Biomedical subjects

E S Ford

Publications and source records attributed to E S Ford.

At least 37 records · Page 2Linked to original sources

PubMed2000

Association between total homocyst(e)ine and the likelihood for a history of acute myocardial infarction by race and ethnicity: Results from the Third National Health and Nutrition Examination Survey.

BACKGROUND: Few studies examining the association between total homocyst(e)ine and coronary heart disease have included blacks or Hispanics. METHODS: Data from the third National Health and Nutrition Examination Survey (3173 patients), a nationally representative survey of US adults, were used to examine the relation between total homocyst(e)ine and an electrocardiogram or a physician's diagnosis of acute myocardial infarction (259 patients) among whites, blacks, and Mexican Americans >/=40 years old. RESULTS: Vitamin B(12) and serum folate concentrations were significantly lower among persons with a total homocyst(e)ine concentration >/=15 micromol/L than among those with a total homocyst(e)ine concentration </=10 micromol/L. Persons with a total homocyst(e)ine concentration >/=15 micromol/L were also older and more likely to be hypertensive, have a higher cholesterol concentration, and smoke. Compared with persons with a total homocyst(e)ine concentration </=10 micromol/L, persons with a concentration >/=15 micromol/L had an odds ratio (OR) for myocardial infarction of 1.8 (95% confidence interval [CI], 1.2-2.9) after adjustment for cardiovascular disease risk factors. Similar associations were noted among whites (OR 1.8, 95% CI, 1.1-3.1) and blacks (OR 1.9, 95% CI, 0.8-4.2); a more modest association was noted among Mexican Americans (OR 1.2, 95% CI, 0.3-5.0). The association between total homocyst(e)ine and myocardial infarction was also more pronounced in persons without hypertension or diabetes. CONCLUSIONS: Almost a 2-fold increased likelihood of myocardial infarction among persons with a total homocyst(e)ine concentration >/=15 micromol/L was noted in this nationally representative survey. The magnitude of the association did not differ by race or ethnicity.

Age Distribution↗

PubMed2000

Serum C-reactive protein and fibrinogen concentrations and self-reported angina pectoris and myocardial infarction: findings from National Health and Nutrition Examination Survey III.

C-reactive protein may predict the risk of cardiovascular disease, but its association with angina pectoris in the general population has not been clearly established, however. We used data from National Health and Nutrition Examination Survey III conducted from 1988-1994 to examine the associations between serum C-reactive protein and plasma fibrinogen concentrations and self-reported angina pectoris and myocardial infarction among 7,948 U.S. men and women aged 40 years and older. C-reactive protein and fibrinogen concentrations were moderately correlated (r = 0.43). After adjustment for age, sex, race or ethnicity, education, smoking status, systolic blood pressure, serum cholesterol, high-density lipoprotein cholesterol, history of diabetes mellitus, body mass index, and physical activity, fibrinogen (but not C-reactive protein) concentration was significantly associated with self-reported angina pectoris. Neither fibrinogen or C-reactive protein concentrations were significantly associated with angina pectoris when entered in the model simultaneously. C-reactive protein and fibrinogen concentrations were positively associated with myocardial infarction when entered separately into models, but only C-reactive protein concentration was significantly associated with myocardial infarction when both variables were entered simultaneously. These cross-sectional data showed a significant positive association between C-reactive protein concentration and myocardial infarction but not self-reported angina pectoris in the U.S. population.

Adult↗

PubMed2000

Serum vitamins, carotenoids, and angina pectoris: findings from the National Health and Nutrition Examination Survey III.

PURPOSE: Whether various vitamins and carotenoids can protect against ischemic heart disease remains an unsettled question. METHODS: We performed a cross-sectional analysis of data from National Health and Nutrition Examination Survey III (1988-1994) and examined the associations between serum vitamins A, C, E, and B12, serum folate, red blood cell folate, serum carotenoids, and angina pectoris in a representative population-based sample of 11,327 men and women aged 35->90 years. RESULTS: After adjusting for age, sex, race or ethnicity, education, smoking status, systolic blood pressure, serum cholesterol, high-density lipoprotein cholesterol, history of diabetes mellitus, body mass index, and physical activity with multiple logistic regression analysis, no significant associations were present for any of the serum vitamin concentrations and angina pectoris. Significant linear trends were observed for serum concentrations of alpha-carotene (p < 0.001), beta-carotene (p = 0.026), and beta-cryptoxanthin (p = 0.003). Compared with participants with carotenoid concentrations in the lowest quartile, participants with concentrations in the highest quartile had odds ratios for angina pectoris of 0.45 (95% confidence interval (CI) 0.31-0.65), 0.57 (95% CI 0.38-0.86), and 0.57 (95% CI 0.38-0.84) for alpha-carotene, beta-carotene, and beta-cryptoxanthin, respectively. CONCLUSIONS: These results provide little support for a cross-sectional association between angina pectoris and serum and red blood cell folate concentrations or concentrations of vitamins A, C, E, and B12. Several serum carotenoid concentrations were associated with a reduced risk for angina pectoris, however.

Adult↗

PubMed2000

Serum C-reactive protein and self-reported stroke: findings from the Third National Health and Nutrition Examination Survey.

C-reactive protein may predict the risk of coronary heart disease, but its association with stroke has not been well studied. We used data from the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994, to examine the association between serum C-reactive protein concentrations and self-reported past history of stroke among 8850 US men and women aged >/=40 years. The unadjusted geometric mean of C-reactive protein concentration was higher among participants with stroke than those without stroke (0. 45+/-0.02 versus 0.32+/-0.01, P<0.001). After adjusting for age, sex, race or ethnicity, education, smoking status, systolic blood pressure, serum cholesterol, high density lipoprotein cholesterol, history of diabetes mellitus, body mass index, and physical activity, the odds ratio for stroke among participants with C-reactive protein concentrations >/=0.55 mg/dL compared with participants with concentrations </=0.21 mg/dL was 1.71 (95% CI 1.11 to 2.64 [odds ratio per mg/dL 1.19, 95% CI 1.05 to 1.34]). These cross-sectional data support findings from other studies suggesting that C-reactive protein concentration may be a risk factor or marker for stroke in the US population.

Adult↗

PubMed2000

Diabetes trends in the U.S.: 1990-1998.

OBJECTIVE: To examine trends in diabetes prevalence in the U.S. RESEARCH DESIGN AND METHODS: This study was conducted via telephone surveys in states that participated in the Behavioral Risk Factor Surveillance System between 1990 and 1998. The participants consisted of noninstitutionalized adults aged 18 years or older. The main outcome measure was self-reported diabetes. RESULTS: The prevalence of diabetes rose from 4.9% in 1990 to 6.5% in 1998--an increase of 33%. Increases were observed in both sexes, all ages, all ethnic groups, all education levels, and nearly all states. Changes in prevalence varied by state. The prevalence of diabetes was highly correlated with the prevalence of obesity (r = 0.64, P<0.001). CONCLUSIONS: The prevalence of diabetes continues to increase rapidly in the U.S. Because the prevalence of obesity is also rising, diabetes will become even more common. Major efforts are needed to alter these trends.

Adult↗

PubMed1999

Are health care professionals advising obese patients to lose weight?

CONTEXT: Implementation of the National Institutes of Health's 1998 guidelines, which recommended that health care professionals advise obese patients to lose weight, required baseline data for evaluation. OBJECTIVES: To describe the proportion and characteristics of obese persons advised to lose weight by their health care professional during the previous 12 months and to determine whether the advice was associated with reported attempts to lose weight. DESIGN: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. SETTING: Population-based sample from 50 states and the District of Columbia. PARTICIPANTS: A total of 12835 adults, 18 years and older, classified as obese (body mass index > or =30 kg/m2), who had visited their physician for a routine checkup during the previous 12 months. MAIN OUTCOME MEASURES: Reported advice from a health care professional to lose weight, and reported attempts to lose weight. RESULTS: Forty-two percent of participants reported that their health care professional advised them to lose weight. Using multivariate logistic regression analysis, we found that the persons who were more likely to receive advice were female, middle aged, had higher levels of education, lived in the northeast, reported poorer perceived health, were more obese, and had diabetes mellitus. Persons who reported receiving advice to lose weight were significantly more likely to report trying to lose weight than those who did not (OR, 2.79; 95% CI, 2.53-3.08). CONCLUSIONS: Less than half of obese adults report being advised to lose weight by health care professionals. Barriers to counseling need to be identified and addressed.

Adult↗

PubMed1999

Body mass index and colon cancer in a national sample of adult US men and women.

The evidence supporting obesity as a risk factor for colon cancer remains inconclusive, especially among women. The author studied the association between obesity and colon cancer in a nationally representative cohort of men and women aged 25-74 years who participated in the First National Health and Nutrition Examination Survey from 1971 to 1975 and were subsequently followed up through 1992. Among the 13,420 persons included in the analytic sample, 222 incident cases of colon cancer were identified. Height and weight were measured during the baseline examination. Compared with participants whose body mass index was less than 22 kg/m2, the hazard ratios were 1.79 (95% confidence interval (CI): 0.87, 3.71), 1.86 (95% CI: 0.86, 4.03), 2.47 (95% CI: 1.14, 5.32), 3.72 (95% CI: 1.68, 8.22), and 2.79 (95% CI: 1.22, 6.35) for participants with a body mass index of 22-<24 kg/m2, 24-<26 kg/m2, 26-<28 kg/m2, 28-<30 kg/m2, and > or = 30 kg/m2, respectively. The hazard ratios were similar for men and women. Subscapular skinfold thickness, but not triceps skinfold thickness, was positively associated with colon cancer incidence among men but not women, after adjustment for body mass index and other possible confounders. These results strongly support the hypothesis that excess body weight is a risk factor for colon cancer among both men and women.

Adult↗

PubMed1999

Serum alpha-tocopherol status in the United States population: findings from the Third National Health and Nutrition Examination Survey.

Despite the role vitamin E may have in protecting against various chronic conditions, little is known about vitamin E status in the US population. Using data from the Third National Health and Nutrition Examination Survey (1988-1994), the authors examined the distribution and correlates of serum alpha-tocopherol among 16,295 US adults aged 18 or more years. The mean concentration of alpha-tocopherol was 26.8 micromol/liter (geometric mean, 25.0 micromol/liter). The 25th, 50th, and 75th percentiles were 19.6, 24.1, and 30.4 micromol/liter, respectively. The mean alpha-tocopherol/cholesterol ratio was 5.1 (geometric mean, 4.9); the 25th, 50th, and 75th percentiles were 4.1, 4.7, and 5.5 (10(-3)), respectively. About 27% of the US population had a low alpha-tocopherol concentration (<20 micromol/liter). After age standardization, 29% of the men, 28% of the women, 26% of the Whites (men, 27%, and women, 26%), 41% of the African Americans (men, 42%, and women, 40%), 28% of the Mexican Americans (men, 29%, and women, 27%), and 32% of the other participants (men, 36%, and women, 29%) had this low concentration. For all participants, age, educational attainment, serum cholesterol, and several serum vitamins and carotenoids were directly related to and high density lipoprotein cholesterol was inversely related to serum alpha-tocopherol concentration in multiple linear regression analysis. Men had a higher concentration than did women, and African Americans had the lowest concentration of any racial or ethnic group. These results show that important proportions of US adults have a low serum alpha-tocopherol concentration, which may increase their risk for chronic diseases in which low dietary intake or blood concentration of alpha-tocopherol have been implicated.

Adolescent↗

PubMed1999

Diabetes mellitus and serum carotenoids: findings from the Third National Health and Nutrition Examination Survey.

Little is known about carotenoids, a diverse group of plant compounds with antioxidant activity, and their association with diabetes, a condition characterized by oxidative stress. Data from phase I of the Third National Health and Nutrition Examination Survey (1988-1991) were used to examine concentrations of alpha-carotene, beta-carotene, cryptoxanthin, lutein/zeaxanthin, and lycopene in 40- to 74-year-old persons with a normal glucose tolerance (n = 1,010), impaired glucose tolerance (n = 277), newly diagnosed diabetes (n = 148), and previously diagnosed diabetes (n = 230) based on World Health Organization criteria. After adjustment for age, sex, race, education, serum cotinine, serum cholesterol, body mass index, physical activity, alcohol consumption, vitamin use, and carotene and energy intake, geometric means of beta-carotene were 0.363, 0.316, and 0.290 micromol/liter for persons with a normal glucose tolerance, impaired glucose tolerance, and newly diagnosed diabetes, respectively (p = 0.004 for linear trend), and geometric means for serum lycopene were 0.277, 0.259, and 0.231 micromol/liter, respectively (p = 0.044 for linear trend). All serum carotenoids were inversely related to fasting serum insulin after adjustment for confounders (p < 0.05 for each carotenoid). If confirmed, these data suggest new opportunities for research that include exploring a possible role for carotenoids in the pathogenesis of insulin resistance and diabetes.

Adult↗

PubMed1999

Serum and red blood cell folate concentrations, race, and education: findings from the third National Health and Nutrition Examination Survey.

BACKGROUND: Little is known about the relations between race or ethnicity, educational attainment, and serum and red blood cell folate concentrations. OBJECTIVE: We examined the relation between educational attainment and serum and red blood cell folate concentrations in 8457 white, African American, and Mexican American men and women aged > or = 17 y. DESIGN: We performed a cross-sectional analysis using data from Phase 1 of the third National health and Nutrition Examination Survey (1988-1991). RESULTS: White men had significantly higher adjusted serum and red blood cell folate concentrations (16.9 and 502.6 nmol/L, respectively) than did African American men (15.6 and 423.3 nmol/L, respectively) or Mexican American men (16.0 and 457.0 nmol/L, respectively); white women had significantly higher concentrations (18.4 and 515.9 nmol/L, respectively) than did African American women (16.3 and 415.4 nmol/L, respectively) or Mexican American women (15.9 and 455.7 nmol/L, respectively). For the entire sample, rank correlation coefficients between educational attainment and serum and red blood cell folate were 0.11 and 0.12, respectively, and were larger in white participants than in other participants. No significant linear trends between adjusted serum or red blood cell folate and educational attainment were found. Among participants with > 12 y of education, the mean adjusted concentrations of serum folate were 15% and 18% lower and those of red blood cell were 18% and 22% lower in African American men and women than in white men and women, respectively. CONCLUSIONS: African Americans and Mexican Americans could benefit most from public health programs to boost folate intakes by encouraging increased intake of folate-rich foods and vitamin supplements.

Adult↗

PubMed1999

Serum vitamin C concentrations and diabetes: findings from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Previous studies suggested that diabetes mellitus may lower serum vitamin C concentrations, but most of these studies used clinic-based populations with established diabetes of varying duration and did not adjust for important covariates. OBJECTIVE: Using a population-based sample and adjusting for important covariates, we asked whether serum vitamin C concentrations in persons with newly diagnosed diabetes differed from those in persons without diabetes. DESIGN: Data were obtained from the third National Health and Nutrition Examination Survey (1988-1994). Serum vitamin C was assayed by using reversed-phase HPLC with multiwavelength detection. Diabetes status (n = 237 persons with diabetes; n = 1803 persons without diabetes) was determined by oral-glucose-tolerance testing of the sample aged 40-74 y. RESULTS: After adjustment for age and sex, mean serum vitamin C concentrations were significantly lower in persons with newly diagnosed diabetes than in those without diabetes. After adjustment for dietary intake of vitamin C and other important covariates, however, mean concentrations did not differ according to diabetes status. CONCLUSION: When assessing serum vitamin C concentrations by diabetes status in the future, researchers should measure and account for all factors that influence serum vitamin C concentrations.

Adult↗

PubMed1999

Serum magnesium and ischaemic heart disease: findings from a national sample of US adults.

BACKGROUND: Animal and human data suggest that magnesium may play an important role in ischaemic heart disease. Few prospective epidemiological studies have related serum magnesium concentrations to mortality from ischaemic heart disease (IHD) or all-causes. METHODS: Data from the National Health and Nutrition Examination Survey Epidemiologic Followup Study were used to examine the association between serum magnesium concentration, measured between 1971-1975, and mortality from IHD or all-causes in a national sample of 25-74-year-old participants followed for about 19 years. RESULTS: The analytical samples for IHD and all-cause-mortality included 12 340 and 12 952 participants, respectively (1005 IHD deaths, 2637 IHD deaths or hospitalizations, 4282 total deaths). Hazard ratios for IHD mortality from proportional hazards analysis comparing the second (1.59-<1.68 mEq/l), third (1.68-<1.77 mEq/l), and fourth (> or =1.77 mEq/1) quartiles of serum magnesium concentration with the lowest quartile were 0.79 (95% CI: 0.58-1.08), 0.66 (95% CI: 0.47-0.93), 0.69 (95% CI: 0.52-0.90), respectively. For all-cause mortality, hazards ratios were 0.82 (95% CI: 0.72-0.93), 0.84 (95% CI: 0.73-0.96), 0.85 (95% CI: 0.75-0.95). No significant interactions between serum magnesium concentration and age, sex, race, and education were observed. CONCLUSION: Serum magnesium concentrations were inversely associated with mortality from IHD and all-cause mortality.

Adult↗

PubMed1999

Radon and lung cancer: a cost-effectiveness analysis.

OBJECTIVES: This study examined the cost-effectiveness of general and targeted strategies for residential radon testing and mitigation in the United States. METHODS: A decision-tree model was used to perform a cost-effectiveness analysis of preventing radon-associated deaths from lung cancer. RESULTS: For a radon threshold of 4 pCi/L, the estimated costs to prevent 1 lung cancer death are about $3 million (154 lung cancer deaths prevented), or $480,000 per life-year saved, based on universal radon screening and mitigation, and about $2 million (104 lung cancer deaths prevented), or $330,000 per life-year saved, if testing and mitigation are confined to geographic areas at high risk for radon exposure. For mitigation undertaken after a single screening test and after a second confirmatory test, the estimated costs are about $920,000 and $520,000, respectively, to prevent a lung cancer death with universal screening and $130,000 and $80,000 per life-year for high risk screening. The numbers of preventable lung cancer deaths are 811 and 527 for universal and targeted approaches, respectively. CONCLUSIONS: These data suggest possible alternatives to current recommendations.

Aged↗

PubMed1999

Body mass index, diabetes, and C-reactive protein among U.S. adults.

OBJECTIVE: The author examined the relationship between C-reactive protein and BMI and diabetes status among 16,573 participants aged > or = 20 years of the Third National Health and Nutrition Examination Survey (1988-1994). RESEARCH DESIGN AND METHODS: The study had a cross-sectional design. RESULTS: Geometric mean concentrations of C-reactive protein were lowest among individuals with a BMI < 18.5 kg/m2 and increased with increasing BMI categories. Restricting the analysis to participants without various medical conditions did not change the relation. After adjusting for age, sex, race or ethnicity, and education, using logistic regression analysis, odds ratios for an elevated C-reactive protein concentration (> or = 85th percentile of the sex-specific C-reactive protein concentration distribution) among participants with a BMI of 25 to < 30, 30 to < 35, 35 to < 40, and > or = 40 kg/m2 were 1.51 (95% CI 1.23-1.86), 3.19 (2.60-3.91), 6.11 (4.67-7.98), and 9.30 (6.43-13.46), respectively, compared with participants with a BMI < 25 kg/m2. C-reactive protein concentrations were lowest among those individuals without diabetes or with impaired fasting glucose and highest among those with newly or previously diagnosed diabetes. Compared with participants with a normal fasting glucose, participants with impaired fasting glucose, newly diagnosed diabetes, and previously diagnosed diabetes had 0.99 (0.72-1.37), 1.84 (1.25-2.71), and 1.59 (1.25-2.01) odds of having an elevated C-reactive protein concentration after adjustment for age, sex, race or ethnicity, education, and BMI. CONCLUSIONS: These results confirm cross-sectional findings from previous studies that show elevated C-reactive protein concentrations among individuals who are obese or have diabetes. The implications of these findings, however, remain unclear.

Adolescent↗

PubMed1999

Diabetes and serum ferritin concentration among U.S. adults.

OBJECTIVE: We examined the association between serum ferritin concentration and the risk of diabetes. RESEARCH DESIGN AND METHODS: We examined the cross-sectional associations among ferritin concentration, glucose tolerance status, and concentrations of insulin, glucose, and glycosylated hemoglobin in 9,486 U.S. adults aged > or = 20 years from the Third National Health and Nutrition Examination Survey (1988-1994). RESULTS: After adjusting for age, sex, ethnicity, education, BMI, alcohol consumption, alanine aminotransferase concentration, C-reactive protein concentration, and examination session attended, and after dichotomizing ferritin concentration into < 300 and > or = 300 micrograms/l for men and < 150 and > or = 150 micrograms/l for women, the odds ratios for newly diagnosed diabetes were 4.94 (95% CI 3.05-8.01) for men and 3.61 (2.01-6.48) for women. The increased risk of newly diagnosed diabetes was concentrated among participants with transferrin saturations < 45%. All multiple linear regression coefficients between ferritin concentration and concentrations of insulin, glucose, and glycosylated hemoglobin were positive and significant for both men and women. CONCLUSIONS: Elevated serum ferritin concentration was associated with an increased risk of diabetes. We were unable to eliminate conclusively the possibility that the observed association reflected inflammation rather than excess body iron stores.

Adolescent↗

PubMed1998

Characteristics of survey participants with and without a telephone: findings from the third National Health and Nutrition Examination Survey.

This study examines the potential coverage bias in telephone surveys. Data were analyzed from the first phase of the third National Health and Nutrition and Examination Survey conducted from 1988 to 1991. In that survey, 10,120 persons 17 years and older were interviewed and 9034 were examined. About 2.7% of respondents reported not having a telephone. Differences in demographic and lifestyle variables, but not physiological or anthropometric variables, existed between persons with a telephone and those without one. Respondents without a telephone were more likely to report that an impairment or health problems limited their work or activities. Compared with respondents with a telephone, those without one were more likely to be current smokers, to be less physically active, to never have had their blood pressure checked or have had it checked more than 5 years ago, and to never have had their cholesterol checked. Based on data from a 24-hour dietary recall, persons without a telephone consumed less vitamin A, vitamin C, vitamin E, and carotene than did respondents with a telephone. However, prevalence estimates of health characteristics obtained from telephone surveys in populations with high telephone coverage are unlikely to be seriously affected by coverage bias nor are conclusions of comparisons involving populations with low telephone coverage.

Adolescent↗

PubMed1998

Serum folate and risk for coronary heart disease: results from a cohort of US adults.

PURPOSE: To assess the role of serum folate in the risk for coronary heart disease in a national cohort of US adults. METHODS: Data from the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (N = 1921) were used to determine whether a low serum folate concentration was associated with an increased risk for incident coronary heart disease (N = 284). The Cox proportional hazards model adjusted for age, sex, race, education, serum cholesterol, systolic blood pressure, body mass index, cigarette smoking, and alcohol consumption. RESULTS: The association between folate and risk for coronary heart disease differed by age group (p = 0.03). Among persons aged 35-55 years, the relative risk for heart disease was 2.4 (95% confidence interval (CI), 1.1-5.2) for persons in the lowest quartile (< or = 9.9 nmol/L) when compared with those in the highest quartile (> or = 21.8 nmol/L). However, among persons > or = 55 years the relative risk was 0.5 (95% CI, 0.3-0.8) for comparisons of the lowest versus highest quartiles. CONCLUSIONS: If the age differences in the risk for heart disease are confirmed, randomized clinical trials assessing the role of folic acid for the prevention of heart disease may need to include young adults in order to demonstrate benefits related to folate supplementation.

Adult↗

PubMed1998

Health insurance status and cardiovascular disease risk factors among 50-64-year-old U.S. women: findings from the Third National Health and Nutrition Examination Survey.

To examine the cardiovascular disease risk factors profile and use of preventive health services for cardiovascular disease among uninsured women aged 50-64 years, we studied data from the National Health and Nutrition Examination Survey III (NHANES III), conducted from 1988 to 1994. Insured women (n = 1308) and uninsured women (n = 303) had similar levels of blood pressure and lipids, but uninsured women were more likely to be current smokers, sedentary, and overweight and to consume less fiber, vitamin C, folate, calcium, and potassium than insured women. Compared with insured women, uninsured women were less likely to have had their blood pressure checked during the previous 6 months, to have had their cholesterol level checked, and to be aware of hypercholesterolemia. Insured women (24.9%) were three times more likely to use estrogen replacement therapy than uninsured women (7.9%). NHANES III data suggest that women without health insurance have a worse cardiovascular disease risk factor profile and use healthcare services less frequently than women with health insurance.

Cardiovascular Diseases↗