination. In this study, we asked 81 participants to recall activity patterns for the year prior to 2 to 3 years ago so that we could compare recalled activity patterns to those reported 2 to 3 years ago (labeled as "distantly recalled") as well as to activity patterns reported at the other CARDIA examinations. We found that distantly recalled physical activity patterns were highly correlated with those reported at the time of the examination where they were obtained (vigorous activity r = 0.84, moderate activity r = 0.64, and total activity r = 0.81). Distantly recalled activity was less highly associated with activity reported currently (vigorous activity r = 0.57, moderate activity r = 0.45, total activity r = 0.59). The activity recalled the best was jogging or running (r = 0.76) and the activity with the poorest recall was racket sports (r = 0.53). Distantly recalled physical activity also was related to resting pulse rate obtained during the time period of the recalled activity (r = -0.21). These findings suggest that people can recall activity patterns of several years ago with high reliability.

Adolescent↗
PubMed1995

Whole grain intake and cancer: a review of the literature.

There has been little research concerning the health effects of whole grain intake in humans. We have synthesized 15 american and European case-control and prospective studies of whole grain intake. Most subjects were middle aged or older. The studies employed disparate dietary methods, and the foods referred to and quantities eaten are ill defined. Nevertheless there is a striking consistency in reduced risk for colorectal and gastric cancers associated with intake of whole grain, also found in isolated studies of endometrial cancer and coronary heart disease. Because reduced risk was not associated with refined grain intake, these findings do not appear to be confounded by participant confusion concerning refined vs. whole grains. The independence of these findings from reduced risk associated with fruit and vegetable intake is not established. There should be further research to establish whether whole grain intake is protective against chronic disease.

Colorectal Neoplasms↗
PubMed1995

Dietary antioxidants and plasma lipids: the CARDIA Study.

OBJECTIVE: To determine if dietary antioxidants play a role in preventing coronary heart disease (CHD) by having an impact on lipid levels. METHODS: Data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study were used to assess the associations of reported intake of vitamins A, C, E and beta carotene, and their use in supplements, with lipid levels in a black and white, healthy adult (18 to 30 years of age at the baseline examination) population. RESULTS: After adjusting for age, education level, physical activity, body size, alcohol consumption and caloric intake, vitamin A, beta carotene, and vitamin C (white women) intake were directly associated with HDL-cholesterol levels among women who smoked cigarettes, with the strongest associations being observed for white women. Black men who took supplements of vitamins A and C and did not smoke cigarettes had significantly higher HDL-cholesterol levels compared to those in the lowest levels of dietary intake. Although vitamin E was associated with higher levels of HDL-cholesterol, the association was only of borderline significance among white men who smoked cigarettes (p = 0.06). We did not observe any consistent associations between antioxidants and other plasma lipids, including total cholesterol, LDL-cholesterol, or triglycerides. CONCLUSIONS: We conclude that dietary antioxidants are associated with HDL-cholesterol levels in some subsets of the population, although these associations may be operating in conjunction with other lifestyle behaviors.

Adolescent↗
PubMed1995

Ability of the Atherosclerosis Risk in Communities (ARIC)/Baecke Questionnaire to assess leisure-time physical activity.

BACKGROUND: The Atherosclerosis Risk in Communities (ARIC)/Baecke Questionnaire is a general survey of both occupational and leisure (sport and exercise related and non-sport and exercise related) physical activity. METHODS: Its ability to assess leisure physical activity was studied in 78 men and women, age 20-59 years, by comparison to: six 48-hour physical activity records; 14 48-hour Caltrac accelerometer readings (Caltrac); three peak oxygen consumption (VO2 peak) determinations; and per cent body fat. These criteria measures were obtained over a year's duration. RESULTS: The following associations were evident in men and women respectively, between sport and exercise physical activity and: physical activity record heavy intensity activity (r = 0.73 and r = 0.63); VO2 peak (r = 0.67 and r = 0.45); and per cent body fat (r = -0.37, P = 0.08 and r = -0.44). Less concordance was evident (r = 0.39 for men and r = 0.23, NS, for women) between non-sport and exercise physical activity and physical activity record light intensity activity. Questionnaire and physical activity record indices of total leisure activity tended to be more closely related in men (r = 0.59) than women (r = 0.33). For both men and women, survey results were not closely associated with Caltrac readings. CONCLUSIONS: Although there are weaknesses, questionnaire strengths consistent for both men and women include: ease of administration, high reliability, and accurate assessment of heavy intensity activity as well as light intensity activities such as walking and bicycling.

Adipose Tissue↗
PubMed1995

Lowering of body iron stores by blood letting and oxidation resistance of serum lipoproteins: a randomized cross-over trial in male smokers.

OBJECTIVES: The purpose of this study was to test the hypothesis that the reduction of body iron stores by venesection (blood letting) would reduce the susceptibility to oxidation of atherogenic serum lipoproteins. DESIGN: This is a randomized, controlled cross-over trial in 14 regularly smoking men with elevated serum ferritin concentration. The study design comprised two 14-week study periods, with a 14-week wash-out period in between, with either blood donations or control. SETTING: The study site was the Research Institute of Public Health, University of Kuopio. Investigators from the Division of Epidemiology, University of Minnesota, Minneapolis, participated in the planning of the study. SUBJECTS: Fourteen volunteers who were heavy smokers and had previous experience in blood letting were recruited for the study. INTERVENTIONS: During the intervention periods, the subjects donated 450 mg (500 mL) of blood three times in 14 weeks. MAIN OUTCOME MEASUREMENTS: Oxidation resistance of very low density lipoprotein (VLDL)/low density lipoprotein (LDL) was measured after inducing oxidation with haemin and H2O2. RESULTS: Serum ferritin concentration was reduced by 44% [95% confidence interval (CI) 8-82%, P = 0.021] during the venesection periods, the maximal oxidation velocity was decreased by 20% (95% CI 3-30%, P = 0.032), and the lag time to start of oxidation was lengthened (oxidation resistance increased) by 33% (95% CI 1-64%, P = 0.036). CONCLUSIONS: These observations indicate that the reduction of body iron stores by venesection can increase the oxidation resistance of serum VLDL/LDL in regularly smoking men.

Adult↗
PubMed1995

Do adolescents and parents report each other's physical activity accurately?

In research concerning socialization into sports there is a need to assess children's reports of parental physical activity. Reports by young adolescents and their parents of each other's leisure-time physical activity and related issues were compared with self-reported measures. A total of 755 family units in western Norway, consisting of 755 13-year-olds, mean age 13.3 +/- 0.3 years (425 boys, 330 girls, 644 fathers and 732 mothers) completed a self-administered physical activity questionnaire. Pearson's between self-reports by parents and the reports by their children varied between 0.56 (P < 0.001) and 0.07 (nonsignificant). Pearson's r between off-springs' self-reported physical activity and reports by their parents varied between 0.41 and 0.55 (P < 0.001). The results support cautious use of young adolescents' reports of parental physical activity.

Adolescent↗
PubMed1995

The role of animation as a program development strategy.

As an approach to community organization, animation involves the activation of people to take responsibility for their own affairs, with the aim of achieving their own, self-defined ends. The authors analyze the use of animation as a strategy of social program development undertaken by a nonprofit organization to initiate a clubhouse serving people with serious mental illness. Six animation strategies and their impact on the local community, sponsoring organization, and subsequent clubhouse program development are examined. The authors recognize the intensive resource requirements of animation, but they conclude that successful animation results in a program that enjoys high levels of community support, understanding, and legitimacy.

Community Health Planning↗