Heavier Women Research Articles

Obesity, body size, and risk of postmenopausal breast cancer: the Women's Health Initiative (United States).

Body size is an important modifiable risk factor for breast cancer. Although obesity has generally been found to be associated with increased risk for postmenopausal breast cancer, there remain questions concerning the role of body fat distribution, lifetime weight history, and effects within specific subgroups of women. We assessed the relationship of several anthropometric measures and risk of postmenopausal breast cancer in 85,917 women aged 50-79 at entry in the Women's Health Initiative Observational Study. Women were enrolled during 1993-1998 at 40 clinics in the US and 1030 developed invasive breast cancer by April 2000. Upon entry, trained clinical center staff measured each woman's height, weight, and waist and hip circumference. Anthropometric factors were not associated with breast cancer among women who had ever used hormone replacement therapy (HRT). Among HRT non-users, heavier women (baseline body mass index (BMI) >31.1) had an elevated risk of postmenopausal breast cancer (relative risk (RR) = 2.52; 95% confidence interval (CI) = 1.62-3.93), compared to slimmer women (baseline BMI < 22.6). The elevation in risk associated with increasing BMI appeared to be most pronounced among younger postmenopausal women. Change in BMI since age 18, maximum BMI, and weight were also associated with breast cancer in HRT non-users. While both waist and hip circumference were associated with breast cancer risk, their ratio, a measure of fat distribution, was not (RR = 1.33; 95% CI = 0.88-2.01). Our study confirms previously reported findings that generalized obesity is an important risk factor for postmenopausal breast cancer, but only among women who have never taken HRT. Lifetime weight gain is also a strong predictor of breast cancer. Waist to hip ratio, a measure of weight distribution, does not appear to be related to postmenopausal breast cancer risk.

Wage and non-wage compensation among young alcoholic and heavy drinking women: A preliminary analysis

The association between drinking and selected job characteristics among women aged 24 to 31 is examined. Using the 1989 NLSY, women are classified as alcohol abusers or dependent based on DSM-III-R criteria or as heavy drinkers based on reported frequency of six or more drinks. Heavy drinking is negatively associated with wage and non-wage compensation. These effects diminish when human capital measures are controlled. Current alcoholism and current and past heavy drinking are strongly negatively associated with years of schooling. The association between alcoholism and job compensation and characteristics is not as strong as that seen for heavy drinking. It is not known if this is a consequence of errors in identifying alcoholic women in population-based surveys.

Levonorgestrel concentrations during 7 years of continuous use of Jadelle contraceptive implants☆

Serum levonorgestrel concentrations were assayed in a multicenter, 7-year study of 199 users of Jadelle rod implants. We examined drug levels, patterns of changes, factors affecting drug levels, and concentrations at which pregnancies occurred. Mean levonorgestrel concentrations declined from 435 pg/mL at 1 month of use to 64% of that value (280 pg/mL) at the end of 3 years. Between the end of the third and fifth years neither mean nor median serum levels varied markedly. At 5 years the mean concentration was again 64% of the first month’s mean. Declining levels were observed thereafter through the end of 7 years when the mean, 224 pg/mL, was 52% of the 1-month value. Last measured drug concentrations of women who became pregnant during Jadelle use had mean and median values of 152 and 144 pg/mL, respectively, and a maximum value of 180 pg/mL. Analyses indicated ponderal index, body weight, duration of use, and a single clinical center were the most important variables affecting measured levonorgestrel levels. Approximately one-third of assays in the sixth and seventh years were found to be below 180 pg/mL, suggesting that Jadelle levonorgestrel implants would not maintain sufficiently high levels of effectiveness against pregnancy after 5 years and that heavier women would then be at greater risk of pregnancy.

Location of the ureters in relation to the uterine cervix by computed tomography

Objective: Our aim was to determine the distance of the ureter from the cervix and the influence of age and weight on this distance. Study Design: The distance of the ureter from the uterine cervix was determined by evaluating the computed pelvic tomograms from 52 women. Age and body mass index were compared to this distance by means of regression analysis. Results: At the most dorsal reflection of the ureter, the average distance from ureter to cervical margin was 2.3 ± 0.8 cm (range, 0.1-5.3 cm). There was no relationship to age, but there was a linear relationship between this distance and body mass index (R2 = 0.075; P =.049); thus the ureter was slightly more proximal to the cervical margin in heavier women. Conclusions: In women with apparently normal pelvic anatomy, the average distance between the ureter and cervix is >2 cm. The finding that this distance is <0.5 cm in 12% of the women studied may explain the relatively common occurrence of ureteral injury during hysterectomy. The relationship between body mass index and location is clinically insignificant. (Am J Obstet Gynecol 2001;184:336-9.)

Effect of body mass on the association between estrogen replacement therapy and mortality among elderly US women.

In observational studies, estrogen replacement therapy is associated with decreased cardiovascular disease rates and increased breast cancer rates. Recent evidence suggests that the impact of estrogen use on disease outcomes may vary by body mass. In a prospective study of 290,827 postmenopausal US women with no history of cancer or cardiovascular disease at enrollment in 1982, the authors examined the association between postmenopausal estrogen use and all-cause, coronary heart disease, stroke, all-cancer, and breast cancer death rates and whether these associations differed by body mass. After 12 years of follow-up, results from Cox proportional hazards models showed that all-cause death rates were lower among baseline estrogen users than never users (rate ratio (RR) = 0.82, 95% confidence interval (CI): 0.78, 0.87). The lowest relative risk was found for coronary heart disease (RR = 0.66, 95% CI: 0.58, 0.77). The inverse association between estrogen use and coronary heart disease mortality was strongest for thin women (body mass index <22 kg/m2) (RR = 0.49, p for interaction = 0.02). Breast cancer mortality did not increase with estrogen use overall, and no increased risk was observed for thin or heavy women. In this population, the reduction in coronary heart disease mortality among estrogen users was greatest for thinner women. Additional studies are needed to confirm or refute these results.

Relation of body mass index to tumor markers and survival among young women with invasive ductal breast carcinoma.

Obesity has been shown to affect breast carcinoma prognosis, with the heaviest women having a higher mortality due to breast carcinoma. Few studies have focused on premenopausal women or the correlation of body mass index (BMI) to tumor characteristics related to prognosis. The authors conducted a population-based follow-up study for mortality of 1177 women younger than 45 years of age who had invasive ductal breast carcinoma diagnosed from 1983 through 1992. Histologic slides and/or tumor tissue were collected for pathologic review, immunohistochemistry assays, and bivariate flow cytometric analysis. Women with breast carcinoma who were in the highest quartile of BMI were 2.5 times as likely (95% confidence interval [CI], 1.6-3.9) to die of their disease within 5 years of diagnosis compared with women in the lowest quartile of BMI. The tumors of the women in the highest quartile of BMI were more likely to be estrogen receptor negative (odds ratio [OR], 1.5; 95% CI, 1.0-2.2) and to have a high S-phase fraction (OR, 1.9; 95% CI, 1.2-3.1), high histologic grade (OR, 1.7; 95% CI, 1.0-2.9), high mitotic cell count (OR, 2.0; 95% CI, 1.2-3.1), and large tumor size (2 to < 5 cm: OR, 2.3; 95% CI, 1.5-3.1; or > or = 5 cm: OR, 2.7; 95% CI, 1.5-4.8) compared with the tumors of women whose BMI was in the first quartile. Relative to the large tumors (> or = 2 cm) in women in the lowest BMI quartile, the large tumors in women in the highest BMI quartile were more likely to express markers of high proliferation, indicating they may have grown faster than similar size tumors of the thinnest women. In a multivariate analysis including the tumor characteristics, obesity, as measured by being in the highest quartile of BMI, remained an independent prognostic factor for mortality (hazard ratio, 1.7; 95% CI, 1.0-2.9; P < 0.05. Our study results indicated that being in the highest quartile of BMI was a strong predictor of mortality in women with breast carcinoma diagnosed at a young age. The tumors of the heavy women were larger and more likely to have markers of high cellular proliferation than those of thinner women.

Skin disorders in relation to oral contraception and other factors, including age, social class, smoking and body mass index. Findings in a large cohort study.

Over the years, a substantial number of scientific papers has been published considering the possible relationship between oral contraceptive use and various skin disorders. We aimed to investigate the possible effects of oral contraceptives and other factors including age, social class, smoking and body mass index on the occurrence of hospital referral for skin disorders within the Oxford Family Planning Association (Oxford-FPA) contraceptive study. We carried out a cohort study with long-term follow up of 17,032 women aged 25-39 years recruited at 17 family planning centres in England and Scotland between 1968 and 1974. The main outcome measure was the pattern of referral to hospital for skin disorders among the participants. The conditions considered (number of women affected in parentheses) were: malignant melanoma (48); other skin cancers (83); benign skin neoplasms (384); boils and cellulitis (334); eczema and dermatitis (327); erythematous disease (54); psoriasis (92); hypertrophic and atrophic conditions (59); diseases of the nails (80); diseases of the hair and hair follicles (74); diseases of the sebaceous glands (362); pigmented naevi (383); and unspecified eruptions (199). Some of these disease categories are broad, which complicates interpretation of the findings. As the data relate to hospital referrals, while most skin disorders are largely managed within primary care, it is difficult to know to what extent our findings can be generalized to disease patterns in the community. None the less, a number of interesting results emerged. These included increased risks (approximately twofold) of referral to hospital for boils and cellulitis in heavy women, for psoriasis in women who smoke, and for pigmented naevi in women of higher social class. Referral for pigmented naevi was reduced by about half in women with a high body mass index. Of the oral contraceptive associations studied, we consider that only an increased risk of referral for eczema or dermatitis in current or recent pill users (relative risk 1.6, 95% confidence interval 1.2-2.1) might reflect a causal relationship. There was no increased risk in past users nor was the risk related to duration of use. These findings are very similar to those reported from the Royal College of General Practitioners oral contraception study. Hospital referral for certain skin disorders was related to age, social class, smoking and body mass index within the Oxford-FPA study. Hospital referral for skin disorders generally seems to be unrelated to oral contraceptive use within the study, the possible exception being eczema and dermatitis, which occur more commonly in current and recent pill users than in non-users.

The effect of maternal weight on efficacy of intravaginal misoprostol for cervical ripening

Objective: To evaluate the effect of maternal weight on misoprostol cervical ripening in labor induction.Materials and Methods: This was a retrospective chart review of all patients receiving intravaginal misoprostol tablets for cervical ripening between August 1, 1995, and January 1, 1998. Patients received 50 μg of misoprostol serially every 8 hours until Bishop score was 7 or higher, labor occurred, intervention was required, or a total of 500 μg was used. Patients were arbitrarily grouped between maternal weights of 165 lb or more and less than 165 lb.Results: There were 124 women less than 165 lb and 243 women more than 165 lb. There was no difference between the groups in demographics, but indications for delivery were different, with preeclampsia, chronic hypertension, and diabetes being higher among the large women. Oxytocin was used more frequently and for longer periods of time in large women, and the mean number of misoprostol tablets was also greater in women more than 165 lb. Their time to labor or induction (11.8 versus 14.4) was higher and the time from first misoprostol to delivery (19 versus 24 hours) was longer. The incidence of hyperstimulation was no different nor was the number of patients who received terbutaline. Stage 1 labor was longer in heavier women, as was the incidence of cesarean delivery and epidural use. Birth weights were higher in the larger women, as well.Conclusions: Women less than 165 lb require fewer misoprostol insertions to receive equivalent success in women greater than 165 lb. In addition, women less than 165 lb deliver in a significantly shorter period of time than women of larger weights.

Prognostic indicators for successful vaginal birth after cesarean delivery

Objective: To determine characteristics associated with successful trials of labor after cesarean delivery (TOLAC) and to determine the success of vaginal birth after cesarean delivery (VBAC) in a subset of patients with previous cesarean delivery for failure to progress at full dilatation.Methods: A retrospective chart review from January 1997 through April 1998 of patients undergoing TOLAC at our institution. Four hundred forty-four charts met the inclusion criteria. Statistics were analyzed using the χ2 test and the Fisher’s exact test (2-tail).Results: The following characteristics were found to be statistically significant positive prognostic indicators: history of prior vaginal delivery (P = 2.05E-5); spontaneous rather than induced labor (P = 0.0001); greater dilation (P = 1.22E-6); and greater effacement (P = 0.001). Heavier women were less successful (P = 0.004); and use of a ripening agent led to a decreased rate of success (P = 0.016). In women previously undergoing cesarean delivery for arrest of descent at full dilatation, 74.5% (P = 2.0E-4) delivered vaginally. The operative vaginal delivery rate was 40% in this subgroup.Conclusions: Lower maternal weight at delivery, history of prior vaginal delivery, spontaneous labor, lack of need for ripening agents, and greater dilatation and effacement on admission correlated with successful VBAC. Three quarters of women with a prior cesarean delivery for arrest of descent at full dilatation delivered vaginally. This is in marked contrast to prior literature, which reported success rates of 16% or less in these patients. This subset of patients had a 40% operative delivery rate, as opposed to 11.8% of patients in the general population at our center. This stresses the importance of maintaining skills in the art of operative vaginal delivery.

Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk

Whether menopausal hormone replacement therapy using a combined estrogen-progestin regimen increases risk of breast cancer beyond that associated with estrogen alone is unknown. To determine whether increases in risk associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. Cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program. Twenty-nine screening centers throughout the United States. A total of 46355 postmenopausal women (mean age at start of follow-up, 58 years). Incident breast cancers by recency, duration, and type of hormone use. During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval [CI], 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin-only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m2 or less, increases in RR with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only. Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.

Television Situation Comedies: Female Weight, Male Negative Comments, and Audience Reactions

A content analysis of 18 prime-time television situation comedies (two episodes each) examined the body weights of 37 central female characters (92% White, 8% Black), the negative comments they received from male characters about their weight or bodies, and the audience reactions (e.g., laughter) following the negative comments. It was found that (a) below-average weight females were overrepresented in the programs, (b) the heavier the female character, the significantly more negative comments were made about or to her, and (c) negative comments were significantly associated with audience reactions. These results indicate that situation comedies present males making derogatory remarks about heavier women's weights and bodies, with this behavior being reinforced by audience laughter. This combination of thinness modeling and vicarious reinforcement likely contributes to the internalization of gender and weight stereotypes which deleteriously affect the health of female adolescents.

Sabbath Night in the Church of the Piranha

SABBATH NIGHT IN THE CHURCH OF THE FlRANHAJEdward Falco MATT AND CHRIS PENROSE leaned against the wall on either side of their living room's towering windows and peeked down the sunlit driveway, where Matt's mother struggled to get out of her car seat. His mother was heavy, always had been, all the long years of his childhood and adolescence, which he remembered as one unending moment of yearning for escape. His father was short and muscular from daily workouts at the YMCA gym. Anyone else watching a powerfully built little man straining to help a heavy woman out of her bucket seat—almost anyone else—would have found the sight amusing . Matt, however, didn't. Nor did his fifteen-year-old son, Chris. "Penrose," Chris said, "you told them to quit popping in like this." He stepped back from the window and crossed his arms over his chest like a schoolmaster addressing an undisciplined child. "Now she's going to demand to see my room again; I'm going to say no again; she's going to look at me with disgust again, like how could I possibly have the audacity not to allow her to inspect my room like some kind of Marine sergeant; then she's going to look at you with contempt for not being tougher with me, and I'm going to tell her off again; then she's going to—" "Well, perhaps," Matt interrupted, "perhaps some of that can be avoided, Chris? Do you think?" Chris paused pregnantly, his face a mask of indignation. "Master," he said. "I'm not calling you Master. Forget it. M is the best I can manage." "I can live with M." "Fine, M," Matt said. "While we're on the subject of names, perhaps you could manage to call me Dad once in a while. You used to call me Dad. Now I'm Penrose." "When was the last time I called you Dad?" "You always used to." "Since I moved in?" "That's the point. Since you moved in I've been Penrose." Chris stared at his father in silence, as if waiting for Matt to comprehend the absurdity of his argument. He was a tall, muscular kid with sandy blond hair that he wore longish, partly covering his ears. A silver Egyptian ankh dangled from his right earlobe. The Missouri Review · 7 "Okay," Matt said. "So you weren't caUing me anything the last couple of years with your mother." "I didn't talk to you for two years." "But before that you caUed me Dad." Chris continued with the schoolmaster stare. "How about this?" Matt said. He touched the fingertips of his right hand to his right temple, paused and then formaUy offered his request. "M," he said. "I'd appreciate it if you would call me Dad, rather than Penrose." "I'm not calling you Dad," Chris said. "Forget it. Best I can do is Penrose." "Forever?" Matt said. "That's it? I'm Penrose forever?" "Maybe if you'd refer to me as I've requested," Chris said, "I'd be more inclined to refer to you—" "You want me to call you Master1. That's not fair." "Why is it not fair? It's not Master like I'm your master. It's a title, like Professor or Doctor. Besides," he added, "caUing you Dad puts me in exactly the kind of subordinate role—" "Don't start with the lectures!" "Exactly the kind of subordinate role that you're afraid calling me Master will put you in." Matt counted to ten. "You are m a subordinate role," he said. "I'm the father. I'm the old guy with the wrinkles; you're the young guy with the muscles. I get the authority; you get the sexy girlfriends. That's the way it is." Chris shrugged. Matt wentback to the window. His mother had gotten herself turned around so that her legs were out of the car and her weight was balanced on the outer edge of the seat. His father was crouched beside her with his arms around his knees. Chris said, "What are they doing here anyway?" "Another surprise...

Menstrual risk factors and early-onset breast cancer.

Epidemiologic studies provide evidence for increased breast cancer risk among women with prolonged exposure to endogenous estrogens and progesterone. Menstrual cycle characteristics, such as early menarche, rapid initiation of regular ovulatory cycles, short cycle length, and more days of flow, all potentially contribute to higher cumulative ovarian hormone exposure. We assessed the associations between these characteristics and breast cancer risk in a population-based, case-control study of 1505 controls and 1647 newly diagnosed cases, all younger than 45 years of age. Compared to women with menarche at > or =15 years, we observed some increase in risk for women with younger ages at menarche, although those with very early ages were not at particularly high risk [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1-1.9 for menarche at age 12 and OR = 1.2, 95% CI = 0.9-1.7 for menarche at age < or =10]. Women who reported having regular menstrual cycles within 2 years of menarche were at increased breast cancer risk (OR = 1.7, 95% CI = 1.2-2.3), compared to those never having regular cycles. Stratification by current body mass index revealed slightly stronger associations with menstrual characteristics among thinner women (< 22.0 kg/m2) compared to heavier women (> 28.8 kg/m2). These findings suggest that future studies should focus on clarifying how the interrelated effects of body size and menstrual factors, such as age at menarche and cycle regularity, contribute to breast cancer etiology.

The Additional Risk of Endometrial Cancer Associated with Unopposed Estrogen Use in Women with Other Risk Factors

We analyzed data from a population-based case-control study of endometrial cancer. Our goal was to identify a subgroup of women in whom the additional cancer risk associated with unopposed estrogen use was sufficiently small so as to not be a deterrent to taking a hormone preparation of this type. Researchers interviewed women with endometrial cancer (N = 553) and controls (N = 752) regarding hormone use. The additional risk of endometrial cancer associated with unopposed estrogen use did not vary substantially in the presence or absence of hypertension, parity, oral contraceptive use, or smoking. The results suggest that, although heavier women may experience a greater risk of endometrial cancer associated with unopposed estrogen use (8.2 per 1,000 per year) than lighter women (4.2 per 1,000 per year), long-term users in the latter group nonetheless face a substantial absolute increase in risk. We conclude that subdividing women on the basis of the presence or absence of other known risk factors for endometrial cancer fails to delineate a subgroup that is exempt from the increased risk of this cancer associated with use of unopposed estrogens. 83.6% of estrogen users reported taking conjugated estrogens.

Tamoxifen therapy for breast cancer and endometrial cancer risk.

Tamoxifen is effective in treating breast cancer, reduces breast cancer incidence among high-risk women, and is associated with increased endometrial cancer risk. This study was designed to examine the possible modifying effects of endometrial cancer risk factors on the tamoxifen-endometrial cancer association. We conducted a case-control study of endometrial cancer (324 case patients and 671 individually matched control subjects) nested within a population-based cohort of patients with breast cancer diagnosed from 1978 through 1992 within four regions of the United States. We obtained information on breast cancer treatment and endometrial cancer risk factors through interviews and reviews of medical records. All P values reported are two-sided. Endometrial cancer risk was associated with tamoxifen therapy for breast cancer (odds ratio = 1.52; 95% confidence interval [CI] = 1. 07-2.17). Risk increased with duration of tamoxifen use (P for trend =.0002). Women with more than 5 years of exposure to tamoxifen had 4. 06-fold greater odds of developing endometrial cancer than nonusers (95% CI = 1.74-9.47). Prior use of estrogen replacement therapy (ERT) increased risk associated with tamoxifen use (P for homogeneity of trends <.0001). Risk associated with tamoxifen use was stronger among heavier women than among thinner women, although trends did not differ statistically (P =.10). Tamoxifen dose-response effects were more pronounced among women with both previous ERT exposure and higher body mass index than among women in other risk groups. ERT use and obesity, both established endometrial cancer risk factors and markers of estrogen exposure, substantially modify the association between tamoxifen use and endometrial cancer risk among patients with breast cancer. Women with positive ERT histories and those who are obese, when prescribed tamoxifen, may warrant closer surveillance for endometrial cancer than women without such histories.

Is there a relationship between balance, gait performance and muscular strength in 75-year-old women?

To see if there is a relationship between clinical and laboratory tests of balance, muscular strength and gait in elderly women. A randomized population-based study. Malmö, Sweden. We investigated balance with a simple test of standing on one leg, as well as a computerized balance platform. Muscular strength was tested by computerized dynamometer. Extension and flexion of the knee and dorsiflexion of the ankle were tested. We measured the time and number of steps taken to walk a certain distance and the subjects' height and weight. 418 randomly selected 75-year-old women, of whom 230 took part. There was no relation between the computerized balance tests and any of the other tests. The non-computerized balance test was correlated with gait time and number of steps (r = -0.50, P<0.001 and r = -0.40, P<0.001, respectively). Tests of extension and flexion, strength of the knee and ankle dorsiflexion were related to gait, speed and number of steps. Heavy women had poorer balance when assessed by the non-computerized test (r = -0.32, P<0.001) and with the computerized, stable platform, eyes-open test (r = 0.27, P<0.001) and eyes-closed test (r = 0.44, P<0.001). The heavier an individual was, the slower her gait and the shorter her steps, despite having stronger knee muscles. There is no relationship between the simple balance tests and computerized platform tests. Muscle strength of the leg is not necessarily linked to balance, but rather to gait performance.

Physical Activity Patterns in a Diverse Population of Women

Background.Demographic and psychosocial correlates of activity in domains other than recreational activity have not been well characterized and may be particularly relevant for health promotion efforts aimed at women.Methods.Cross-sectional relationships between recreational, occupational, and household/caregiving physical activity and demographic and psychosocial factors were assessed with a mail survey in a random sample of 2,636 ethnically diverse women members of a large health maintenance organization, ages 20–65. Activity was assessed with a modified Baecke questionnaire that uses categorical responses regarding frequency of domain-specific activities to create four semicontinuous activity indices (sports/exercise, active living, occupational, household/caregiving).Results.Multivariable logistic regression analysis showed that the likelihood of being in the highest quartile of the sports/exercise and active-living indices, compared with the other three quartiles, was decreased among older, nonwhite, less well educated, heavier women who had young children at home, lacked motivation to exercise, and perceived external obstacles to exercise behavior. The odds ratios (ORs) ranged from 0.38, 95% confidence interval (CI) 0.33–0.45, associated with low motivation, to 0.95, 95% CI 0.93–0.98, associated with increasing body mass index. Social support and confidence in one's ability to continue to exercise, even when faced with other pressures and demands (termed self-efficacy), were associated with increased likelihood of high levels of sports/exercise and active living (OR = 2.34, 95% CI 1.83–2.98 and OR = 3.96, 95% CI 2.92–5.38, respectively). In contrast, the highest quartile of household/caregiving activity was positively associated with increasing age (OR = 1.28, 95% CI 1.16–1.42), Hispanic ethnicity (OR = 1.58, 95% CI 0.55–1.01), being married (OR = 1.70, 95% CI 1.33–2.18), having young children at home (OR = 6.99, 95% CI 4.33–11), and greater time constraints as a barrier to exercise (OR = 1.55, 95% CI 1.38–1.74) and was negatively associated with employment (OR = 0.38, 95% CI 0.30–0.47). Increased likelihood of the highest quartile of occupational activity was associated with high school education or less (OR = 2.26, 95% CI 1.74–2.94) and current smoking (OR = 1.66, 95% CI 1.23–2.23), while self-efficacy regarding exercise was associated with decreased likelihood (OR = 0.77, 95% CI 0.61–0.96).Conclusions.These findings suggest that demographic and psychosocial correlates of physical activity vary by domain and that initiatives to promote physical activity in the population need to take these differences into account.

Complex relation between increasing fat mass and decreasing high density lipoprotein cholesterol levels: evidence from a population-based study of premenopausal women.

High density lipoprotein (HDL) cholesterol levels can be used to predict cardiovascular disease risk in women. To better understand variability in HDL cholesterol levels, the authors examined the relation with three domains (body size and type, sex hormone status, and carbohydrate metabolism) in a cross-sectional population-based 1993-1994 study of 402 premenopausal women from Tecumseh, Michigan. They found that these domains explained 27% of the total variation in HDL cholesterol levels; waist-to-hip ratio was the term that explained the highest proportion of variability (6% after fat mass, sex hormone binding globulin, and insulin levels were added to the model). In analyses restricted to women whose body mass index was > or = 32 kg/m2, which constituted 19% of this population, neither body mass index nor fat mass was a significant predictor of variability in HDL cholesterol levels. Significant variables were insulin levels, waist-to-hip ratio, and smoking. This finding suggests that there is a saturation of the relation between increasing fat mass and lower HDL cholesterol levels, as evidenced by the lack of a relation between the two among the heaviest women. Meanwhile, among the heaviest women, increasing insulin levels and a higher waist-to-hip ratio remained predictors of low levels of HDL cholesterol.

Lower levels of physical functioning are associated with higher body weight among middle-aged and older women.

To compare levels of physical function, across levels of body mass index (BMI), among middle- to older-aged women. Cross-sectional study. Physical function, body weight and other covariates were measured in 1992. 56510 women aged 45-71 y, free of cardiovascular disease and cancer, participating in the Nurses' Health Study. The four physical function scores on the Medical Outcomes Study (MOS) Short Form-36 (SF36) Health Survey: physical functioning, vitality, bodily pain and role limitations. After adjusting for age, race, smoking status, menopausal status, physical activity and alcohol consumption, there was a significant dose-response gradient between increasing levels of BMI in 1992 and reduced function. For example, women with a BMI between 30-34.9 kg/m2 averaged: 9.0 point lower physical functioning score (95% Confidence interval (CI) -9.5, -8.5), 5.6 point lower vitality score (95% CI: -6.1, -5.1), and 7.0 point lower freedom from pain score (95% CI: -7.6, -6.4). These declines represent an approximate 10% loss of function compared to the reference category of women with BMIs ranging from 22.0-23.9 kg/m2. For the same BMI comparison, heavier women were at 66% increased risk of limitations in ability to work or perform other roles (RR = 1.66; 95% odds ratio (OR) CI: 1.56, 1.76). These findings were replicated when the sample was restricted to women who had maintained their BMI over a ten year period. In addition to increasing risk of chronic health conditions, greater adiposity is associated with lower every day physical functioning, such as climbing stairs or other moderate activities, as well as lower feelings of well-being and greater burden of pain.

Alternative methods of maternal weight adjustment in maternal serum screening for Down syndrome and neural tube defects

Serum markers used in screening for Down syndrome and neural tube defects are often adjusted to take account of the effect of maternal weight on the marker levels. The standard adjustment procedure is based on a linear relationship between the marker concentration, expressed as the log of the multiple of the median (MOM), and maternal weight on a linear scale. It has been proposed that maternal weight adjustment may be better performed using a linear relationship between marker concentration expressed in MOM and the reciprocal of maternal weight. In a dataset of 8905 singleton pregnancies in white women without Down syndrome or neural tube defects we compared the two methods of weight adjustment and found that both were satisfactory and neither had an obvious advantage over the other. In the analysis it was noticed that hCG levels in very heavy women (> 120 kg) were higher than expected from the decreasing linear trend with maternal weight--a result that was statistically highly significant (p < 0.01) but for which we have no explanation. In screening it will have virtually no effect because the finding was restricted to only the 0.3 per cent of the heaviest women.