60-year Group Research Articles

Obstructive sleep apnea as a risk factor for silent cerebral infarction

Previous studies have suggested that obstructive sleep apnea (OSA) may be a risk factor for stroke. In this study, we assessed that OSA is an independent risk factor of silent cerebral infarction (SCI) in the general population, and in a non-obese population. This study recruited a total of 746 participants (252 men and 494 women) aged 50-79years as part of the Korean Genome and Epidemiology Study (KoGES); they underwent polysomnography, brain magnetic resonance imaging and health screening examinations. SCI was assessed by subtypes and brain regions, and lacunar infarction represented lesions <15mm in size in the penetrating arteries. Moderate-severe OSA was determined by apnea-hypopnea index ≥15. The results indicated that 12.06% had moderate-severe OSA, 7.64% of participants had SCI and 4.96% had lacunar infarction. Moderate-severe OSA was associated positively with SCI [odds ratio (OR): 2.44, 95% confidence interval (CI): 1.03-5.80] and lacunar infarction (OR: 3.48, 95% CI: 1.31-9.23) in the age ≥65-year group compared with those with non-OSA. Additionally, in the basal ganglia, OSA was associated with an increase in the odds for SCI and lacunar infarction in all age groups, and especially in the ≥65-year age group. In the non-obese participants, OSA was also associated positively with SCI in the ≥65-year age group, lacunar infarction in all age groups, and especially in the ≥65-year age group. There was also a positive association with the basal ganglia. Moderate-severe OSA was associated positively with SCI and lacunar infarction in elderly participants. Treatment of OSA may reduce new first-time cerebrovascular events and recurrences.

Relationship between obesity, overweight and physical function in students of Han nationality aged 7 - 18 years in 2010

To study the effects of overweight and obesity on physical function (including systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse, weight vital capacity index) in children and adolescents. The data of 2010 Chinese National Survey on Students Constitution and Health was analyzed. The samples of overweight and normal-weight group were randomly selected from the data by matching gender, urban or rural for getting the same number sample size as obese group (10 601 each group). The students aged 7 - 18 years were classified into 3 groups by BMI percentiles (P₅, P₁₅, P₂₅, P₅₀, P₇₅, P₈₅ and P₉₅), to analyze the change of physical function along with BMI percentile. Compared to the normal-weigh group, SBP of the obese boys of all age groups increased by 8.0 - 12.0 mm Hg, DBP increased by 4.7 - 5.9 mm Hg, while SBP of the obese girls increased by 7.5 - 11.6 mm Hg, DBP increased by 4.7 - 6.1 mm Hg, with statistical significance (P < 0.05). In 13 - 15-year group, pulse of obese boys was 0.8 times/min higher than that of normal-weight. In 16 - 18-year group, pulse of obese boys was 1.1 times/min higher than that of overweight or normal-weight, while pulse of obese girls were 1.5 and 1.7 times/min higher than that of overweight and normal-weight, respectively (P < 0.05). Pulses in boys aged 7 - 9 years when BMI were P₅, P₅₀, P(95) were 87.63, 87.00, 87.83 times/min, and pulses in boys aged 10 - 12 were 85.66, 85.30, 85.43 times/min, respectively. Pulses in boys aged 13 - 15 years when BMI were P₅, P₅₀, P₉₅ were 82.60, 81.39, 82.34 times/min, and pulses in boys aged 16 - 18 years were 80.15, 79.00, 79.98 times/min. In both boys and girls of all age groups, weight vital capacity index had the trend of obese < overweight < normal-weight (P < 0.05). Compared to the normal-weight group, weight vital capacity index of overweight boys decreased by 6.4 - 8.4 ml/kg, that of obese boys decreased by 11.9 - 14.8 ml/kg, while that of overweight girls decreased by 5.3 - 7.7 ml/kg, that of obese girls decreased 11.0 - 11.5 ml/kg. Compared to the normal-weight, overweight and obese children and adolescents had elevated blood pressure, increased pulse, decreased weight vital capacity index.

James Mackenzie Lecture 2011: multimorbidity, goal-oriented care, and equity

![][1] Today we face an important demographic and epidemiological transition, confronting us with the challenge of non-communicable diseases (NCDs), which occur more and more in the context of multimorbidity. In the next decade, multimorbidity will become the rule, no longer the exception: 50% of the those aged ≥65 years have at least three chronic conditions, whereas 20% of the ≥65-year group have at least five chronic conditions.1 In the case of COPD, for example, more than half of the patients have at least one comorbid disease.2 In recent years, not only Western countries, but also developing countries started with ‘chronic disease management-programmes’ to improve care. The design of those programmes include most frequently: strategies for case-finding, protocols describing what should be done and by whom, the importance of information and empowerment of the patient, and the definition of process- and outcome-indicators that may contribute to the monitoring of care. Wagner has described the different components of the Chronic Care Model (CCM) as developed in the context of primary health care.3 The CCM has inspired policy makers and providers all over the world and is widely accepted in the US and Canada, Europe, and Australia. Taking into account the epidemiological transition, we are faced with the question: ‘How will this approach work in a situation of multimorbidity’? Let us illustrate this with a patient from our general practice, we call her ‘Jennifer’ (Box 1). #### Box 1. Jennifer Jennifer is 75 years old. Fifteen years ago she lost her husband. She has been a patient at the practice for 15 years now. During these 15 years she has been through a difficult medical history: hip replacement surgery for osteoarthritis, hypertension, type 2 diabetes, and COPD. She lives independently at home, with some help from her youngest daughter, Elisabeth. I visit her regularly … [1]: /embed/graphic-1.gif

Increasing incidence of glioblastoma multiforme and meningioma, and decreasing incidence of Schwannoma (2000-2008): Findings of a multicenter Australian study

Background:The incidence of primary brain tumors by subtype is currently unknown in Australia. We report an analysis of incidence by tumor subtype in a retrospective multicenter study in the state of New South Wales (NSW) and the Australian Capital Territory (ACT), with a combined population of >7 million with >97% retention rate for medical care.Methods:Data from histologically confirmed primary brain tumors diagnosed from January 2000 through December 2008 were weighted for patient outflow and data completeness, and age standardized and analyzed using joinpoint analysis.Results:A significant increasing incidence in glioblastoma multiforme (GBM) was observed in the study period (annual percentage change [APC], 2.5; 95% confidence interval [CI], 0.4–4.6, n = 2275), particularly after 2006. In GBM patients in the ≥65-year group, a significantly increasing incidence for men and women combined (APC, 3.0; 95% CI, 0.5–5.6) and men only (APC, 2.9; 95% CI, 0.1–5.8) was seen. Rising trends in incidence were also seen for meningioma in the total male population (APC, 5.3; 95% CI, 2.6–8.1, n = 515) and males aged 20–64 years (APC, 6.3; 95% CI, 3.8–8.8). Significantly decreasing incidence trends were observed for Schwannoma for the total study population (APC, –3.5; 95% CI, –7.2 to –0.2, n = 492), significant in women (APC, –5.3; 95% CI, –9.9 to –0.5) but not men.Conclusion:This collection is the most contemporary data on primary brain tumor incidence in Australia. Our registries may observe an increase in malignant tumors in the next few years that they are not detecting now due to late ascertainment. We recommend a direct, uniform, and centralized approach to monitoring primary brain tumor incidence by subtype, including the introduction of nonmalignant data collection.

Colon and rectal cancer in Ibadan, Nigeria: an update

Colorectal cancer was hitherto a rarity in the rural African in general and in Nigerians inclusive. Ibadan is a sprawling city in Western Nigeria with a population of about 2.5 million inhabitants. Lately, several publications from surgeons in this city have alluded to an increase in the number of colorectal cancer cases managed in the teaching hospital. To examine the incidence of this disease over 10 years in order to confirm or exclude the apparent significant increase in colorectal cancer cases in Ibadan, Nigeria. This is a retrospective study highlighting the age, sex, clinical features, operations performed and histopathological subtypes of patients who had surgery for colorectal cancer in the University College Hospital Ibadan between July 1995 and August 2004. Two and sixty-eight patients were seen over 10 years. The male:female ratio was 1.16:1. The mean age was 41 years and the peak age was the 51- to 60-years group. Fourteen per cent of the patients were 30 years and below. Sixty-two per cent of the patients had rectal carcinoma while 33.2% had colonic carcinoma. Around 60.7% of colonic lesions were right-sided. The most common histopathological subtype was adenocarcinoma (78.8%), mucinous adenocarcinoma was 10.8% and signet ring type was 2.6%. Colorectal cancer is a disease on the increase in Ibadan. The mean age of 41 years is much lower than in the Western world. The male:female ratio still favours male patients slightly. About one in seven patients are 30 years and below. Adenomatous polyps were absent in the resected specimens.

Noroviruses as cause of gastroenteritis in elderly patients

Gastroenteritis is one of the infections which are particularly important in elderly people. Knowledge of the main pathogens causing gastroenteritis in this group of patients, whose number will dramatically increase in coming decades, is essential. The contribution of group A rotavirus, adenovirus types 41 and 42, norovirus and astrovirus as causes of gastroenteritis among patients of all ages, especially those with over 65 was evaluated over an extended time period. A total of 4024 fecal samples, collected during seven seasons (October 2000 to September 2007), were tested with a commercial immunoassay (rotavirus) and an "in house" nested RT-PCR (adenovirus, norovirus and astrovirus). Although norovirus was the second most common cause of gastroenteritis (7.9%) in the total population, it was predominant in the age group over the age of 6, causing 7.2% of gastroenteritis in the 6-16-year-old group, 8.6% in the 16-64-year-old group, and 11.1% in the >65-year group (p=0.001). In the last age group, norovirus was the most frequently detected (11.1%), followed by adenovirus (7.4%), astrovirus (3.6%) and rotavirus (3.3%) (p<0.0001). In addition, norovirus was rarely found in association with other viruses. Our data suggest that the elderly are highly vulnerable to certain infections, and indicate the need to introduce simple tests for an early identification of norovirus in cases of gastroenteritis affecting elderly patients, improving patient care by reducing unnecessary treatments and hospital stays.

Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age

Decompressive surgery can be life saving after malignant cerebral infarction. However, severe residual disability occurs in a significant number of surviving patients. Most discussion about the benefits of surgery is based on studies performed in patients who are < or = 60 years of age. Less is known about the benefits of the procedure in the elderly population. The authors undertook a review of the literature on decompressive craniectomy for malignant cerebral infarction and compared the mortality and outcome data published in patients older and younger than 60 years of age. The authors discuss their analysis, with specific reference to the limitations of the studies analyzed, the outcome measures used, and the special considerations required when discussing stroke recovery in the elderly. Studies on decompressive craniectomy for malignant middle cerebral artery infarction reported in the English literature were analyzed. A cutoff point for age of > 60 or < or = 60 years was set, and the study population was segregated. No studies specifically analyzed patients > 60 years old. A total of 19 studies was identified, 10 of which included patients who were > 60 years of age. A comparison between the 2 age groups was made within the 10 studies and also among all the patients in the 19 studies. Mortality rates and outcome scores were assessed for each study, and a Barthel Index (BI) score of < 60 or a modified Rankin Scale (mRS) score of > 3 was considered to represent a poor outcome. Rates were compared using the Fisher exact test, and p values < 0.05 were considered statistically significant. Nineteen studies were found, which included 273 patients undergoing decompressive craniectomy for malignant cerebral infarcts. Ten of these studies included 73 patients (26.7%) who were > 60 years of age. The mean follow-up times ranged from 5.75 to 12.3 months in the > 60-years group and 4.2 to 28 months in the < or = 60-years group. The mortality rate was significantly higher, at 51.3% in the > 60-years group (37 of 72 patients) compared with 20.8% (41 of 197 patients) in the < or = 60-years group (p < 0.0001). Similarly, patients who survived in the > 60-years group had significantly higher rates of poor outcomes, at 81.8% (27 of 33), compared with 33.1% (47 of 142) in the < or = 60-year-old group (p < 0.0001). The BI was the most commonly used primary outcome measure (15 out of 19 studies), followed by the mRS score, which was used in 4 studies. The mortality rate and functional outcome, as measured by the BI and mRS, were significantly worse in patients > 60 years of age following decompressive craniectomy for malignant infarction. Age is an important factor to consider in patient selection for surgery. However, cautious interpretation of the results is required because the outcome scores that were used only measure physical disability, whereas other factors, including psychosocial, financial, and caregiver burden, should be considered in addition to age alone.

Effect of reducing the number of items of the Oral Health Impact Profile on responsiveness, validity and reliability in edentulous populations

The 49-item Oral Health Impact Profile (OHIP) has shown strong responsiveness, reliability and validity. However, the large number of items included may limit its use in clinical trials, clinical practice and surveys. The main objective of this study is to assess the effect of reducing the number of items in each domain, one at a time, on responsiveness, reliability and validity of the OHIP in edentulous populations. Data used in this study were obtained from two randomized clinical trials comparing mandibular implant overdentures and conventional dentures among 102 subjects between 35 and 65 years of age, and 60 subjects over the age of 65 years. Participants were edentulous individuals who wished to replace their current prostheses. Subjects in both trials were asked to complete the 49-item OHIP prior to treatment and at 2 months post-treatment. Within the study, effect sizes were computed at each stage of item reduction using the impact method. Intraclass correlation coefficients and Pearson's correlation coefficients were also assessed at each stage of item reduction. In addition, receiver-operating characteristic (ROC) curves were used to indicate the accuracy with which measurement changes corresponded to judgements of important changes in Oral Health Related Quality of Life (OHRQL). The results indicated that, in general, domain responsiveness was not affected by the reduction of the number of items used per domain. However, there was a decrease in reliability, especially within the 'psychological' and 'social' disabilities and 'handicap' domains (35- to 65-year group). In addition, there was a decrease in construct validity of the 'physical pain', 'psychological' and 'social disabilities' domains (35- to 65-year group), as well as on 'physical pain', 'psychological discomfort', 'physical' and 'psychological' disabilities in the 65-year and older group. This occurred primarily, when reducing from two to one item per domain. Among the 35- to 65-year group, there were consistencies in patients' ratings of the importance of similarly measured changes in oral health. The results indicate that although the 49-item OHIP responsiveness could be maintained with item reduction, this will lead to compromises in reliability and validity.

Genotyping of the JC virus in urine samples of healthy Korean individuals.

A human polyomavirus, JC virus (JCV) is ubiquitous in humans and infects children asymptomatically. It persists in renal tissue and is excreted progeny in urine. DNAs from urine samples of 100 healthy Korean individuals were screened for the presence of JCV by polymerase chain reaction (PCR). Twenty of the samples were positive for JCV. JCV DNA was found in one individual (4%) in the 1-19-year group, two individuals (9%) in the 20-39-year group, ten individuals (38%) in the 40-59-year group, seven individuals (28%) in the over 60-year group. The prevalence of JC viral DNA was the highest in the 40-59-year-old Korean population. To investigate genotypes of JCV in Korea, the genotypes were determined by DNA sequence analysis of the regulatory region (333 bp) and the VT-intergenic region (656 bp) of DNA from the 20 JCV isolates. We have identified three distinctive JCV strains in the regulatory region and ten distinctive JCV strains in the VT-intergenic region of DNA from the 20 isolates. Based on restriction fragment length polymorphism (RFLP) analysis and phylogenetic analysis of the VT-intergenic region of JCV, two distinct subtypes, CY and type 2A (MY), were found to be prevalent in this Korean population. CY and type 2A of JCV were identified in 13 individuals (65%) and four individuals (20%), respectively. Interestingly, type 1, which was distributed mostly in Europe, was found in 3 (15%) isolates from healthy Korean individuals.

Increased Frequency of the C3*F Allele and the Leiden Mutation of Coagulation Factor V in Patients with Severe Coronary Heart Disease Who Survived Myocardial Infarction

The aim of the present study was to compare the frequencies of the F allele of C3 complement component and the Leiden mutation of coagulation factor V in patients with severe coronary heart disease (CHD) who survived myocardial infarction (MI; group A), and those who had no MI in their case history (group B). We have determined the C3 allele frequencies by electrophoresis, and Leiden mutation by PCR in 338 patients with severe CHD and in 490 and 523 healthy controls, respectively. The C3*F allele frequency was significantly (p = 0.006) higher in group A (0.213) that in group B (0.132). A significant (p = 0.045) difference was found between ≤60-year group A (0.077) and group B (0.029) patients in the frequency of Leiden mutation. These findings indicate that the C3*F allele and the Leiden mutation may be associated with an increased risk of developing myocardial infarction in CHD patients.

Childhood and adolescent diabetes mellitus in Arabs residing in the United Arab Emirates

In 9 years (1990–1998), 40 Arab patients between the ages of 0 and 18 years had newly diagnosed diabetes mellitus (DM) at the Al-Ain hospital, United Arab Emirates (UAE). In this cohort, 35 patients had Type 1 DM while the remaining five patients had features of early onset Type 2 DM. For Type 1 DM patients, the mean age at diagnosis of was 9.2±4.1 years. At presentation, their mean plasma glucose was 27.6±11/mmol with 28 (80%) patients having diabetic ketoacidosis (DKA), both being much higher than generally reported in the West. The mean insulin requirement increased from 0.84±0.27 U/kg per 24 h (0–9-year group) to 1.02±0.33 U/kg per 24 h (10–18-year group), P=0.055. The home glucose monitoring and the glycaemic control of these Type 1 DM patients were sub-optimal with 28% of patients having recurrence of DKA. Among the Type 2 DM patients, four (80%) were obese with a positive family history of Type 2 DM. All of them initially responded to diet and oral hypoglycaemic drugs. Public education about DM in childhood and prevention of adolescent obesity remain major public health challenges in the UAE.

Increased immunosuppressive vulnerability in elderly renal transplant recipients.

The results of renal transplantation have improved steadily over the last 10 years. This improvement is in large part attributable to improvements in immunosuppressive pharmacotherapy. Several phase III clinical trials have demonstrated decreased acute rejection rates with relatively little, if any, increase in infectious complications in a broad cross-section of patients (1‐12). It is possible, however, that in certain subpopulations of patients, such as elderly renal transplant recipients, the risk/benefit ratio of acute rejection versus infection may be different from that of the general renal transplant population. If this were the case, the appropriate immunosuppressive regimen for that population should be reconsidered. Renal transplantation is a relatively safe option for renal replacement therapy in elderly patients with end-stage renal disease (ESRD). In 1976, Tersigni et al. (13) reported a series of nine ESRD patients above the age of 60 years successfully treated with renal transplantation. Shortly thereafter, Wedel et al. (14) published a series of 41 geriatric renal transplant recipients, and pointed out that the risk to these patients was not graft loss from rejection but, rather, death with a functioning graft. This author also reported that there was an increased risk for serious infectious complications in the older age group. With the advent of cyclosporine and more selective immunosuppression, the results of renal transplantation improved in high-risk groups, such as elderly patients. In 1989, Pirsch et al (15) concluded that cadaveric renal transplantation with cyclosporine immunosuppression was safe and an effective therapeutic modality in elderly ESRD patients. Subsequent studies have reinforced that concept (16) but have also reinforced the idea that elderly patients have a degree of immune incompetence (17) and require less aggressive immunosuppressive therapy (17). That theory was supported by the continuing observation of lower rejection rates (17, 18) and lower incidence of chronic rejection (18, 19), but higher risk of infections (19, 20) noted in elderly transplant recipients. Reinforcement of the practice of transplantation in elderly patients came from a study that showed significantly greater survival probability in ESRD patients over the age of 60 who received transplants as opposed to matched patients who remained on dialysis (9). Recent data demonstrate a very similar 5-year graft (54 ‐74%) and patient survival (52‐74%), confirming the improvement made but also the concept that most patients in this high-risk group die with functioning grafts (19). In this study, posttransplant morbidity was attributed primarily to infectious complications and an increased prevalence of malignancy (19). We demonstrated previously, in a single-center study, that intensification of immunosuppressive therapy in elderly transplant recipients increased infectious complications without decreasing the incidence of acute rejection or improvement in graft survival (21). Given the above data, it is possible that the vulnerability to immunosuppression of older renal transplant patients may be very different from that of younger patients. To test this hypothesis, we analyzed a large group of renal transplant recipients with regard to their balance of acute rejection versus death due to infection.

Age-related changes of IgE-mediated allergic reaction in patients with late onset asthma--relationship between IgE-mediated allergy and age at onset

We examined age-related changes in the IgE-mediated allergic reaction in patients with late onset asthma, whose asthma first occurred at over 40 years. 1. The number of patients with a high serum IgE level (over 300 IU/ml) was larger in patients with an age of onset between 40 and (40-49 years group) and in patients older than 60 at age of onset (60-year group) than in patients with an age of onset between 50 and 59 (50-59 year group). 2. A positive RAST score to house dust mite (HDm) allergen was more frequently found in the 40-49 year group and in the 60- year group than in the 50-59 year group. Frequency of positive RAST score to HDm in the 50-59 year group was significantly lower (p < 0.01) than in early-onset asthma patients (age at onset less than 39 years). 3 Frequency of family history of asthma in the 50-59 years group was high, being equal to that of early-onset asthma patients. 4 In the 50-59 year group, the frequency of severe asthma was comparatively higher than that of the other groups. The frequency of IgE-mediated allergic reaction changed in regard to age of onset of asthma, and allergic reactions in late-onset asthma partially resembled those of early-onset asthma. These results suggest that an atopic constitution is related to the onset of bronchial asthma in the elderly.

Transcranial color-coded sonography of the basal cerebral circulation. Reference data from 115 volunteers.

Transcranial color-coded sonography is a new development in noninvasive cerebral vascular imaging. Reference data using this technique are described. Blood velocities and pulsatility and resistance indices were determined in the anterior cerebral, middle cerebral, posterior cerebral, vertebral, and basilar arteries in 115 volunteers after correction for the angle of insonation. Of 1265 basal arterial segments, 1053 were insonated (83%). The vertebral (98%), basilar (92%), middle cerebral (84%), and posterior (P1) cerebral arteries (84%) were the most successfully insonated, with the anterior (73%) and posterior (P2) cerebral arteries (72%) the least successfully insonated. Mean and end-diastolic blood velocities decreased significantly with age in all vessels (middle cerebral artery mean velocity: 20 to 39 years, 74 cm/s [71-76]; > 60 years, 58 cm/s [55-61], P < .0001; mean with 95% confidence intervals), and peak systolic velocity decreased significantly except in the posterior (P2) cerebral artery. Blood velocities were higher in women except in the > 60-year group. Velocities showed the least interhemispheric asymmetry in the middle cerebral artery (r = .85 and r = .83, peak and mean velocities, respectively) and the greatest asymmetry in the posterior (P2) cerebral artery (r = .58 and r = .59, peak and mean velocities, respectively). Pulsatility and resistance indices increased significantly with age in all vessels (middle cerebral artery pulsatility index: 20 to 39 years, 0.84 [0.82-0.87], > 60 years, 0.97 [0.93-1.02], P < .0001; middle cerebral artery resistance index: 20 to 39 years, 0.55 [0.54-0.56], > 60 years, 0.62 [0.60-0.64], P < .0001). Transcranial color-coded sonography can image the basal cerebral arteries and distinguish vertebral from basilar artery flow and enables pulsed Doppler interrogation with correction for the angle of insonation.

Employment after spinal cord injury.

The purpose of this study was to compare preinjury and postinjury employment rates in a diverse sample of persons with spinal cord injuries. Several employment variables were compared in individuals grouped into cohorts based on injury level, chronologic age, age at injury, time since injury, and years of education. The study sample (N = 286) was highly educated (mean = 14.2 years of education) and was an average of 18.6 years postinjury. Forty-eight percent of the participants were working at the time of the study, and 75% had worked at some time since injury. Only 12% of the persons who were employed at the time of injury returned to the same job after injury. Several noteworthy findings among the groups were: (1) participants with paraplegia were more likely than those with quadriplegia to return to their preinjury jobs; (2) employment rates were dramatically lower in the 51- to 60-year group; (3) more than 85% of persons in the cohorts who were at least 21 years postinjury had worked at some time since injury; (4) younger age at injury was associated with higher current employment rates; and (5) nearly 95% of all participants with 16 or more years of education had worked at some point since injury. The study results reaffirmed the need for comprehensive rehabilitation, identified the need for retraining several years after injury, and pointed to the role of higher education in producing high employment rates.

Association of hyperglycemia with dietary cyanogen and socio-economic level. The study of rural communities in South-East Nigeria

An association of asymptomatic hyperglycemia with dietary cyanogens and socio-economic level was ascertained in 2,000 volunteers in rural communities in South-East Nigeria. The staples of the poor consisted of one or two bulky carbohydrate meals (derivatives of different species of cocoyam, cassava, yam and maize) eaten with vegetable soup in palm oil, melon seeds, snail, occasional meat and fish. The diet of the high income class included also beans, rice and more animal proteins. Alcohol (mainly palm wine) was consumed only occasionally. The subjects were divided into male and female and were age-matched into various age groups. Anthropometric data of each subject was obtained alongside the family history and socio-economic status. The subjects were further divided into low income vis-a-vis high income groups. All the subjects were normal volunteers, ambulatory, asymptomatic and free from chronic or acute illness. The fasting capillary whole blood glucose (FBG) and 2-h blood glucose following a 75 g oral glucose tolerance test (OGTT) of each subject were measured. The body mass index (BMI) and dental caries scoring of each subject were also determined. The FBG levels and 2-h blood glucose following OGTT were significantly elevated in all subjects particularly in the low income groups except in the under 18-year group. The increases were observed in males and females although glucose levels were lower in the female age group. However, diagnosis of impaired glucose tolerance according to WHO criteria was present in both income groups. The BMI increased as the age increased particularly in the low income groups. There was a strong relationship between age, FBG, IGT and dental caries, respectively in the population. It is concluded that there was strong relationship between poverty, asymptomatic hyperglycemia, and impaired glucose tolerance in the area where cyanogen in diet was higher while there was marginal animal protein in the diet of the poor.