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Biomedical subjects

M I Schmidt

Publications and source records attributed to M I Schmidt.

36 records · Page 2Linked to original sources
PubMed1996

A metabolic syndrome in whites and African-Americans. The Atherosclerosis Risk in Communities baseline study.

OBJECTIVE: To describe clustering of hypertriglyceridemia, low HDL cholesterol, hypertension, diabetes, and hyperuricemia and its association with fasting insulin, waist-to-hip ratio (WHR), and BMI for African-American and white men and women. RESEARCH DESIGN AND METHODS: Observed frequencies of clusters were compared with those expected in 14,481 participants, 45-64 years of age, of the Atherosclerosis Risk in Communities (ARIC) baseline survey, 1987-1989. Associations of clusters with insulin, central adiposity, and overall obesity, as well as with abnormalities, were analyzed through multiple logistic regression. RESULTS: Clustering beyond chance was observed in all four sex/ethnic groups (P < 0.001), with 7% of the sample presenting 30% of the abnormalities in large clusters (> or = 3 abnormalities per individual). The odds ratio (OR) for the association of each abnormality with clustering of the remaining four ranged from 1.6 to 8.8 (P < 0.01). These odds of clustering were notably large in white women. Of the abnormalities, hypertriglyceridemia demonstrated the highest OR (5.0-8.8) and diabetes had the lower OR in African-American subjects than in white subjects (P < 0.001). Insulin, WHR, and BMI were statistically associated with clustering in all groups (P < 0.001, except for BMI in African-Americans.

Arteriosclerosis↗
PubMed1995

Association of the waist-to-hip ratio is different with wine than with beer or hard liquor consumption. Atherosclerosis Risk in Communities Study Investigators.

Specific alcoholic beverage associations with the waist-to-hip ratio were characterized in 12,145 African-American and white men and women ages 45-64 years. Estimated waist-to-hip ratios of those consuming more than six nonwine alcohol drinks/week and more than six wine drinks/week (vs. nondrinkers) were 0.007 larger (p < 0.001) and 0.009 smaller (p < 0.05), respectively. In similar comparisons, the odds ratios for a large waist-to-hip ratio were 1.4 (95% confidence interval 1.1-1.7) for nonwine and 0.45 (95% confidence interval 0.21-0.95) for wine intake. The opposite direction in adjusted associations for wine and nonwine (mainly beer) drinking supports the popular concept of the "beer belly."

Adipose Tissue↗
PubMed1995

Correlates of body fat distribution. Variation across categories of race, sex, and body mass in the atherosclerosis risk in communities study. The Atherosclerosis Risk in communities (ARIC) Study Investigators.

Though central adiposity is a strong, independent risk factor for cardiovascular and all-cause mortality, relatively little is known about its determinants. To characterize the association of central adiposity with several of its possible determinants, while describing variability in these associations across sex, race, and level of body mass index, we conducted a cross-sectional survey of 15,800 white and African-American men and women ages 45 to 64 years participating in the Atherosclerosis Risk in Communities baseline survey, 1987 to 1989. After adjustment for other possible determinants, African Americans had markedly larger subscapular skinfold thickness and subscapular/triceps ratios than did whites, while whites had larger waist/hip ratios. Large, statistically significant variations in waist/hip ratio associations with age, percent of weight gained after age 25, smoking, and physical activity in the workplace existed across categories of sex, race, and body mass index. Based on our findings, we concluded that major variation exists in the waist/hip ratio and in its associations with its possible determinants across categories of race, sex and obesity.

Adipose Tissue↗
PubMed1994

Variation in glucose tolerance with ambient temperature.

Ambient temperature may affect venous glucose concentration after glucose tolerance tests. We analysed 1030 standardised 75 g tests. Although mean fasting values did not differ, post-load values did: adjusted mean 2 h glucose concentration was 1.03 mmol/L lower at lower (5-14 degrees C) than at higher (25-31 degrees C) temperatures (p < 0.001). The occurrence of abnormal glucose tolerance doubled on warmer days. The diagnostic accuracy of the glucose tolerance test showed clinically significant temperature-associated variation. These variations, if confirmed, call for temperature standardisation during glucose tolerance testing and/or alternative strategies for use when standardisation is not feasible.

Adult↗
PubMed1993

[Risk factors for non-communicable diseases in a metropolitan area in the south of Brazil. Prevalence and simultaneity].

Three-quarters of deaths in Rio Grande do Sul State, Brazil, are due to non-communicable diseases-cardiovascular diseases, alone, being responsible for 35% of them. To evaluate the prevalence of risk factors for these diseases, a household survey of 1,157 randomly sampled individuals between 15 and 64 years of age was undertaken in 1986 and 1987 in census tracts of 4 areas of the city of Porto Alegre. The age- and sex-adjusted prevalence of smoking was 40%, hypertension 14%, obesity 18%, overall sedentary life-style 47%, and excessive alcohol consumption 7%. Thirty-nine percent of the sample presented two or more of these five risk factors, and only 22% of men and 21% of women had none of them. The high frequencies and simultaneous presence of these risk factors indicate their importance for programs aimed at the prevention of non-communicable diseases and the promotion of adult health.

Adolescent↗
PubMed1993

Validity of self-reported weight--a study of urban Brazilian adults.

In order to evaluate the validity of self-reported weight for use in obesity prevalence surveys, self-reported weight was compared to measured weight for 659 adults living in the Porto Alegre county, RS Brazil in 1986-87, both weights being obtained by a technician in the individual's home on the same visit. The mean difference between self-reported and measured weight was small (-0.06 +/- 3.16 kg; mean +/- standard deviation), and the correlation between reported and measured weight was high (r = 0.97). Sixty-two percent of participants reported their weight with an error of < 2 kg, 87% with an error of < 4 kg, and 95% with an error of < 6 kg. Underweight individuals overestimated their weight, while obese individuals underestimated theirs (p < 0.05). Men tended to overestimate their weight and women underestimate theirs, this difference between sexes being statistically significant (p = 0.04). The overall prevalence of underweight (body mass index < 20) by reported weight was 11%, by measured weight 13%; the overall prevalence of obesity (body mass index > or = 30) by reported weight was 10%, by measured weight 11%. Thus, the validity of reported weight is acceptable for surveys of the prevalence of ponderosity in similar settings.

Adolescent↗
PubMed1993

Socioeconomic distribution of noncommunicable disease risk factors in urban Brazil: the case of Pôrto Alegre.

The study reported here sought to assess the degree to which the prevalences of five risk factors for noncommunicable diseases--hypertension, smoking, obesity, sedentary lifestyle, and excessive alcohol consumption--varied individually and in combination for urban Brazilians with differing socioeconomic status in terms of educational achievement, income, and social class. For this purpose, 1986-1987 data from a cross-sectional household survey of 1,157 randomly selected adults 15-64 years of age residing in the major Brazilian city of Pôrto Alegre were analyzed. In general, it was found that less privileged socioeconomic situations tended to be associated with higher risk factor prevalences. However, this was not the case for obesity and sedentary lifestyle among men, and may not have been the case with respect to hypertension among women. When the effects of education, income, and social class were considered simultaneously, higher risk factor prevalences were most strongly associated with low educational attainment. Important exceptions to this rule were found for smoking among women and excessive alcohol consumption among men, where higher risk factor prevalences were most associated with social class. Once the effects of education and social class were accounted for, low income generally tended to be associated with lower prevalences of the risk factors studied.

Adolescent↗
PubMed1992

Association of waist-hip ratio with diabetes mellitus. Strength and possible modifiers.

OBJECTIVE: To characterize the association between central obesity, as measured by the waist-hip ratio (WHR), and non-insulin-dependent diabetes mellitus (NIDDM), considering the effects of sex, age, overall obesity, and family history of diabetes. RESEARCH DESIGN AND METHODS: Case-control study nested within a community-based survey. We selected 151 subjects with NIDDM and 301 nondiabetic control subjects as a systematic sample of survey screening negative individuals. RESULTS: Odds ratios for NIDDM, comparing a high WHR (greater than or equal to 0.926 for men, greater than or equal to 0.83 for women) to a low WHR were 4.72 with a 95% confidence interval of 2.39-9.34, and 2.17 with a 95% confidence interval of 1.03-4.58, for women and men, respectively, controlling for age, overall obesity, and a family history of diabetes. Women with high WHRs in the presence of these risk factors are notably at risk for diabetes. CONCLUSION: Central obesity, as measured by the WHR, is importantly and independently associated with NIDDM.

Adult↗
PubMedDate not supplied

Assessment of weight gain during pregnancy in general prenatal care services in Brazil.

Obesity is an emerging major health risk for women around the world. In this regard, little attention has been given to pregnancy, a moment of risk not only for major weight gain in these women, but also for macrosomia in their offspring. The objective of this study is to evaluate weight gain during pregnancy. Data pertains to a cohort of pregnant women attending general prenatal care clinics in six state capitals in Brazil, from 1991 to 1995. We studied women aged 20 years and over with singleton pregnancies and no diagnosis of diabetes outside pregnancy, enrolled at approximately 20 - 28 weeks of gestation. According to the Institute of Medicine criteria, 38% (95%CI: 36-40%) of the women studied gained less and 29% (95%CI: 28-31%) had more than the recommended total weight gain. These proportions vary according to pre-pregnancy nutritional status. Given the increasing epidemic of obesity, the high prevalence of overweight and obesity in Brazilian women prior to pregnancy, and the lack of achievement of recommended weight gain during pregnancy, more effective means of managing weight gain during pregnancy are necessary.

Adult↗
PubMedDate not supplied

[Evidence-based medicine].

The growing array of diagnostic and therapeutic options available to the clinician has created the necessity of techniques, such as the randomized clinical trial, to evaluate their effectiveness. Recently, with the increasing penetration of the methods of clinical epidemiology into medical practice, the concept of an evidence-based medicine has arisen. Emphasizing the necessity of solid clinical evidence for clinical decision-making, evidence-based medicine provides a framework for the integration of research results into clinical practice. The evidence is graded, principally on the basis of study design, and norms are established as to what constitutes adequate evidence for clinical decision-making. The combination of this new paradigm of medical practice with the power of modern telecommunications is causing a revolution in the way medicine is practiced. Its integration into clinical practice is being facilitated by quantitative overviews of the literature, and the creation of clinical guidelines based on these reviews. Shortcomings of the traditional sources of evidence have been documented. New sources of evidence, such as the ACP Journal Club, and the Cochrane Collaboration, diminish dramatically the time required of clinicians to obtain the best available evidence. All health professionals should familiarize themselves with evidence-based medicine.

Databases, Bibliographic↗
PubMedDate not supplied

Frequency of early-morning rise in blood glucose in children with diabetes at camp.

To estimate the frequency of an early-morning glucose rise (EMR) in relatively unselected children with insulin-dependent diabetes mellitus (IDDM), we assessed capillary blood glucose (CBG) at midsleep (0200-0430) and prebreakfast (0700-0800) in 97 children with diabetes at camp. The EMR (prebreakfast CBG-midsleep CGB) was inversely related to the midsleep CBG level (r = -.45, P less than .001). Of the 49 children with midsleep CBG less than 200 mg/dl, the mean EMR was 34 +/- 60 mg/dl, and 18 of these children had rises of greater than 40 mg/dl. In conclusion, when midsleep glycemia is less than 200 mg/dl, a rise in blood glucose from midsleep to prebreakfast, often greater than 40 mg/dl, is a common element of glycemic control among children with IDDM. The relative importance of the Somogyi phenomenon, the dawn phenomenon, and mere insulin insufficiency in the early-morning hours cannot be determined from these data.

Adolescent↗
PubMedDate not supplied

The dawn phenomenon, an early morning glucose rise: implications for diabetic intraday blood glucose variation.

Eleven insulin-dependent (type I) diabetic subjects were studied during a 24-h period to assess intraday blood glucose (BG) variation and related free insulin (FI) levels. Ten patients exhibited the dawn phenomenon, a rise in early morning fasting blood glucose (123 +/- 81.1 m/dl; mean +/- SD). This increase was positively and significantly correlated with the morning postprandial BG peak (r = 0.723; P = 0.012). FI/BG ratios were highest during the night (0.717 and 0.666 at 2200 and 0400 h, respectively) and lowest during the early morning (0.294 at 0800 h) (P less than 0.01). Three of the four observed hypoglycemic episodes occurred during the period when free insulin levels were high relative to BG. We conclude that the dawn phenomenon contributed directly and significantly to the BG maximum and indirectly, in some cases, to nocturnal hypoglycemia. It thus played an important role in the intraday blood glucose variation of such patients.

Adolescent↗
PubMedDate not supplied

Fasting early morning rise in peripheral insulin: evidence of the dawn phenomenon in nondiabetes.

The dawn phenomenon, a tendency for glucose to rise between 0500 and 0800 h in subjects with diabetes, is also reflected as an increase in insulin required to maintain normoglycemia during closed-loop insulin infusion. Individuals without diabetes have minimal or absent rises in early morning glucose. To test the hypothesis that the absence of early morning glucose increases in subjects without diabetes is due to an increase in insulin levels, we measured insulin levels from 2400 to 0800 h in four male and two female volunteers. Subjects were on an unrestricted diet with three main meals and one bedtime snack at 2100 h. Blood samples were collected continuously in hourly pools by a constant-rate withdrawal pump. We observed the following: (1) hourly integrated concentration of glucose was stable from 2400 to 0800 h (range of mean plasma values, 94.5-97.3 mg/dl), and (2) hourly integrated concentration of insulin increased from the 0300-0400 (4.6 microU/ml) to the 0700-0800-h pool (6.2 microU/ml) (P less than 0.05). The observed increase in insulin in the early morning hours despite stable levels of glucose indicates a temporally increased insulin need in nondiabetic individuals similar to that found in individuals with diabetes. The mechanism underlying this increased insulin need may be similar in diabetes and nondiabetes, with the ensuing rise in glucose being dependent on the availability of compensatory insulin.

Adult↗
PubMedDate not supplied

The flashlight test lacks validity as a screen for nocturnal hypoglycemia.

Though never validated, the flashlight test is a commonly used screen for nocturnal hypoglycemia. Between 2 a.m. and 4 a.m., we applied the test to 107 children at Eagle's Nest Camp for Children with Diabetes. We validated the test against simultaneously determined capillary blood glucose values (Glucoscan). An eyelid squint in response to the flashlight was considered an intact test. No significant difference existed between mean glucoses for intact and nonintact responses. Both sensitivity and positive predictive value are too low for the flashlight test to be useful in screening for nocturnal hypoglycemia.

Adolescent↗
PubMedDate not supplied

Tendencies in adult mortality in Rio Grande do Sul, Brazil, 1970-1985. An international comparison.

"In order to evaluate mortality trends in adults aged 30-69 years in the State of Rio Grande do Sul [Brazil], changes in age-standardized mortality from 1970 to 1985 were calculated and compared with trends of 33 other countries. Virtual stability in Rio Grande do Sul over this 16-year period contrasts with dramatic reduction in age-standardized all-cause and cardiovascular disease mortality in many countries.... The data demonstrate that major declines in adult mortality can be achieved, and suggest that, during the period 1970-1985, Rio Grande do Sul participated little in the international tendency toward improved adult health." (SUMMARY IN POR)

Age Factors↗
PubMedDate not supplied

[High mortality rates among Brazilian adult populations--an international comparison].

Adult disease in an increasingly important public health problem in Brazil. In order to compare adult mortality in Brazil to that in other countries, age-adjusted coefficients for adults aged 30-69 of the States of São Paulo and Rio Grande do Sul and of the city of Fortaleza (Ceará State) are compared to those of similarly aged adults in a series of 33, principally European, countries. The Brazilian population coefficients for overall, cerebrovascular and cardiovascular mortality are among the highest of the series; those for ischemic heart disease occupy median positions. These comparisons illustrate the precarious state of adult health in Brazil and, given the growing possibilities of preventing cardiovascular and other non-communicable diseases, help demonstrate the need for preventive programs in Brazil aimed at the major common and lethal diseases of the productive years of life.

Adult↗