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ABSTRACT: This study was conducted with participants from trials examining the effects of an Iyengar yoga program on cardiovascular disease risk. The objective of the current study was to evaluate the perceived benefits of yoga in a population of older, predominantly overweight adults participating in a gentle 8-week yoga program.
This study used a constructivist-interpretive approach to naturalistic inquiry.
A total of 42 participants completed the intervention and met the inclusion criteria for the current qualitative study.
The 8-week Iyengar yoga program included two 90-min yoga classes and five 30-min home sessions per week. Participants completed weekly logs and an exit questionnaire at the end of the study.
Qualitative data from weekly logs and exit questionnaires were compiled and conventional content analysis performed with the use of ATLAS.ti to facilitate the process.
Four broad themes emerged from content analysis: practicing yoga improved overall physical function and capacity (for 83% of participants); practicing yoga reduced stress/anxiety and enhanced calmness (83% of participants); practicing yoga enriched the quality of sleep (21% of participants); and practicing yoga supported efforts toward dietary improvements (14% of participants).
These results suggest that yoga may have ancillary benefits in terms of improved physical function, enhanced mental/emotional state, enriched sleep quality, and improved lifestyle choices, and may be useful as a health promotion strategy in the prevention and management of chronic disease.
Complementary therapies in medicine 02/2013; 21(1):14-28. · 1.95 Impact Factor
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ABSTRACT: Abstract Background: Restless legs syndrome (RLS) is a common and highly burdensome sleep disorder. While relaxation therapies, including yoga, are often recommended for RLS management, rigorous supporting research is sparse. The goal of this preliminary study was to assess the effects of yoga on RLS symptoms and related outcomes in women with RLS. Methods: Participants were 13 nonsmoking women with moderate to severe RLS, who did not have diabetes, sleep apnea, or other serious concomitant chronic conditions, and who were not pregnant. The intervention was a gentle, 8-week Iyengar yoga program. Core outcomes assessed pre- and post-treatment were RLS symptoms and symptom severity (International RLS Scale [IRLS] and RLS ordinal scale), sleep quality (Medical Outcomes Study Sleep Scale), mood (Profile of Mood States), and perceived stress (Perceived Stress Scale). Participants also completed yoga logs and a brief exit questionnaire regarding their experience with the study. Results: Ten (10) women, aged 32-66 years, completed the study. Participants attended an average 13.4±0.5 (of 16 possible) classes, and completed a mean of 4.1±0.3 (of 5 possible) homework sessions/week. At follow-up, participants demonstrated striking reductions in RLS symptoms and symptom severity, with symptoms decreasing to minimal/mild in all but 1 woman and no participant scoring in the severe range by week 8. Effect sizes (Cohen's d) were large: 1.6 for IRLS total, and 2.2 for RLS ordinal scale. IRLS scores declined significantly with increasing minutes of homework practice per session (r=0.70, p=0.025) and total homework minutes (r=0.64, p<0.05), suggesting a possible dose-response relation. Participants also showed significant improvements in sleep, perceived stress, and mood (all p's≤0.02), with effect sizes ranging from 1.0 to 1.6. Conclusions: These preliminary findings suggest that yoga may be effective in attenuating RLS symptoms and symptom severity, reducing perceived stress, and improving sleep and mood in women with RLS.
Journal of alternative and complementary medicine (New York, N.Y.) 12/2012; · 1.69 Impact Factor
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ABSTRACT: The current study described patterns of yoga practice and examined differences in physical activity over time between individuals with or at risk for type 2 diabetes who completed an 8-week yoga intervention compared with controls.
A longitudinal comparative design measured the effect of a yoga intervention on yoga practice and physical activity, using data at baseline and postintervention months 3, 6, and 15.
Disparate patterns of yoga practice occurred between intervention and control participants over time, but the subjective definition of yoga practice limits interpretation. Multilevel model estimates indicated that treatment group did not have a significant influence in the rate of change in physical activity over the study period. While age and education were not significant individual predictors, the inclusion of these variables in the model did improve fit.
Findings indicate that an 8-week yoga intervention had little effect on physical activity over time. Further research is necessary to explore the influence of yoga on behavioral health outcomes among individuals with or at risk for type 2 diabetes.
Journal of Physical Activity and Health 01/2012; 9(1):53-61.
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ABSTRACT: Objective. To examine the effects of yoga versus an educational film program on sleep, mood, perceived stress, and sympathetic activation in older women with RLS. Methods. Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight, sedentary postmenopausal women. Seventy-five women were randomized to receive either an 8-week yoga (n = 38) or educational film (n = 37) program. All 75 participants completed an RLS screening questionnaire. The 20 women who met all four diagnostic criteria for RLS (n = 10 yoga, 10 film group) comprised the population for this nested study. Main outcomes assessed pre- and post-treatment included: sleep (Pittsburgh Sleep Quality Index), stress (Perceived Stress Scale), mood (Profile of Mood States, State-Trait Anxiety Inventory), blood pressure, and heart rate. Results. The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood, and significantly greater reductions in insomnia prevalence, anxiety, perceived stress, and blood pressure (all P's≤0.05). Adjusted intergroup effect sizes for psychosocial variables were large, ranging from 1.9 for state anxiety to 2.6 for sleep quality. Conclusions. These preliminary findings suggest yoga may offer an effective intervention for improving sleep, mood, perceived stress, and blood pressure in older women with RLS.
Evidence-based Complementary and Alternative Medicine 01/2012; 2012:294058. · 4.77 Impact Factor
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ABSTRACT: Restless legs syndrome (RLS) is a potentially debilitating sleep disorder that affects a significant percentage of North American and European adults. Although standardized RLS diagnostic criteria are now established and widely accepted, reported prevalence estimates have varied widely. In this paper, we review the literature regarding RLS prevalence in North American and Western European adult populations, examine potential sources of variation, briefly discuss the impact of RLS, and offer recommendations for future research.
To identify qualifying studies, we searched 6 scientific databases and scanned bibliographies of relevant review papers and all identified articles. Studies including fewer than 300 participants, that did not use any of the 4 standard diagnostic criteria, were published prior to 1995 or targeted clinical populations were excluded.
Thirty-four papers detailing results of large, population-based studies in 16 North American and Western European countries met our inclusion criteria, including 5 multi-country studies (N=69,992 participants) and 29 single country studies (N=163,188 participants); all but one were cross-sectional. Reported general prevalence rates ranged from 4% to 29% of adults, averaging 14.5±8.0% across studies. Reported prevalence averaged higher in primary care populations than in populations derived from random sampling or geographically defined cohorts (19.5±7.9% vs. 12.3±7.2%). Diagnostic and severity criteria differed considerably among studies, as did inclusion criteria, with corresponding variation in prevalence estimates. Prevalence averaged higher in women and older adults; more limited data suggest race/ethnicity, parity, health status, and other factors may also contribute to the observed variation in prevalence. RLS has profound, negative effects on health, well-being, and quality of life, yet detection rates remain low.
Collectively, these studies indicate that RLS is a common disorder of major clinical and public health significance in the Western industrialized world, affecting between 4% and 29% of adults. The wide variation in reported prevalence likely reflects differences in demographic factors, health status, and other population characteristics; study population source and sampling frame; and inconsistencies in RLS diagnostic criteria and procedures. Prospective studies and corresponding incidence data on RLS are lacking, hindering the evaluation of both causal factors and sequelae.
Sleep Medicine 08/2011; 12(7):623-34. · 3.40 Impact Factor
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ABSTRACT: Restless legs syndrome (RLS) is a distressing sleep and sensorimotor disorder that affects a large percentage of adults in the western industrialized world and is associated with profound reductions in quality of life. However, the etiology of RLS remains incompletely understood. Enhanced understanding regarding both the antecedents and sequelae of RLS could shed new light on the pathogenesis of RLS. Evidence from an emerging body of literature suggests associations between RLS and diabetes, hypertension, obesity, and related conditions linked to sympathetic activation and metabolic dysregulation, raising the possibility that these factors may likewise play a significant role in the development and progression of RLS, and could help explain the recently documented associations between RLS and subsequent cardiovascular disease. However, the relation between RLS and these chronic conditions has received relatively little attention to date, although potential implications for the pathogenesis and treatment of RLS could be considerable. In this paper, we systematically review the recently published literature regarding the association of RLS to cardiovascular disease and related risk factors characterized by sympathoadrenal and metabolic dysregulation, discuss potential underlying mechanisms, and outline some possible directions for future research.
Sleep Medicine Reviews 07/2011; 16(4):309-39. · 6.93 Impact Factor
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ABSTRACT: The study objectives were to ascertain whether a novel educational film class is an acceptable and feasible comparison group for a randomized controlled trial regarding the effects of an active mind-body therapy on cardiovascular disease risk in postmenopausal women.
Seventy-five (75) participants attended a baseline assessment visit and were randomly assigned to either a yoga group or an educational film (control) group. Both groups attended two 90-minute classes/week for 8 weeks, followed by a second assessment visit. Those not attending the second assessment were classified as dropouts. Over 60 films covering a range of topics relevant to the study population were evaluated; 15 were selected by consensus of at least 2 researchers and 1 layperson. Each film session followed the same format: an informal greeting period, viewing of the film, and a 15-minute postfilm discussion. To determine acceptability and feasibility of the film class, potential between-group differences in dropout and attendance were examined, and participant feedback given during class and on end-of-study questionnaires were evaluated.
The relation between group assignment and dropout was not significant (χ(2) [1, N = 75] = 0.14, p = 0.71). One-way analysis of variance (ANOVA) indicated no significant between-group difference in number of classes attended for the yoga (X = 13.67 ± 3.10) versus film group (13.26 ± 1.97), F(1,63) = 0.39, p = 0.53). Participant feedback regarding the film program was positive.
These findings support the feasibility and acceptability of this educational film control. Easy to standardize and tailor to a variety of populations, this film program may offer an attractive alternative to the more traditional educational control.
Journal of alternative and complementary medicine (New York, N.Y.) 05/2011; 17(5):453-8. · 1.69 Impact Factor
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ABSTRACT: Upper respiratory tract infections (URIs) are a common complaint in competitive swimmers and can adversely affect performance. No intervention has yet been shown to reduce URI incidence in intensively trained athletes. The University of Virginia varsity swim team received three weeks of training in qigong for the purpose of reducing stress and improving health. Our primary objective was to assess the relationship between qigong practice and symptoms of URI during a time when swimmers would be at high URI risk. Secondary objectives were to assess degree of compliance with a qigong practice regimen, to evaluate differences between qigong practitioners and non-practitioners, and to determine the response-rate and reliability of a newly developed internet-based, self-report survey. The design was observational, cross-sectional, and prospective. Weekly data on cold and flu symptoms, concurrent health problems and medication use, and qigong practice were gathered for seven weeks. Retrospective information on health and qigong training response was also collected. Participants were 27 of the 55 members of the University of Virginia Swim Team in the Virginia Athletic Department. Main outcomes were measures of aggregated cold/flu symptoms and Qigong practice. Survey completion was 100%, with no missing data, and reliability of the instrument was acceptable. Cold and flu symptoms showed a significant non-linear association with frequency of qigong practice (R(2) = 0.33, p < 0.01), with a strong, inverse relationship between practice frequency and symptom scores in swimmers who practised qigong at least once per week (R(2) = 0.70, p < 0.01). Qigong practitioners did not differ from non-practitioners in demographic or lifestyle characteristics, medical history, supplement or medication use, or belief in qigong. These preliminary findings suggest that qigong practice may be protective against URIs among elite swimmers who practice at least once per week.
The American Journal of Chinese Medicine 01/2011; 39(3):461-75. · 1.98 Impact Factor
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ABSTRACT: To systematically review the peer-reviewed literature regarding the effects of self-administered mind-body therapies on menopausal symptoms.
To identify qualifying studies, we searched 10 scientific databases and scanned bibliographies of relevant review papers and all identified articles. The methodological quality of all studies was assessed systematically using predefined criteria.
Twenty-one papers representing 18 clinical trials from 6 countries met our inclusion criteria, including 12 randomized controlled trials (N=719), 1 non-randomized controlled trial (N=58), and 5 uncontrolled trials (N=105). Interventions included yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy. Eight of the nine studies of yoga, tai chi, and meditation-based programs reported improvement in overall menopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating vasomotor and other menopausal symptoms, although intergroup findings were mixed. Most studies reviewed suffered methodological or other limitations, complicating interpretation of findings.
Collectively, findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Additional large, methodologically sound trials are needed to determine the effects of specific mind-body therapies on menopausal symptoms, examine long-term outcomes, and investigate underlying mechanisms.
Maturitas 02/2010; 66(2):135-49. · 2.77 Impact Factor
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ABSTRACT: It has become increasingly evident that bidirectional ("top-down and bottom-up") interactions between the brain and peripheral tissues, including the cardiovascular and immune systems, contribute to both mental and physical health. Therapies directed toward addressing functional links between mind/brain and body may be particularly effective in treating the range of symptoms associated with many chronic diseases. In this paper, we describe the basic components of an integrative psychophysiological framework for research aimed at elucidating the underlying substrates of mind-body therapies. This framework recognizes the multiple levels of the neuraxis at which mind-body interactions occur. We emphasize the role of specific fronto-temporal cortical regions in the representation and control of adverse symptoms, which interact reciprocally with subcortical structures involved in bodily homeostasis and responses to stress. Bidirectional autonomic and neuroendocrine pathways transmit information between the central nervous system and the periphery and facilitate the expression of affective, autonomic, hormonal, and immune responses. We propose that heart rate variability (HRV) and markers of inflammation are important currently available indices of central-peripheral integration and homeostasis within this homeostatic network. Finally, we review current neuroimaging and psychophysiological research from diverse areas of mind-body medicine that supports the framework as a basis for future research on the specific biobehavioral mechanisms of mind-body therapies.
EXPLORE The Journal of Science and Healing 01/2010; 6(1):29-41. · 1.03 Impact Factor
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ABSTRACT: Osteoarthritis of the knee is a major cause of disability among adults worldwide. Important treatment options include nonpharmacologic therapies, and especially symptom management strategies in which patients take an active role. Among these, mind-body therapies may have particular promise for alleviating the distressful symptoms associated with osteoarthritis of the knee. However, systematic reviews are lacking. The objective of this paper is to review English-language articles describing clinical studies evaluating the effects of patient-driven mind-body therapies on symptoms of knee osteoarthritis. Eight studies, representing a total of 267 participants, met the inclusion criteria. Interventions included tai chi, qigong, and yoga. Collectively, these studies suggest that specific mind-body practices may help alleviate pain and enhance physical function in adults suffering from osteoarthritis of the knee. However, sample sizes are small, rigorous investigations are few, and the potential benefits of several mind-body therapies have not yet been systematically tested. Additional high-quality studies are needed to clarify the effects of specific mind-body therapies on standardized measures of pain, physical function, and related indices in persons with osteoarthritis of the knee, and to investigate possible underlying mechanisms.
Current Rheumatology Reviews 11/2009; 5(4):204-211.
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ABSTRACT: There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus (DM 2). However, systematic reviews are lacking. This article critically reviews the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2. We performed a comprehensive literature search using four computerized English and Indian scientific databases. The search was restricted to original studies (1970-2006) that evaluated the metabolic and clinical effects of yoga in adults with DM 2. Studies targeting clinical populations with cardiovascular disorders that included adults with comorbid DM were also evaluated. Data were extracted regarding study design, setting, target population, intervention, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria. We identified 25 eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4 randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, as well as improvement in specific clinical outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for the prevention and management of cardiovascular complications in this population. However, the limitations characterizing most studies preclude drawing firm conclusions. Additional high-quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs in populations with DM 2.
Evidence-based Complementary and Alternative Medicine 01/2008; 4(4):469-86. · 4.77 Impact Factor
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ABSTRACT: Obesity may be a state of chronic oxidative stress. Oxidative stress may be the mechanism underlying the development of co-morbidities in obesity. This review provides a summary of the available evidence regarding systemic oxidative stress in young, older and clinical obese populations.
Medline was searched for all available articles published between 1975 and 2006 that evaluated oxidative stress biomarkers in resting conditions or following various interventions in overweight and obese humans.
Obesity elevates oxidative stress in young, old and clinical populations as shown by elevations in lipid peroxidation (malondialdehyde, hydroperoxides, 4-hydroxynonenal, isoprostanes, conjugated dienes) or protein oxidation (8-hydroxy-deoxyguanosine). Lipid peroxidation is associated with several indices of adiposity and a low systemic antioxidant defence (i.e. antioxidant enzymes, tissue dietary antioxidants, glutathione). Oxidative stress may be exacerbated with acute exercise, advancing age or co-existing clinical conditions and may be corrected by improving antioxidant defences through fat volume reduction via surgery, pharmacological agents, exercise and/or dietary modification.
Oxidative stress is related to chronic disease in obesity, but is reversible with one or more interventions described above.
Diabetes Obesity and Metabolism 12/2007; 9(6):813-39. · 3.38 Impact Factor
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ABSTRACT: To determine if a tailored yoga program could improve age-related changes in hip extension, stride length, and associated indices of gait function in healthy elders, changes that have been linked to increased risk for falls, dependency, and mortality in geriatric populations.
Single group pre-post test exploratory study. A 3-dimensional quantitative gait evaluation, including kinematic and kinetic measurements, was performed pre- and postintervention. Changes over time (baseline to postintervention) in primary and secondary outcome variables were assessed using repeated-measures analysis of variance.
Yoga exercises were performed in an academic medical center (group classes) and in the subjects' homes (yoga home-practice assignments). Pre- and postassessments were performed in a gait laboratory.
Twenty-three healthy adults (age range, 62-83 y) who were naive to yoga were recruited; 19 participants completed the program.
An 8-week Iyengar Hatha yoga program specifically tailored to elderly persons and designed to improve lower-body strength and flexibility. Participants attended two 90-minute yoga classes per week, and were asked to complete at least 20 minutes of directed home practice on alternate days.
Peak hip extension, average anterior pelvic tilt, and stride length at comfortable walking speed.
Peak hip extension and stride length significantly increased (F1,18=15.44, P<.001; F1,18=5.57, P=.03, respectively). We also observed a trend toward reduced average pelvic tilt (F1,18=4.10, P=.06); adjusting for the modifying influence of frequency of home yoga practice strengthened the significance of this association (adjusted F1,17=14.30, P=.001). Both the frequency and duration of yoga home practice showed a strong, linear, dose-response relationship to changes in hip extension and average pelvic tilt.
Findings of this exploratory study suggest that yoga practice may improve hip extension, increase stride length, and decrease anterior pelvic tilt in healthy elders, and that yoga programs tailored to elderly adults may offer a cost-effective means of preventing or reducing age-related changes in these indices of gait function.
Archives of Physical Medicine and Rehabilitation 09/2005; 86(9):1830-7. · 2.28 Impact Factor
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ABSTRACT: Preeclampsia has been linked to increased risk for cardiovascular disease and, more recently, to reduced risk for breast cancer later in life. The altered chronic disease risk associated with prior preeclampsia may reflect underlying metabolic differences. In this case-control study, we examined the metabolic profiles of older mothers with and without a history of preeclampsia in their first pregnancies. At the time of the study, subjects were non-pregnant, non-smoking women who completed their first pregnancies at age 30 or older, were pre-menopausal, and were free of serious chronic disease. Cases were 13 women who experienced preeclampsia in their first pregnancies; controls were 13 women with uncomplicated first pregnancies, frequency matched to cases on race/ethnicity, current age, and age at delivery. A fasting blood sample was collected from each subject during the luteal phase (day 19-22) of the menstrual cycle and assayed for specific factors thought to be linked to hypertensive disease or breast cancer. Compared to women with uncomplicated pregnancies, those with a history of preeclampsia had significantly elevated levels of fasting serum triglycerides, insulin and glucose, and a higher fasting insulin resistance index, suggesting that women with prior preeclampsia were relatively insulin resistant. In addition, cases had higher levels of insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) and a higher molar ratio of IGFBP-3 to IGF-1 than did controls. Adjustment for obesity and other potential confounders did not appreciably alter the magnitude of these associations. This preliminary study suggests that women with a history of preeclampsia have persistent metabolic abnormalities consistent with their observed excess risk for cardiovascular morbidity and mortality, and their apparent reduced risk for breast cancer later in life.
Gynecologic and Obstetric Investigation 02/2005; 59(4):192-201. · 1.28 Impact Factor
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ABSTRACT: There is growing evidence that perinatal factors associated with altered gestational hormones may influence subsequent breast cancer risk in the mother. Events occurring during the first pregnancy may be particularly important. In this matched case-control study, we investigated the relation between characteristics of a woman's first pregnancy and her later breast cancer risk using linked records from the New York State birth and tumor registries. Cases were 2,522 women aged 22 to 55 diagnosed with breast cancer between 1978 and 1995 and who had also completed a first pregnancy in New York State (NY) at least 1 year prior to diagnosis. Controls were 10,052 primiparous women not diagnosed with breast or endometrial cancer in NY and matched to cases on county of residence and date of delivery. Information on factors characterizing the woman's first pregnancy was obtained from the pregnancy record of each subject. The association of these factors to breast cancer risk was assessed using conditional logistic regression. Extreme prematurity (< 32 weeks gestational age) was associated with elevated maternal breast cancer risk [adjusted odds ratio (OR)=2.1, 95% confidence interval (CI) 1.2,3.9], as were abruptio placentae (OR = 1.8, CI 1.1,3.0) and multifetal gestation (OR=1.8, CI 1.1,3.0). Preeclampsia was associated with a marked reduction in breast cancer risk among women who bore their first child after age 30 (OR=0.3, CI 0.2,0.7) and in the first 3 years after delivery (OR=0.2 (0.1-0.9). These findings suggest that certain perinatal factors influence maternal breast cancer risk and offer indirect support for a role of gestational hormones, and particularly gestational estrogens, in the etiology of breast cancer.
International Journal of Cancer 11/2004; 112(2):306-11. · 5.44 Impact Factor
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ABSTRACT: Studies have linked low birth weight to elevated risk for adult hypertension and insulin resistance. However, the relation between birth weight and later risk for pregnancy-induced hypertension (PIH), a disorder associated with insulin resistance and predictive of chronic hypertension, has not been well studied. This case-control study used linked hospital discharge and vital record data from New York State. Subjects were healthy women born in New York State who completed a first pregnancy there between 1994 and 1998. Records from each woman's own birth (1970-1985) were linked to those from her first pregnancy. Cases were 2,180 women diagnosed with PIH. Controls were the 22,955 remaining women with no record of PIH. Birth weight showed a U-shaped relation to risk for PIH, with the highest risks associated with very low and very high birth weights. Relative to women born at 3.5-4.0 kg, odds ratios adjusted for gestational age were 2.1 (95% confidence interval (CI): 1.1, 3.9) and 1.6 (95% CI: 1.1, 2.4), respectively, for women with birth weights less than 1.5 kg and greater than 4.5 kg. Adjustment for other perinatal factors reduced the association with high birth weight to 1.1 (95% CI: 0.7, 1.7) but strengthened that with lower birth weights, leaving a strong, inverse relation between birth weight and PIH risk (p for trend < 0.0001). These findings support a possible role for early life factors, particularly fetal growth, in the etiology of PIH.
American Journal of Epidemiology 12/2003; 158(9):861-70. · 5.22 Impact Factor
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ABSTRACT: Several studies have reported links between reduced fetal growth and subsequent risk for type 2 diabetes among older adults, but the association between indices of fetal growth and gestational diabetes mellitus (GDM), a major complication of pregnancy and a strong predictor of type 2 diabetes, remains little explored.
To test the hypothesis that a woman's own fetal growth is inversely related to her later risk for GDM.
Case-control study of linked hospital discharge and vital record data from the New York State Department of Health.
Healthy women who completed their first pregnancies in New York State between 1994 and 1998 and who were also born in New York State. Records from each woman's first pregnancy were linked to those from her own birth (1970-1985). Cases were 440 women with a record of GDM. Controls were 22 955 remaining women with no indication of GDM.
A woman's own birth weight, alone and adjusted for gestational age.
Birth weight showed a U-shaped relationship to a woman's risk of GDM in her first pregnancy, with the highest risks associated with low and high birth weights. Odds ratios (ORs) adjusted for gestational age were 2.16 (95% confidence interval [CI], 1.04-4.50) for birth weight of less than 2000 g and 1.53 (95% CI, 1.03-2.27) for a birth weight of 4000 g or more. Adjustment for potential confounding factors, particularly prepregnancy body mass index and maternal diabetes, increased the OR for low birth weight to 4.23 (95% CI, 1.55-11.51), but reduced the OR for high birth weight to 0.92 (95% CI, 0.54-1.57), leaving a strong inverse dose-response relationship between birth weight and risk of GDM (adjusted P for trend <.001).
In this large population-based study, a woman's own birth weight was strongly and inversely related to her risk of GDM, suggesting that early life factors may be important in the etiology of this disorder.
JAMA The Journal of the American Medical Association 05/2002; 287(19):2534-41. · 30.03 Impact Factor
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ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death and disability in the industrialized world, and its prevalence is rapidly increasing among developing nations. The increasing global prevalence of CVD reflects in part the concurrent rise in insulin resistance, obesity, dyslipidemia, and other atherogenic changes associated with insulin resistance syndrome (IRS). Evidence suggests that chronic stress and related psychosocial factors also play an important role in the development and progression of IRS-related states and ultimately, in the pathogenesis of CVD. Designed to address these interrelated psychological and physiological components of health, yoga and other traditional mind-body therapies may offer particular promise in both the primary and secondary prevention of CVD. In this article, we review the evidence regarding the potential benefits of specific mind-body modalities for CVD risk reduction and discuss possible mechanisms underlying these observed effects.
Alternative therapies in health and medicine 13(5):44-51. · 1.77 Impact Factor
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ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death and disability in the industrialized world, and the prevalence is increasing rapidly among developing nations. The rising prevalence of CVD worldwide may be attributed in large part to specific atherogenic changes in insulin resistance, adiposity, lipid profiles, and other indices of insulin resistance syndrome (IRS), a cluster of metabolic and hemodynamic abnormalities that are strongly predictive of CVD. A growing body of research suggests that chronic psychosocial stress and related factors significantly contribute to the pathogenesis of IRS-related abnormalities, associated insulin-resistant states, and CVD, in part by promoting dysregulation of the sympathoadrenal system and hypothalamic-pituitary-adrenal axis. In this article, we review the literature supporting the relationships between these factors, outline the neurophysiologic responses to chronic stress, and discuss the pathways by which chronic or recurrent psychosocial stress may lead to a destructive cascade of neuroendocrine, metabolic, inflammatory, and neuropsychological changes that fosters the development of IRS and, ultimately, CVD.
Alternative therapies in health and medicine 13(4):46-52. · 1.77 Impact Factor
