Biomedical subjects

S M Shetterly

Publications and source records attributed to S M Shetterly.

31 records · Page 2Linked to original sources

PubMed1995

Relationship between habitual physical activity and insulin area among individuals with impaired glucose tolerance. The San Luis Valley Diabetes Study.

OBJECTIVE: To determine whether higher levels of physical activity are associated with lower fasting insulin levels and lower insulin areas under the oral glucose tolerance curve in individuals with impaired glucose tolerance (IGT) in a community setting. RESEARCH DESIGN AND METHODS: Data from a cross-sectional study of a population consisting of 219 Hispanic and non-Hispanic white men and women with IGT (by World Health Organization criteria) in two rural Colorado counties were analyzed. Total physical activity was assessed by a 7-day physical activity recall, from which metabolic equivalents (METs) were estimated (expressed as MET h/week). Relationships of MET h/week with fasting insulin levels and insulin areas were assessed while considering obesity, age, and other risk factors known to influence fasting insulin level and insulin area. RESULTS: Among all subjects, univariate analyses showed that higher physical activity levels were associated with lower mean insulin areas and fasting insulin levels (both P < 0.05). Multiple linear regression showed that higher levels of physical activity were significantly associated with lower values of of the insulin area (P < 0.001) but not with fasting insulin levels. The relationship between insulin area and habitual physical activity was independent of obesity, fat distribution, and age. CONCLUSIONS: On the basis of cross-sectional data, we conclude that higher levels of habitual physical activity are associated with lower insulin areas in a population of individuals with IGT. Understanding the impact of physical activity on markers of insulin action in individuals with IGT is important because of the greatly enhanced risk of non-insulin-dependent diabetes mellitus and, hence, cardiovascular disease in this population.

Adult↗

PubMed1994

ApoA-IV polymorphism associated with myocardial infarction in obese NIDDM patients. The San Luis Valley Diabetes Study.

Non-insulin-dependent diabetes mellitus (NIDDM) confers myocardial infarction (MI) risk unexplained by known factors. In 356 NIDDM patients and 1,087 people with normal glucose tolerance, we investigated the association between MI risk and polymorphism at codon 360 in the apolipoprotein A-IV (apoA-IV) gene. During 1984-1992, MI was diagnosed in 84 diabetic and in 106 nondiabetic people. The risk of MI did not differ by apoA-IV phenotype in nondiabetic people; however, in NIDDM patients, those with the apoA-IV 1-2 phenotype had 2.8 (95% confidence interval: 1.4-5.6) higher MI risk than those with the 1-1 phenotype, adjusting for age, gender, ethnicity, hypertension, smoking, body mass index, fat centrality, and low-density lipoprotein and high-density lipoprotein cholesterol. The risk of MI was particularly high in obese NIDDM patients with the apoA-IV 1-2 phenotype: 5.1 (2.4-11.2) times that in obese apoA-IV 1-1 NIDDM patients and 7.7 (3.6-16.7) times that in lean nondiabetic people. The effect of apoA-IV 1-2 did not appear to be a part of the insulin-resistance syndrome nor was it dependent on diabetes duration or control. One half of the excess MI risk in the diabetic population studied was explained by the apoA-IV 1-2 phenotype. These results indicate that approximately 17% of NIDDM patients have a high MI risk apoA-IV phenotype that is particularly deleterious in obese patients.

Adult↗

PubMed1994

Risk factors for distal symmetric neuropathy in NIDDM. The San Luis Valley Diabetes Study.

OBJECTIVE: To investigate risk factors for distal symmetric (sensory) neuropathy among prevalent cases of non-insulin-dependent diabetes mellitus (NIDDM) in a population-based study in southern Colorado. RESEARCH DESIGN AND METHODS: Prevalent neuropathy was identified in 77 of 277 people with NIDDM by a standardized history and neurologic examination. Fifteen known or suspected risk factors for neuropathy were determined without knowledge of neuropathy status. RESULTS: Older age at examination, longer duration of diabetes, higher glycohemoglobin percentage, lower fasting C-peptide, insulin use, and presence of retinopathy and nephropathy (microalbumin > or = 200 micrograms/ml) were all significantly associated with neuropathy. Sex, ethnicity (Hispanic versus non-Hispanic white), height, systolic blood pressure, peripheral vascular disease, cigarette and alcohol use, and serum lipid levels were not significantly associated with neuropathy. In a multivariate logistic model, increasing age (odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1-1.6), longer duration of diabetes (OR = 1.3, CI = 1.0-1.6), increased glycohemoglobin percentage (OR = 1.5, CI = 1.1-2.1), and insulin use (OR = 2.8, CI = 1.3-6.1) were associated with neuropathy. Retinopathy (OR = 3.0, CI = 1.2-7.7), but not nephropathy, was important when added to this model. CONCLUSIONS: Worse glycemic control and insulin use were independently associated with neuropathy in people with NIDDM. Whether insulin use represents another marker for severity of the metabolic disturbance or is an independent risk factor for neuropathy requires further study. We could not confirm associations of neuropathy with height, with nephropathy, or with retinopathy, independent of duration of diabetes.

Adult↗

PubMed1994

Patterns and predictors of hypertension incidence among Hispanics and non-Hispanic whites: the San Luis Valley Diabetes Study.

OBJECTIVES: To determine whether Hispanics are at lower risk for the development of hypertension than non-Hispanic Whites. We also examined selected predictors of hypertension incidence and explored the role of markers of insulin resistance in the development of hypertension. DESIGN: A cohort study of a geographically-based sample of Hispanic and non-Hispanic white southern Colorado residents who were re-examined an average of 4 years after their baseline examination. METHODS: These analyses included 664 participants who were normotensive and confirmed nondiabetic by an oral glucose tolerance test at their baseline examination. Hypertension was defined as systolic blood pressure > or = 140 mmHg or diastolic blood pressure > or = 90 mmHg or use of antihypertensive medication. RESULTS: Hispanics and non-Hispanic Whites had similar hypertension incidence rates. The strongest predictors of hypertension incidence were baseline blood pressure and age. Higher baseline heart rates and higher body mass index also predicted hypertension. Increased fasting insulin levels were associated with hypertension incidence among lean participants, though the association disappeared once baseline blood pressure levels were added to the models. Models investigating change in systolic or diastolic blood pressure levels found higher baseline levels of insulin area under the glucose tolerance curve predicted greater increases in systolic blood pressure in non-Hispanic Whites only. CONCLUSIONS: Hypertension incidence rates were similar in Hispanics and non-Hispanic Whites. Higher levels of insulin area were associated with larger increases in systolic blood pressure among non-Hispanic Whites only.

Adult↗

PubMed1993

Waist-hip ratio measurement location influences associations with measures of glucose and lipid metabolism. The San Luis Valley Diabetes Study.

The ratio of waist to hip circumference is widely used to characterize fat distribution patterns but the locations for measurement are not standardized. Between 1986 and 1988, we measured two waist and two hip circumferences on 616 Hispanic and non-Hispanic white subjects, aged 30 to 74 years. Intraclass correlation coefficients, based on repeat measurements of 38 subjects, showed that minimum waist and maximum hip circumferences attained or exceeded the level of repeatability seen with the landmark-based circumference measures. Sex-specific partial correlation coefficients, adjusted for age and body mass index, indicated wide variation in the magnitudes of associations of the two waist-hip ratios with measures of insulin, high-density-lipoprotein cholesterol, triglycerides, and diastolic blood pressure. Models with simple waist circumference generally produced partial correlation coefficients of equal or greater magnitude compared to the coefficients seen with the waist-hip ratio.

Adult↗

PubMed1993

Is the risk of coronary heart disease lower in Hispanics than in non-Hispanic whites? The San Luis Valley Diabetes Study.

A less favorable cardiovascular risk factor profile, but paradoxically lower coronary heart disease mortality and prevalence have been reported for Hispanic men compared to non-Hispanic white men. Since mortality and prevalence data are susceptible to bias, the patterns of coronary heart disease incidence, as well as prevalence and mortality, were investigated in a biethnic Hispanic and non-Hispanic white population of the San Luis Valley in Colorado. Little evidence was found for lower incidence, prevalence, or mortality due to coronary heart disease among Colorado Hispanics without diabetes. The risk of coronary heart disease among diabetic Hispanics appeared, however, to be approximately 50% lower than among non-Hispanic whites, especially in men. Adjustment for selected cardiovascular risk factors (age, gender, diabetes, hypertension, cigarette smoking, body mass index, and high-density lipoprotein cholesterol and triglycerides levels) did not change this ethnic pattern. The plausible explanations of a lower coronary heart disease risk among diabetic Hispanics, compared to non-Hispanic whites, include both biologic mechanisms and artifacts due to deficiencies of mortality classification or differential access to health care. The existing evidence is insufficient to conclude that the risk of coronary heart disease in the general population differs between Hispanics and non-Hispanic whites. The ethnic patterns of coronary heart disease incidence should be investigated further through population-based incidence studies.

Adult↗

PubMed1992

The roles of insulin, obesity, and fat distribution in the elevation of cardiovascular risk factors in impaired glucose tolerance. The San Luis Valley Diabetes Study.

The objective of this study was to determine whether a less favorable risk factor pattern for cardiovascular disease among persons with impaired glucose tolerance could be explained by fasting insulin, obesity, and/or a central distribution of body fat. Between 1984 and 1988, cardiovascular risk factors were examined cross-sectionally in Hispanic and non-Hispanic white participants in the San Luis Valley Diabetes Study who had either impaired (n = 173) or normal (n = 1,107) glucose tolerance. Sex-specific analysis of covariance models were constructed to adjust risk factor levels for age, age and insulin, and age, insulin, body mass index, and centrality index. Both males and females with impaired glucose tolerance had higher age-adjusted mean diastolic blood pressures, heart rates, uric acid levels, and triglyceride levels and lower levels of high density lipoprotein (HDL) cholesterol and HDL3 cholesterol than normal subjects; differences were significant for all risk factors except HDL cholesterol and HDL3 cholesterol in males. Differences in diastolic blood pressure in males, and differences in heart rate and triglyceride in both sexes, remained significant after adjustment for all covariates. However, differences in uric acid in males and differences in diastolic blood pressure and HDL3 cholesterol in females were attenuated to borderline significance levels. Differences in uric acid and HDL cholesterol in females were diminished to nonsignificant levels, especially after adjustment for obesity-related measures. With few exceptions, fasting insulin did not appear to play a major role in accounting for differences in these risk factors. With adjustment, ethnic differences (Hispanic vs. non-Hispanic white) were smaller and were statistically significant less often than differences observed between impaired and normal glucose tolerant groups. The authors concluded that hyperinsulinemia, obesity, and a central body fat distribution accounted for some, but usually not all, of the less favorable cardiovascular risk factor pattern found in subjects with impaired glucose tolerance.

Adult↗

PubMed1992

Prevalence of coronary heart disease in subjects with normal and impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study.

The prevalence of coronary heart disease was studied in 1984-1988 in 1,092 individuals with normal glucose tolerance, 173 individuals with impaired glucose tolerance, and 429 individuals with non-insulin-dependent diabetes mellitus, who were age 25-74 years and were from a biethnic community in the San Luis Valley, Colorado. Glucose tolerance was classified using the World Health Organization criteria, and coronary heart disease prevalence was assessed using the Rose Questionnaire and a resting electrocardiogram. Compared with normal glucose tolerance, coronary heart disease was significantly more prevalent in diabetic non-Hispanic white women (odds ratio (OR) for all end points combined = 3.2, 95% confidence interval (Cl) 1.8-5.5) and men (OR = 1.9, 95% Cl 1.1-3.3) and in diabetic Hispanic women (OR = 1.7, 95% Cl 1.1-2.5), but not men (OR = 1.0, 95% Cl 0.6-1.7). Among diabetic men, the prevalence of possible myocardial infarction was lower in Hispanics than in non-Hispanic whites (OR = 0.4, 95% Cl 0.2-0.7). Similar patterns of coronary heart disease were observed in individuals with impaired glucose tolerance. The paradoxically low prevalence of coronary heart disease in Hispanics with non-insulin-dependent diabetes mellitus, especially men, may be due to unknown protective factors, increased case fatality, or competing mortality in this group.

Adult↗

PubMed1992

Determinants of total high density lipoprotein cholesterol and high density lipoprotein subfraction levels among Hispanic and non-Hispanic white persons with normal glucose tolerance: the San Luis Valley Diabetes Study.

Determinants of total high-density lipoprotein cholesterol (HDL-C) and HDL subfractions were assessed in Hispanic and non-Hispanic white persons (n = 932), aged 20-74 years, in the San Luis Valley, Colorado. Using multiple regression, BMI was negatively associated with HDL-C, HDL2-C, and HDL3-C in men and HDL-C and HDL3-C in women. Among females, current smokers had lower HDL-C and subfractions. Women on beta-blockers had lower HDL3-C levels. For both sexes, a positive association was observed between age and HDL-C and subfractions and physical activity with HDL-C and HDL3-C. Drinking alcohol (> or = 50 g/week) was associated with higher HDL-C and HDL3-C in both sexes and HDL2-C in women. The positive association of age and negative associations of the subscapular/triceps ratio and fasting insulin had consistent relationships with HDL-C, HDL2-C, and HDL3-C in men and women. Ethnicity was not significantly associated with HDL-C or subfractions after controlling for body fat distribution or fasting insulin.

Adrenergic beta-Antagonists↗

PubMed1991

Relationship between habitual physical activity and insulin levels among nondiabetic men and women. San Luis Valley Diabetes Study.

OBJECTIVE: To determine whether higher levels of physical activity would be associated with lower fasting insulin and C-peptide levels in a free-living nondiabetic population. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted with a Hispanic and non-Hispanic white population of 442 men and 489 women with normal glucose tolerance (by World Health Organization criteria) in two rural Colorado counties. Total physical activity was assessed by a 7-day physical activity recall from which metabolic equivalents were estimated. Relationships between metabolic equivalents and fasting insulin and C-peptide were assessed while considering obesity, age, and other risk factors known to influence fasting insulin levels. RESULTS: Among all subjects, univariate analyses showed that higher activity levels were associated with lower mean fasting insulin and C-peptide levels (P less than or equal to 0.05). Multiple linear regression showed that higher activity was significantly associated with lower values of log fasting insulin and C-peptide levels in men only (P less than 0.001) independent of obesity, fat distribution, and age. Men in the highest tertile of activity had an adjusted mean fasting insulin level of 59.2 pM and fasting C-peptide level of 0.5 nM compared with a fasting insulin level of 72.7 pM and fasting C-peptide level of 0.6 mM for men in the lowest tertile of activity. The magnitude of the inverse association between activity and insulin was greatest in older rather than younger men. Physical activity was not associated with fasting insulin or C-peptide levels in women in the multivariate analyses. CONCLUSIONS: Based on cross-sectional data, we conclude that higher levels of habitual physical activity are associated with lower fasting insulin and C-peptide levels in Hispanic and non-Hispanic white men.

Adult↗

PubMed1990

Accuracy of reported family history of diabetes mellitus. Results from San Luis Valley Diabetes Study.

There are two possible sources of bias in the assessment of family history of diabetes: 1) a person with diabetes may be more likely to report a diabetic relative than a nondiabetic person would be, and 2) relatives of individuals with diabetes may be more likely to be tested for diabetes than relatives of nondiabetic individuals. We conducted a study on a subsample of families of subjects in the San Luis Valley Diabetes Study to examine these issues. A sample of 5 White and 5 Hispanic subjects (probands) with diabetic glucose tolerance tests and the same number with normal glucose tolerance were selected. The 20 probands all provided contact information on their 227 primary family members. Ninety-two percent of the family members had interviews completed by themselves or, if deceased, by surrogates other than the proband. Family members were asked by telephone if they had ever been tested for diabetes, when they had been most recently tested, why they had been tested, and if they had ever been told they had diabetes. The results showed that study subjects accurately reported family history of diabetes, because there were no discrepancies between proband and family reports. A positive family history of diabetes was associated with increased reported screening in Hispanics, but a similar effect in White families was not seen. Women were also more likely to report being screened than men regardless of whether there was a positive family history of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Colorado↗

PubMedDate not supplied

Association of education level with atherogenic diets in a rural biethnic population.

Better definition of dietary intakes among subpopulations will facilitate the implementation of relevant public health interventions. This study describes total calorie and macronutrient intake by level of education as reported by Hispanic and non-Hispanic white persons in the rural San Luis Valley of southern Colorado. Current diet was assessed for a geographically based sample of 552 Hispanic and 754 non-Hispanic white (NHW) adults 30-74 years of age in two counties of rural southern Colorado 1984-1988). Diet was assessed by 24-hour recall. Hispanic men and women reported lower total calorie intakes at all ages than NHWs; however, the macronutrient composition was similar between groups (38.5% and 46.0% of calories from fat and carbohydrate, respectively). Ethnic differences in body size and reported physical activity did not account for ethnic differences in reported calorie intake. In both ethnic groups, subjects with more education reported higher calorie intake and less atherogenic diets (lower total fat, saturated fat, cholesterol, and Keys Index; higher polyunsaturated fat, P/S ratio, and total carbohydrate). In Hispanics and NHWs, lower education groups may require targeted interventions to decrease total fat, saturated fat, and cholesterol. Further study is needed to understand the ethnic difference in reported calorie intake.

Adult↗

PubMedDate not supplied

Ethnic differences in micronutrient intake in a rural biethnic population.

Differences in micronutrient intake have been observed between populations of differing socioeconomic status (SES) and ethnicity. This study reports micronutrient intake among Hispanic and non-Hispanic white (NHW) persons in the rural San Luis Valley of southern Colorado. Current diet was assessed for a geographically based sample of 552 Hispanic and 754 NHW adults 30-74 years of age in two counties of rural southern Colorado (1984-1988). Diet was assessed by 24-hour recall. NHWs reported higher mean calorie intakes than Hispanics of both genders. NHWs had greater intakes of calcium, magnesium, potassium, phosphorus, riboflavin, niacin, zinc, vitamin A, and vitamin C than Hispanics, after accounting for ethnic differences in gender, age, and calorie intake. Differences in intake by gender were observed within and between ethnic groups. After adjusting for gender, age, ethnicity, and calories, we observed no statistically significant trends by SES measures. We conclude that diets of Hispanic adults would benefit from the addition of fresh fruits, vegetables, and high-calcium foods.

Adult↗