Corresponding Values For Women Research Articles

Gender-Specific Health-Adjusted Life Expectancy of Type 2 Diabetes Mellitus Among the Rural Elderly Population.

Objectives: This study aimed to estimate the life expectancy (LE) and health-adjusted life expectancy (HALE) of type 2 diabetes mellitus (T2DM) among the rural elderly population. Methods: A total of 10,318 participants aged 65 to 79 were derived from the Henan Rural Cohort. The LE and HALE were calculated via the Sullivan method and multistate life table. Results: Among 10,318 subjects, 1,325 suffered from T2DM at the baseline, and 394 participants had newly-developed T2DM. The results from the Sullivan method showed that the LE, HALE, and HALE/LE were 17.98, 16.18years, and 89.95% for men aged 65 to 69, and the corresponding estimates for women were 21.81, 18.73years, and 85.86%, respectively. The LE, HALE and HALE/LE calculated via multistate life table were 19.86, 17.53years, and 88.29% for men at aged 65, and the corresponding values for women were 25.01, 20.87years, and 83.44%, respectively. Conclusion: Rural elderly women have a longer LE and HALE of T2DM, but they have lower quality of life than men. More attention should be paid to T2DM among rural elderly people, especially in women. Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Gender differences in the impact of 3-year status changes of metabolic syndrome and its components on incident type 2 diabetes mellitus: a decade of follow-up in the Tehran Lipid and Glucose Study.

The aim of this study was to examine the gender differences in the association between status changes of metabolic syndrome (MetS) and its components, using Joint Interim Statement (JIS) criteria, with the risk of type 2 diabetes mellitus (T2DM) among an urban population. The study included 4,463 Iranian adult participants (2,549 women) aged ≥20 years. Based on status changes of MetS and its components during 3 years, subjects were categorized into four groups: MetS-free (reference), MetS-developed, MetS-recovery, and MetS-stable. A similar categorization was applied to MetS components. Multivariable Cox regression models were used for estimating hazard ratios (HRs) and women-to-men ratios of HRs (RHRs). During a median follow-up of 9.3 years, 625 T2DM events (351 women) occurred. Compared with the reference, the HRs of the MetS-developed, -recovery, and -stable groups among men for incident T2DM were 2.90, 2.60, and 4.92; the corresponding values for women were 2.73, 2.88, and 5.21, respectively (all p-values < 0.01), without significant gender difference in these relationships. In both genders, the fasting plasma glucose (FPG) component, regardless of the change in status, was strongly and significantly associated with incident T2DM with HRs ranging from 2.49 to 9.42; a similar association was also found for high waist circumference (WC)-recovery and -stable groups, with HRs ranging from 1.58 to 2.85 (p-values ≤ 0.05). Regarding gender differences, the development and persistence of high blood pressure (BP) status exposed men to greater T2DM risk than women with women-to-men RHRs of 0.43 (0.26-0.72) and 0.58 (0.39-0.86), respectively. Moreover, stable low levels of high-density lipoprotein cholesterol (HDL-C) and high triglyceride (TG) levels conferred higher T2DM risk in women than in men, with women-to-men RHRs of 1.67 (0.98-2.86) and 1.44 (0.98-2.14), respectively (both p-values = 0.06). Among Tehranian adults, in both genders, all status changes of MetS, even those recovered from MetS, have a higher risk of T2DM compared to those who never had MetS. Also, all statuses of high FPG, in addition to recovered and stable high WC, were strongly associated with T2DM risk. Specifically, men with stable or developed high BP and women with stable dyslipidemic status were at differentially increased risk of incident T2DM.

Role of mode of induction and delivery and women’s satisfaction after induction of labour at term: An observational study

This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman’ satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible for the study. The questionnaire investigated women’s opinion regarding information about induction, pain control, length of induction, their experience about induction, labour and delivery and their attitude towards induction in a subsequent pregnancy. Women were also asked to fill in the Italian version of the Birth Satisfaction Scale-Revised (BSS-R).A total of 300 women entered the study. The answer to the question about a “positive attitude towards induction in a subsequent pregnancy was “absolutely yes” or “yes” respectively in the 77.8%, 52.8% and 48.6% of women who were induced with oral drugs, vaginal drugs and Cook balloon (heterogeneity chi-square p = 0.05). The corresponding values for women who delivered vaginally or by caesarean section (CS) were 63.3% and 36.4% (chi-square p = 0.0009). The mean BSS-R total score was higher among women who underwent IOL with oral drugs than with vaginal drugs (p < 0.0001) or Cook Balloon (p < 0.0001), and among women who delivered vaginally than in those who delivered by CS (p < 0.0001). Women were asked “What do you think is important for a method of induction?”: 47.3% (95% CI 41.7%-53.0%) of women answered that “should make the induction as painless as possible”, 47.0% (95% CI 41.4%-52.7%) “should induce labour quickly”, 44.3% (95% CI 38.8%-50.0%) “should be safe for baby”.This study showed that vaginal delivery was associated with a higher rate of satisfaction among induced women. Considering mode of induction, oral drugs were associated with a higher level of satisfaction. Control of pain and quick induction were the most appreciated characteristics.

Association of ideal cardiovascular health metrics and incident type 2 diabetes mellitus among an urban population of Iran: One decade follow up in the Tehran Lipid and Glucose Study.

Aims/IntroductionTo evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident type 2 diabetes mellitus among Iranian men and women.Materials and MethodsThe study population included 7,488 Iranian adults aged ≥20 years (4,236 women) free from diabetes at baseline. The ICVHM was defined according to the American Heart Association's 2020 impact goals. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) for ICVHM both as continuous and categorical variables.ResultsOver the median of 9.1 years of follow‐up, we identified 922 new cases of type 2 diabetes mellitus (526 women). Body mass index <30 kg/m2, untreated systolic/diastolic blood pressure <120/80 mmHg in both sexes, and physical activity ≥1,500 MET min/week (only among men) were significantly associated with a lower risk of type 2 diabetes mellitus. Each additional unit in the ICVHM was associated with a 21 and 15% lower risk of type 2 diabetes mellitus in men and women, respectively (P‐values <0.05). Compared with participants having poor cardiovascular health, the HR for type 2 diabetes mellitus risk was 0.69 (95% confidence interval [CI] 0.56–0.85) and 0.35 (95% CI 0.21–0.59) for men with intermediate and ideal CVHM, respectively. The corresponding values for women were 0.79 (95% CI 0.65–0.97) and 0.30 (95% CI 0.15–0.60), respectively. In a subpopulation with nutritional data (n = 2,236), ideal and intermediate nutritional status was associated with 83 and 77% lower risk of type 2 diabetes mellitus only among women (P‐values <0.05).ConclusionWe found a strong inverse association between having higher global ICVHM with incident type 2 diabetes mellitus; which is mainly attributable to normal blood pressure, normal body weight, and intensive physical activity (only for men).

Burden of Cancer Due to Cigarette Smoking and Alcohol Consumption in Korea

This study aimed to estimate the burden of cancer in Koreans attributable to smoking and alcohol consumption using disability-adjusted life years and population attributable fractions. We estimated the burden of 12 cancers due to simultaneous and independent smoking and alcohol exposure in Koreans aged ≥40 years. In men, the cancer burden attributable to the combined risk factors, smoking alone, and alcohol consumption alone were 9.5, 14.8, and 6.1%, respectively; the corresponding values for women were 1.1, 2.5, and 2.7%, respectively. In men, tracheal, bronchial, and lung cancers were the most common cancer types. The disease burden may have been reduced by 16.8, 32.3, and 4.1% in the absence of the combined risk factors, smoking alone, and alcohol consumption alone, respectively. Our findings suggest that risk factor-based intervention may have the greatest preventative effect for lung cancer among all cancers in men. Our real-world data methodology could provide further evidence-based methods to explore and facilitate effective health promotion interventions for specific target groups and may lay the foundation for the establishment of healthcare services according to population subgroups or regional characteristics.

Development and validation of the EHS-COPD model to predict sex-specific risk of chronic obstructive pulmonary disease (COPD) in older Chinese adults: Hong Kong's Elderly Health Service Cohort.

BackgroundNo screening program is recommended for chronic obstructive pulmonary disease (COPD) in adults based on current clinical practice guidelines. Risk prediction models for COPD developed in Western settings may not be directly applicable to older Chinese adults. To evaluate the performance of an existing risk prediction model for COPD developed in a Western setting in Chinese adults and investigate whether a new risk prediction model performs better in predicting 5-year risk of COPD (EHS-COPD).MethodsThis study is based on 135,822 participants aged 65+ years from Hong Kong’s Elderly Health Service (EHS) cohort. We assessed the performance of an existing risk prediction model in the entire cohort, and in a random sub-sample of 91,133 participants, we recalibrated the existing model and derived a new model using extended Cox proportional hazards regression. Candidate risk predictors from the literature and the EHS cohort were considered for inclusion. Risk prediction performance, discrimination, and calibration of the newly derived models were assessed in the remaining 44,689 participants.ResultsThe existing risk prediction model overestimated the 5-year risk of COPD in older Chinese adults (65+ years); after recalibration, it still overestimated the 5-year risk of COPD for both men and women. The new EHS-COPD risk prediction model, including time-varying factors (i.e., age and smoking status) and time-invariant factors (i.e., education level, public assistance, alcohol use, body mass index, physical activity, existing hypertension, recent falls, cognitive function, and self-rated health status), had an improved performance. For men, EHS-COPD explained 19.5% of COPD risk, the D statistic was 23.1, and Harrell’s C statistic was 0.93. The corresponding values for women were 8.5%, 21.1, and 0.93.ConclusionsThe existing COPD risk prediction model overpredicted COPD risk in older Chinese and could not be recalibrated to predict well. A revised prediction model using time-invariant and time-varying factors provides a better tool for identifying older Chinese adults at high risk of developing COPD.

Effect of Chamomile Oil on Cesarean Section Pain in Primiparous Women: A Randomized Clinical Trial

Pain after cesarean section can turn the pleasant event of childbirth into an unpleasant experience for the mother. Pain relief through non-pharmaceutical methods, such as aromatherapy, could potentially be a useful intervention. In this study, the analgesic effect of chamomile oil was studied. The current research was conducted to study the effect of chamomile oil on cesarean section pain in primiparous women. This was a randomized, double-blind clinical trial wherein 128 primiparous pregnant women (who willingly selected cesarean section) took part. In the aromatherapy group, the subjects inhaled one drop of 5% chamomile oil, and in the control group, the subjects inhaled one placebo drop. In both groups, the subjects inhaled for 15-20 minutes at a distance of 5 cm from the nose at 4, 8, and 12 hours after surgery, and pain intensity was measured half an hour before and after inhalation using the Visual Analog Scale (VAS). For data analysis, the software SPSS (version 25) and descriptive statistics (frequency, frequency percentage, mean, and standard deviation) were used. In order to determine the significance, inferential statistics (Mann-Whitney, Wilcoxon, independent t-test, and Chi-square) were used. Data indicated that the intervention and placebo groups were homogeneous in terms of demographic variables. The average weights and heights of women in the intervention group were 86/5± 5/9 and 163/7 ±5/1, respectively. Corresponding values for women in the control group were 84/5± 5/7 kg and 163/4± 5/8 cm. The finding of the current research indicates that the intervention and placebo groups showed no significant statistical difference in terms of baseline pain before intervention (p=0.08), while the difference between the two groups was significant in terms of pain, 4, 8, and 12 hours after the intervention (p<0.01). Therefore, inhalation of chamomile oil reduced pain intensity significantly compared to post-intervention. According to the results of the present study, inhalation of chamomile oil following the cesarean sectionin primiparous women reduced pain and also the need for analgesics. Therefore, the use of aromatherapy with chamomile oil as a simple way without any side effects for the reduction of pain in mothers after the cesarean section is recommended.

Where should the safe limits of alcohol consumption stand in light of liver enzyme abnormalities in alcohol consumers?

ObjectivesTo estimate the prevalence and risk factors for abnormal liver enzymes in a large age- and gender stratified population-based sample of apparently healthy individuals with or without alcohol consumption and other health-related risk factors (adiposity, physical inactivity, smoking).MethodsData on alcohol use, smoking, diet and physical activity were recorded using structured questionnaires from 13,976 subjects (6513 men, 7463 women, aged 25–74 years) in the national FINRISK studies. Alcohol data was used to categorize the participants into abstainers, light drinkers, moderate drinkers and heavy drinkers. Serum gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT) activities were measured using standard kinetic methods.ResultsMale light drinkers, moderate drinkers and heavy drinkers showed significantly higher relative risks of abnormal GGT than abstainers: 1.37 (95% confidence interval 1.11 to 1.71, p < 0.01), 2.72 (2.08 to 3.56, p < 0.0005), and 6.10 (4.55 to 7.17, p < 0.0005), respectively. Corresponding values for women were 1.22 (0.99 to 1.51, p = 0.065), 1.90 (1.44 to 2.51, p < 0.0005), and 5.91 (3.80 to 9.17, p < 0.0005). Estimated threshold doses for a significant GGT elevation was 14 standard weekly alcohol doses for men and 7 for women. Excess body weight and age over 40 years modulated the thresholds towards smaller quantities of alcohol. The risk of abnormal GGT was also significantly influenced by physical inactivity and smoking. The relative risks of abnormal ALT activities were increased in male heavy drinkers, especially in those presenting with adiposity and sedentary lifestyle.ConclusionsAlcohol use markedly increases the risk for abnormal liver enzyme activities in those presenting with age over 40 years, obesity, smoking or sedentary lifestyle. The data should be considered in public health recommendations and in the definitions of safe limits of alcohol use.

New Records in Human Power.

Maximal aerobic and anaerobic power are crucial performance determinants in most sport disciplines. Numerous studies have published power data from elite athletes over the years, particularly in runners, cyclists, rowers, and cross-country (XC) skiers. This invited review defines the current "world records" in human upper limits of aerobic and anaerobic power. Currently, [Formula: see text]max values of ∼7.5 and 7.0L·min-1 in male XC skiers and rowers, respectively, and/or ∼90mL·kg-1·min-1 in XC skiers, cyclists, and runners can be described as upper human limits for aerobic power. Corresponding values for women are slightly below 5.0L·min-1 in rowers and XC skiers and ∼80mL·kg-1·min-1 in XC skiers and runners. Extremely powerful male athletes may reach ∼85W·kg-1 in countermovement jump (peak vertical power) and ∼36W·kg-1 in sprint running (peak horizontal power), cycling (instantaneous power during force-velocity testing from a standing position), and rowing (instantaneous power). Similarly, their female counterparts may reach ∼70W·kg-1 in countermovement jump and ∼30W·kg-1 in sprint running, cycling, and rowing. The presented values can serve as reference values for practitioners and scientists working with elite athletes. However, several methodological considerations should be taken into account when interpreting the results. For example, calibrated apparatus and strict procedures are required to ensure high measurement validity and reliability, and the sampling rate for anaerobic power assessments must be strictly predetermined and carefully measured. Doping is also a potential confounding factor when interpreting the human upper limits of aerobic and anaerobic power.

Gender, High-Sensitivity Troponin I, and the Risk of Cardiovascular Events (from the Nord-Trøndelag Health Study)

Gender is an important determinant of cardiovascular risk, and men generally develop cardiovascular disease earlier than women. Increased levels of high-sensitivity cardiac troponin I (hs-TnI) have been shown to be predictive of cardiovascular death, with stronger effects in women. However, it remains unclear whether the stronger association between hs-TnI and cardiovascular death in women is based on the ability of hs-TnI to predict myocardial infarction (MI) or heart failure (HF). Accordingly, we aimed to assess the influence of gender on the association between levels of hs-TnI and incident MI and HF. hs-TnI was measured in 5,060 women and 4,054 men participating in the prospective observational Nord-Trøndelag Health Study using the Architect STAT High-Sensitive Troponin assay. All subjects were free from known coronary heart disease at baseline. After a median follow-up of 5,105 and 6,169days, 292 MIs and 209 admissions for HF were registered, respectively. In our total cohort, hs-TnI was associated with the incidence of both end points, with adjusted hazard ratio per 1 SD in log hs-TnI 1.19 (95% CI 1.02 to 1.39) for MI and 1.58 (1.38 to 1.82) for HF. The corresponding values for women and men were 1.35 (1.02 to 1.78) versus 1.13 (0.93 to 1.38) for MI and 1.55 (1.26 to 1.91) versus 1.61 (1.36 to 1.90) for HF. The C-index for hs-TnI was stronger for women than men for MI (p<0.001), and no such difference was observed for HF (p= 0.06). In conclusion, in the general population, the association between hs-TnI concentrations and MI is stronger in women than in men. For HF, the impact of gender on the prognostic value of hs-TnI is less pronounced. Increased levels of troponin I in women may thus reflect an adverse phenotype more prone to the development of cardiovascular disease.

Abstract P084: Cardiovascular Disease Burden in African Americans: The Jackson Heart Study

Background: African Americans (AA) bear an excess burden of CVD compared to Whites. This burden persists when socioeconomic status (SES) and other known CVD risk factors are considered. One limitation to studies of Black-White disparities in CVD is that population subgroups with lower SES may be over-represented among AA compared to Whites. We aimed to quantify CVD burden in the Jackson Heart Study (JHS), an exclusively AA cohort with a balanced representation of SES. Methods: Baseline distributions of SES indicators in 5,301 JHS participants were compared to the US 2000 Census data. Baseline prevalence of myocardial infarction (MI), stroke and hypertension were compared to the National Health and Nutrition Examination Survey (NHANES) data collected during a comparable time period as the JHS baseline exam (2000-2004) (population reference including all races). Indirect standardization methods based on population age and sex specific prevalence were used to calculate the expected prevalence of MI, stroke and hypertension in the JHS. Standardized prevalence ratios (SPR) was calculated by dividing the observed by the expected prevalence. An SPR greater than 1 indicates excess burden. Results: Compared to national data, JHS participants were more likely to have some college education (61% vs. 52%) or a bachelor’s degree (32% vs. 24%), were more likely to hold management or professional occupations (36% vs. 34%), but had somewhat lower income, which could be in part due to a higher proportion (64%) of women in the JHS cohort. The observed baseline prevalence of MI, stroke and hypertension in JHS was 5.5%, 4.4% and 60.1%. The SPR for MI, stroke and hypertension were 1.05 (95% CI 0.88, 1.25), 1.39 (95% CI 1.12, 1.69) and 1.51 (1.42, 1.60) for men. The corresponding values for women were 1.61 (95% CI 1.37, 1.89), 1.33 (95% CI 1.12, 1.57) and 1.43 (95% CI 1.37, 1.50). Further analyses evaluating CVD risk factors (smoking, weight, physical activity, serum cholesterol, blood pressure and diabetes) found excess burden in overweight/obesity, physical inactivity, elevated blood pressure (≥140/90 mmHg), and diabetes among JHS participants compared to the population reference. Conclusions: We found an excess burden for stroke and hypertension in men, and an excess burden for MI, stroke and hypertension in women in the JHS. We also found an excess burden for CVD risk factors in the JHS cohort. Despite comparable SES between JHS and US population, we found an excess burden of CVD and CVD risk factors in this AA cohort.

Prehypertension Tsunami: A Decade Follow-Up of an Iranian Adult Population.

ObjectivePrehypertension is associated with cardiovascular disease (CVD). There is no study to examine the incidence and risk factors of prehypertension in a sex stratified setting. The aim of this study was to examine the effect modification of sex for different risk factors which predicts the progression from normotension to prehypertension in a Middle East population-based cohort, during a median follow-up of 9.2 years.MethodsA multivariate Cox analysis was performed among 1466 and 2131 Iranian men and women, respectively, who were free of prehypertension, hypertension, CVD and diabetes at baseline and free of incident hypertension without preceding prehypertension at follow-up. Incident prehypertension at follow-up was defined as systolic blood pressure (SBP) of 120–139 mmHg and/or diastolic blood pressure (DBP) of 80–89 mmHg.ResultsOverall, 1440 new cases of prehypertension were identified resulting in an incidence rate of 593/10000 person-years; the corresponding values for women and men were 489/10000 and 764/10000person-years, respectively. There were significant interactions between gender with age, DBP, waist-to-hip-ratio (WHpR) and estimated glomerular filtration rate (eGFR) (all P-values <0.05) in multivariate analysis. Strong associations were found between age, body mass index (BMI) and SBP with incident prehypertension in both genders. However, the effect of DBP and WHpR was significant among women and 2-hour post challenge plasma glucose (2h-PCPG)was an independent risk factor for men. In the sex-adjusted analysis, glomerular hyperfiltration [Hazard ratio (HR) and 95%CI: 1.01 (1.00–1.01), P-value = 0.02], age, BMI, WHpR, SBP and DBP had higher risks while being female [HR (95%CI): 0.81(0.69–0.94), P-value = 0.01] had a lower risk for incident prehypertension.ConclusionAccording to this study results, among Iranian population with high incidence of prehypertension, general adiposity and glomerular hyperfiltration in total, 2h-PCPG in men and central adiposity in women should be emphasized as risk factors for prehypertension.

Prevalence and changes over time of ideal cardiovascular health metrics among African–Americans: The Jackson Heart Study

ObjectivesThe aim of this study is to assess the prevalence and changes over time of ideal Life's Simple Seven (LSS) in African–Americans. MethodsProspective cohort of 5301 African–Americans from the Jackson Heart Study (JHS) from 2000 to 2013. Each of the LSS metrics was categorized as poor, intermediate, or ideal. ResultsAmong men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal LSS was 3.3%, 23.0%, 33.5%, 24.7%, 11.6%, 3.6%, 0.3%, and 0%, respectively. Corresponding values for women were 1.7%, 26.3%, 33.1%, 22.8%, 11.9%, 3.7%, 0.6%, and 0%. Prevalence of ideal diet was 0.9%. The proportions of those meeting LSS ideal recommendations for cholesterol and fasting glucose declined from the first through third JHS visits across all age groups, whereas prevalence of ideal BMI declined only in participants <40years at a given visit. Prevalence of ideal blood pressure did not change over time and being ideal on physical activity improved from the first [18.3% (95% CI: 17.3% to 19.3%)] to third visit [24.8% (95% CI: 23.3% to 26.3%)]. ConclusionsOur data show a low prevalence of ideal LSS (especially diet, physical activity, and obesity) in the JHS and a slight improvement in adherence to physical activity recommendations over time.

OP77 Socio-economic status, comorbidity, and one-year mortality in patients with diabetes in Scotland 2004–2011

Background Previous studies have observed higher mortality among deprived individuals with type 2 diabetes mellitus (T2DM) than among people with T2DM from more affluent backgrounds. This differential mortality may reflect, inter alia, socially-patterned variation in levels of comorbidity (clinical conditions additional to diabetes). The study reported here sought to establish whether socio-economic status (SES) and comorbidity exert independent effects on mortality at one year after diagnosis with T2DM. Methods Data for 71,334 men and 57,853 women diagnosed with T2DM in Scotland at ages 25 and above during 2004–2011 were obtained from a national diabetes register. Hospital discharge records covering the period 20 years prior to T2DM diagnosis were used to derive patients’ historic burden of comorbidity as defined by the Charlson Comorbidity Index (CCI), an established measure of comorbidity. Socio-economic status was represented by the Scottish Index of Multiple Deprivation (SIMD), a small-area based measure of SES. A logistic regression model was fitted in which survival at one year after T2DM diagnosis was predicted initially by age and CCI; the model was then augmented with the addition of SES (represented by quintiles of the distribution of SIMD). Values of the discrimination index (representing the area under the Receiver Operating Characteristic [ROC] curve) were obtained for models without and with SIMD quintile, to establish whether addition of SES materially improved the prediction of one-year mortality. Separate models were fitted for each sex. Results There were 1703 deaths in men and 1502 deaths in women. Proportions of men with no comorbidities ranged from 66.9% (most deprived SIMD quintile) to 73.7% (least deprived SIMD quintile). Corresponding proportions for women were 67.3% (most deprived) and 74.2% (least deprived). For men, the area under the ROC curve (AUC) was 0.804 for the baseline model (no SES), and 0.806 for the model augmented with SES. Corresponding values for women were 0.821 (baseline model) and 0.822 (augmented model). For both sexes, SES exhibited a significant effect on one-year mortality in the augmented model: odds ratios for the contrast between the least deprived and most deprived quintiles of SIMD were 0.701 (95% confidence interval: 0.590, 0.832) for men and 0.766 (0.640, 0.917) for women. Conclusion Prediction of one-year mortality in people with T2DM was only marginally improved by the addition of SES (relative to the effects of age and of comorbidity). Previously-observed social gradients in mortality among people with diabetes may partly reflect unmeasured effects of comorbidity.

Abstract P114: Low Prevalence of Ideal Cardiovascular Health Metrics among African Americans: The Jackson Heart Study

Background: While the prevalence of cardiovascular health metrics or Life’s Simple Seven (LSS) has been shown to be far from optimal in the US, such information has been predominantly reported in Caucasians. The burden of cardiovascular disease among African Americans underscores the need to evaluate the prevalence and secular trends of LSS in other ethnic groups. Objective: To test the hypothesis that the prevalence of the LSS is far from ideal among participants of the Jackson Heart Study. Methods: We analyzed LSS with 3,500 African Americans from the Jackson Heart Study, using data from their first clinic visit (2000-2004). Standard methods were used to measure blood pressure, glucose, body mass index (BMI), and cholesterol. Information on physical activity, smoking, and diet was collected with interviewer-administered questionnaires. Each of the LSS metrics (smoking status, diet, physical activity, BMI, fasting blood glucose, total cholesterol, and blood pressure) was categorized as poor, intermediate, or ideal, as defined by the AHA guidelines. Results: The mean age at baseline was 56.9 ± 12.2 years and 2,350 participants (67%) were women. Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal cardiovascular health metrics was 6.6%, 25.8%, 32.7%, 21.6%, 10.6%, 2.3%, 0.4%, and 0%, respectively. Corresponding values for women were 3.2%, 28.1%, 32.9%, 22.3%, 10.1%, 2.9%, 0.38%, and 0%. While about two-thirds of men and women reported ideal smoking status, almost none reported ideal diet quality, and few met recommendations for BMI and blood pressure ( Figure) . Conclusions: Our data are consistent with less than optimal prevalence of cardiovascular health metrics in both men and women from the Jackson Heart Study. The lower prevalence of meeting ideal recommendations for diet, physical activity, BMI, and blood pressure underscores the need for targeted interventions to improve these modifiable lifestyle factors in order to reduce the burden of cardiovascular disease among African-Americans.

Association between Serum Albumin, Insulin Resistance, and Incident Diabetes in Nondiabetic Subjects

BackgroundSerum albumin has been suggested to be associated with insulin resistance. We evaluated the association between serum albumin concentration and insulin resistance. We also investigated whether serum albumin level has an independent effect on the development of diabetes.MethodsIn our study, 9,029 subjects without diabetes, who underwent comprehensive health check-ups annually for 5 years, were categorized into tertiles based on their serum albumin levels at baseline. The odds ratio (OR) for the prevalence of insulin resistance, defined as the top quartile of homeostasis model assessment of insulin resistance and the presence of impaired fasting glucose and nonalcoholic fatty liver disease, was evaluated cross-sectionally. Also, the hazard ratio (HR) for incident diabetes was estimated longitudinally, according to the baseline albumin tertiles using Cox proportional hazard analysis respectively.ResultsFrom the lowest to the highest tertile of albumin, the multivariable-adjusted ORs of insulin resistance increased significantly in both men and women. During the mean follow-up period of nearly 4 years, 556 (6.1%) subjects progressed to diabetes. The multivariable-adjusted HR (95% confidence interval [CI]) of diabetes in men were 1, 1.09 (95% CI, 0.86 to 1.40), and 1.10 (95% CI, 0.86 to 1.41), respectively, from the lowest to the highest tertiles of baseline albumin. Corresponding values for women were 1, 1.21 (95% CI, 0.66 to 2.21), and 1.06 (95% CI, 0.56 to 2.02), respectively.ConclusionOur study showed that increased serum albumin level was associated with insulin resistance. However, serum albumin did not have an independent effect on the development of diabetes.

OS009. Second trimester serum hyperglycosylated human chorionic gonadotrophin and preeclampsia

Hyperglycosylated human chorionic gonadotrophin (hCG-h), produced by the placental trophoblast cells, is involved in placental development in early pregnancy. Decreased second trimester urine hCG-h is associated with later preeclampsia, which may be a sign of impaired trophoblastic invasion preceding symptoms of the disease. To study whether maternal second trimester serum hCG-h concentrations predict later development of preeclampsia. Fifty-five women with subsequent preeclampsia, 21 women with gestational hypertension, 30 normotensive women with small-for-gestational-age (SGA) infants and 83 controls with uneventful pregnancies were included in the study. Their serum hCG and hCG-h concentrations were analyzed by fluoroimmunoassay at 14-17weeks of gestation. The proportion of hCG-h of total hCG (%hCG-h) was calculated and converted to multiples of the median (MoMs) of the controls. MoMs of the groups were compared by Mann-Whitney U test. Pearson's correlation was used to analyze correlations between clinical characteristics and serum marker concentrations. The results are given as medians with 95% confidence intervals (95% CI). A two-tailed P<0.05 was considered significant. The concentrations of hCG-h and %hCG-h decreased with advancing gestational weeks in women with subsequent preeclampsia (r=-0.289, p=0.032 and r=-0.464, p<0.001), but not in women in the other groups. There was a tendency towards lower concentrations of hCG-h and %hCG-h in women with subsequent preeclampsia than in controls. The median MoMs of %hCG-h were 0.89 (95% CI,0.79-1.00) in women with subsequent preeclampsia and 1.00 (0.91-1.11) in controls. The corresponding values for women with subsequent gestational hypertension were 1.00 (0.86-1.16), for those with subsequent SGA infants they were 1.09 (0.89-1.23). The difference between preeclampsia and the other groups together was significant (p=0.029). Earlier studies suggest that decreased urine hCG-h concentrations reflect changes in placental function that precede the development of preeclampsia. At 14-17weeks of gestation, the serum concentrations of hCG-h showed moderate validity to predict later development of preeclampsia. Further studies on the utility of hCG-h for prediction of subsequent preeclampsia are warranted.

Association between modifiable lifestyle factors and residual lifetime risk of diabetes

Background and aimsWhile clinical trials have reported beneficial effects of diet, exercise, and weight loss on incident diabetes in subjects with obesity or impaired glucose tolerance, little is known about the incremental benefit of not smoking and moderate drinking on diabetes risk. We sought to examine the association between modifiable lifestyle factors and residual lifetime risk of diabetes. Methods and ResultsProspective cohorts involving 20,915 men (1982–2008) and 36,594 women (1992–2008). Modifiable lifestyle factors and adiposity were ascertained at baseline in each cohort and incident diabetes was ascertained during follow up. The mean age at baseline was 53.5 y in men and 54.6 y in women. During an average follow up of 22.6 y in men and 13.0 y in women, 2096 men and 2390 women developed diabetes. At age 45 y, the residual lifetime risk of diabetes (95% CI) for men with 0, 1, 2, 3, and 4 + healthy lifestyle factors was 30.5 (27.3–33.7); 21.5 (19.9–23.0); 15.1 (13.9–16.3); 10.3 (9.1–11.5); and 7.3 (5.7–8.9) percent; respectively. Corresponding values for women were 31.4 (28.3–34.5); 24.1 (21.8–26.5); 14.2 (12.7–15.7); 11.6 (9.7–13.5); and 6.4 (4.2–8.6) percent, respectively. ConclusionsThese data show an inverse and graded relation between desirable lifestyle factors and residual lifetime risk of diabetes in men and women. Not smoking and moderate drinking may have additional benefits when added to exercise, weight control, and diet.

Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity

Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility. We examined the ability of the Edmonton obesity staging system, a 5-point ordinal classification system that considers comorbidity and functional status, in predicting mortality in a nationally representative US sample. We analyzed data from the National Health and Human Nutrition Examination Surveys (NHANES) III (1988-1994) and the NHANES 1999-2004, with mortality follow-up through to the end of 2006. Adults (age ≥ 20 yr) with overweight or obesity who had been randomized to the morning session at the mobile examination centre were scored according to the Edmonton obesity staging system. We examined the relationship between staging system scores and mortality, and Cox proportional hazards models were adjusted for the presence of the metabolic syndrome or hypertriglyceridemic waist. Over 75% of the cohort with overweight or obesity were given scores of 1 or 2. Scores of 4 could not be reliably assigned because specific data elements were lacking. Survival curves clearly diverged when stratified by scores of 0-3, but not when stratified by obesity class alone. Within the data from the NHANES 1988-1994, scores of 2 (hazard ratio [HR] 1.57; 95% confidence interval [CI] 1.16 to 2.13) and 3 (HR 2.69; 95% CI 1.98 to 3.67) were associated with increased mortality compared with scores of 0 or 1, even after adjustment for body mass index and the metabolic syndrome. We found similar results after adjusting for hypertriglyceridemic waist (i.e., waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men; the corresponding values for women were ≥ 85 cm and ≥ 1.5 mmol/L), as well as in a cohort eligible for bariatric surgery. The Edmonton obesity staging system independently predicted increased mortality even after adjustment for contemporary methods of classifying adiposity. The Edmonton obesity staging system may offer improved clinical utility in assessing obesity-related risk and prioritizing treatment.

Acquired Erythrocytosis Upon Treatment with Infliximab for Ankylosing Spondylitis: Figure 1.

To the Editor: We describe a patient with ankylosing spondylitis (AS) who was treated with infliximab and developed polycythemia that was Janus kinase 2 (JAK2)-negative (V617F and exon 12 mutation). This is the first report of a patient with AS that developed erythrocytosis on treatment with infliximab. A 31-year-old man of Italian and German ethnicity with HLA-B27-positive AS was started on treatment with infliximab (5 mg/kg dose) in May 2007 because of lack of response to nonsteroidal antiinflammatory drugs. The disease showed excellent response to infliximab. He had a 15-pack-year smoking history. Prior to starting infliximab, in April 2007 his hemoglobin was 14.5 g/dl, hematocrit 45.5%, and platelet count 334 x 103/μl. He gradually developed erythrocytosis (June 2008) with hemoglobin 20.3 g/dl, hematocrit 56.6%, and platelet count 218 x 103/μl, and was referred to the hematology clinic in July 2008. His peripheral blood smear was noted to be benign. Jak2 mutation was negative including exons 12/14, and erythropoietin level was normal. Bone marrow biopsy revealed erythroid hyperplasia and a mild increase in reticulin staining. He was started on aspirin and therapeutic phlebotomies until his hematocrit decreased to 43.6%, and it has remained below 45% after 12 months of phlebotomies with continued treatment with infliximab. Polycythemia is suspected in men when hematocrit rises above 52% or hemoglobin concentration above 18.5 g/dl; the corresponding values for women are … Address correspondence to Dr. M. Antonelli, Department of Rheumatology, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. E-mail: mantonelli{at}metrohealth.org