Years In Middle-aged Men Research Articles

Longditudinal Study of Type-2 Diabetics – Do the morbidly obese really have better outcomes?

ABSTRACT
 BackgroundDiabetes continues to utilise 10% of the NHS budget and have considerable impact on people’s lives. Abertawe bro Morganwyg Health board identified diabetes and obesity as a strategic priorities. Working in collaboration with SAIL and We Predict ABM identified this as an area for which greater insights could be gained from linked data. Type-2 diabetes is not easily identified through ICD-10 and READ codes but if new diabetics can be identified through linked data and followed up over time local areas can understand the progression locally, which populations are at risk of serious outcomes and where interventions may be made.
 ObjectivesTo identify newly diagnosed type-2 diabetics and matched controls in order to produce and analyse difference to the key outcomes of interest – death, retinopathy, myocardial infarction, CVD, CKD and amputation. In addition to produce sub group analysis – including by age group, gender, BMI and deprivation.
 ApproachA stakeholder group of GPs, managers, NHS analysts and SAIL employees were consulted. Several approaches to define and identify newly diagnosed type 2 diabetics were considered. The final algorithm consisted of a combination of 227 linked primary and secondary care codes. All 635,552 patients in the historical data set were eligible for inclusion. Suitable matched controls (patients who did not have a Type-2 Diabetes diagnosis matched based on Gender and Age Group) were identified, and allocated a synthetic ‘date of diagnosis’ or date of entry into ‘study’. The ‘cases’ and controls were then followed up to each of the key outcomes of interest for as long as data was available (in some cases 20 years). Using ‘R’ relevant analysis including survival curves were produced. After feedback to key stakeholders different approaches to presenting (visualising) the outputs were developed. Finally all the statistics and visualisation was automated.
 Results 47,848 people were identified with a new a diagnosis of diabetes. Large differences in mortality were clearly evident in people with diabetes in ABM HB – for example 10 years in middle aged men when diagnosed with diabetes compared to those who were not.
 There were some surprising results where people with higher BMIs appeared to have better outcomes when compared to groups of people in similar categories but with lower BMI. However this finding was not consistent - there was a difference in micro vascular and macro vascular outcomes.

Dietary inflammatory index and recurrence of depressive symptoms: Results from the Whitehall II Study.

There is a growing interest in understanding the role of inflammation in diet-depression relationship. The present study examined whether the dietary inflammatory index (DII, a measure of the inflammatory potential of individuals' diets) is associated with recurrent depressive symptoms (DepS) (CES-D score>16 or taking antidepressants both at baseline and follow-up) assessed over 5 years in middle-aged men (n=3178) and women (n=1068) from the Whitehall II Study. For each increment of 1 SD of DII score, odds of recurrent DepS increased by 66% (95 % CI:1.30-2.12) in women while no significant association between DII and recurrent DepS was observed in men (OR=1.12, 95 % CI: 0.92-1.36). This association was little attenuated after adjustment for confounders and after taking into account levels of interleukin-6 and C-reactive protein. In conclusion, there is an association between pro-inflammatory diet and recurrent DepS in women which seems not be driven by circulating inflammatory markers.

Longitudinal impact of aging on muscle quality in middle-aged men.

The present follow-up study aims at assessing the longitudinal changes in muscle quality after an interval of 9.45 years in middle-aged men. In addition, the relative contribution of muscle mass, muscle strength, and muscle power at middle age to these changes was investigated. The results showed a small, though unexpected, increase in total body and leg muscle mass (respectively 0.22 ± 0.04 and 0.29 ± 0.06 % yearly, p < 0.0001), whereas basic strength (-0.71 to -0.87 % yearly, p < 0.0001) and velocity-dependent strength and power (-1.19 to -1.86 % yearly, p < 0.0001) declined. Consequently, muscle quality, defined as the ratio of basic strength or velocity-dependent strength and power to muscle mass decreased (-1.46 to -2.43 % yearly, p < 0.0001) from baseline to follow-up. We found that baseline basic strength is a strong determinant of the decline in muscle quality basic strength with advancing age, whereas only a small part of the age-associated decline in muscle quality based on velocity-dependent strength and power could be explained. To conclude, our results indicate that muscle becomes less efficient at middle age and that baseline muscle strength is a strong predictor of this change. These findings imply that unmeasured neural factors, influencing both contraction speed and the capacity of muscle to produce strength, are possibly other involved determinants. Therefore, timely interventions including strength training and higher-velocity strength training at middle age are recommended.

Validation of metabolic syndrome score by confirmatory factor analysis in children and adults and prediction of cardiometabolic outcomes in adults

We validated the metabolic syndrome (MetS) score by confirmatory factor analysis (CFA) in children, middle-aged men, and older women and men and by investigating the relationships of the MetS score to incident type 2 diabetes, myocardial infarction, and cardiovascular and overall death in middle-aged men. We assessed the core features of MetS, calculated the MetS score using z scores for waist circumference, insulin, glucose, triacylglycerols, HDL-cholesterol and blood pressure, and carried out CFA to investigate whether MetS represents a single entity in population samples of 491 children, 1,900 middle-aged men, 614 older women and 555 older men from Finland. We also followed-up incident type 2 diabetes for 11 years and other outcomes for 17-18 years in middle-aged men. We carried out second-order CFAs in which the MetS was represented by a second-order latent variable underlying four latent variables characterised by abdominal obesity, insulin resistance, dyslipidaemia and raised blood pressure in different age groups. These second-order factors and factors derived from first-order CFA using previously proposed models were strongly associated with a composite MetS score in all age groups (r = 0.84-0.94) and similarly predicted type 2 diabetes, cardiovascular outcomes and mortality in middle-aged men. The risk of type 2 diabetes, myocardial infarction, cardiovascular death and overall death increased 3.67-, 1.38-, 1.56- and 1.44-fold, respectively, for a 1 SD increase in the MetS score. The MetS can be described as a single entity in all age groups. The MetS score is a valid tool for research evaluating cardiometabolic risk in different age groups. Further research is needed to define cut-off points for risk estimation in clinical practice.

Apolipoprotein B/apolipoprotein A-I in relation to the metabolic syndrome and change in carotid artery intima-media thickness during 3 years in middle-aged men.

The apolipoprotein B (apoB)/apolipoprotein A-I (apoA-I) ratio is a measure of the relationship between different lipoprotein particles and a powerful predictor of coronary death. The aim was to examine whether apoB/apoA-I was associated with the metabolic syndrome (MetS) at baseline and also with the future change in carotid artery intima-media thickness (IMT). In 313 58-year-old men, carotid artery IMT was measured bilaterally by high-resolution B-mode ultrasound at baseline and after 3 years of follow-up. Serum apolipoprotein concentrations and the components of MetS were measured at study entry. ApoB/apoA-I showed statistically significant associations with body mass index, waist-to-hip ratio, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) particle size, insulin, and diastolic blood pressure. Two thirds of the patients with MetS had high apoB/apoA-I ratios (>0.90) compared with one third of those without the syndrome (P<0.001). The IMT change was associated with apoB, total cholesterol, LDL cholesterol, triglycerides, and inversely with HDL cholesterol and LDL particle size at entry, and there was a strong colinearity between these variables. The subjects with apoB/apoA-I above the first tertile (0.74) had a 20-microm-higher (95% CI, 7 to 33) annual increase in IMT compared with those below this level after adjustment for blood pressure and smoking. The apoB/apoA-I ratio was strongly associated with MetS and its components at baseline. ApoB/apoA-I at baseline was related to the change in carotid artery IMT during 3 years of follow-up. There was a strong colinearity between apoB/apoA and the atherogenic lipids.

Changes in carbon monoxide transfer over 22 years in middle-aged men

We measured single breath CO transfer (TL co), single breath alveolar volume (VA), CO transfer coefficient (Kco) and forced expiratory volume in 1 sec (FEV1) in 84 men, mean age 40·5 years at recruitment, in 1975 and in 1997. At recruitment, 42 men were cigarette smokers and 42 were not smoking. Mean annual decline in FEV1was similar in never- (34·2 ml yr−1) and ex- (33·1 ml yr−1) smokers and faster (51·0 ml yr−1) in continuing smokers.In contrast to predictions from cross-sectional reference values, there was no fall in TL coor Kcoin men who did not smoke over the period of follow-up. In the 16 men who smoked throughout follow-up there was a 10% fall in TL co(P=0·043) but most of this was due to a significant fall in VA(P=0·017), presumably reflecting uneven gas mixing.These results indicate the need for population-based longitudinal studies of TL coand Kco. If single breath estimates of VAare used in subjects with even mild airflow obstruction, Kcorather than TLcoshould be used to assess alveolar function.

Nutritional, Metabolic, and Genetic Determinants of the Progression of Coronary Heart Disease

The St. Thomas' Atherosclerosis Regression Study (STARS) showed that treatment of mild hypercholesterolemia with diet or diet plus cholestyramine favorably influences the course of coronary heart disease (CHD) over 3 years in middle-aged men. The study employed quantitative angiography to measure change in coronary luminal dimensions. Angiographic benefit was paralleled by improvement in clinical outcomes. The study allowed a detailed analysis of the nutritional, metabolic, and genetic determinants of the progression of CHD. Significant associations were found between changes in both focal and diffuse estimates of coronary atherosclerosis and the plasma concentrations of low-density lipoprotein (LDL) cholesterol and apolipoprotein (apo) B, dietary intake at total and saturated fat, and polymorphisms of the apo-AI gene promoter region and angiotensin-converting enzyme (ACE) gene. Up to 38% of the variance in the progression of CHD could be explained by the independent effects of LDL cholesterol and dietary intake of saturated fat. The ACE genotype was only an independent predictor of the progression of CHD in patients whose LDL cholesterol had been substantially reduced with diet and cholestyramine. The clinical significance of the nutritional, metabolic and genetic findings is discussed.

Influence of smoking habits on change in carbon monoxide transfer factor over 10 years in middle aged men.

Emphysema is associated with a reduction in carbon monoxide transfer coefficient (TLCO/VA), but little is known about the evolution of changes in TLCO/VA in middle aged smokers at risk of developing chronic airflow obstruction. TLCO/VA (single breath method) was measured on two occasions 10 years apart in 122 middle aged men. Initially TLCO/VA averaged 97% predicted in never smokers (n = 42, mean age 37.2 years), 99% predicted in ex-smokers (n = 21, mean age 41.9 years), and 85% predicted in those who smoked over 15 cigarettes a day (n = 42, mean age 42.0 years). Mean rates of decrease in TLCO/VA over 10 years, however, were similar in the three groups, so that differences between smokers and non-smokers did not increase during the 10 years. Seventeen men (mean age 40.9 years) who initially were smokers became sustained ex-smokers within two years of the first measurement; in these men mean absolute values of TLCO/VA rose, averaging 89% predicted at the first assessment but 102% predicted 10 years later. By the age of about 40 years TLCO/VA was lower in smokers than in never smokers but this difference did not increase over the following 10 years. Sustained ex-smokers had values similar to those of never smokers even when TLCO/VA was known to have been reduced while they were smoking. Changes in TLCO/VA associated with stopping smoking were considerably larger than could be explained by carbon monoxide back pressure, indicating that mechanisms other than irreversible increase in the size of terminal air spaces underlie the lower values in smokers. To detect emphysema in smokers it is necessary to use reference equations that take account of current smoking.