Lifestyle Cohort Study Research Articles

Chronic Use of Antihypertensive Medications and Peak Exercise Blood Pressure in Adult Men and Women from the BALL ST Cohort.

To determine if individuals chronically (>1 yr) prescribed antihypertensive medications have a normal BP response to peak exercise compared with unmedicated individuals. Participants included 2555 adults from the Ball State Adult Fitness Longitudinal Lifestyle STudy cohort who performed a peak treadmill exercise test. Participants were divided into groups by sex and antihypertensive medication status. Individuals prescribed antihypertensive medications for >1 yr were included. Exaggerated and blunted SBP within each group was categorized using the Fitness Registry and the Importance of Exercise: A National Database (FRIEND) and absolute criteria as noted by the American Heart Association. The unmedicated group had a greater prevalence ( P < 0.05) of blunted SBP responses, whereas the medicated group had a higher prevalence ( P < 0.05) of exaggerated SBP responses using both the FRIEND and absolute criteria. Peak SBP was higher ( P < 0.01) in medicated compared with unmedicated participants in the overall cohort when controlling for age and sex, but not after controlling for resting SBP ( P = 0.613), risk factors ( P = 0.104), or cardiorespiratory fitness ( P = 0.191). When men and women were assessed independently, peak SBP remained higher in the medicated women after controlling for age and resting SBP ( P = 0.039), but not for men ( P = 0.311). Individuals on beta-blockers had a higher peak SBP even after controlling for age, sex, risk factors, and cardiorespiratory fitness ( P = 0.022). Individuals on antihypertensive medications have a higher peak SBP response to exercise. Given the prognostic value of exaggerated peak SBP, control of exercise BP should be considered in routine BP assessment and in the treatment of hypertension.

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Racial and ethnic disparities in chronic disease risk in adolescence after prenatal polydrug exposure: Examination of the Hispanic paradox

Racial disparities exist in fetal development which in turn can influence growth and development of chronic disease later in life. The purpose of this study was to explore potential racial and ethnic differences in chronic disease risk factors throughout the pediatric years given prenatal exposure to substance use. Data from the Maternal Lifestyle Study cohort was used for this analysis. Urine toxicology confirmed maternal substance use (y/n) and offspring height, weight, and systolic blood pressure (SBP) data at 16 years was analyzed. Linear mixed effects modeling with an interaction term for adolescent race/ethnicity and maternal drug use assessed growth trajectories (body mass index (BMI) percentile) and cardiovascular disease risk factors (elevated SBP). Of the sample (n = 1,388 mother/infant dyads), 23% (n = 319) of mothers used three substances during pregnancy and 14% (n = 200) used four or five. Controlling for BMI, Hispanic adolescents prenatally exposed to any singular substance had 13 mmHg higher SBP at age 16 than their unexposed counterparts (95% Confidence Interval [CI]: 12.24, 14.01). Prenatal exposure to >1 substance significantly lowered SBP in Hispanic adolescents only. Results here showed that Hispanic adolescents exposed to singular substance are at higher risk of elevated SBP in adolescence, but SBP decreased when exposed to >1 substance. The Hispanic paradox may play a role; future studies should continue to explore this. Additionally, barriers to prenatal care for Hispanic women should be addressed in order to prevent substance use during pregnancy which can reduce chronic disease risk in offspring adolescence.

Maternal Microbial Metabolites and Risk of Fetal Growth Extremes: A Longitudinal Multi-Racial/Ethnic Cohort Study

ObjectivesFetal growth extremes [small- and large-for-gestational age (SGA and LGA)] represent high-risk phenotypes for cardiometabolic disorders. Metabolomic profiling of the in-utero milieu may elucidate pathophysiology of fetal growth extremes and inform dietary recommendations and upstream risk factors. We aimed to identify microbiome-derived metabolites associated with SGA and LGA.MethodsA random sample of 140 SGA, 134 LGA and 140 appropriate for gestational age (AGA) was drawn from the Pregnancy Environment and Lifestyle Study cohort. Using fasting serum at gestational weeks (GW) 10–13 and 16–19,1167 known metabolites were measured by gas and liquid chromatography (LC)/time-of-flight mass spectrometry (TOF-MS) and hydrophilic interaction LC/quadrupole TOF-MS, of which 165 microbial metabolites were linked with the Virtual Metabolic Human Database. After adjusting for sociodemographic, lifestyle, reproductive history, and clinical factors, we identified significant pathways associated with risk of SGA and LGA vs. AGA using chemical similarity enrichment analysis, controlling for the false discovery rate (PFDR).ResultsAt GW 10–13, branched-chain amino acids (AA), dicarboxylic acids (DA) and medium-chain hydroxy acids were positively, while phosphatidylcholines, saturated fatty acids (FA) and glucogenic AA were inversely associated with SGA risk (all PFDR < 0.01). At GW 16–19, positive associations of branched-chain AA and DA and inverse associations of saturated FA with SGA risk persisted, while unsaturated triglycerides (TG) were inversely associated with SGA risk (all PFDR < 0.01). At GW 10–13, glucogenic AA, DA, hippurates, phenylacetylglutamine and cresols were positively, whereas phosphatidylcholine and unsaturated TG were inversely associated with LGA risk (all PFDR < 0.04). At GW 16–19, carnitine, saturated TG, cyclic AA, DA, glyceric acids, phenylacetylglutamine and cresols were positively, while aromatic, basic and sulfur AA, sugar alcohols, phosphatidylcholines and unsaturated TG were inversely associated with LGA risk (all PFDR < 0.05).ConclusionsDistinct microbial metabolites in early to mid-pregnancy are associated with SGA and LGA risk, calling for further investigation into microbiome-metabolome-host interactions.Funding SourcesThe research was supported by NIDDK, NIEHS, and NIH Office of Directors.

Synergistic effects of hip and knee osteoarthritis and comorbidities among older adults: analysis of the oxford pain, activity and lifestyle cohort study

Purpose: Previous studies in hip and knee osteoarthritis populations have focused on the independent effects of comorbidities on patient-reported outcomes. However, hip and knee osteoarthritis may interact with comorbidities, resulting in an increased impact beyond the effects attributable to each condition alone, known as a synergistic effect. A better understanding of synergistic effects on functional activities such as mobility and self-care is important to personalise management for older adults with hip and/or knee osteoarthritis for maximal benefits.The purpose of this study was to estimate independent and synergistic effects of hip and/or knee osteoarthritis and comorbidities on mobility and self-care limitations in a population-based cohort of older people in England (UK).

Fatigue, Quality of Life, and Physical Fitness Following an Exercise Intervention in Survivors of Multiple Myeloma: A Randomised Controlled Trial Using a Zelen Design

▪Background. The benefit of exercise on fatigue and wellbeing in patients with solid tumours (breast, prostate, colorectal) is supported by some randomised controlled trials (RCT). In multiple myeloma (myeloma), osteolytic bone destruction causes persistent pain and fracture risk, leading to reduced physical functioning, and barriers to exercise. There is a paucity of research in this patient group. We aimed to test the efficacy of a previously piloted exercise intervention in a randomised controlled trial in myeloma survivors.Methods. MASCOT used a double-consent adapted Zelen design to reduce contamination of control group, often found in RCT. Eligible patients had completed chemotherapy and had at least stable disease for ≥6 weeks. Screening for fracture risk was carried out by multi-disciplinary team. After initial consent to a lifestyle cohort study and completion of baseline tests, subjects were randomised to exercise intervention (re-consented) or control (usual care). Control subjects were not informed of the randomisation, and not re-consented. The 12-week intervention was tailored aerobic and resistance exercises with behavioural support and home exercise. Subjects attended weekly supervised gym sessions in weeks 1-12, and then monthly until 6 months. All subjects were assessed at 3, 6 and 12 months. The primary outcome was between group differences in fatigue (Functional Assessment of Chronic Illness Therapy, FACIT-F) change at 3 months. Regression models were run with the 3-or 6-month fatigue as the dependent variable, with the baseline values and trial arm allocation as independent variables, with same methodology for secondary endpoints (QOL, physical fitness, muscle strength, body composition).Results. From June 2014 to November 2016, 138 patients consented to the cohort study, of whom 131 were randomised (control, 42, intervention 89). Time from last treatment was 15 months (median, range: 2-251), median age was 63yrs (35-86), 55% were male and 67% had bone disease. Of 89 participants randomised to the intervention, 51(57%) consented; main reasons for declining were number of visits and/or travel distance. Median attendance at sessions was 75%, and 40 completed the programme at 3 months. 3- and 12-month follow-up was 88%, 95% and 63%, 74% respectively, for exercise and control. Forty participants with complete cases in each arm were included in the analyses (per protocol).Baseline levels of fatigue were similar in the exercise and control groups (40.8±7.8, 41.7±10.7); with 7(17%) and 10(24%) subjects reporting clinical fatigue (score<34). Groups were matched for all other variables. There was no between group difference in fatigue at 3-months (2.14, 95%CI -0.51,4.79, p=0.1) or 6-months. We found no between-group differences in physical functioning, emotional functioning, anxiety, or depression at 3 or 6 months. VO2peak improved significantly at 3-months(p=0.024) but not at 6-months(p=0.26). Leg muscle strength improved at 6-months(p=0.027), with a trend for improvement at 3 months(p=0.052). Trends to improvement in physical activity self-efficacy(p=0.053) and body fat percentage(p=0.051) at 3 months were not seen at 6 months.Because the trial included patients who did not have clinical fatigue at baseline, hence limited scope for improvement in this endpoint, we undertook subgroup analysis of patients with clinical fatigue at baseline. Here, patients who completed the exercise intervention reported feeling less tired (less fatigue) at 3 months, which was maintained at 6- and 12-months. (Figure). They also had improved leg strength at each time point (Figure), which was not seen in the control arm. A similar pattern was observed for VO2peak .In interviews, participants voiced a sense of achievement, their confidence to exercise under supervision and were pleased to have the opportunity to improve their physical wellbeing.Conclusion. Benefits in fatigue appeared limited to subjects with clinical fatigue at baseline, although improvements in muscle strength and fitness were seen in the group as a whole, and patient testimonies were positive. Future research should consider modifying the intervention delivery format to reduce barriers to recruitment and attendance and incorporate fatigue screening before enrolment. DisclosuresRabin:Takeda: Consultancy, Other: Travel support , Speakers Bureau; Celgene: Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Janssen: Consultancy, Other: Travel support, Speakers Bureau. Popat:Amgen: Honoraria. Yong:TAkeda: Honoraria, Research Funding; janssen: Honoraria; Celgene: Honoraria; Amgen: Honoraria, Research Funding.

Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance.

Objective:We examined the associations of central obesity measures, waist-to-hip ratio (WHR) and waist circumference (WC), in early pregnancy with subsequent risk of gestational diabetes (GDM); and evaluated the potential mediating role of insulin resistance markers.Methods:Within the prospective Pregnancy Environment and Lifestyle Study cohort of 1,750 women, waist and hip circumferences were measured at gestational weeks 10–13. In a nested case-control study within the cohort, 115 GDM cases and 230 controls had fasting serum insulin, HOMA-IR, and adiponectin measurements at gestational weeks 16–19. Poisson and conditional logistic regression models were used, adjusting for established risk factors for GDM including prepregnancy overweight/obesity.Results:For women with WHR<0.85, one or more established risk factors increased GDM risk 1.99-fold (95% CI 0.99–4.02). For women with WHR≥0.85, but no established risk factors, GDM risks increased 2.41-fold (1.14–5.06), and with other risk factors, 6.22-fold (3.49–11.10). Similar but attenuated results were observed for WC≥88 cm. Insulin, HOMA-IR, and adiponectin levels mediated the WHR-GDM association by 9511%; corresponding mediation proportions for the WC-GDM association were 35–41% (all P-values<0.04).Conclusions:Central obesity in early pregnancy represented a high-risk phenotype for GDM independent of other risk factors including overweight/obesity and may inform early screening and prevention strategies.

Relationship between rice consumption and body weight gain in Japanese workers: white versus brown rice/multigrain rice.

Increasing obesity rates have driven research into dietary support for body weight control, but previous studies have only assessed changes in body weight of ±3 kg. We investigated the relationships between white or brown/multi-grain rice consumption and 1-year body weight gain ≥3 kg in Japanese factory workers (n = 437). Routine medical check-up data from a 1-year nutrition and lifestyle cohort study were analysed. Participants were divided into white rice and brown/multi-grain rice consumption groups and further classified by tertile of rice consumption. Multiple logistic regression analyses were performed by tertile. At 1 year, high white rice consumption was significantly associated with increased risk of body weight gain ≥3 kg compared with low white rice consumption, maintained after adjustment for age, sex, and consumption of other obesogenic foods (p = 0.034). In the brown/multi-grain rice consumption group, however, there was no significant difference in risk between high and low consumption, even after multi-variate adjustment (p = 0.387). The consumption of white rice, but not brown rice/multi-grain rice, was positively correlated with the risk of a 1-year body weight gain of 3 kg or more. This suggests that brown rice/multi-grain rice consumption is useful for body weight control among Japanese workers.

Liver Enzymes in Early to Mid-pregnancy, Insulin Resistance, and Gestational Diabetes Risk: A Longitudinal Analysis.

Background: Liver enzymes may be implicated in glucose homeostasis; liver enzymes progressively change during pregnancy but longitudinal data during pregnancy in relation to insulin resistance and gestational diabetes (GDM) risk are lacking. We investigated longitudinal associations of γ-glutamyl transferase (GGT) and alanine aminotransferase (ALT) with insulin secretion and resistance markers across early to mid-pregnancy and subsequent GDM risk.Methods: Within the prospective Pregnancy Environment and Lifestyle Study cohort, 117 GDM cases were ascertained and matched to 232 non-GDM controls in a nested case-control study. Fasting blood samples were collected at two clinic visits (CV1, gestational weeks 10–13; CV2, gestational weeks 16–19). Linear mixed model and conditional logistic regression were used, adjusting for major risk factors for GDM.Results: In repeated measure analysis, after adjusting for confounders including body mass index and waist-to-hip ratio, GGT per standard deviation increment was associated with elevated fasting glucose and HOMA-IR (% change = 1.51%, 95% CI 0.56–2.46% and 7.43%, 95% CI 1.76–13.11%, respectively) and decreased adiponectin (% change = −2.86%, 95% CI−5.53 to −0.20%) from CV1 to CV2. At CV1 and CV2, GGT levels comparing the highest versus lowest quartile were associated with 3.01-fold (95% CI 1.32–6.85) and 3.51-fold (95% CI 1.37–8.97) increased risk of GDM, respectively. Progressively increased (<median at CV1, ≥median at CV2) and stably high (≥median at both CV1 and CV2) GGT levels were associated with 3.89- and 2.39-fold increased risk of GDM, compared to stably low levels (<median at both CV1 and CV2), respectively (both P < 0.05). Similar but non-significant trends were observed for ALT.Conclusion: Elevated levels of GGT in early and mid-pregnancy, even within the conventional normal range, and its progressive increase from early to mid-pregnancy may be implicated in the pathogenesis of GDM, highlighting its potential to inform early screening or preventive strategies to mitigate subsequent risk of GDM.

Association between meeting the WCRF/AICR cancer prevention recommendations and colorectal cancer incidence: results from the VITAL cohort.

In 2007, the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) published eight recommendations regarding body weight, physical activity, and dietary behaviors aimed at reducing cancer incidence worldwide. In this paper, we assess whether meeting the WCRF/AICR recommendations is associated with lower colorectal cancer (CRC) incidence; evaluate whether particular recommendations are most strongly associated with lower CRC incidence; and assess whether associations differ by sex. We operationalized six of the recommendations (related to body weight, physical activity, energy density, plant foods, red and processed meat, and alcohol) and examined their association with CRC incidence over 7.6years of follow-up in the prospective VITamins And Lifestyle Study cohort. Participants included 66,920 adults aged 50-76years at baseline (2000-2002) with no history of CRC and with complete data for the recommendations evaluated. Incident colorectal cancers (n=546) were tracked through 2009. Compared with meeting no recommendations, meeting 1-3 recommendations was associated with 34-45% lower CRC incidence, and meeting 4-6 was associated with 58% lower incidence (95% CI 34%, 74%) in fully adjusted analyses. The recommendations most strongly associated with lower CRC risk for women were related to body fatness and red and processed meat, while for men these were alcohol intake and red and processed meat. Differences by sex were statistically significant (p<0.05) for the recommendations related to body weight and to alcohol. Meeting the WCRF/AICR recommendations, particularly those related to alcohol, body weight, and red and processed meat, could substantially reduce CRC incidence; however, associations differ by sex.

Associations of long-chain ω-3 fatty acids and fish intake with endometrial cancer risk in the VITamins And Lifestyle cohort

Inflammation plays an important role in endometrial cancer etiology. Long-chain ω-3 (n-3) polyunsaturated fatty acids (PUFAs), derived from marine sources, are thought to be antiinflammatory; however, several studies of fish consumption suggest an increase in risk. This study examined whether intakes of long-chain ω-3 PUFAs, including eicosapentaenoic acid (EPA; 20:5ω-3) and docosahexaenoic acid (DHA; 22:6ω-3), from diet and supplements and intake of fish are associated with endometrial cancer risk. Between 2000 and 2002, 22,494 women aged 50-76 y, living in western Washington State, were recruited to the VITamins And Lifestyle cohort study. Incident endometrial cancers (n = 263) were identified through the Surveillance, Epidemiology, and End Results cancer registry after 9 y of follow-up. Multivariable-adjusted HRs and 95% CIs for the association of intakes of individual long-chain ω-3 PUFAs and fish with endometrial cancer risk were estimated by using Cox proportional hazards. Women in the highest compared with the lowest quintile of dietary EPA + DHA intake had a 79% increased risk of endometrial cancer (95% CI: 16%, 175%; P-trend = 0.026). Results were similar for EPA and DHA measured individually and for fish intake. When data were stratified by body mass index (in kg/m²; <25 or ≥ 25), increases in risk of long-chain ω-3 PUFAs were restricted to overweight and obese women, and statistically significant reductions in risk were observed for normal-weight women. The overall increased risk reported here confirms the findings of several prior observational studies of fish intake, which observed similar increases in risk. Randomized trials are needed to confirm these findings.

Associations between allergies and risk of hematologic malignancies: Results from the VITamins and lifestyle cohort study

Immune dysregulations associated with allergies may affect cancer cell biology but studies on the relationship between allergies and risk of hematologic malignancies (HM) yielded inconsistent results. Herein, we used the vitamins and Lifestyle (VITAL) cohort to examine this association. From 2000 to 2002, 66,212 participants, aged 50-76, completed a baseline questionnaire on cancer risk factors, medical conditions, allergies, and asthma. Through 2009, incident HMs (n = 681) were identified via linkage to the surveillance, epidemiology, and end results cancer registry. After adjustment for factors possibly associated with HMs, a history of airborne allergy was associated with increased risk of HMs (hazard ratio [HR] = 1.19 [95% confidence interval: 1.01-1.41], P = 0.039) in Cox proportional hazards models. This association was limited to allergies to plants/grass/trees (HR = 1.26 [1.05-1.50], P = 0.011) and was strongest for some mature B-cell lymphomas (HR = 1.50 [1.14-2.00], P = 0.005). Gender-stratified analyses revealed that the associations between airborne allergies overall and those to plants, grass, and trees were only seen in women (HR = 1.47 [1.14-1.91], P = 0.004; and HR = 1.73 [1.32-2.25], P < 0.001) but not men (HR = 1.03 [0.82-1.29], P = 0.782; and HR = 0.99 [0.77-1.27], P = 0.960). Together, our study indicates a moderately increased risk of HMs in women but not men with a history of allergies to airborne allergens, especially to plant, grass, or trees.

The association between television watching time and all-cause mortality after breast cancer

Sedentary time is a rapidly emerging independent risk factor for mortality in the general population, but its prognostic effect among cancer survivors is unknown. In a multiethnic, prospective cohort of breast cancer survivors, we hypothesized that television watching time would be independently associated with an increased risk of death from any cause. The Health, Eating, Activity, and Lifestyle Study cohort included 687 women diagnosed with local or regional breast cancer. On average 30 (±4) months postdiagnosis, women completed self-report assessments on time spent sitting watching television/videos in a typical day in the previous year. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for death from any cause (n = 89) during the 7years of follow-up. Television time (top tertile vs. bottom tertile) was positively related to risk of death (HR, 1.94; 95% CI, 1.02, 3.66, p trend = 0.024), but the association was attenuated and not statistically significant after adjustment for aerobic moderate-vigorous intensity physical activity (HR, 1.70; 95% CI, 0.89, 3.22, p trend = 0.14) and all covariates (HR, 1.39; 95% CI, 0.69, 2.82, p trend = 0.48). In this first published investigation on this topic, we did not observe a statistically significant multivariate-adjusted association between television watching time and risk of death among women diagnosed with breast cancer. These results begin an evidence base on this topic that can be built upon to inform lifestyle recommendations for this expanding, aging population.

Types of Fish Consumed and Fish Preparation Methods in Relation to Pancreatic Cancer Incidence: The VITAL Cohort Study

The associations of types of fish and fish preparation methods with pancreatic cancer risk remain unknown. The authors conducted a prospective cohort study in western Washington State among 66,616 adults, aged 50-76 years, who participated in the VITamins And Lifestyle cohort study. Diet was assessed by a food frequency questionnaire. Pancreatic cancer cases were identified by linkage to the Surveillance, Epidemiology, and End Results cancer registry. During an average follow-up of 6.8 years, 151 participants developed pancreatic cancer (adenocarcinoma). Long-chain (n-3) polyunsaturated fatty acids (LC-PUFAs) and nonfried fish intake were inversely associated with pancreatic cancer incidence. When the highest and lowest tertiles of exposure were compared, the multivariable-adjusted hazard ratio of pancreatic cancer was 0.62 (95% confidence interval: 0.40, 0.98) (P(trend) = 0.08) for LC-PUFAs and 0.55 (95% confidence interval: 0.34, 0.88) (P(trend) = 0.045) for nonfried fish. Docosahexaenoic acid showed a greater inverse association with pancreatic cancer than eicosapentaenoic acid. No statistically significant associations were observed with fried fish and shellfish consumption. The potential health impact of fish consumption may depend on the types of fish consumed and fish preparation methods. LC-PUFAs, particularly docosahexaenoic acid, and nonfried fish, but not shellfish or fried fish, may be beneficial in the primary prevention of pancreatic cancer.

A Cohort Study of Vitamin D Intake and Melanoma Risk

Data suggest that vitamin D intake may have chemopreventive efficacy against melanoma, but there have been no published epidemiologic studies examining the association between vitamin D intake and melanoma risk in a large prospective cohort. We examined whether dietary and supplemental vitamin D intake was associated with melanoma risk among 68,611 men and women who were participants of the Vitamins and Lifestyle cohort study. Participants reported dietary vitamin D intake over the past year and 10-year use of multivitamin and individual vitamin D supplements on a baseline questionnaire. After follow-up through 2006, 455 incident melanomas were identified through linkage to the Surveillance, Epidemiology, and End Results cancer registry. Cox proportional hazards regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for vitamin D intake after adjustment for melanoma risk factors. Compared with the lowest quartile, we did not detect a risk reduction of melanoma in the highest quartiles of dietary vitamin D intake (RR=1.31, CI=0.94-1.82), 10-year average supplemental vitamin D intake (RR=1.13, CI=0.89-1.43), or combined dietary and supplemental intake (1.05, CI=0.79-1.40). In this large prospective cohort, we did not find an association between vitamin D intake and melanoma risk.

Population Prevalence of Albuminuria in the Australian Diabetes, Obesity, and Lifestyle (AusDiab) Study: Immunonephelometry Compared With High-Performance Liquid Chromatography

Microalbuminuria is an independent risk factor for cardiovascular morbidity and mortality in the general population. Standard immunochemical urinary albumin assays detect immunoreactive albumin, whereas high-performance liquid chromatography (HPLC) detects both immunoreactive and immunounreactive albumin. Using data from the Australian Diabetes, Obesity, and Lifestyle cohort study of randomly selected community-based Australian adults, spot urine samples were tested for albuminuria (spot urine albumin-creatinine ratio [ACR]: normal, < 30 mg/g; microalbuminuria, 30 to 300 mg/g; and macroalbuminuria, > 300 mg/g) by using both immunonephelometry (IN) and HPLC (n = 10,010). Bland-Altman analysis showed significant bias, with a greater ACR by means of HPLC, particularly at lower levels of ACR. Mean ACR was 15.8 mg/g (95% confidence interval [CI], 12.3 to 19.2) by means of IN compared with 30.0 mg/g (95% CI, 27.0 to 35.0) by means of HPLC. The prevalence of microalbuminuria was 4 times greater by means of HPLC compared with IN (20% versus 5.5%). In all demographic and comorbid subgroups associated with microalbuminuria, the prevalence of microalbuminuria increased by 2 to 4 times. A total of 1,743 subjects (17.4%) classified as normoalbuminuric by means of IN were reclassified as microalbuminuric by means of HPLC. Using multivariate logistic regression, women, patients with untreated and treated hypertension, and those with impaired glucose tolerance or diabetes were associated significantly with a change in category from normoalbuminuric to microalbuminuria by means of HPLC. HPLC measures significantly more urinary albumin within the normoalbuminuria and microalbuminuria range, resulting in a significant increase in prevalence of microalbuminuria. Longitudinal studies are needed to determine whether the extra individuals identified by means of HPLC are at increased risk for developing hard clinical outcomes (renal and cardiovascular).

A comprehensive examination of health conditions associated with obesity in older adults

Over 70% of older adults in the United States are overweight or obese. To examine the overall health burden of obesity in older adults, the Vitamins and Lifestyle cohort study of western Washington State recruited 73,003 adults aged 50 to 76 who completed a self-administered questionnaire on current height and weight, medical history, and risk factors. Cross-sectional analysis of body mass index (BMI) and health conditions was performed using data collected in 2000 to 2002. Participants were categorized as normal weight, overweight, obese I, or obese II/III using BMI cut-points. Health conditions included 7 serious diseases, 2 conditions associated with cardiovascular disease risk, 23 medical conditions, and 11 health complaints. Odds ratios (ORs) from logistic regression models were used to examine associations of the four BMI categories with each health condition. Analyses were gender stratified and adjusted for age, education, race/ethnicity, and smoking status. Among women, 34% were overweight, 16% in the obese I category, and 10% in obese categories II/III. Among men, 49% were overweight, 18% in the obese I category, and 6% in obese categories II/III. Overall, 37 of 41 conditions examined for women and 29 of 41 conditions examined for men were associated with increased levels of BMI (trend p <0.05 for all models). For women and men, respectively, the highest ORs comparing obese II/III to normal weight were diabetes (OR=12.5 and 8.3), knee replacement (OR=11.7 and 6.1), and hypertension (OR=5.4 and 5.6). Obesity also increased the odds of several rare diseases such as pancreatitis (OR=1.9 and 1.5) and health complaints such as chronic fatigue (OR=3.7 and 3.5) and insomnia (OR=3.5 and 3.1). A broad range of diseases and health complaints are associated with obesity. Clinicians should be aware of the diverse ways in which being overweight or obese may affect the health of their patients when counseling them about weight loss.

VITamins And Lifestyle cohort study: study design and characteristics of supplement users.

Vitamin and mineral supplements are among the most commonly used drugs in the United States, despite limited evidence on their benefits or risks. This paper describes the design, implementation, and participant characteristics of the VITamins And Lifestyle (VITAL) Study, a cohort study of the associations of supplement use with cancer risk. A total of 77,738 men and women in western Washington State, aged 50-76 years, entered the study in 2000-2002 by completing a detailed questionnaire on supplement use, diet, and other cancer risk factors, and 70% provided DNA through self-collected buccal cell specimens. Supplement users were targeted in recruitment: 66% used multivitamins, 46% used individual vitamin C, 47% used individual vitamin E, and 46% used calcium, typically for 5-8 of the past 10 years. Analyses to identify confounding factors, the main study limitation, showed that regular nonsteroidal anti-inflammatory drug use, intake of fruits and vegetables, and recreational physical activity were strongly associated with supplement use (p < 0.001). The authors describe a follow-up system in which cancers, deaths, and changes of residence are tracked efficiently, primarily through linkage to public databases. These methods may be useful to other researchers implementing a large cohort study or designing a passive follow-up system.