Biomedical subjects

Mary Ann Johnson

Publications and source records attributed to Mary Ann Johnson.

At least 19 recordsLinked to original sources

PubMed2006

Serum 25-hydroxyvitamin D concentrations in girls aged 4-8 y living in the southeastern United States.

BACKGROUND: Evidence suggests that adults and adolescents throughout the United States are at risk of poor vitamin D status. However, vitamin D concentrations in young American children have not been assessed. OBJECTIVE: The relations between serum 25-hydroxyvitamin D [25(OH)D] and bone were examined in prepubertal girls. DESIGN: In the present cross-sectional study, serum 25(OH)D concentration was assessed in 168 prepubertal girls aged 4-8 y living in the southeastern United States with the use of radioimmunoassay. Bone area, bone mineral content, and areal bone mineral density were measured from total body, lumbar spine, proximal femur, and forearm with dual-energy X-ray absorptiometry. Data were analyzed with analysis of variance, analysis of covariance, stepwise multiple regression, and partial correlations. RESULTS: The mean (+/-SD) serum 25(OH)D was 93.8 +/- 28.1 nmol/L (range: 31.1-181.4 nmol/L). In a multiple regression analysis, race and season were the strongest predictors of vitamin D status. The black girls had lower mean 25(OH)D values than did the white girls (P < 0.01), and 25(OH)D values were significantly different in the total sample between the seasons (P < 0.001), ranging from 74.4 nmol/L during the winter months to 107 nmol/L during the summer. After adjustment for season, age, race, and body mass index, 25(OH)D values were negatively correlated with forearm bone mineral content (r = -0.18; P = 0.02). CONCLUSIONS: Unlike prior reports of adults and adolescents living in the southeastern United States, vitamin D status was adequate in the children of the present study. 25(OH)D concentrations were not positively associated with higher bone mineral.

Absorptiometry, Photon↗

PubMed2006

Elevated serum S-adenosylhomocysteine in cobalamin-deficient elderly and response to treatment.

BACKGROUND: S-Adenosylmethionine (SAM)-dependent methylation reactions produce S-adenosylhomocysteine (SAH), the precursor of homocysteine, which has been associated with adverse events when it is elevated. OBJECTIVE: We studied a cohort of elderly with a high prevalence of cobalamin deficiency to determine whether SAH, SAM, or their ratio was abnormal; whether they correlated with other markers of vitamin deficiency; and whether they changed with cobalamin therapy. DESIGN: A convenience sample of elderly attending nutrition centers was enrolled for baseline demographic, biochemical, and nutritional assessments. Methylmalonic acid (MMA), total homocysteine, and other metabolites were measured by using gas chromatography-mass spectrometry. Serum SAM and SAH were measured by using stable-isotope-dilution liquid chromatography-mass spectrometry. Subjects found to have elevated serum MMA were treated with oral cyanocobalamin tablets (1000 microg/d) for 3 mo. Subjects with normal MMA were randomly assigned to 1 of 3 dosage groups: 0, 25, or 100 microg cyanocobalamin/d. RESULTS: The 149 elderly subjects had a mean age of 76.3 y; 81% were female, and 30% were African American. Serum MMA concentrations were elevated in 30% and SAH concentrations were elevated in 64% of the cohort. Those with elevated MMA concentrations had higher SAH and SAM concentrations. High-dose oral cobalamin lowered SAH, MMA, and total homocysteine concentrations significantly, although subjects with creatinine concentrations >109 umol/L had higher posttreatment SAH than did those with lower creatinine. CONCLUSIONS: Elevated serum SAH concentrations are common in elderly and are strongly influenced by both renal status and cobalamin deficiency. These elevated concentrations can be lowered with high-dose oral cobalamin therapy.

Aged↗

PubMed2006

Influence of personality and health behaviors on fatigue in late and very late life.

There is limited understanding about variables associated with fatigue in late and very late life. The purpose of this study was to explore the longitudinal influences of personality and health behaviors on changes in fatigue. One hundred and seventy-eight participants of the Georgia Centenarian Study were part of this study. Multiple regression analyses were computed to assess the influence of personality, physical activity, stress management, and nutritional risk on fatigue after initial fatigue, self-reported health, and psychosocial variables were controlled for. Anxiety, physical activity, and nutritional risk had significant longitudinal effects on fatigue. Older adults who were anxious, less engaged in physical activity, and who had higher levels of nutritional risk were more likely to show increased fatigue levels. The results suggest that more clinical and research attention should be paid to changes of fatigue in older populations.

Activities of Daily Living↗

PubMed2006

What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status?

The prevalence of vitamin B12 deficiency increases in the elderly, mainly because atrophic gastritis decreases the production of the acid and digestive enzymes needed to cleave protein-bound vitamin B12 from the natural chemical form of vitamin B12 found in meat, poultry, fish, and dairy foods. Depending on the biochemical criterion that is used, 5% to more than 20% of older adults have marginal or frank vitamin B12 deficiency. Adults over 50 years of age should meet the Recommended Dietary Allowance by consuming vitamin B12 in the crystalline form, which does not require gastric acid or enzymes for initial digestion. A recent clinical trial suggests that an oral dose of 500 microg/d of crystalline vitamin B12 is needed to reverse biochemical signs of vitamin B12 deficiency in older adults.

Aged↗

PubMed2006

Vitamin D, aging, and the 2005 Dietary Guidelines for Americans.

The 2005 Dietary Guidelines for Americans recommend that older adults, people with dark skin, and those exposed to insufficient ultraviolet radiation (i.e., sunlight) consume extra vitamin D from vitamin D-fortified foods and/or supplements. Individuals in these high-risk groups should consume 25 microg (1000 IU) of vitamin D daily to maintain adequate blood concentrations of 25-hydroxyvitamin D, the biomarker for vitamin D status. This review considers recommendations for vitamin D-rich foods and dietary supplements, as well as specific problems with self-prescribing sun exposure or artificial sources of ultraviolet radiation to meet the vitamin D recommendations for older people.

Aged↗

PubMed2006

Awareness of fish advisories and mercury exposure in women of childbearing age.

Methylmercury crosses the placenta and increases the risk of impaired neurodevelopment in the fetus. Federal guidelines for fish intake and fish advisories are in place to help people of all ages limit their exposure to mercury from fish. However, recent studies suggest that the awareness of fish advisories is low among women of childbearing age. Fish intake is strongly correlated with hair mercury concentrations. In women in states with fish advisories, hair mercury concentrations were 7-fold higher in women who consumed 20 or more servings of fish than in those who reported nofish consumption in the past 3 months (0.59 vs. 0.08 microg/g). Among this high fish consumption group, the 75th and 95th percentile of hair mercury concentrations were 0.99 and 2.29 microg/g, respectively. This is of concern because the US Environmental Protection Agency (EPA) recommends that hair mercury be less than 1 microg/g. Public health campaigns to reduce mercury exposure need further refinement to reach women of childbearing age.

Adult↗

PubMed2005

Introduction to and perspectives from the Symposium on Nutrient Disease Relationships: closing the scientific knowledge gap.

The U.S. Congress through the Nutrition Labeling and Education Act of 1990 authorized the use of health claims on food labels. These claims describe the relationship between a substance and a disease or health-related condition. In addition, Congress directed the U.S. FDA to apply a significant scientific agreement standard in approving these claims. Since 1990, the FDA has approved several health claims, but has also denied claims that did not meet this standard. The purpose of The Nutrient Disease Relationships: Closing the Scientific Knowledge Gap symposium was to provide researchers with perspectives to keep in mind when designing studies that examine the relationship between a nutrient and a disease or health-related condition, to help close the scientific knowledge gap for nutrient-disease relationships of scientific, consumer, and public health interest.

Health Education↗

PubMed2005

Influence of vitamin K on anticoagulant therapy depends on vitamin K status and the source and chemical forms of vitamin K.

Warfarin therapy requires close monitoring to avoid excessive bleeding and to maintain the effective therapeutic concentration assessed with the internationalized ratio (INR). High vitamin K intake can decrease the therapeutic effectiveness of warfarin, while poor vitamin K status appears to increase the sensitivity to small changes in vitamin K intake, especially from supplements. Very large amounts of vitamin K from a single meal with vegetables (400 g of vegetables with 700 to 1500 microg of vitamin K1) can measurably change INR, but occasional typical servings (<100 g) would probably have little lasting impact on INR. Warfarin requirements may change in those altering their intake of dark-green vegetables. The 2005 Dietary Guidelines for Americans recommends 3 cups/week of dark-green vegetables, which contain about 100 to 570 microg/serving of vitamin K1. Less well-known sources and chemical forms of vitamin K, such as MK-7 in natto (a fermented Japanese product), also measurably influence INR. Additional research is needed in warfarin-treated patients to fully quantify the interactions among various sources and chemical forms of vitamin K, age, genotype, and other factors.

Anticoagulants↗

PubMed2005

Elevated methylmalonic acid is related to cognitive impairement in older adults enrolled in an elderly nutrition program.

Vitamin B12 status has been linked to cognitive impairment among older adults. Deficit in methylmalonic acid (MMA) may be reflective of cognitive impairment because it is a biochemically sensitive marker of B12 deficiency. In a cross-sectional study the contributions of different indices of B12 status, including serum B12, MMA and total homocysteine (tHcy), were measured in relation to cognitive functioning. B12 deficiency as measured by elevated MMA concentrations appeared to be most reflective of cognitive impairment and appeared to contribute unique variance to cognitive measures after controlling for other biochemical variables. Demographic variables, particularly education and age, were more strongly associated with cognitive measures than was MMA. Monitoring and reducing serum MMA concentrations by increasing the intake of vitamin B12 may provide protection against cognitive decline in this and other older populations.

Aged↗

PubMed2005

Nutrition and health education intervention for whole grain foods in the Georgia older Americans nutrition programs.

This study examined the effects of a nutrition education intervention on improving the intake and behaviors related to whole grain foods in congregate meal recipients in senior centers in north Georgia. Participants were a convenience sample and completed a pretest, an educational intervention, and a post-test (N = 84, mean age = 77 years, 88% female, 76% Caucasian, and 24% African American). At the pre-test, most participants agreed that eating more whole grain foods would help reduce their risk of cancer (69%), heart disease (76%), type 2 diabetes (65%), and bowel disorders (82%), but consumption of 11 whole grain foods was low (10.5 times/week). Following the intervention, participants were more likely to suggest one or more correct ways to identify whole grain foods (45 vs. 62%, P< or = 0.05), and to report an increased intake of whole grain bread, cereal, and crackers (5.8 vs. 6.9 times/week, P < or = 0.05). While awareness of the health benefits of whole grain foods was high, the intakes were low. As a first step, this intervention improved several aspects of the consumption of whole grain foods; however, additional interventions that target the individual and the congregate meal program are needed to increase intakes to the recommended three servings daily.

Aged↗

PubMed2005

Living in low-latitude regions in the United States does not prevent poor vitamin D status.

Vitamin D deficiency may occur throughout the life cycle, and is described as an unrecognized epidemic. The risk of deficiency may be increased by darker skin color, overweight and obesity, and low vitamin D intakes, while living in low latitudes and not using protective measures against the sun may decrease risk. However, a recent study reported that Hispanic adults living in the high-sun-exposure area of Miami have a high prevalence of poor vitamin D status in the winter, suggesting that living at low latitudes alone does not protect against vitamin D deficiency. The vitamin D status of Hispanics needs further investigation, given the large number of Hispanics living in southern regions of the United States and the emerging role of vitamin D in numerous health disorders.

Florida↗

PubMed2004

Caregiver burden in Alzheimer's disease.

OBJECTIVE: To review the literature pertaining to caregiver burden in Alzheimer's disease (AD) and the role of medications and the pharmacist in reducing caregiver burden. DATA SOURCES: A MEDLINE search was conducted to identify relevant studies, review articles, case reports, and letters in the English language published from 1985 to September 2003. Additional references were obtained from bibliographies of these articles. STUDY SELECTION: All studies evaluating caregiver burden and AD, as well as the role of medications in reducing caregiver burden that were accessible to the authors. DATA SYNTHESIS: Caring for the caregiver is a significant part of managing a patient with AD. Many predictors of caregiver burden in AD have been identified. A number of measurement tools have been developed to assess caregiver burden in the research setting. A wide variety of interventions to reduce caregiver burden have been studied. These interventions range from education and support services to drug therapies. Most often these strategies have been studied individually; however, combining drug treatments with nonpharmacologic interventions may be the best approach to improve the quality of life for the caregiver of a patient with dementia and the care recipient. Most of the studies to date of drug therapy and caregiver burden have evaluated cholinesterase inhibitors. Other drug therapies that have been studied include memantine, antipsychotics, antidepressants, and selegiline. PRIMARY CONCLUSIONS AND CLINICAL APPLICATIONS: The pharmacist can play an important part in reducing the caregiver burden associated with AD. It is important to identify caregivers at risk for experiencing significant caregiver burden since the consequences of excess burden to the caregiver-and the care recipient-can be devastating. Among the many tasks of providing such care, caregivers are responsible for administering and managing medications. The difficulties associated with the care recipient's medications can be reduced through effective communication, education, and services available from a pharmacist. Pharmacists are probably the most accessible health care professional for the caregiver. Being able to provide accurate information about AD and its management is an important way to ease the burden of care. Finally, pharmacists can play a significant part in supporting the community in caring for the families of patients with Alzheimer's disease by volunteering with the local chapter of the Alzheimer's Association.

Journal Article↗

PubMed2004

Nutrition and aging--practical advice for healthy eating.

This article provides practical advice about foods and dietary supplements that are beneficial for the health of older people. Overweight and obesity are among the most common nutrition-related disorders in older people. A plant-based diet is associated with reduced risk of chronic diseases such as obesity, cardiovascular disease, cancer, and diabetes. Vitamin B12 deficiency is prevalent in older adults, but there are misconceptions about the causes, consequences, and treatments. Diminished synthesis of vitamin D in the skin that occurs with aging and poor dietary intake contribute to the high prevalence of poor vitamin D status in older adults. Vitamin D deficiency is associated with chronic disorders beyond poor bone health. Supplements containing vitamin B12 and vitamin D will help older adults meet their needs for these key nutrients.

Aged↗

PubMed2003

Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services.

BACKGROUND: The effect of the folate food fortification program on the prevalence of hyperhomocysteinemia in the older population with coexisting vitamin B-12 deficiency is not known. OBJECTIVE: The objective was to determine the prevalence of hyperhomocysteinemia and vitamin B-12 deficiency in elderly who were using Title IIIc nutrition services, after folate food fortification in the United States. DESIGN: Demographic, nutritional, cognitive, routine diagnostic, and serum methylmalonic acid (MMA) and total homocysteine (tHcy) tests were performed in a convenience sample of 103 elderly enrolled in nutrition service programs in rural northeast Georgia. A subgroup (n = 27) was treated with vitamin B-12, 2.5 mg, and a multivitamin with 400 micro g folic acid, 2 mg vitamin B-6, and 27 mg ferrous fumarate. RESULTS: The total cohort included 103 participants (+/- SD age: 76.4 +/- 8.1; 80% female; 68% white, 32% African American). Vitamin B-12 deficiency (serum vitamin B-12 < 258 pmol/L and MMA > 271 nmol/L) was present in 23%. Mean serum folate was high, 39.3 nmol/L, and no subject had serum folate < 6.8 nmol/L. Mean tHcy was 17.6 +/- 7.2 micro mol/L in vitamin B-12-deficient subjects and 10.8 +/- 3.6 micro mol/L in those who were nondeficient. Determinants of high tHcy were vitamin B-12 deficiency, high serum creatinine, and low red blood cell folate. Those with vitamin B-12 deficiency were more likely to have poor cognition (58% compared with 20%, P < 0.001) and anemia (38% compared with 18%, P = 0.042). High-dose oral B-12 therapy lowered mean MMA and tHcy by 49% and 32%, respectively. CONCLUSION: Vitamin B-12 deficiency was prevalent and was associated with poor cognition, anemia, and hyperhomocysteinemia.

Activities of Daily Living↗

PubMed2003

Health characteristics of elderly residents in personal care homes. Dementia, possible early dementia, and no dementia.

Personal care homes are becoming an integral part of the gerontological health care environment. This exploratory descriptive study compares the health characteristics of elderly personal care home residents without dementia or cognitive impairment, residents with possible early dementia, and residents with dementia. Results indicate a number of residents with possible early dementia, but without a diagnosis of dementia, may be residing in personal care homes. Additionally, the three groups may have distinctly different service needs. Residents with dementia were particularly at risk for problems with decision-making, communication, and impaired instrumental activities of daily living (IADL). Medication management for residents with dementia emerged as a particular concern. Most physical health characteristics, such as health care usage, were not significantly different in the three groups. Suggestions for strategies to promote the health and well-being of this growing population are discussed.

Activities of Daily Living↗

PubMed2002

The changes in caregiver burden following nursing home placement.

This longitudinal study explored changes in perceived burden among Taiwanese family caregivers (n=77) from nursing home placement of an elder to four months postadmission. Higher burden at placement was related to the level of dependence of the care recipients (p=0.004), or caregiver's poor health (p<0.01). After nursing home placement for four months, global burden decreased (p<0.01) contributed primarily by lessened burden in three sub-scales: lack of family support, impact of schedule and impact of health. Burden scores on caregiver esteem and impact of finances were not decreased after placement. Duration of caregiving was the only demographic factor predicting change in global burden (p<0.001). Changes in impact on finances, and impact on health were, respectively, predicted by the perceived health (p=0.005), and religious preference (p=0.01). These results provide valuable information to healthcare providers for an understanding of the changes of caregiving burden after nursing home placement and the correlates of these changes, which may help devise an appropriate policy for alleviating the caregiver's burden.

Aged↗

PubMed2002

Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic.

OBJECTIVE: The substantial discrepancy in the male-to-female ratio between clinic-referred (10 to 1) and community (3 to 1) samples of children with attention deficit hyperactivity disorder (ADHD) suggests that gender differences may be operant in the phenotypic expression of ADHD. In this study the authors systematically examined the impact of gender on the clinical features of ADHD in a group of children referred to a clinic. METHOD: The study included 140 boys and 140 girls with ADHD and 120 boys and 122 girls without ADHD as comparison subjects. All subjects were systematically assessed with structured diagnostic interviews and neuropsychological batteries for subtypes of ADHD as well as emotional, school, intellectual, interpersonal, and family functioning. RESULTS: Girls with ADHD were more likely than boys to have the predominantly inattentive type of ADHD, less likely to have a learning disability, and less likely to manifest problems in school or in their spare time. In addition, girls with ADHD were at less risk for comorbid major depression, conduct disorder, and oppositional defiant disorder than boys with ADHD. A statistically significant gender-by-ADHD interaction was identified for comorbid substance use disorders as well. CONCLUSIONS: The lower likelihood for girls to manifest psychiatric, cognitive, and functional impairment than boys could result in gender-based referral bias unfavorable to girls with ADHD.

Adolescent↗

PubMed2002

The age-related eye disease study (AREDS).

Some of the earliest and best known manifestations of malnutrition involve visual disorders, such as blindness that results from vitamin A deficiency. Interest is now being focused on the role of nutrition in the prevention and treatment of chronic age-related disorders. The Age-related Eye Disease Study (AREDS) was conducted in order to determine whether high-dose supplementation could influence the natural progres sion of eye disease in older Americans. AREDS found that prospective administration of purified vitamin C, vitamin E, beta-carotene, zinc, and copper had some benefits for age-related maculopathy, but had virtually no impact on the progression of cataracts.

Adult↗