Objectives—Pain has been associated with cognitive problems in pain patients. This study evaluate... more Objectives—Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. Study Design—A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. Main Outcome Measures—The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Disclosures: There are no conflicts of interest for any of the authors. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. I will follow up with an email attachment of the ethical approval from the SWAN Study. http://www.swanstudy.org/ The contributors and their roles are listed in the cover letter. Competing interests are listed in the cover letter. Results—Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) −0.074 (0.021); p value <0.01] and this association was partially explained by depressive symptoms [β (SE) −0.061 (0.022); p value <0.01 after adjusting for depressive symptoms]. Additionally, an independent association between a greater composite pain score and poorer cognitive performance was identified without adjusting for depressive symptoms, [β (SE) −0.002 (0.0009); p value <0.05] but was no longer significant after adjusting for depressive symptoms. Conclusions—Our results suggest that in mid-life women, greater pain is associated with poorer cognitive performance, and depressive symptoms play an important role in this association. Clinicians should be aware of these relationships when evaluating patients.
Background—Several cohort studies report associations between chronic exposure to ambient fine pa... more Background—Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods—We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1,923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results—We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m 3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions—In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
During midlife, physical functioning limitations emerge and depressive symptoms are highly preval... more During midlife, physical functioning limitations emerge and depressive symptoms are highly prevalent. We examined the relationship between physical functioning and depressive symptoms in the Michigan Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven performance-based physical functioning measures quantifying strength, balance, coordination, flexibility and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D scores were associated with performance-based functions including slower timed walk sit-to-stand, and stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age increased, those with higher CES-D scores were more likely to have perceived limitations in physical functioning, though the association was weak. History of depressive symptoms was not significant in any model. These findings suggest that higher concurrent depressive symptoms are modestly associated with slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms played little or no role in current physical functioning of mid-life women. When evaluating physical function, women’s current mental health status should be considered. 2010 Elsevier
Background—Due to the public health burden of age-related declines in physical functioning, it is... more Background—Due to the public health burden of age-related declines in physical functioning, it is important to identify targets for intervention for the prevention of functional decline. We prospectively examined whether higher levels of inflammatory and hemostatic markers (high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA-ag), fibrinogen, and Factor VIIc (FVIIc)) were prospectively associated with reporting greater limitations in perceived physical functioning, and explored potential racial differences in the associations, in a multi-ethnic sample of mid-life women.
We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP... more We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP) and fibrinogen are related to measures of physical functioning in midlife women. Our sample included 543 participants in the Michigan site of Study of Women's Health Across the Nation (SWAN). Predictors included CRP from serum and fibrinogen from plasma. Performance-based outcomes included measures of gait, hand grip strength, flexibility, stair climb, 40-foot walk, and chair rise. Perception of physical functioning was assessed with the Medical Outcomes Study Short-Form 36 questionnaire. Regression analyses adjusted for relevant covariates. Cross-sectional associations were identified between higher CRP and more time spent in double support (with both feet on the floor while walking), shorter forward reach, slower 2-lb lift, and slower stair climb. Higher CRP and fibrinogen were associated with worse perceived functioning in cross-sectional analyses. Predictive associations across time were found between higher CRP and increased time spent in double support, diminishing forward reach distance and grip strength and worse perceived physical functioning. Predictive associations across time were also found between higher fibrinogen and greater time spent in double support, slower stair climb and worse perceived physical functioning. Our results suggest that inflammatory processes are associated with poor physical functioning in midlife women.
Context—Physical functioning represents an integrated marker of aging. Whether menopause is assoc... more Context—Physical functioning represents an integrated marker of aging. Whether menopause is associated with an accelerated decline in physical functioning is not known. Objective—To characterize whether losses in physical functioning are related to the natural or surgical menopause or time, following adjustment for body size and smoking behavior.
Context—Understanding the menopause association with body weight is important because excess weig... more Context—Understanding the menopause association with body weight is important because excess weight increases risk for stroke, incident cardiovascular disease, cardiovascular mortality, and all-cause mortality among the middle-aged. Objective—To examine chronological age and ovarian age and consider how these could influence body size and composition in mid-life women. Main Outcome Measures—Waist circumference, fat mass and skeletal muscle mass, from bioelectrical impedance, was assessed in 7 annual serial measures. Annual follicle-stimulating hormone (FSH) values were assayed by ELISA. The final menstrual period (FMP) was defined retrospectively following 12 months of amenorrhea. Results—There was an absolute cumulative six-year increase in fat mass of 3.4 kg and a six-year decrease in skeletal muscle mass of ~0.23 kg. There was an absolute cumulative six-year increase of ~5.7 cm in waist circumference. The log FSH change was positively correlated with log (fat mass) change. Waist circumference increased over the time period, but one year following FMP, the rate of increase slowed. Fat mass continued to increase with no change in rate. Conclusions—Both time (chronological aging) and ovarian aging contributed to substantial changes in body composition (fat and skeletal muscle mass) and waist circumference. These changes have important ramifications for establishing a metabolic environment that can be healthy or unhealthy.
Smoking, diet and physical activity may impact chronic diseases, in part, by promoting or attenua... more Smoking, diet and physical activity may impact chronic diseases, in part, by promoting or attenuating oxidative stress. We evaluated associations between lifestyle factors and urine F 2a-isoprostanes, a marker of oxidative stress among 1610 participants of Study of Women's Health Across the Nation (SWAN). Dietary intake and physical activity were assessed at baseline and year 05 (Y05). These data were related to Y05 urinary F 2a-isoprostane concentration with regression analyses. Median urine F 2a-isoprostane concentration was 433 ng/L overall, 917 ng/L in smokers (inter-quartile range: 467, 1832 ng/L) and 403 ng/L in non-smokers (inter-quartile range: 228, 709 ng/L; P<0.0001 for difference). Higher trans fat intake was associated with higher urine F 2a-isoprostane concentration; partial Spearman correlations (ρ x|y) between Y05 urine F 2a-isoprostane concentration and trans fatty acids were 0.19 (P=0.03) and 0.13 (P <0.0001) in smokers and non-smokers, respectively. Increased log trans fat intake from baseline to Y05 was associated with higher concentration of logurine F 2a-isoprostanes in non-smokers (β=0.131, SE=0.04, P =0.0003). In non-smokers, the partial correlation (ρ x|y) between lutein and urine F 2a-isoprostane concentration was −0.13 (P <0.0001). Increased intake of log lutein from baseline to Y05 was also associated with lower log urine F 2a-isoprostane concentration (β= −0.096, SE=0.03, P =0.0005) in non-smokers. Increased zinc intake from baseline to Y05 was associated with lower log urine F 2a-isoprostane concentration in smokers and non-smokers (β= −0.346, SE=0.14, P =0.01), and −0.117, 0.04 (P =0.001), respectively]. In conclusion, diet (fat subtypes, zinc, vegetable components) and smoking were associated with urine F 2a-isoprostanes, a marker of oxidative stress.
Commonly studied physical functions include activities such as walking and climbing
stairs. Despi... more Commonly studied physical functions include activities such as walking and climbing stairs. Despite the acknowledged role of environmental factors and behavioral strategies to compensate for reduced performance capacity or environmental barriers in characterizing physical functioning, most assessments do not take these factors into account. This article presents a new conceptual model for assessment of relevant physical functioning while accounting for habitual environmental factors and compensation strategies.
Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community... more Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community-dwelling adults with Down syndrome in the Chicago area. Dietary intake was measured using a food frequency questionnaire completed by the participant's primary caregiver; anthropometric measures included height and weight and waist circumference. Plasma glucose and lipid concentrations were assessed following a 10-hour fast. Overall, 89% of participants were overweight or obese, 54% had large waist circumferences, and none met the current guidelines for fruit and vegetable intake. Mean concentrations for lipids and glucose, however, were within normal limits; and prevalence for hypertension, elevated lipids, and glucose were less than those for the general population of the United States.
Background: Adult obesity is associated with the metabolic syndrome ; however, the prevalence of ... more Background: Adult obesity is associated with the metabolic syndrome ; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. Objective: The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of 3 of the following risk factors: HDL 40 mg/dL, triacylglycerol 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. Design: A cross-sectional study of obesity and the metabolic syndrome was conducted in third-to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capillary finger-stick samples. Results: Age-and sex-specific BMI percentiles were assessed in 385 students, 90 of whom were full participants in this study (participants) and 295 of whom had only height and weight measurements taken (other students). Risk factors of the metabolic syndrome were assessed in the 90 participants (23%). No significant differences in BMI percentiles were found between the participants and the other students. Overall, 44% of the participants had BMIs at or above the 85th percentile, and 59% had an elevated BMI or one metabolic syndrome risk factor. The metabolic syndrome was present in 5.6% of all participants, in 13.8% of participants with BMIs at or above the 95th percentile, and in 0% of participants with BMIs below the 95th percentile. Conclusions: Most of the African American children attending 2 urban schools in low-income neighborhoods were overweight or had one or more risk factors for the metabolic syndrome. School-based screening programs in high-risk populations may provide an efficient venue for the screening of obesity and related risk factors. Am J Clin Nutr 2005;81:970 –5.
Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban commu... more Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005;86:664-71. Objectives: To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data. Design: Cross-sectional. Setting: Urban university. Participants: Ninety-five community-dwelling men with paraplegia (age range, 20 –59y). Interventions: Not applicable. Main Outcome Measures: Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression. Results: Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets. Conclusions: Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases.
Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborho... more Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Arch Phys Med Rehabil 2008;89:1468-73. Objectives: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). Design: A cross-sectional study. Setting: Urban university. Participants: Men with SCI (N131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. Results: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR].19; 95% confidence interval [CI], .04 –.80), metabolic syndrome (OR.15; 95% CI, .03–.66) and high CRP (OR.17; 95% CI, .04 –.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR.14; 95% CI, .04 –.49) than their counterparts. Conclusions: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome , and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.
Objectives—Pain has been associated with cognitive problems in pain patients. This study evaluate... more Objectives—Pain has been associated with cognitive problems in pain patients. This study evaluated the extent to which experiences of pain are associated with cognitive performance in a community sample of mid-life women, and the contribution of depressive symptoms to this association. Study Design—A cross-sectional analysis was used with data from the Study of Women's Health Across the Nation (SWAN). Associations between aspects of pain and cognitive performance were evaluated using statistical models with and without depressive symptoms. Main Outcome Measures—The cognitive performance score was a composite of three cognitive tests, the Digit Span Backward Test, the Symbol Digit Modalities Test and the East Boston Memory Test. Disclosures: There are no conflicts of interest for any of the authors. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. I will follow up with an email attachment of the ethical approval from the SWAN Study. http://www.swanstudy.org/ The contributors and their roles are listed in the cover letter. Competing interests are listed in the cover letter. Results—Greater pain experiences that interfered with daily work were independently associated with poorer cognitive performance, [β (SE) −0.074 (0.021); p value <0.01] and this association was partially explained by depressive symptoms [β (SE) −0.061 (0.022); p value <0.01 after adjusting for depressive symptoms]. Additionally, an independent association between a greater composite pain score and poorer cognitive performance was identified without adjusting for depressive symptoms, [β (SE) −0.002 (0.0009); p value <0.05] but was no longer significant after adjusting for depressive symptoms. Conclusions—Our results suggest that in mid-life women, greater pain is associated with poorer cognitive performance, and depressive symptoms play an important role in this association. Clinicians should be aware of these relationships when evaluating patients.
Background—Several cohort studies report associations between chronic exposure to ambient fine pa... more Background—Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods—We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1,923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results—We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m 3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions—In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
During midlife, physical functioning limitations emerge and depressive symptoms are highly preval... more During midlife, physical functioning limitations emerge and depressive symptoms are highly prevalent. We examined the relationship between physical functioning and depressive symptoms in the Michigan Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven performance-based physical functioning measures quantifying strength, balance, coordination, flexibility and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D scores were associated with performance-based functions including slower timed walk sit-to-stand, and stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age increased, those with higher CES-D scores were more likely to have perceived limitations in physical functioning, though the association was weak. History of depressive symptoms was not significant in any model. These findings suggest that higher concurrent depressive symptoms are modestly associated with slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms played little or no role in current physical functioning of mid-life women. When evaluating physical function, women’s current mental health status should be considered. 2010 Elsevier
Background—Due to the public health burden of age-related declines in physical functioning, it is... more Background—Due to the public health burden of age-related declines in physical functioning, it is important to identify targets for intervention for the prevention of functional decline. We prospectively examined whether higher levels of inflammatory and hemostatic markers (high-sensitivity C-reactive protein (hs-CRP), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA-ag), fibrinogen, and Factor VIIc (FVIIc)) were prospectively associated with reporting greater limitations in perceived physical functioning, and explored potential racial differences in the associations, in a multi-ethnic sample of mid-life women.
We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP... more We investigated whether subclinical inflammatory markers high-sensitivity C-reactive protein (CRP) and fibrinogen are related to measures of physical functioning in midlife women. Our sample included 543 participants in the Michigan site of Study of Women's Health Across the Nation (SWAN). Predictors included CRP from serum and fibrinogen from plasma. Performance-based outcomes included measures of gait, hand grip strength, flexibility, stair climb, 40-foot walk, and chair rise. Perception of physical functioning was assessed with the Medical Outcomes Study Short-Form 36 questionnaire. Regression analyses adjusted for relevant covariates. Cross-sectional associations were identified between higher CRP and more time spent in double support (with both feet on the floor while walking), shorter forward reach, slower 2-lb lift, and slower stair climb. Higher CRP and fibrinogen were associated with worse perceived functioning in cross-sectional analyses. Predictive associations across time were found between higher CRP and increased time spent in double support, diminishing forward reach distance and grip strength and worse perceived physical functioning. Predictive associations across time were also found between higher fibrinogen and greater time spent in double support, slower stair climb and worse perceived physical functioning. Our results suggest that inflammatory processes are associated with poor physical functioning in midlife women.
Context—Physical functioning represents an integrated marker of aging. Whether menopause is assoc... more Context—Physical functioning represents an integrated marker of aging. Whether menopause is associated with an accelerated decline in physical functioning is not known. Objective—To characterize whether losses in physical functioning are related to the natural or surgical menopause or time, following adjustment for body size and smoking behavior.
Context—Understanding the menopause association with body weight is important because excess weig... more Context—Understanding the menopause association with body weight is important because excess weight increases risk for stroke, incident cardiovascular disease, cardiovascular mortality, and all-cause mortality among the middle-aged. Objective—To examine chronological age and ovarian age and consider how these could influence body size and composition in mid-life women. Main Outcome Measures—Waist circumference, fat mass and skeletal muscle mass, from bioelectrical impedance, was assessed in 7 annual serial measures. Annual follicle-stimulating hormone (FSH) values were assayed by ELISA. The final menstrual period (FMP) was defined retrospectively following 12 months of amenorrhea. Results—There was an absolute cumulative six-year increase in fat mass of 3.4 kg and a six-year decrease in skeletal muscle mass of ~0.23 kg. There was an absolute cumulative six-year increase of ~5.7 cm in waist circumference. The log FSH change was positively correlated with log (fat mass) change. Waist circumference increased over the time period, but one year following FMP, the rate of increase slowed. Fat mass continued to increase with no change in rate. Conclusions—Both time (chronological aging) and ovarian aging contributed to substantial changes in body composition (fat and skeletal muscle mass) and waist circumference. These changes have important ramifications for establishing a metabolic environment that can be healthy or unhealthy.
Smoking, diet and physical activity may impact chronic diseases, in part, by promoting or attenua... more Smoking, diet and physical activity may impact chronic diseases, in part, by promoting or attenuating oxidative stress. We evaluated associations between lifestyle factors and urine F 2a-isoprostanes, a marker of oxidative stress among 1610 participants of Study of Women's Health Across the Nation (SWAN). Dietary intake and physical activity were assessed at baseline and year 05 (Y05). These data were related to Y05 urinary F 2a-isoprostane concentration with regression analyses. Median urine F 2a-isoprostane concentration was 433 ng/L overall, 917 ng/L in smokers (inter-quartile range: 467, 1832 ng/L) and 403 ng/L in non-smokers (inter-quartile range: 228, 709 ng/L; P<0.0001 for difference). Higher trans fat intake was associated with higher urine F 2a-isoprostane concentration; partial Spearman correlations (ρ x|y) between Y05 urine F 2a-isoprostane concentration and trans fatty acids were 0.19 (P=0.03) and 0.13 (P <0.0001) in smokers and non-smokers, respectively. Increased log trans fat intake from baseline to Y05 was associated with higher concentration of logurine F 2a-isoprostanes in non-smokers (β=0.131, SE=0.04, P =0.0003). In non-smokers, the partial correlation (ρ x|y) between lutein and urine F 2a-isoprostane concentration was −0.13 (P <0.0001). Increased intake of log lutein from baseline to Y05 was also associated with lower log urine F 2a-isoprostane concentration (β= −0.096, SE=0.03, P =0.0005) in non-smokers. Increased zinc intake from baseline to Y05 was associated with lower log urine F 2a-isoprostane concentration in smokers and non-smokers (β= −0.346, SE=0.14, P =0.01), and −0.117, 0.04 (P =0.001), respectively]. In conclusion, diet (fat subtypes, zinc, vegetable components) and smoking were associated with urine F 2a-isoprostanes, a marker of oxidative stress.
Commonly studied physical functions include activities such as walking and climbing
stairs. Despi... more Commonly studied physical functions include activities such as walking and climbing stairs. Despite the acknowledged role of environmental factors and behavioral strategies to compensate for reduced performance capacity or environmental barriers in characterizing physical functioning, most assessments do not take these factors into account. This article presents a new conceptual model for assessment of relevant physical functioning while accounting for habitual environmental factors and compensation strategies.
Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community... more Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community-dwelling adults with Down syndrome in the Chicago area. Dietary intake was measured using a food frequency questionnaire completed by the participant's primary caregiver; anthropometric measures included height and weight and waist circumference. Plasma glucose and lipid concentrations were assessed following a 10-hour fast. Overall, 89% of participants were overweight or obese, 54% had large waist circumferences, and none met the current guidelines for fruit and vegetable intake. Mean concentrations for lipids and glucose, however, were within normal limits; and prevalence for hypertension, elevated lipids, and glucose were less than those for the general population of the United States.
Background: Adult obesity is associated with the metabolic syndrome ; however, the prevalence of ... more Background: Adult obesity is associated with the metabolic syndrome ; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. Objective: The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of 3 of the following risk factors: HDL 40 mg/dL, triacylglycerol 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. Design: A cross-sectional study of obesity and the metabolic syndrome was conducted in third-to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capillary finger-stick samples. Results: Age-and sex-specific BMI percentiles were assessed in 385 students, 90 of whom were full participants in this study (participants) and 295 of whom had only height and weight measurements taken (other students). Risk factors of the metabolic syndrome were assessed in the 90 participants (23%). No significant differences in BMI percentiles were found between the participants and the other students. Overall, 44% of the participants had BMIs at or above the 85th percentile, and 59% had an elevated BMI or one metabolic syndrome risk factor. The metabolic syndrome was present in 5.6% of all participants, in 13.8% of participants with BMIs at or above the 95th percentile, and in 0% of participants with BMIs below the 95th percentile. Conclusions: Most of the African American children attending 2 urban schools in low-income neighborhoods were overweight or had one or more risk factors for the metabolic syndrome. School-based screening programs in high-risk populations may provide an efficient venue for the screening of obesity and related risk factors. Am J Clin Nutr 2005;81:970 –5.
Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban commu... more Tomey KM, Chen DM, Wang X, Braun-schweig CL. Dietary intake and nutritional status of urban community-dwelling men with paraplegia. Arch Phys Med Rehabil 2005;86:664-71. Objectives: To evaluate nutritional status, dietary intake, nutrition knowledge, and depression of healthy urban men with chronic spinal cord injury (SCI) and to compare these findings with national guidelines and data. Design: Cross-sectional. Setting: Urban university. Participants: Ninety-five community-dwelling men with paraplegia (age range, 20 –59y). Interventions: Not applicable. Main Outcome Measures: Dietary intake, body mass index (BMI), waist circumference, knowledge of nutrition, and depression. Results: Diets included too much total and saturated fat, and inadequate fiber, calcium, fruit, and dairy intake. Most participants met protein needs, but most calorie levels were at or below recommendations. By using standard BMI and waist circumference cut-points for the able-bodied, approximately half of participants were overweight, 19% were obese, 7.5% were underweight, and more than one third had large waist circumferences. Participants with low knowledge of nutrition and high BMI who lived alone, smoked, and who had low family incomes were at significantly higher risk for lower quality diets. African Americans had the poorest diets. Conclusions: Intake of several key nutrients did not meet guidelines, and many BMI and waist circumference values were outside recommended ranges. These data highlight the need for clinicians to screen, counsel, and treat people with SCI to prevent related chronic diseases.
Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborho... more Liang H, Tomey K, Chen D, Savar NL, Rim-mer JH, Braunschweig CL. Objective measures of neighborhood environment and self-reported physical activity in spinal cord injured men. Arch Phys Med Rehabil 2008;89:1468-73. Objectives: To assess the relationship between objective neighborhood environment and self-reported physical activity (PA) and between PA and obesity-related risk factors in people with spinal cord injury (SCI). Design: A cross-sectional study. Setting: Urban university. Participants: Men with SCI (N131), 20 to 59 years old, at least 1 year postinjury and using wheelchair for mobility most of the time. Interventions: Not applicable. Main Outcome Measures: Metabolic syndrome (abdominal obesity, elevated blood pressure, glucose, triglycerides, and low-high density lipoprotein cholesterol) and high C-reactive protein (CRP), as well as total PA metabolic equivalent score. Results: Lower PA was associated with higher prevalence rate for elevated triglycerides, metabolic syndrome, and high CRP. Compared with those in low PA tertile, those in high PA tertile had significantly lower odds for elevated triglycerides (odds ratio [OR].19; 95% confidence interval [CI], .04 –.80), metabolic syndrome (OR.15; 95% CI, .03–.66) and high CRP (OR.17; 95% CI, .04 –.71) while adjusting for relevant factors. In crude analysis, lower PA was associated with neighborhood environmental characteristics including shorter distance to nearest transit stops, smaller mean block area, greater number of transit stops, high vacant housing, and higher neighborhood crime rate. In multivariate analysis higher total crime was the only risk factor significantly associated with lower PA level. Those living in higher crime rate neighborhoods had 86% lower odds of having greater than median PA level (OR.14; 95% CI, .04 –.49) than their counterparts. Conclusions: In men with SCI, lower PA is independently associated with having elevated triglycerides, metabolic syndrome , and high CRP. Additionally, lower PA is associated with higher neighborhood crime rate.
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Papers by Ella August (Formerly Kristin Tomey)
We examined the relationship between physical functioning and depressive symptoms in the Michigan
Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven
performance-based physical functioning measures quantifying strength, balance, coordination, flexibility
and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning
sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified
concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive
symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was
used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D
scores were associated with performance-based functions including slower timed walk sit-to-stand, and
stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age
increased, those with higher CES-D scores were more likely to have perceived limitations in physical
functioning, though the association was weak. History of depressive symptoms was not significant in any
model. These findings suggest that higher concurrent depressive symptoms are modestly associated with
slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms
played little or no role in current physical functioning of mid-life women. When evaluating physical
function, women’s current mental health status should be considered.
2010 Elsevier
stairs. Despite the acknowledged role of environmental factors and behavioral strategies
to compensate for reduced performance capacity or environmental barriers in
characterizing physical functioning, most assessments do not take these factors into
account. This article presents a new conceptual model for assessment of relevant
physical functioning while accounting for habitual environmental factors and compensation
strategies.
We examined the relationship between physical functioning and depressive symptoms in the Michigan
Study of Women’s Health Across the Nation (SWAN) cohort of mid-life women (n ¼ 377). Seven
performance-based physical functioning measures quantifying strength, balance, coordination, flexibility
and range of motion and perceived physical functioning, assessed with the SF-36 physical functioning
sub-score, were included. The Center for Epidemiological Studies Depression Scale (CES-D) identified
concurrent depressive symptom trajectory from 2000/2001 through 2005/2006 and history of depressive
symptoms from 1996/1997 through 1999/1900. Longitudinal mixed-effects regression modeling was
used to evaluate relationships. Median age of participants was 50 years. As age increased, higher CES-D
scores were associated with performance-based functions including slower timed walk sit-to-stand, and
stair climb after adjusting for five-year history of depressive symptoms and relevant covariates. As age
increased, those with higher CES-D scores were more likely to have perceived limitations in physical
functioning, though the association was weak. History of depressive symptoms was not significant in any
model. These findings suggest that higher concurrent depressive symptoms are modestly associated with
slower movement and a perception of poorer functioning. In contrast, history of depressive symptoms
played little or no role in current physical functioning of mid-life women. When evaluating physical
function, women’s current mental health status should be considered.
2010 Elsevier
stairs. Despite the acknowledged role of environmental factors and behavioral strategies
to compensate for reduced performance capacity or environmental barriers in
characterizing physical functioning, most assessments do not take these factors into
account. This article presents a new conceptual model for assessment of relevant
physical functioning while accounting for habitual environmental factors and compensation
strategies.