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Biomedical subjects

H S Kahn

Publications and source records attributed to H S Kahn.

At least 19 recordsLinked to original sources
PubMed1998

Increased cancer mortality following a history of nonmelanoma skin cancer.

CONTEXT: Cancer registries have reported an increased incidence of melanoma and certain noncutaneous cancers following nonmelanoma skin cancer (NMSC). Whether these findings were attributable to intensified surveillance, shared risk factors, or increased cancer susceptibility remains unclear. OBJECTIVE: To determine whether a history of NMSC predicts cancer mortality. DESIGN: Prospective cohort with 12-year mortality follow-up adjusted for multiple risk factors. SETTING: Cancer Prevention Study II, United States and Puerto Rico. PARTICIPANTS: Nearly 1.1 million adult volunteers who completed a baseline questionnaire in 1982. MAIN OUTCOME MEASURE: Deaths due to all cancers and common cancers. RESULTS: After adjusting for age, race, education, smoking, obesity, alcohol use, and other conventional risk factors, a baseline history of NMSC was associated with increased total cancer mortality (men's relative risk [RR], 1.30; 95% confidence interval [CI], 1.23-1.36; women's RR, 1.26; 95% CI, 1.17-1.35). Exclusion of deaths due to melanoma reduced these RRs only slightly. Mortality was increased for the following cancers: melanoma (RR, 3.36 in men, 3.52 in women); pharynx (RR, 2.77 in men, 2.81 in women); lung (RR, 1.37 in men, 1.46 in women); non-Hodgkin lymphoma (RR, 1.32 in men, 1.50 in women); in men only, salivary glands (RR, 2.96), prostate (RR, 1.28), testis (RR, 12.7), urinary bladder (RR, 1.41), and leukemia (RR, 1.37); and in women only, breast (RR, 1.34). All-cause mortality was slightly increased (adjusted men's RR, 1.03 [95% CI, 1.00-1.06]; women's RR, 1.04 [95% CI, 1.00-1.09]). CONCLUSIONS: Persons with a history of NMSC are at increased risk of cancer mortality. Although the biological mechanisms are unknown, a history of NMSC should increase the clinician's alertness for certain noncutaneous cancers as well as melanoma.

Aged↗
PubMed1998

Health-related behaviors of women physicians vs other women in the United States.

OBJECTIVE: To examine the health-related behaviors of women physicians compared with those of other women of high and not high socioeconomic status and with national goals. METHODS: We examined the results of a questionnaire-based survey of a stratified random sample, the Women Physicians' Health Study, and a US telephone survey (Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention, Atlanta, Ga). We analyzed 3 samples of women aged 30 to 70 years: (1) respondents from the Women Physicians' Health Study (n = 4501); (2) respondents from the Behavioral Risk Factor Surveillance System (n = 1316) of the highest socioeconomic status; and (3) all other respondents from the Behavioral Risk Factor Surveillance System (n = 35,361). RESULTS: Women physicians were more likely than other women of high socioeconomic status and even more likely than other women not to smoke. The few physicians (3.7%) who smoked reported consuming fewer cigarettes per day, and physicians who had stopped smoking reported quitting at a younger age than women in the general population. Women physicians were less likely to report abstaining from alcohol, but those who drank reported consuming less alcohol per episode than other women and were less likely to report binging on alcohol than women in the general population. Unlike women in the general population and even other women of high socioeconomic status, women physicians' reported behaviors exceeded national goals for the year 2000 in all examined behaviors and screening habits. CONCLUSIONS: Women physicians report having generally good health habits even when compared with other socioeconomically advantaged women and report exceeding all examined national goals for personal screening practices and other personal health behaviors. Women physicians' behaviors may provide useful standards for other women in the United States.

Adult↗
PubMed1998

Diabetes in urban African Americans. XII. Anthropometry for assessing municipal hospital outpatients recently diagnosed with type 2 diabetes.

OBJECTIVE: Abdominal obesity is associated with insulin resistance and cardiovascular risk factors, but there has been little information published to advance the use of abdominal anthropometry in the care of diabetic patients. RESEARCH METHODS AND PROCEDURES: A cross-sectional survey of municipal hospital outpatients recently diagnosed with type 2 diabetes (73 men and 142 women of whom 89% were African Americans). Age-adjusted linear regression was used to compare the supine sagittal abdominal diameter (SAD), supine waist circumference, four anthropometric ratios, and the body mass index (kg/m2) for their ability to predict serum fasting C-peptide and lipid levels. RESULTS: The best predictor of log-transformed C-peptide was SAD/height (p<0.0001 for men; p=0.0003 for women). SAD/thigh circumference was the best predictor of log-transformed triglycerides for men (p=0.002) and of total cholesterol/HDL cholesterol for women (p=0.043). The body mass index was less able to predict C-peptide, HDL cholesterol and total cholesterol/HDL cholesterol than was SAD/height or SAD/thigh circumference or waist circumference/height. DISCUSSION: Anthropometric indices of abdominal obesity appear to be correlated with insulin production and lipid risk factors among municipal-hospital, type 2 diabetic patients much as they are in other studied populations. Since anthropometric data are inexpensively obtained and immediately available to the practitioner, their utility for preliminary clinical assessment deserves to be tested in prospective outcome studies.

Abdomen↗
PubMed1998

Are geographic regions with high income inequality associated with risk of abdominal weight gain?

Geographic regions characterized by income inequality are associated with adverse mortality statistics, but the pathophysiologic mechanisms that mediate this ecologic relationship have not been elucidated. This study used a United States mail survey of 34158 male and 42741 female healthy-adult volunteers to test the association between residence in geographic regions with relative income inequality and the likelihood of weight gain at the waist. Respondents came from 21 states that were characterized by the household income inequality (HII) index, a measure reflecting the proportion of total income received by the more well off 50% of households in the state. The main outcome measure was self-reported weight gain mainly at the waist as opposed to weight gain at other anatomic sites. After controlling for age, other individual-level factors, and each state's median household income, men's likelihood of weight gain at the waist was positively associated (p = 0.0008) with the HII index. Men from states with a high HII (households above the median receive 81.6% to 82.6% of the income) described weight gain at the waist more often than men from states with a low HII (households above the median receive 77.0% to 78.5% of the income) (odds ratio = 1.12, 95% confidence interval 1.03 to 1.22). Women's results showed a non-significant trend in the same direction. An association between ecologically defined socio-environmental stress and abdominal obesity may help to clarify the pathophysiologic pathways leading to several major chronic diseases.

Abdomen↗
PubMed1998

Sagittal abdominal diameter as a practical predictor of visceral fat.

OBJECTIVE: To evaluate the relationships between the supine sagittal abdominal diameter (SAD) and visceral fat, as well as to evaluate intra- and inter-observer reliability of sagittal diameter measurement. PATIENTS: Twenty-eight women ranging in age from 27-78 y with a body mass index (BMI) ranging from 16.9-48.1 kg/m2 and 23 men ranging in age from 32-75 y with BMI ranging from 20-41.6 kg/m2. MEASUREMENT: Body fat distribution was measured by waist circumference, waist to hip ratio (WHR), SAD, anthropometrically assessed and a single slice of computed tomography (CT) at the L4-L5 level. RESULTS: In both genders, a significant association was found between visceral adipose tissue (AT) and SAD, as evaluated by CT (women r = 0.80; men r = 0.83, P < 0.001), and SAD by anthropometry (women r = 0.76; men r = 0.82, P < 0.001), as well as between visceral AT and waist circumference (women r = 0.76, men r = 0.86, P < 0.001) and WHR (women r = 0.57, P < 0.01, men r = 0.80, P < 0.001). A significant association was also found between subcutaneous AT and SAD by anthropometry (women r = 0.79, men r = 0.74, P < 0.001). After adjusting for BMI, the association between subcutaneous AT and SAD was no longer significant in men and only moderately significant in women (r = 0.42, P < 0.05), while the association between visceral AT and SAD by anthropometry remained significant in both genders (women r = 0.63, P < 0.001; men r = 0.66, P < 0.001). When the subjects were divided into two groups according to BMI (lean to moderately overweight women with BMI < 28 and men with BMI < 30 and obese women with BMI > 28 and men with BMI > 30) we found that the relationships between SAD by anthropometry, as well as SAD by CT and visceral AT, were higher in lean to moderately overweight subjects than in those who were obese. High inter-observer correlation was found concerning SAD measurement (r = 0.99, P < 0.001). Intra- and inter-observer precision as evaluated by coefficient of variation and intraclass correlation coefficient for SAD measurement was very high. CONCLUSION: Our study shows the usefulness of SAD by anthropometry to predict visceral fat and its very high inter- and intra-observer precision.

Abdomen↗
PubMed1998

Risk factors for self-reported colon polyps.

OBJECTIVE: Investigate risk factors for colon polyp using multivariate analyses. DESIGN: In a group responding to a 1992 mail survey, we assessed the association between physician-diagnosed colon polyp and possible risk factors reported primarily 10 years earlier. SETTING: Survey respondents within the Cancer Prevention Study II. PARTICIPANTS: Respondents, 72,868 men and 81,356 women, who reported no polyp diagnosis when questioned in 1982 at ages 40 to 64 years. MEASUREMENTS AND MAIN RESULTS: The characteristics of 7,504 men (10.3%) and 5,111 women (6.3%) reporting a first colon polyp were compared with those of participants who did not report a polyp. After adjustments for age, family history of colorectal cancer, and other potential risk factors, polyp occurrence was associated with 1982 histories of smoking, former smoking, alcohol use of at least two drinks per day (odds ratios [ORs] from 1.5 to 1.1; all p < .005), and a body mass index > or = 28 kg/m2 (men's OR 1.06; 95% confidence interval [CI] 1.00, 1.13; women's OR 1.08; 95% CI 0.99, 1.17). Polyps were also associated with a diagnosis of gallbladder disease or gallstone at any time and with gallbladder surgery up to 1982 (OR from 2.7 to 1.3; all p < .001). Polyp occurrence was inversely associated with 1982 histories of high exercise level (men's OR 0.83; 95% CI 0.76, 0.91; women's OR 0.90; 95% CI 0.78, 1.03), frequent aspirin use in women (OR 0.85; 95% CI 0.77, 0.95), and high parity in women (OR 0.84; 95% CI 0.75, 0.94). Among participants lacking a clinically normal gallbladder, the polyp risks associated with smoking and high body mass index were reduced (p < .04 for interactions). CONCLUSIONS: Despite the limitations and potential biases in these self-reported data, the risk factors described here may be useful for identifying persons at modestly increased risk of having a colon polyp. The effect-modifying role of gallbladder status deserves further investigation.

Adult↗
PubMed1997

Contrasting factors associated with abdominal and peripheral weight gain among adult women.

OBJECTIVE: To identify contrasts between the risk factors associated with abdominal weight gain and those associated with peripheral weight gain. DESIGN: Prospective mail survey. SUBJECTS: 44080 white, non-Hispanic, healthy women who were questioned in 1982 (baseline age 40-54 y) and 1992 about weight, diet, alcohol use, smoking, 10 physical activities and other variables. MEASUREMENTS: Self reports in 1992 identified 4261 women who gained weight in the abdomen and 7440 women who gained in the periphery (sites other than the abdomen). Using identical logistic models adjusted for age, baseline body mass index (BMI) and numerous covariates, the abdominal-gain group and the peripheral-gain group were separately compared with 10,888 women who did not gain weight. RESULTS: The likelihood of abdominal gain exceeded that of peripheral gain (by comparison of estimated odds ratios, abdominal vs peripheral) for high meat eaters (1.50 vs 1.15), frequent users of liquor (1.09 vs 0.54), moderate cigarette smokers (0.86 vs 0.59), heavy cigarette smokers (0.96 vs 0.36), cigarette quitters (2.13 vs 1.63), women with high parity (1.52 vs 1.15) and those who reported major weight gain since age 18 y (1.22 vs 0.65). Abdominal gain was less likely than peripheral gain for high vegetable eaters (0.71 vs 0.91), women who exercised > or = 4 h/wk [(especially aerobics/ calisthenics (0.28 vs 0.91) or walking (0.84 vs 1.06)], women who completed menopause (0.74 vs 0.98) and consistent users of estrogen replacement therapy (0.93 vs 1.22). CONCLUSION: A behavior or characteristic may be associated differently with the risks of abdominal and peripheral weight gain. This insight could strengthen recommendations for preventing major chronic diseases.

Abdomen↗
PubMed1997

Stable behaviors associated with adults' 10-year change in body mass index and likelihood of gain at the waist.

OBJECTIVES: The purpose of this study was to identify behaviors associated with change in body mass index or with weight gain at the waist. METHODS: A cohort of 79236 White, non-Hispanic, healthy adults was questioned in 1982 and 1992 about diet and 10 physical activities. Estimates were made of the mean effects of stable behaviors on 10-year change in body mass index and on odds ratios for gain at the waist. RESULTS: Ten-year changes in body mass index was associated positively with meat consumption and smoking cessation and inversely with vegetable consumption, vitamin E supplementation, continued smoking, and some vigorous activities (e.g., jogging/running). Women's body mass index decreased with walking 4 or more hours per week and with regular alcohol intake, but these behaviors had a smaller effect on men's body mass index. weight gain was inversely associated with high vegetable consumption, walking 4 or more hours per week, and jogging/running 1 to 3 hours per week but not with less demanding physical activities. CONCLUSIONS: Simple derivation of behaviors associated with weight loss or reduced abdominal obesity may enhance programs designed to prevent obesity and chronic diseases.

Adult↗
PubMed1996

The abdominal diameter index and sudden coronary death in men.

Alternative anthropometric indexes were compared for their ability to discriminate between 35 Atlanta men with sudden coronary death and 81 male controls. With or without adjustments for age, race, and body mass index, the abdominal diameter index (supine sagittal abdominal diameter divided by midthigh circumference) was associated with sudden coronary death more strongly than the waist/hip ratio or waist/thigh ratio of circumferences.

Abdomen↗
PubMed1996

The accumulation of visceral adipose tissue may be influenced by intra-abdominal temperature.

Despite the established link between visceral obesity and major chronic diseases, little is known about physiologic factors that directly and specifically lead to the accumulation of visceral fat. I hypothesize that reduced intra-abdominal temperature might be a physical factor underlying the partitioning of adipose tissue to the intra-abdominal region rather than the periphery. The hypothesis is supported by biochemical reports that rat and bovine lipoprotein lipase have increased activity when incubated at lower temperatures. Persons exercising in cool water have been found to preserve subcutaneous fat whereas comparable exercise without local cooling results in subcutaneous fat loss. Pima Indians, a group that commonly acquires extreme levels of visceral fat, have been found to have lower intra-abdominal temperatures during sleep than weight-matched European-Americans. In a study of four young men and four young women, I have noted that mean intra-abdominal basal temperatures were higher for women than men (36.51 +/- 0.18 degrees C vs. 35.91 +/- 0.11 degrees C; p = .0014). Since the men are more likely to acquire visceral obesity at later age, this also provides support for my hypothesis. Investigators might wish to examine further the temperature dependence of adipose-tissue lipoprotein lipase, the temperature variation between sites of adipose tissue, and the effects of foods, physical activities, smoking and drugs on localized body temperature.

Abdomen↗
PubMed1996

Simple anthropometric indices associated with ischemic heart disease.

In a case-control study of 217 hospitalized incident cases of ischemic heart disease and 261 controls we compared various anthropometric indices for the strength of their associations to the outcome event. The ratio of supine sagittal abdominal diameter to midthigh girth ("abdominal diameter index"; ADI) was the simple index that best discriminated cases from controls for both men (standardized difference, 0.65; p < 0.0001) and women (standardized difference, 0.95; p < 0.0001). The waist-to-thigh ratio of girths (WTR) (standardized difference, 0.57 and 0.90; p < 0.0001) was nearly as strong as the ADI and stronger than the traditional waist-to-hip ratio (standardized difference, 0.34 and 0.68; p < 0.005). After adjustments for age and race, the men's odds ratio for ischemic heart disease (tertile 3 vs. tertile 1) was 5.5 (95% CI, 2.9-10) using ADI and 5.1 (2.6-10) using the WTR. The women's odds ratio was 6.3 (1.9-20) using ADI and 8.7 (2.3-33) using the WTR. Further adjustments for body mass index and cardiovascular risk factors did not substantially change these risk estimates. Similar odds ratios were estimated by analyses restricted to 169 neighborhood-matched case-control pairs. In contrast, increased midthigh girth and subcutaneous fat mass (sum of three skinfolds) were associated with a protective effect against ischemic heart disease. Anthropometry using the ADI or WTR could offer a low-cost, noninvasive method for the clinical or epidemiologic evaluation of ischemic heart disease risk.

Anthropometry↗
PubMed1994

Abdominal obesity and mortality risk among men in nineteenth-century North America.

The health consequences of an adverse body-fat distribution (e.g., android, upper-body, visceral) have only recently concerned the medical community. Ninety years ago, however, actuarial study demonstrated the relationship of body-fat distribution to the mortality experience of insured, North American men. Thirty-four insurance companies pooled their data on males issued life policies between 1870 and 1899. Special classes of risk were defined by weight for height at baseline or by the observation that abdominal girth exceeded the girth of the expanded chest (abdominal obesity). The mortality experience of each risk class was compared to an age-stratified, actuarial table of the period. We present new analyses of these historical data relating specifically to the mortality impact of abdominal obesity. Among 163,567 overweight men, the prevalence of abdominal obesity increased with age and with degree of overweight. Among moderately overweight men, those with abdominal obesity experienced 133% of the expected mortality rate compared to 112% of the expected mortality for those who were not abdominally obese. Severely overweight men with abdominal obesity experienced 152% of the expected mortality compared to 135% of the expected mortality for severely overweight men who were not abdominally obese. We believe this nineteenth-century, acturial study of waist and chest girths was the first demonstration that body-fat distribution can influence longevity. These early actuarial findings, taken with more recent reports, establish that abdominal enlargement, but not necessarily an 'upper-body' fat distribution, constitutes a major health hazard. Future research must establish which abdominal-obesity index best predicts disease outcomes.

Abdomen↗