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Tessa L Crume,
Jeanette S Andrews,
Ralph B D'Agostino,
David J Pettitt,
Elizabeth J Mayer-Davis,
Jennifer R Law,
Lawrence Dolan,
Jean M Lawrence,
Sharon Saydah,
Carla Greenbaum, Beatriz L Rodriguez,
Dana Dabelea
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ABSTRACT: Abstract We explored the influence of exposure to maternal diabetes in utero on β cell decline measured by fasting C-peptide (FCP) among 1079 youth <20 years with diabetes, including 941 with type 1 and 138 with type 2 diabetes. Youths exposed to maternal diabetes had FCP levels that were 17% lower among youth with type 2 diabetes [95% confidence interval (CI): -34%, +6%] and 15% higher among youth with type 1 diabetes (95%CI: -14%, +55%) than their unexposed counterparts, although differences were not statistically significant (p=0.13 and p=0.35, respectively). Exposure to maternal diabetes was not associated with FCP decline in youth with type 2 (p=0.16) or type 1 diabetes (p=0.90); nor was the effect of in utero exposure on FCP modified by diabetes type. Findings suggest that exposure to maternal diabetes in utero may not be an important determinant of short-term β-cell function decline in youth with type 1 or type 2 diabetes.
Journal of pediatric endocrinology & metabolism: JPEM 05/2013; · 0.88 Impact Factor
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Giuseppina Imperatore,
James P Boyle,
Theodore J Thompson,
Doug Case,
Dana Dabelea,
Richard F Hamman,
Jean M Lawrence,
Angela D Liese,
Lenna L Liu,
Elizabeth J Mayer-Davis, Beatriz L Rodriguez,
Debra Standiford
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ABSTRACT: OBJECTIVE To forecast the number of U.S. individuals aged <20 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) through 2050, accounting for changing demography and diabetes incidence. RESEARCH DESIGN AND METHODS We used Markov modeling framework to generate yearly forecasts of the number of individuals in each of three states (diabetes, no diabetes, and death). We used 2001 prevalence and 2002 incidence of T1DM and T2DM from the SEARCH for Diabetes in Youth study and U.S. Census Bureau population demographic projections. Two scenarios were considered for T1DM and T2DM incidence: 1) constant incidence over time; 2) for T1DM yearly percentage increases of 3.5, 2.2, 1.8, and 2.1% by age-groups 0-4 years, 5-9 years, 10-14 years, and 15-19 years, respectively, and for T2DM a yearly 2.3% increase across all ages. RESULTS Under scenario 1, the projected number of youth with T1DM rises from 166,018 to 203,382 and with T2DM from 20,203 to 30,111, respectively, in 2010 and 2050. Under scenario 2, the number of youth with T1DM nearly triples from 179,388 in 2010 to 587,488 in 2050 (prevalence 2.13/1,000 and 5.20/1,000 [+144% increase]), with the greatest increase in youth of minority racial/ethnic groups. The number of youth with T2DM almost quadruples from 22,820 in 2010 to 84,131 in 2050; prevalence increases from 0.27/1,000 to 0.75/1,000 (+178% increase). CONCLUSIONS A linear increase in diabetes incidence could result in a substantial increase in the number of youth with T1DM and T2DM over the next 40 years, especially those of minority race/ethnicity.
Diabetes care 12/2012; 35(12):2515-2520. · 8.09 Impact Factor
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ABSTRACT: Baseline risk factors were associated with fractures that developed after 29-31 years among Japanese-American men. Hip fracture risk increased with increasing BMI (28% increase for 1 U increase), physical activity (7% increase for 1 U increase), and was decreased with increasing arm girth (27% decrease for 1 U increase).
The objective of this study was to identify risk factors among Japanese-American men aged 45-68 years at baseline that were associated with prevalence and incidence of fractures at advanced age.
We used baseline information from Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS). The HHP was a prospective study with primary focus on risk factors for cardiovascular disease. A cohort of 8,006 men of Japanese ancestry aged 45-68 years residing on Oahu was recruited in 1965 and followed for 31 years. The HAAS started in 1991 in conjunction with the HHP with a focus on age-related health conditions. Self-reported hip, spine, and forearm fracture prevalence was ascertained in 1991-1993 among 3,845 men aged 71-93 years. Incidence was obtained during the period (1994-1999) among 2,737 men aged 74-98 years. Poisson regression models were used to determine multi-variable adjusted prevalence and incidence ratios for fracture.
Incident hip fracture was directly associated with baseline body mass index (BMI) and physical activity, and inversely associated with left upper arm girth. Incident spine fracture was directly associated with baseline age. Prevalent hip fracture was directly associated with baseline pack-years of smoking. Prevalent spine fracture was inversely associated with baseline education, and directly associated with standing height and use of medication for diabetes. Prevalent forearm fracture was inversely associated with baseline age, and directly associated with education.
Results indicated that multiple baseline demographic lifestyle and anthropometric characteristics predict fracture risk at advanced age. In addition, associations varied by fracture location.
Archives of Osteoporosis 12/2011; 6(1-2):197-207.
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Beth Waitzfelder,
Catherine Pihoker,
Georgeanna Klingensmith,
Doug Case,
Andrea Anderson,
Ronny A Bell,
Jean M Lawrence,
Elizabeth J Mayer-Davis,
Giuseppina Imperatore,
Debra Standiford, Beatriz L Rodriguez,
Dana Dabelea,
Michael Seid
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ABSTRACT: To describe demographic and clinical characteristics associated with self-reported receipt of tests and measurements recommended by the American Diabetes Association (ADA) for children and youths with diabetes.
The study included 1514 SEARCH for Diabetes in Youth study participants who completed a survey about diabetes care received. Quality-of-care measures were based on ADA guidelines for eye examinations and glycohemoglobin (hemoglobin A1c [HbA1c]), lipid level, microalbuminuria, and blood pressure measurements, and a composite variable of these 5 indicators was created. Multivariate logistic regression models were used to assess the association of selected demographic and clinical characteristics with the reported receipt of all recommended tests and measurements according to age and diabetes type subgroups.
Overall, 95% of the participants reported having their blood pressure checked at all or most visits, 88% had lipid levels measured, 83% had kidney function tested, 68% underwent HbA1c testing, and 66% underwent an eye examination, in accordance with ADA recommendations. Participants aged 18 years or older, particularly those with type 2 diabetes, tended to have fewer tests of all kinds performed. Age and family income emerged as important correlates of overall quality of care in multivariate models; older age and lower income were associated with not meeting guidelines.
Although there was relatively good adherence to ADA-recommended guidelines for most indicators, efforts are needed to improve rates of HbA1c testing and eye examinations, particularly among older youths.
PEDIATRICS 08/2011; 128(3):531-8. · 4.47 Impact Factor
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Ian J Brown,
Jeremiah Stamler,
Linda Van Horn,
Claire E Robertson,
Queenie Chan,
Alan R Dyer,
Chiang-Ching Huang, Beatriz L Rodriguez,
Liancheng Zhao,
Martha L Daviglus,
Hirotsugu Ueshima,
Paul Elliott
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ABSTRACT: The obesity epidemic has focused attention on relationships of sugars and sugar-sweetened beverages (SSBs) to cardiovascular risk factors. Here we report cross-sectional associations of SSBs, diet beverages, and sugars with blood pressure (BP) for United Kingdom and US participants of the International Study of Macro/Micronutrients and Blood Pressure. Data collected include four 24-hour dietary recalls, two 24-hour urine collections, 8 BP readings, and questionnaire data for 2696 people ages 40 to 59 years of age from 10 US/United Kingdom population samples. Associations of SSBs, diet beverages, and sugars (fructose, glucose, and sucrose) with BP were assessed by multiple linear regression. SSB intake related directly to BP, with P values of 0.005 to <0.001 (systolic BP) and 0.14 to <0.001 (diastolic BP). SSB intake higher by 1 serving per day (355 mL/24 hours) was associated with systolic/diastolic BP differences of +1.6/+0.8 mm Hg (both P<0.001) and +1.1/+0.4 mm Hg (P<0.001/<0.05) with adjustment for weight and height. Diet beverage intake was inversely associated with BP (P 0.41 to 0.003). Fructose- and glucose-BP associations were direct, with significant sugar-sodium interactions: for individuals with above-median 24-hour urinary sodium excretion, fructose intake higher by 2 SD (5.6% kcal) was associated with systolic/diastolic BP differences of +3.4/+2.2 mm Hg (both P<0.001) and +2.5/+1.7 mm Hg (both P=0.002) with adjustment for weight and height. Observed independent, direct associations of SSB intake and BP are consistent with recent trial data. These findings, plus adverse nutrient intakes among SSB consumers, and greater sugar-BP differences for persons with higher sodium excretion lend support to recommendations that intake of SSBs, sugars, and salt be substantially reduced.
Hypertension 02/2011; 57(4):695-701. · 6.21 Impact Factor
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Emily D Szmuilowicz,
JoAnn E Manson,
Jacques E Rossouw,
Barbara V Howard,
Karen L Margolis,
Nancy C Greep,
Robert G Brzyski,
Marcia L Stefanick,
Mary Jo O'Sullivan,
Chunyuan Wu,
Matthew Allison,
Diederick E Grobbee,
Karen C Johnson,
Judith K Ockene, Beatriz L Rodriguez,
Gloria E Sarto,
Mara Z Vitolins,
Ellen W Seely
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ABSTRACT: Emerging evidence suggests that women with menopausal vasomotor symptoms (VMS) have increased cardiovascular disease (CVD) risk as measured by surrogate markers. We investigated the relationships between VMS and clinical CVD events and all-cause mortality in the Women's Health Initiative Observational Study (WHI-OS).
We compared the risk of incident CVD events and all-cause mortality between four groups of women (total N = 60,027): (1) no VMS at menopause onset and no VMS at WHI-OS enrollment (no VMS [referent group]), (2) VMS at menopause onset but not at WHI-OS enrollment (early VMS), (3) VMS at both menopause onset and WHI-OS enrollment (persistent VMS [early and late]), and (4) VMS at WHI-OS enrollment but not at menopause onset (late VMS).
For women with early VMS (n = 24,753), compared with no VMS (n = 18,799), hazard ratios (95% CIs) in fully adjusted models were as follows: major coronary heart disease (CHD), 0.94 (0.84-1.06); stroke, 0.83 (0.72-0.96); total CVD, 0.89 (0.81-0.97); and all-cause mortality, 0.92 (0.85-0.99). For women with persistent VMS (n = 15,084), there was no significant association with clinical events. For women with late VMS (n = 1,391), compared with no VMS, hazard ratios (95% CIs) were as follows: major CHD, 1.32 (1.01-1.71); stroke, 1.14 (0.82-1.59); total CVD, 1.23 (1.00-1.52); and all-cause mortality, 1.29 (1.08-1.54).
Early VMS were not associated with increased CVD risk. Rather, early VMS were associated with decreased risk of stroke, total CVD events, and all-cause mortality. Late VMS were associated with increased CHD risk and all-cause mortality. The predictive value of VMS for clinical CVD events may vary with the onset of VMS at different stages of menopause. Further research examining the mechanisms underlying these associations is needed. Future studies will also be necessary to investigate whether VMS that develop for the first time in the later postmenopausal years represent a pathophysiologic process distinct from the classic perimenopausal VMS.
Menopause (New York, N.Y.) 02/2011; 18(6):603-10. · 3.08 Impact Factor
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ABSTRACT: Brain iron promotes neurodegeneration in Parkinson's disease (PD). While hemoglobin (Hb) is the most abundant source of peripheral iron in humans, its relationship with PD is uncertain. This report examines the association between Hb in late life and PD incidence. From 1991 to 1993, Hb was measured in 3507 men in the Honolulu-Asia Aging Study. Men were aged 71-93 years and without PD. Participants were followed until 2001 for incident PD. Hb levels declined markedly with age. For men aged 71-75 years, 14.8% had levels < 14 g/dL versus 53.6% in those aged 86 and older (p < 0.001). During follow-up, 47 men developed PD (19.8/10,000 person-years). After age adjustment, PD incidence rose significantly from 10.3 to 34.9/10,000 person-years as Hb increased from < 14 to ≥ 16 g/dL (p = 0.024; relative hazard 3.2; 95% confidence interval, 1.2-8.9). Associations persisted after accounting for early mortality and adjustments for concomitant risk factors. While Hb declines with advancing age, evidence suggests that Hb that remains high in elderly men is associated with an increased risk of PD.
Neurobiology of aging 08/2010; 33(5):914-20. · 5.94 Impact Factor
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Beatriz L Rodriguez,
Dana Dabelea,
Angela D Liese,
Wilfred Fujimoto,
Beth Waitzfelder,
Lenna Liu,
Ronny Bell,
Jennifer Talton,
Beverly M Snively,
Ann Kershnar,
Elaine Urbina,
Stephen Daniels,
Giuseppina Imperatore
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ABSTRACT: To determine the prevalence and correlates of elevated blood pressure (BP) in youth with type 1 or type 2 diabetes mellitus by using data from the SEARCH Study.
The analysis included youth aged 3 to 17 years with type 1 (n = 3691) and type 2 diabetes mellitus (n = 410) who attended a research visit. Elevated BP was defined as systolic or diastolic values >or=95 percentile, regardless of drug use. In youth with elevated BP, awareness was defined as self-report of an earlier diagnosis. Control was defined as BP values <90th percentile and <120/90 mm Hg in youth with an earlier diagnosis who were taking BP medications.
The prevalence of elevated BP in youth with type 1 diabetes mellitus was 5.9%; minority ethnic groups, obese adolescents, and youth with poor glycemic control were disproportionately affected. In contrast, 23.7% of adolescents with type 2 diabetes mellitus had elevated BP (P < .0001), Similarly, 31.9% of youth with type 2 diabetes mellitus and elevated BP were aware, compared with only 7.4% of youth with type 1 diabetes mellitus (P < .0001). Once BP was diagnosed and treated, control was similar in type 1 (57.1%) and type 2 diabetes mellitus (40.6%).
Our findings identify high-risk groups of youth with diabetes mellitus at which screening and treatment efforts should be directed.
The Journal of pediatrics 08/2010; 157(2):245-251.e1. · 4.02 Impact Factor
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ABSTRACT: Arterial stiffness occurs early in the atherosclerotic process; however, few data are available concerning risk factors for arterial stiffness in youth with diabetes. We identified factors associated with arterial stiffness in youth with diabetes and assessed the effects of these factors on the relationship between arterial stiffness and diabetes type (type 1 vs. type 2).
A subset of patients from the SEARCH for Diabetes in Youth study with type 1 (n = 535) and type 2 diabetes (n = 60), aged 10-23 years (52% male; 82% non-Hispanic white; diabetes duration 65 +/- 49 months) had arterial stiffness, anthropometrics, blood pressure, fasting lipids, and A1C measured. Arterial stiffness was measured by brachial distensibility (brachD), pulse wave velocity (PWV), and augmentation index adjusted to heart rate of 75 beats/min (AI75).
Youth with type 2 diabetes had worse brachD (5.2 +/- 0.9 vs. 6.1 +/- 1.2%/mmHg), PWV (6.4 +/- 1.3 vs. 5.3 +/- 0.8 m/s), and AI75 (6.4 +/- 9.9 vs. 2.2 +/- 10.2%) than those with type 1 diabetes (P < 0.01 for each). These differences were largely mediated through increased central adiposity and higher blood pressure in youth with type 2 diabetes. We also found a pattern of association of arterial stiffness measures with waist circumference and blood pressure, independent of diabetes type.
Youth with type 2 diabetes have worse arterial stiffness than similar youth with type 1 diabetes. Increased central adiposity and blood pressure are associated with measures of arterial stiffness, independent of diabetes type. Whether these findings indicate that youth with type 2 diabetes will be at higher risk for future complications requires longitudinal studies.
Diabetes care 04/2010; 33(4):881-6. · 8.09 Impact Factor
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Zhao Guo,
Katsuyuki Miura,
Tanvir Chowdhury Turin,
Atsushi Hozawa,
Nagako Okuda,
Tomonori Okamura,
Shigeyuki Saitoh,
Kiyomi Sakata,
Hideaki Nakagawa,
Akira Okayama,
Katsushi Yoshita,
Takashi Kadowaki,
Sohel R Choudhury,
Yasuyuki Nakamura, Beatriz L Rodriguez,
David J Curb,
Paul Elliott,
Jeremiah Stamler,
Hirotsugu Ueshima
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ABSTRACT: There have been few studies on the relationships of the dietary polyunsaturated to saturated fatty acid ratio (P/S) to cardiovascular risk factors and metabolic syndrome. We hypothesized that there would be favorable relationships.
Metabolic cardiovascular risk factors from dietary nutrient intake were investigated in 1,004 men and women aged 40-59 years from 4 population samples of Japanese. Multiple linear regression analysis was used to examine the relationship of the dietary P/S ratio to the following risk factors: hemoglobin A1c, blood pressure, serum triglycerides, LDL and total cholesterol, and HDL-cholesterol. Adjusted odds ratio of having metabolic syndrome was also calculated.
The dietary P/S ratio was significantly and inversely related to serum total and LDL cholesterol with control for possible confounding variables. We did not find any significant relationship between the P/S ratio and single metabolic risk factors or the prevalence of metabolic syndrome.
Managing the P/S ratio is important to control serum LDL-cholesterol; however, increasing the P/S ratio may not improve metabolic risk factors. Other countermeasures, such as weight control, greater physical activity, and smoking cessation should be recommended to prevent and control metabolic syndrome.
Journal of atherosclerosis and thrombosis 03/2010; 17(8):777-84. · 2.69 Impact Factor
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Clementina D Ceria-Ulep,
John Grove,
Randi Chen,
Kamal H Masaki, Beatriz L Rodriguez,
Tim A Donlon,
Jack Guralnik,
Bradley J Willcox,
D Craig Willcox,
Claudio Nigg,
J David Curb
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ABSTRACT: Objectives. To investigate the reliability and correlations with age of the balance components of the EPESE, NHANES, and the Good Balance Platform System (GBPS) in a normal population of adults. Design. Cross-sectional. Setting. Urban Medical Center in the Pacific. Participants. A random sample of 203 healthy offspring of Honolulu Heart Program participants, ages 38-71. Measurements. Subjects were examined twice at visits one week apart using the balance components of the EPESE, NHANES, and the good balance system tests. Results. The EPESE and NHANES batteries of tests were not sufficiently challenging to allow successful discrimination among subjects in good health, even older subjects. The GBPS allowed objective quantitative measurements, but the test-retest correlations generally were not high. The GBPS variables correlated with age only when subjects stood on a foam pad; they also were correlated with anthropometric variables. Conclusion. Both EPESE and NHANES balance tests were too easy for healthy subjects. The GBPS had generally low reliability coefficients except for the most difficult testing condition (foam pad, eyes closed). Both height and body fat were associated with GBPS scores, necessitating adjusting for these variables if using balance as a predictor of future health.
Current Gerontology and Geriatrics Research 01/2010; 2010:849761.
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ABSTRACT: To investigate the impact of occupational exposure to pesticides, metals, and solvents on mortality.
Middle-aged Japanese-American men (n = 7,540) who had participated in the Honolulu Heart Program during 1965-1968.
Industrial hygienists assessed participants' potential for exposure based on their primary job. Cumulative exposure scores were categorized as none, low, medium, and high. The underlying cause of death was ascertained by a physician panel. All associations were assessed using Cox proportional hazards models.
A total of 4, 485 deaths occurred. Compared to no exposure, pesticide exposure was significantly associated with mortality from all causes, circulatory diseases, stroke, and all cancers. Results for all-cause mortality at the 0-yr lag after risk-factor adjustment were: Low, hazard ratio (HR) = 0.85, 95% confidence interval (CI)=0.68-1.08; medium, HR = 1.18, 95% CI = 1.01-1.37; and high, HR = 1.29, 95% CI = 1.06-1.57; trend, p=0.002. Exposure to metals and solvents was significantly associated with mortality from all causes, cancer, and respiratory disease, and exposure to solvents was additionally associated with mortality from circulatory disease. Associations were strongest at the 15-yr lag.
Results show that occupational exposures to pesticides, metals, and solvents during mid-life are independently associated with increased mortality, and indicate potential importance of exposures that occurred approximately 15 years prior to death.
Work 01/2010; 37(2):205-15. · 0.52 Impact Factor
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Lenna L Liu,
Joyce P Yi,
Jennifer Beyer,
Elizabeth J Mayer-Davis,
Lawrence M Dolan,
Dana M Dabelea,
Jean M Lawrence, Beatriz L Rodriguez,
Santica M Marcovina,
Beth E Waitzfelder,
Wilfred Y Fujimoto
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ABSTRACT: Given limited reports on diabetes among U.S. Asian and Pacific Islander youth, we describe the clinical characteristics, incidence, and prevalence of diabetes among Asian, Pacific Islander, and mixed Asian-Pacific Islander youth.
Data were collected from 245 Asian, Pacific Islander, and Asian-Pacific Islander participants in the SEARCH for Diabetes in Youth Study, a population-based study of diabetes in youth (aged <20 years). Additionally, we estimated the incidence and prevalence of type 1 and type 2 diabetes for Asian, Pacific Islander, and Asian-Pacific Islander youth combined.
Most participants with type 2 diabetes were obese (range Asian 71% to Pacific Islander 100%) with mean BMI >33 kg/m(2). In those with type 1 diabetes, Pacific Islanders were more likely to be obese, with a mean BMI of 26 vs. 20 kg/m(2) for Asian and Asian-Pacific Islander youth (P < 0.0001). The incidence of type 1 diabetes for youth aged 0-9 years was 6.4 per 100,000 person-years and 7.4 per 100,000 person-years for youth aged 10-19 years. The incidence of type 2 diabetes was 12.1 per 100,000 person-years for youth aged 10-19 years.
While Asian and Asian-Pacific Islanders with type 1 and type 2 diabetes had lower mean BMIs than Pacific Islanders, all Asian, Pacific Islander, and Asian-Pacific Islanders with type 2 diabetes had mean BMIs above adult ethnicity-specific definitions of obesity. While the majority of Asian, Pacific Islander, and Asian-Pacific Islander youth had type 1 diabetes, older Asian, Pacific Islander, and Asian-Pacific Islander youth (aged 10-19 years) have an incidence of type 2 diabetes almost double that of type 1 diabetes. Public health efforts to prevent type 2 diabetes and obesity in Asian, Pacific Islander, and Asian-Pacific Islander adolescents are needed.
Diabetes care 03/2009; 32 Suppl 2:S133-40. · 8.09 Impact Factor
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Ronny A Bell,
Elizabeth J Mayer-Davis,
Jennifer W Beyer,
Ralph B D'Agostino,
Jean M Lawrence,
Barbara Linder,
Lenna L Liu,
Santica M Marcovina, Beatriz L Rodriguez,
Desmond Williams,
Dana Dabelea
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ABSTRACT: To investigate the incidence, prevalence, and clinical characteristics of diabetes among U.S. non-Hispanic white (NHW) youth.
Data from the SEARCH for Diabetes in Youth Study (SEARCH study), a multicenter study of diabetes among youth aged 0-19 years, were examined. Incidence rates were calculated per 100,000 person-years across 4 incident years (2002-2005), and prevalence in 2001 was calculated per 1,000 youths. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed an in-person visit.
The prevalence of type 1 diabetes (at ages 0-19 years) was 2.00/1,000, which was similar for male (2.02/1,000) and female (1.97/1,000) subjects. The incidence of type 1 diabetes was 23.6/100,000, slightly higher for male compared with female subjects (24.5 vs. 22.7 per 100,000, respectively, P = 0.04). Incidence rates of type 1 diabetes among youth aged 0-14 years in the SEARCH study are higher than all previously reported U.S. studies and many European studies. Few cases of type 2 diabetes in youth aged <10 years were found. The prevalence of type 2 diabetes (at ages 10-19 years) was 0.18/1,000, which is significantly higher for female compared with male subjects (0.22 vs. 0.15 per 1,000, P = 0.01). Incidence of type 2 diabetes was 3.7/100,000, with similar rates for female and male subjects (3.9 vs. 3.4 per 1,000, respectively, P = 0.3). High levels of abnormal cardiometabolic and behavioral risk factor profiles were common among youth with both type 1 and type 2 diabetes. For example, within each of four age-groups for youth with type 1 diabetes and two age-groups for youth with type 2 diabetes, >40% had elevated LDL cholesterol, and <3% of youth aged >10 years met current recommendations for intake of saturated fat. Among youth aged >or=15 years, 18% with type 1 and 26% with type 2 diabetes were current smokers.
The SEARCH study is one of the most comprehensive studies of diabetes in NHW youth. The incidence of type 1 diabetes in NHW youth in the U.S. is one of the highest in the world. While type 2 diabetes is still relatively rare, rates are several-fold higher than those reported by European countries. We believe efforts directed at improving the cardiometabolic and behavioral risk factor profiles in this population are warranted.
Diabetes care 03/2009; 32 Suppl 2:S102-11. · 8.09 Impact Factor
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ABSTRACT: Arthritis is the most common chronic disease in the elderly. Studies show that rheumatoid arthritis is a risk factor for cardiovascular morbidity and mortality, and osteoarthritis is associated with an unfavorable cardiovascular risk factor profile.
At the Honolulu Heart Program's fourth examination in 1991 to 1993, arthritis status was assessed among a cohort of 3741 Japanese-American males, ages 71 to 93 years. Arthritis was determined by self-report of physician diagnosis, and subjects were divided into two groups: current arthritis and no current arthritis. Eight years of follow-up data are available for incident coronary heart disease (CHD) in 2777 subjects free of CHD at baseline. Age-adjusted rates of incident CHD and means of cardiovascular risk factors were compared in each group. Cox proportional hazards models were used to calculate relative risks, adjusting for common cardiovascular risk factors, alcohol, and use of aspirin or NSAIDs, or both.
There were 279 cases of incident CHD in the cohort over 8 years; in those with arthritis, 11.7% developed incident CHD, compared to 9.8% in those without arthritis (p = 0.24). Age-adjusted rates of incident CHD in those with and without arthritis were 20.5 and 18.0 per 1000 person-years, respectively (p = 0.25). Arthritis was not significantly associated with CHD risk factors. Arthritis was not a significant independent predictor of incident CHD (relative risk, 1.06; 95% CI, 0.74 to 1.51).
Arthritis, and most probably osteoarthritis, may not be associated with most CHD risk factors or 8-year incident CHD in elderly Japanese-American males.
Bulletin of the NYU hospital for joint diseases 02/2009; 67(2):230-5.
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Robert D Abbott,
Hirotsugu Ueshima,
Atsushi Hozawa,
Tomonori Okamura,
Takashi Kadowaki,
Katsuyuki Miura,
Nagako Okuda,
Yasuyuki Nakamura,
Akira Okayama,
Yoshikuni Kita, Beatriz L Rodriguez,
Katsuhiko Yano,
J David Curb
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ABSTRACT: We sought to identify factors related to total mortality in older Japanese men in Japan and Hawaii.
Baseline data were collected from 1980 to 1982 in 1379 men in Hawaii and 954 men in Japan. Ages ranged from 61 to 81 years, with mortality follow-up during a 19-year period.
Compared with Japan, men in Hawaii had a 2-fold excess of diabetes and a 4-fold excess of prevalent coronary heart disease (P < .001). Total cholesterol and body mass index were also greater in Hawaiian men (P < .001). In contrast, men in Japan had greater systolic blood pressure and were nearly 3 times more likely to smoke cigarettes (P < .001). Although each cohort had elements of a poor risk factor profile, there was a 1.4-fold excess in the risk of death in Japan (49.4 vs. 36.2/1,000 person-years, P < .001). Although mortality was similar after risk factor adjustment, only blood pressure and cigarette smoking accounted for the higher risk of death in Japan.
Cigarette smoking and hypertension explain much of the excess mortality in Japan versus Hawaii. In this comparison of genetically similar cohorts, evidence further suggests that Japanese in Japan are equally susceptible to develop the same adverse risk factor conditions that exist in Hawaii.
Annals of epidemiology 01/2009; 18(12):913-8. · 2.95 Impact Factor
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ABSTRACT: Among youth with diabetes mellitus, elevated blood pressure represents one of the most common comorbidities. Hence, exploring dietary factors that may help prevent or control hypertension in this population is of paramount importance. We investigated whether adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with hypertension in youth with diabetes mellitus from the SEARCH for Diabetes in Youth Study. Between 2001 and 2005, 2830 youth aged 10 to 22 years (2440 with type 1 and 390 with type 2 diabetes mellitus) completed a study visit. For each of the 8 DASH food groups, a score of 10 was assigned when the DASH recommendation was met. Lower intakes were scored proportionately, and the 8 individual scores were summed. The association between the overall DASH score and hypertension was evaluated using multiple logistic regression. The crude prevalence of hypertension was 6.8% for youth with type 1 and 28.2% for youth with type 2 diabetes mellitus. In youth with type 1, a higher adherence to DASH was inversely related to hypertension, independent of demographic, clinical, and behavioral characteristics (tertile 2 versus 1: odds ratio: 0.7, 95% CI: 0.5 to 1.0; 3 versus 1: odds ratio: 0.6, 95% CI: 0.4 to 0.9; P(trend)=0.007). For type 2 diabetes mellitus, the DASH diet was not associated with hypertension (tertile 2 versus 1: odds ratio: 0.8, 95% CI: 0.5 to 1.4; 3 versus 1: odds ratio: 0.9, 95% CI: 0.5 to 1.5; P(trend)=0.6). Prospective observational studies or clinical trials are needed to investigate whether adherence to the DASH guidelines may help prevent hypertension in youth with type 1 diabetes mellitus. In type 2 diabetes mellitus, more research with a larger sample is necessary.
Hypertension 12/2008; 53(1):6-12. · 6.21 Impact Factor
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ABSTRACT: High-density lipoprotein cholesterol (HDL-C) and cholesteryl ester transfer protein (CETP) gene deficiency mutations that increase HDL-C levels have been associated with exceptional longevity. However, a recent clinical trial of a promising CETP inhibitor that markedly increases HDL-C was terminated due to increased mortality. In light of this controversy, we examined the relationship among HDL-C, CETP mutations, and longevity phenotypes in the long-lived Japanese-American men of the Honolulu Heart Program (HHP).
Japanese-American men (n = 3562) were followed for up to 8 years, from average age 78 to average age 84 (maximum age 99), or until death. Total mortality, cause-specific mortality, and healthy survival were evaluated for associations with HDL-C level and CETP genetic variants common in the Japanese population (CD442G and Int 14A).
HDL-C was negatively associated with cardiovascular disease (CVD) mortality (p =.002) but not related to non-CVD (p =.147) or total (p =.547) mortality after adjustment for common risk factors. There was a trend for lower mortality for the men with the Int 14A variant. These men also had higher HDL-C levels (p =.047) and were significantly more likely to be healthy survivors (absence of six major age-related diseases and high physical/cognitive function) beyond the age of 90 years (p =.005).
Low HDL-C level is a risk factor for CVD mortality in elderly Japanese-American men. High HDL-C and the Int 14A variant of the CETP gene may increase odds for healthy aging.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 12/2008; 63(11):1235-40. · 4.60 Impact Factor
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Elizabeth J Mayer-Davis,
Bo Ma,
Andrew Lawson,
Ralph B D'Agostino,
Angela D Liese,
Ronny A Bell,
Dana Dabelea,
Lawrence Dolan,
David J Pettitt, Beatriz L Rodriguez,
Desmond Williams
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ABSTRACT: The extent to which cardiovascular disease (CVD) risk factors cluster in youth with a diagnosis of type 1 (T1DM) or type 2 diabetes mellitus (T2DM) is unclear. Therefore, we aimed to evaluate potential clustering of traditional CVD risk factors that may reflect an unmeasured but unifying single pathology that may explain the phenomenon of the metabolic syndrome in these youths.
Youths who participated in the SEARCH for Diabetes in Youth study with diabetes diagnosed <20 years, with current age >10 years (maximum current age, 22 years) were included. Confirmatory factor analysis (CFA) was performed to determine statistical associations among CVD risk factors, including obesity, blood pressure, triglycerides, and high-density lipoprotein cholesterol (HDL-C). Diabetes type was defined by diabetes autoantibodies (DAA) and fasting C-peptide (FCP); type 1 (T1DM, DAA positive, and FCP <0.8 ng/mL, n = 1198) and type 2 (T2DM, DAA negative, and FCP >2.9 ng/mL, n = 95). For T1DM, the sample was split randomly and analyses were conducted separately in each split sample.
Among five prespecified data structures ranging from a single underlying factor to a hierarchical structure of factors, the worst-fitting model for both of the T1DM split samples was the single-factor structure and the best-fitting model was a three-correlated-factor structure. The three correlated factors identified were obesity, lipids, and blood pressure. Results were very similar for youths with T2DM.
There is little evidence that a single factor underlies the CVD risk factor pattern in youths with diabetes. The concept of the metabolic syndrome provides a useful description of clinical characteristics but does not efficiently capture a single target for etiologic research among youths with diabetes.
Metabolic syndrome and related disorders 10/2008; 7(2):89-95.
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Katsuyuki Miura,
Jeremiah Stamler,
Hideaki Nakagawa,
Paul Elliott,
Hirotsugu Ueshima,
Queenie Chan,
Ian J Brown,
Ioanna Tzoulaki,
Shigeyuki Saitoh,
Alan R Dyer,
Martha L Daviglus,
Hugo Kesteloot,
Akira Okayama,
J David Curb, Beatriz L Rodriguez,
Patricia J Elmer,
Lyn M Steffen,
Claire Robertson,
Liancheng Zhao
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ABSTRACT: Findings from observational and interventional studies on the relationship of dietary linoleic acid, the main dietary polyunsaturated fatty acid, with blood pressure have been inconsistent. The International Study of Macro-Micronutrients and Blood Pressure is an international cross-sectional epidemiological study of 4680 men and women ages 40 to 59 years from 17 population samples in China, Japan, United Kingdom, and United States. We report associations of linoleic acid intake of individuals with their blood pressure. Nutrient intake data were based on 4 in-depth multipass 24-hour dietary recalls per person and 2 timed 24-hour urine collections per person. Systolic and diastolic blood pressures were measured 8 times at 4 visits. With several models to control for possible confounders (dietary or other), linear regression analyses showed a nonsignificant inverse relationship of linoleic acid intake (percent kilocalories) to systolic and diastolic blood pressure for all of the participants. When analyzed for 2238 "nonintervened" individuals (not on a special diet, not consuming nutritional supplements, no diagnosed cardiovascular disease or diabetes, and not taking medication for high blood pressure, cardiovascular disease, or diabetes), the relationship was stronger. With adjustment for 14 variables, estimated systolic/diastolic blood pressure differences with 2-SD higher linoleic acid intake (3.77% kcal) were -1.42/-0.91 mm Hg (P<0.05 for both) for nonintervened participants. For total polyunsaturated fatty acid intake, blood pressure differences were -1.42/-0.98 mm Hg (P<0.05 for both) with 2 SD higher intake (4.04% kcal). Dietary linoleic acid intake may contribute to prevention and control of adverse blood pressure levels in general populations.
Hypertension 08/2008; 52(2):408-14. · 6.21 Impact Factor
