Statistical Adjustment For Age Research Articles

Interactive relations of central versus total obesity and blood pressure to cognitive function

To examine the potential interactive relations of central versus total obesity and blood pressure (BP) to cognitive function. In all, 90 healthy, stroke, and dementia-free middle-aged and older adults (ages 54-81 years; 63% male; 93% White) underwent biomedical and neuropsychological assessment. Relations of central obesity (assessed by waist circumference (WC)) and systolic or diastolic BP to cognitive function were examined in multiple regression models. Next, body mass index (BMI) was substituted for WC in the models. After statistical adjustment for age, education, gender, and other potential confounders including components of the metabolic syndrome (depending on the model), significant interactions of WC and systolic (or diastolic) BP were noted for the Grooved Pegboard - Dominant Hand and Stroop Interference scores, with marginally significant results for Grooved Pegboard - Nondominant Hand. In general, individuals with greater WC and higher BP performed most poorly on these measures. Similar results were obtained for BMI. Independent of other confounders including facets of the metabolic syndrome, the combination of greater WC (or BMI) and higher (systolic or diastolic) BP was associated with diminished performance on tests of motor speed and manual dexterity, and executive function (i.e. response inhibition) accounting for 3-13% of the variance in these measures. In healthy older adults, there are similar, negative relations of central and total obesity to cognitive function that are potentiated by higher BP levels.

Diagnosis of hypertension and high blood pressure levels negatively affect cognitive function in older adults

Hypertension is associated with diminished performance on tests of cognitive function. The degree to which those diagnosed with hypertension have controlled blood pressure (BP) levels may be a critical determinant of cognitive outcomes. Persons with hypertension and poorly controlled BP are likely to display the worst performance on cognitive tests. The purpose is to examine potential interactive relations of hypertension diagnostic status and current BP levels to cognitive function. Participants were 101 healthy older adults (ages 53-84, 62% male, 90% White, 29% diagnosed with hypertension) who engaged in biomedical and neuropsychological assessment. After statistical adjustment for age and education, persons with high BP performed more poorly than those with normal BP on the Visual Reproductions-Immediate and Delayed Recall and the Grooved Pegboard tests. Diagnosed hypertension was related to poorer performance on the Grooved Pegboard tests. An interaction of diagnosed hypertension and BP level revealed that those diagnosed with hypertension and also having poorly controlled BP levels performed least well on the Grooved Pegboard tests and the Trail Making Test-Part A. Irrespective of prior diagnostic status, individuals with high BP displayed compromised performance on tests of nonverbal memory, motor speed, and manual dexterity. However, as compared to the other groups, those diagnosed with hypertension and also having poorly controlled BP elevation were most vulnerable to difficulties on tests of perceptuo-motor speed, motor speed, and manual dexterity. These findings suggest the need for increased attention to preventative efforts with respect to BP assessment and control in older adults to help preserve cognitive function.

Stress-induced blood pressure reactivity and cognitive function

To examine the relation of stress-induced blood pressure (BP) reactivity to cognitive function. Ninety-four healthy stroke- and dementia-free middle-aged and older adults (ages 54 to 79; 62% male; 90% white) completed biomedical, psychophysiological, and neuropsychological assessment procedures. After statistical adjustment for age, education, state anxiety, fasting glucose levels, and resting systolic or diastolic BP (depending on the model), greater systolic BP reactivity was associated with decreased performance on Logical Memory-Immediate Recall (r2 = 0.08; p < 0.007), Logical Memory-Delayed Recall (r2 = 0.06; p < 0.02), and Stroop interference scores (r2 = 0.04; p < 0.05). Enhanced diastolic BP reactivity was similarly associated with decreased performance on Logical Memory-Immediate Recall (r2 = 0.06; p < 0.02) and Stroop interference scores (r2 = 0.06; p < 0.02). Independent of resting clinic blood pressure (BP), systolic and diastolic BP reactivity was associated with diminished performance on tests of immediate and delayed verbal memory and executive function (i.e., response inhibition), accounting for 3 to 8% of the variance in these measures.

Clinical implications of an accurate problem list on heart failure treatment.

The premise of the problem-oriented medical record is that an accurately defined problem list will directly result in more thorough and efficient patient care. However, little empirical evidence exists demonstrating improved patient outcomes as a result of an adequately structured problem list. To determine the impact of problem list documentation of heart failure on the likelihood that evidence-based pharmacotherapy has been prescribed. Cross-sectional study. Community-based primary care clinics in Portland, Oregon. Active patients in the network with a left ventricular ejection fraction of 40% or less, with and without heart failure, in their structured problem list. The proportion of patients prescribed medications with known benefits for systolic dysfunction. In this group of patients with known systolic dysfunction, the likelihood of therapy with either an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker was higher in patients who had heart failure listed on their problem list compared to patients who did not (92.2% vs 76.7%; P<.05). This association remained after statistical adjustment for age, gender, and ejection fraction. Patients with accurate problem list entries were also more likely to receive digoxin (61.1% vs 36.7%; P=.001) and spironolactone (26.7% vs 13.3%; P=.025). There were no differences in the use of beta-blockers between the 2 groups. Accurate documentation of heart failure on the problem list of patients with known systolic dysfunction is associated with a significant increase in the likelihood of being prescribed medications with known clinical benefit.

Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study

We studied the long term impact of running and other aerobic exercise on musculoskeletal pain in a cohort of healthy aging male and female seniors who had been followed for 14 years. We conducted a prospective, longitudinal study in 866 Runners' Association members (n = 492) and community controls (n = 374). Subjects were also categorized as Ever-Runners (n = 565) and Never-Runners (n = 301) to include runners who had stopped running. Pain was the primary outcome measure and was assessed in annual surveys on a double-anchored visual analogue scale (0 to 100; 0 = no pain). Baseline differences between Runners' Association members and community controls and between Ever-Runners versus Never-Runners were compared using chi-square and t-tests. Statistical adjustments for age, body mass index (BMI), gender, health behaviors, history of arthritis and comorbid conditions were performed using generalized estimating equations. Runner's Association members were younger (62 versus 65 years, p < 0.05), had a lower BMI (22.9 versus 24.2, p < 0.05), and less arthritis (35% versus 41%, p > 0.05) than community controls. Runners' Association members averaged far more exercise minutes per week (314 versus 123, p < 0.05) and miles run per week (26 versus 2, p < 0.05) and tended to report more fractures (53% versus 47%, p > 0.05) than controls. Ever-Runners were younger (62 versus 66 years, p < 0.05), had lower BMI (23.0 versus 24.3, p < 0.05), and less arthritis (35% versus 43%, p < 0.05) than Never-Runners. Ever-Runners averaged more exercise minutes per week (291 versus 120, p < 0.05) and miles run per week (23 versus 1, p < 0.05) and reported a few more fractures (52% versus 48%, p > 0.05) than Never-Runners. Exercise was associated with significantly lower pain scores over time in the Runners' Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners. Consistent exercise patterns over the long term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.

Clinical features associated with receipt of alcohol treatment.

In this study, we sought to identify specific clinical features of alcohol dependence and other characteristics of recent drinkers that might help differentiate drinkers who receive treatment. In 1998, field staff for the National Household Survey on Drug Abuse assessed 18,722 sampled adults, including 12,437 who reported drinking in the year prior to survey, most of whom self-marked answers to standard items on drug experiences, including clinical features of alcohol dependence and receipt of treatment. Statistical analyses took into account the complex sampling procedures and the interdependencies between individual responses. Multivariate modeling with generalized linear model and generalized estimating equations with statistical adjustment for age, gender and race revealed that individuals who received treatment reported all seven clinical features more often than drinkers who did not receive treatment, with the greatest differences observed for alcohol-related emotional problems (adjusted odds ratio [adj. OR] = 15.0), health problems (adj. OR = 13.5), reduced important activities (adj. OR = 10.4) and inability to cut down (adj. OR = 10.1) (all p values < .05). The observed treatment-related differences were less pronounced for other clinical features (e.g., reported tolerance [adj. OR = 4.8], using more than was intended [adj. OR = 6.2] and salience of alcohol-related behavior [adj. OR = 6.2]; all p values < .05). Further statistical adjustment for frequency of alcohol use and age of first alcohol use did not alter these estimates appreciably. Reasons for observed excess occurrence of alcohol-related problems among community samples of drinkers who receive treatment deserve more attention in future research. A key research question is whether self-awareness of alcohol-related problems motivates drinkers to seek treatment or if treatment promotes awareness and decreases denial about alcohol problems.

Gender differences in the relation of hypertension to cognitive function in older adults

Here we examined potential interactive relations of hypertension and gender to cognitive function in 98 healthy, older adults (ages 55–83 years; 64% male; 92% White). After statistical adjustment for age and education, hypertensives performed significantly more poorly than normotensives on tests of motor speed and manual dexterity (p < 0.05). The adverse consequences of hypertension in older adults was more pronounced for female than male hypertensives on tests of delayed visual memory, visual attention and working memory, visuoconstructional ability, motor speed and manual dexterity for the non-dominant hand (p < 0.05); these are dimensions of performance for which female gender may be a relative disadvantage. The findings suggest the need to further examine subgroups that are vulnerable to the cognitive correlates of hypertension. The results also highlight the need for increased attention to blood pressure control in older adults for the preservation of cognitive function.

Depression and lipoprotein lipids in healthy, postmenopausal women: The moderating effects of hormone replacement therapy

Objective Naturally occurring low cholesterol levels have been related to increased depressive symptoms in studies conducted predominantly in men. However, depression is more common among women, may increase during the menopause, and may be impacted by hormone replacement therapy (HRT). We therefore examined the potential interactive relation of depressive symptoms and HRT status to lipoprotein lipids among postmenopausal women. Methods Seventy healthy, postmenopausal women (ages 50–70; 36% receiving HRT) completed the Center for Epidemiological Studies Depression Scale and provided two fasting blood samples for assessment of lipoprotein lipids. Results Following statistical adjustment for age, body mass index (BMI), HRT status, and depressive symptoms, the interaction of depression and HRT explained 16% variance in total cholesterol and 17% variance in low-density lipoprotein cholesterol ( Ps<.01). Greater levels of depressive symptoms were associated with lower cholesterol levels only among women who were not taking HRT. Conclusion These findings suggest that HRT may buffer associations between naturally occurring low cholesterol levels and increased symptoms of depression in postmenopausal women.

Framingham stroke risk profile and lowered cognitive performance.

The primary objective of this work was to describe the relationships between 10-year risk for stroke and multiple measures of cognitive performance for a large community-based sample of individuals who were free of clinical stroke and dementia at the time of risk assessment. Participants were 1011 men and 1164 women from the Framingham Offspring Study. The Framingham Stroke Risk Profile was used to assess 10-year risk of stroke. Using a cross-sectional design, we assessed 10-year risk of stroke, the predictor variable, and cognitive performance, the outcome variable, at examination 7 of the Framingham Offspring Study. Multivariable linear regression models were used to relate 10-year risk of stroke to cognitive tests measuring multiple domains of cognitive functioning. With statistical adjustment for age, education, sex, and other correlates of both stroke and cognitive ability, an inverse association between increments in 10-year risk of stroke and cognitive performance level was observed for tests indexing visual-spatial memory, attention, organization, scanning, and abstract reasoning. In stroke- and dementia-free individuals, higher 10-year risk for stroke is associated with performance decrements in multiple cognitive domains.

Plasma interleukin-6 is associated with psychological coronary risk factors: Moderation by use of multivitamin supplements

The current study examined the relation of plasma IL-6 to anger, hostility, and severity of depressive symptoms as a function of multivitamin supplement use in 96 healthy, nonsmoking men (aged 18–46). Plasma IL-6 was independently associated with anger, hostility, and severity of depressive symptoms, as well as with a composite factor score, but only among nonusers. Among users, these associations were not significant. Multivitamin use was associated with lower plasma IL-6 levels, but only among men with high composite factor scores. Statistical adjustments for age, body mass index, resting diastolic blood pressure, fasting total cholesterol, high-density lipoprotein cholesterol, alcohol use, exercise frequency, and educational level did not alter these results. These data suggest that plasma IL-6 is elevated among healthy men characterized by a propensity for anger, a hostile disposition, and greater severity of depressive symptoms and that multivitamin supplements could ameliorate plasma IL-6 levels among these men.

Beware the rising creatinine level

In this issue of the Journal, Smith and colleagues report their findings that demonstrate increases in serum creatinine levels during heart failure hospitalization are associated with worsened outcomes after hospital discharge. The authors conducted a cohort study of 412 patients hospitalized at their institution over a 30-month period who survived to discharge. The change in serum creatinine level (Cr) was defined simply as the difference between the baseline and discharge levels, with “worsened renal function” defined as a Cr 0.1mg/dL. The outcomes examined in this study were survival, readmission, and change in functional status during the 6 months after hospitalization. A Cr 0.3mg/dL was associated with a 60% increased adjusted mortality risk, and surprisingly the Cr was a stronger mortality predictor than the baseline creatinine level. Furthermore, the higher mortality risk associated with Cr 0.3mg/dL was similar at all levels of baseline creatinine level. These findings build upon prior studies that have determined the importance of renal function in the prognosis and management of heart failure. Most previous analyses evaluating the effect of renal function on heart failure outcomes have used a baseline measure from the outpatient setting. 1 A prior study from this group of authors similarly found elevations of creatinine 0.3 mg/dL during heart failure hospitalization to be associated with greater inhospital length of stay and mortality risk. The current study extends these findings by demonstrating an association of increased Cr with worse outcomes for survivors of hospitalization up to 6 months after discharge, and showing a dose-dependent relationship of Cr and increased mortality risk. However, as with most interesting studies, this analysis provokes as many questions as it answers for clinicians managing heart failure patients. The primary questions that arise from this study are: (1) Can the Cr be interpreted as a “diagnostic test” for high mortality risk? (2) Is worsened renal function a causal mechanism leading to increased mortality risk or a marker of poor cardiac function and subsequent under-treatment? and (3) What are the clinical implications of these findings for inpatient and postdischarge heart failure management?

Elevated levels of Factor XI are associated with cardiovascular disease in women

Coronary artery disease (CAD) continues to be the most frequent cause of death among women in the United States. Although elevated levels of clotting factors have been associated with CAD, few of these studies have been performed in women. Elevated levels of Factor XI have previously been associated with venous thrombosis, but little is known about its effect on arterial thrombosis. We selected women referred for cardiac catheterization who were found to have either normal coronaries or evidence of severe CAD and compared levels of homocysteine, anticardiolipin IgG/IgM antibodies, fibrinogen, platelet count, Factor VII, Factor VIII and Factor XI. Women with severe CAD had significantly higher levels of Factor XI than those without CAD (128% vs. 82%, p<0.04). Statistical adjustment for age, diabetes, hypertension, total cholesterol (TC), current smoking, or BMI had no effect on the independent association between CAD status and Factor XI. Factor XI was higher in women with total cholesterol levels >6.18 mmol/l (>239 mg/dl) compared with normocholesteremic women and was also higher in the upper tertile of age, but even when adjusted for these, the association remained significant. This initial study suggests that Factor XI may be an important parameter in arterial as well as venous thrombosis.

The relationship between body mass index and pulse pressure in older adults with isolated systolic hypertension

Background Many longitudinal studies have reported excess cardiovascular mortality among lean hypertensive subjects, suggesting that obesity may mitigate the cardiovascular risk of hypertension. Available evidence also suggests that in middle-aged and older hypertensive subjects, pulse pressure may be a better predictor of cardiovascular complications. However, there are limited data on the relationship between body mass index (BMI) and pulse pressure. Methods Using data from the Third National Health and Nutrition Examination Survey we assessed the convergence validity of pulse pressure as a predictor of cardiovascular complications and examined the relationship between BMI and pulse pressure in 1192 older adults with isolated systolic hypertension who were not receiving blood pressure medicine. Results: There was a good concordance between high pulse pressure and most of the selected cardiovascular risk factors examined in this study. Pulse pressure is higher in the lean (BMI <25) than in the overweight (BMI ≥25; 79 mm Hg vs 74 mm Hg, P < .001) and decreases significantly from 82 mm Hg in the first BMI quintile to 76 mm Hg in the fifth BMI quintile. Pulse pressure continues to decrease with increasing BMI until the index exceeds 30.1. This negative correlation persists in a multivariate model with statistical adjustment for age, sex, diabetes mellitus, and hypercholesterolemia. Conclusion The inverse relation between BMI and pulse pressure observed here may help to explain previous reports of increased cardiovascular risk among lean versus obese subjects with isolated systolic hypertension.

Pre-dialysis clinic attendance improves quality of life among hemodialysis patients.

BackgroundAlthough previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL), is less well defined.MethodsA retrospective incident cohort study was conducted to determine if pre-dialysis clinic attendance was a predictor of better QOL scores measured within the first six months of hemodialysis (HD) initiation. Inclusion criteria were HD initiation from January 1 1998 to January 1 2000, diagnosis of chronic renal failure, and completion of the QOL questionnaire within six months of HD initiation. Patients receiving HD for less than four weeks were excluded. An incident cohort of 120 dialysis patients was identified, including 74 patients who attended at least one pre-dialysis clinic and 46 patients who did not. QOL was measured using the SF 36-Item Health Survey. Independent variables included age, sex, diabetes, pre-dialysis clinic attendance and length of attendance, history of ischemic heart disease, stroke, peripheral vascular disease, heart failure, malignancy, and chronic lung disease, residual creatinine clearance at dialysis initiation, and kt/v, albumin and hemoglobin at the time of QOL assessment. Bivariate and multivariate linear regression analyses were used to identify predictors of QOL scores.ResultsMultivariate analysis suggested that pre-dialysis clinic attendance was an independent predictor of higher QOL scores in four of eight health domains (physical function, p < 0.01; emotional role limitation, p = 0.01; social function, p = 0.01; and general health, p = 0.03), even after statistical adjustment for age, sex, residual renal function, kt/v, albumin, and co-morbid disease. Pre-dialysis clinic attendance was also an independent predictor of the physical component summary score (p = 0.03).ConclusionsWe conclude that pre-dialysis clinic attendance favourably influences patient-perceived quality of life within six months of dialysis initiation.

Effects of the FABP2 A54T mutation on triglyceride metabolism of viscerally obese men.

Viscerally obese individuals are frequently characterized by a proatherogenic condition. A missense mutation (A54T) in the fatty acid binding protein type 2 (FABP2) gene has been associated with insulin resistance and obesity. This study examined the effect of this mutation on lipoprotein levels in viscerally obese hyperinsulinemic condition. A total of 217 men were assigned to one of two groups based on their FABP2 A54T polymorphism. The two genotypic groups showed no difference in either physiological characteristics or lipoprotein/lipid profile, before or after statistical adjustment for age. From this initial sample, 50 men accepted to have their postprandial lipid response assessed and 10 T54/A54 heterozygotes were then individually matched for visceral adipose tissue accumulation and fasting plasma triglyceride (TG) levels with 10 A54/A54 homozygotes. High-density lipoprotein (HDL)-TG levels were significantly increased in the fasting state as well as 4 hours after the test meal (p = 0.04 and p = 0.0008, respectively) in men bearing the A54T mutation. In addition, the area under the curve of postprandial HDL-TG levels was also significantly higher among T54/A54 heterozygotes than among A54/A54 homozygotes (p = 0.04). Interestingly, fasting TG concentrations in large TG-rich lipoproteins (large-TRL; S(f) > 400) were correlated with HDL-TG levels at 4 (r = 0.74, p = 0.01) and 8 hours (r = 0.73, p = 0.01) after the test meal in T54/A54 heterozygotes only. The FABP2 A54T missense mutation may contribute to the TG enrichment of HDL in the postprandial state that, in turn, may alter the risk of atherosclerotic vascular disease.

Back problems among postmenopausal women taking estrogen replacement therapy: the study of osteoporotic fractures.

Cross-sectional and prospective. To investigate the association between estrogen replacement therapy use, back pain, and back function in a large cohort of elderly women. Several studies have suggested that women who use estrogen replacement therapy may be more likely to experience back pain than those who do not. However, the relationships between estrogen replacement therapy, back pain, and impaired back function have not been clearly delineated. At baseline information on estrogen replacement therapy use, functional status, back pain and function, and general lifestyle variables was obtained from 7209 elderly white women (mean age 71 years)enrolled in the Study of Osteoporotic Fractures. Lateral radiographs of the lumbar and thoracic spine were taken at baseline and at the third clinic visit, an average of 3.7 years after the baseline visit. Bone mineral density at the hip and spine was measured approximately 2 years after baseline. Follow-up information on back pain and function was also obtained at the third clinic visit. A total of 1039 (14.4%) women were using estrogen replacement therapy at baseline, 2016(28.0%) reported former use, and 4154 (57.6%) had never used estrogen replacement therapy. Compared with never-users, a statistically significant higher percentage of current estrogen users reported clinical back pain (52.7% vs. 43.4%) and back impairment (12.3% vs. 9.2%) at baseline and at the follow-up visit (pain 50.8% vs. 41%; impairment 16.0% vs. 12.1%). This occurred despite a higher prevalence of vertebral fractures in never-users of estrogen at the baseline visit. Current and former estrogen users without vertebral fractures had statistically significant higher likelihoods of having back pain and back dysfunction at both the baseline and third follow-up visit. The increased likelihood of back pain and back impairment in current and former estrogen users remained despite statistical adjustment for age, vertebral fracture, body mass index,smoking history, parity, exercise, arthritis, and diabetes in multivariate models. The relative risk (95%confidence interval) for impaired back function in former and current users at follow-up was 1.1 (0.9, 1.3) and 1.6 (1.3, 2.0), respectively. Our results indicate that postmenopausal estrogen use is associated with an increased likelihood of back pain and impaired back function in elderly white women.

Previous exposure to hormone replacement therapy and confounders in metabolic studies.

The quantity of intra-abdominal fat is highly associated with the development of diabetes mellitus. We sought to determine whether recent hormone replacement therapy (HRT) use modifies central fat and insulin sensitivity in postmenopausal women compared with women who had never used HRT. We measured intra-abdominal fat, subcutaneous abdominal fat, and sagittal diameter at the L4-L5 vertebral disc space using computed tomography imaging. Total body fat and fat-free mass were measured using dual energy x-ray absorptiometry. Insulin sensitivity was assessed using the euglycemic hyperinsulinemic clamp technique in 42 nonobese postmenopausal women, age 51 +/- 4 years (12 recent HRT users plus 30 never-users). All women who were taking HRT discontinued it for 2 months before the study. After statistical adjustment for age, previous use of HRT was associated with decreased intra-abdominal fat (72 +/- 34 cm2) compared with no HRT use (96 +/- 33 cm2; p = 0.05). This difference remained significant after adjustment for time since menopause. When previous HRT users were compared with nonusers, there were no differences in subcutaneous abdominal fat, sagittal diameter, fat-free mass, total fat, insulin sensitivity, or body weight. Recent HRT use is associated with lower intra-abdominal fat in nonobese, early postmenopausal women. This finding suggests a carry-over effect of HRT on intra-abdominal fat. Recent HRT use does not seem to be associated with differences in glucose disposal.

Menopause-related changes in body fat distribution.

Menopause-related changes in body fat distribution may partially explain the greater risk of cardiovascular and metabolic disease during the postmenopausal years. To date, however, the effect of the menopause transition on body fat distribution remains unclear. Cross-sectional and longitudinal studies using waist circumference or the waist-to-hip ratio show no effect of menopause on body fat distribution. By contrast, studies using dual-energy X-ray absorptiometry showed increased trunk fat in postmenopausal women. Moreover, studies using computed tomography (CT) and magnetic resonance imaging (MRI) show that postmenopausal women have greater amounts of intra-abdominal fat compared to premenopausal women. Collectively, these studies suggest that the menopause transition is associated with an accumulation of central fat and, in particular, intra-abdominal fat. Whether menopause-related differences in trunk or intra-abdominal fat are independent of age and/or adiposity, however, is unclear. Thus, we recently examined the effect of menopausal status on body composition and abdominal fat distribution in 53 middle-aged, premenopausal women (47 +/- 3 years) and 28 early postmenopausal women (51 +/- 4 years). Postmenopausal women had 36% more trunk fat (p < 0.01), 49% greater intra-abdominal fat area (p < 0.01), and 22% greater subcutaneous abdominal fat area (p < 0.05) than premenopausal women. The menopause-related difference in intra-abdominal fat persisted (p < 0.05) after statistical adjustment for age and fat mass, whereas no differences were noted in trunk or abdominal subcutaneous fat. A similar pattern of differences in trunk, subcutaneous, and intra-abdominal fat was observed in subsamples of pre- and postmenopausal women matched for age or fat mass. Our data and that of others suggest that early postmenopausal status is associated with a preferential increase in intra-abdominal fat that is independent of age and total adiposity. Thus, CT and MRI should be used when examining menopause-related changes in body fat distribution.

Exhaustion of drug benefits and disenrollment of medicare beneficiaries from managed care organizations.

Many Medicare beneficiaries enroll in managed care health plans to obtain outpatient drug benefits. Increasing pharmaceutical utilization and costs and decreasing drug benefits increase the likelihood that medication use by such enrollees will exceed drug benefits, which may lead to health plan disenrollment. To test the hypothesis that exhaustion of managed care drug benefits by Medicare beneficiaries is associated with disenrollment from the health plan. Retrospective cohort study followed up for 1 year (1998) using an enrollment/claims database. Four geographically diverse network-model health plans that had annual drug benefits of $300, $500, $600, or $1000. A total of 61,412 elderly Medicare beneficiaries. Voluntary disenrollment from health plans by members who did or did not exhaust their drug benefits. The likelihood of exhausting 1998 drug benefits ranged from 17% to 25% across health plans (P<.001). The relative hazards of disenrollment from the 4 plans when drug benefits had been exhausted were 2.5 (95% confidence interval [CI], 2.3-2.8), 1.9 (95% CI, 1.7-2.1), 2.7 (95% CI, 2.0-3.6), and 2.1 (95% CI, 1.9-2.4). Statistical adjustments for age, sex, prior enrollment, hospital admissions, physician visits, and county of residence did not alter these estimates. Exhaustion of drug benefits was associated with a significant increase in the likelihood of disenrollment of Medicare beneficiaries. This finding arouses concern that Medicare beneficiaries must change plans to have financial access to medications, which can lead to discontinuity in care and diversion of resources from care to administrative matters. Policymakers should strive to avoid fragmented systems of providing drug benefits.

Effect of menopausal status on body composition and abdominal fat distribution.

Preliminary studies suggest that the menopause transition is associated with deleterious changes in body composition and abdominal fat distribution. Limitations of the methodology used in these studies, however, render their conclusions controversial. Thus, the present study used radiologic imaging techniques to examine the effect of menopausal status on body composition and abdominal fat distribution. Cross-sectional. Fifty-three healthy, middle-aged, premenopausal women (mean+/-SD; 47+/-3 y) and 28 early-postmenopausal women (51+/-4 y). Total and regional body composition by dual energy X-ray absorptiometry and abdominal fat distribution by computed tomography. No differences in total body fat-free mass or appendicular skeletal muscle mass were noted between groups. In contrast, total body fat mass was 28% higher (23+/-7 vs 18+/-7 kg) and percentage fat 17% higher (35+/-6 vs 30+/-9%; both P<0.01) in postmenopausal women compared with premenopausal women. Postmenopausal women had a 49% greater intra-abdominal (88+/-32 vs 59+/-32 cm2; P<0.01) and a 22% greater abdominal subcutaneous fat area (277+/-93 vs 227+/-108 cm2; P<0.05) compared to premenopausal women. The menopause-related difference in intra-abdominal fat persisted (P<0.05) after statistical adjustment for age and total body fat mass, whereas no difference in abdominal subcutaneous fat was noted. A similar pattern of differences in total and abdominal adiposity was noted in sub-samples of pre- and postmenopausal women matched for age or fat mass. Our data suggest that early-postmenopausal status is associated with a preferential increase in intra-abdominal fat that is independent of age and total body fat mass. International Journal of Obesity (2000) 24, 226-231