Showing papers by "Barbara V. Howard published in 2006"

Diet and Lifestyle Recommendations Revision 2006 A Scientific Statement From the American Heart Association Nutrition Committee

Abstract: Improving diet and lifestyle is a critical component of the American Heart Association's strategy for cardiovascular disease risk reduction in the general population. This document presents recommendations designed to meet this objective. Specific goals are to consume an overall healthy diet; aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood glucose level; be physically active; and avoid use of and exposure to tobacco products. The recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to 7% of energy, trans fat to 1% of energy, and cholesterol to 300 mg/day by choosing lean meats and vegetable alternatives, fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats; minimize intake of beverages and foods with added sugars; choose and prepare foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and lifestyle recommendations, Americans can substantially reduce their risk of developing cardiovascular disease, which remains the leading cause of morbidity and mortality in the United States. (Circulation. 2006;114:82-96.)

Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006

Abstract: This article summarizes the recent American Heart Association (AHA) Science Statement, Diet and Lifestyle Recommendations, published in Circulation in the July 4, 2006 issue.1 Improving diet and lifestyle recommendations is a critical component of the AHA’s strategy for cardiovascular disease risk reduction in the general population. Specific goals are to consume an overall healthy diet; aim for a healthy body weight; aim for recommended levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides; aim for normal blood pressure; aim for a normal blood glucose level; be physically active; and avoid use of and exposure to tobacco products. The recommendations are to balance caloric intake and physical activity to achieve and maintain a healthy body weight; consume a diet rich in vegetables and fruits; choose whole-grain, high-fiber foods; consume fish, especially oily fish, at least twice a week; limit intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg/d by choosing lean meats and vegetable alternatives, fat-free (skim) or low-fat (1% fat) dairy products and minimize intake of partially hydrogenated fats; minimize intake of beverages and foods with added sugars; choose and prepare foods with little or no salt; if you consume alcohol, do so in moderation; and when you eat food prepared outside of the home, follow these Diet and Lifestyle Recommendations. By adhering to these diet and lifestyle recommendations, the risk of developing cardiovascular disease can be substantially reduced, which remains the leading cause of morbidity and mortality in the United States. Improving diet and lifestyle is a critical component of the AHA strategy to prevent cardiovascular disease (CVD). The 2006 AHA Diet and Lifestyle Recommendations1 were designed to meet this objective and are one component of a comprehensive plan for cardiovascular risk reduction. The recommendations are …

Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial.

Abstract: ContextObesity in the United States has increased dramatically during the past several decades. There is debate about optimum calorie balance for prevention of weight gain, and proponents of some low-carbohydrate diet regimens have suggested that the increasing obesity may be attributed, in part, to low-fat, high-carbohydrate diets.ObjectivesTo report data on body weight in a long-term, low-fat diet trial for which the primary end points were breast and colorectal cancer and to examine the relationships between weight changes and changes in dietary components.Design, Setting, and ParticipantsRandomized intervention trial of 48 835 postmenopausal women in the United States who were of diverse backgrounds and ethnicities and participated in the Women's Health Initiative Dietary Modification Trial; 40% (19 541) were randomized to the intervention and 60% (29 294) to a control group. Study enrollment was between 1993 and 1998, and this analysis includes a mean follow-up of 7.5 years (through August 31, 2004).InterventionsThe intervention included group and individual sessions to promote a decrease in fat intake and increases in vegetable, fruit, and grain consumption and did not include weight loss or caloric restriction goals. The control group received diet-related education materials.Main Outcome MeasureChange in body weight from baseline to follow-up.ResultsWomen in the intervention group lost weight in the first year (mean of 2.2 kg, P<.001) and maintained lower weight than control women during an average 7.5 years of follow-up (difference, 1.9 kg, P<.001 at 1 year and 0.4 kg, P = .01 at 7.5 years). No tendency toward weight gain was observed in intervention group women overall or when stratified by age, ethnicity, or body mass index. Weight loss was greatest among women in either group who decreased their percentage of energy from fat. A similar but lesser trend was observed with increases in vegetable and fruit servings, and a nonsignificant trend toward weight loss occurred with increasing intake of fiber.ConclusionA low-fat eating pattern does not result in weight gain in postmenopausal women.Clinical Trial RegistrationClinicalTrials.gov Identifier: NCT00000611

Effects of conjugated equine estrogen on stroke in the Women's Health Initiative

Abstract: Background— The Women’s Health Initiative (WHI) Estrogen Alone trial assessed the balance of benefits and risks of hormone use in healthy postmenopausal women. The trial was stopped prematurely because there was no benefit for coronary heart disease and an increased risk of stroke. This report provides a thorough analysis of the stroke finding using the final results from the completed trial database. Methods and Results— The WHI Estrogen Alone hormone trial is a multicenter, double-blind, placebo-controlled, randomized clinical trial in 10 739 women aged 50 to 79 years who were given daily conjugated equine estrogen (CEE; 0.625 mg; n=5310) or placebo (n=5429). During an average follow-up of 7.1 years, there were 168 strokes in the CEE group and 127 in the placebo group; 80.3% of strokes were ischemic. For all stroke the intention-to-treat hazard ratio [HR] (95% CI) for CEE versus placebo was 1.37 (1.09 to 1.73). The HR (95% CI) was 1.55 (1.19 to 2.01) for ischemic stroke and 0.64 (0.35, 1.18) for hemorrh...

Prehypertension, Diabetes, and Cardiovascular Disease Risk in a Population-Based Sample The Strong Heart Study

Abstract: There are few data about the impact of the recently-defined category of prehypertension (systolic blood pressure 120 to 139 mm Hg or diastolic blood pressure 80 to 89 mm Hg) on cardiovascular disease incidence. It is also unknown whether this association differs between individuals with or without diabetes. A total of 2629 Strong Heart Study participants free from hypertension and cardiovascular disease at baseline examination were followed for 12 years to observe incident cardiovascular disease. Approximately 42% of the 2629 participants had diabetes. We assessed the prevalence of prehypertension and the hazard ratios of incident cardiovascular disease associated with prehypertension. Prehypertension was more prevalent in diabetic than nondiabetic participants (59.4% versus 48.2%, P<0.001 adjusted for age). Compared with nondiabetic participants with normal blood pressure, the hazard ratios of cardiovascular disease were 3.70 (95% confidence interval: 2.66, 5.15) for those with both prehypertension and diabetes, 1.80 (1.28, 2.54) for those with prehypertension alone and 2.90 (2.03, 4.16) for those with diabetes alone. Impaired glucose tolerance or impaired fasting glucose also greatly increased the cardiovascular disease risk in prehypertensive people. Clinical investigation of more aggressive interventions, such as drug treatment for blood pressure control for prehypertensive individuals with impaired fasting glucose, impaired glucose tolerance, or diabetes is warranted.

A longitudinal study of hypertension risk factors and their relation to cardiovascular disease: the Strong Heart Study.

Abstract: This study estimated hypertension incidence and explored hypertension risk factors and their association with cardiovascular disease. Data collected from 4549 American Indian participants in the 3 exams of the Strong Heart Study were used. Hypertension was defined as systolic blood pressure > or =140 mm Hg, diastolic blood pressure > or =90 mm Hg, or current use of antihypertensive medication. Generalized linear models were used to identify the risk factors for hypertension and the correlates of blood pressures. Cox proportional models with time-dependent covariates and the mixed models were used to explore the association of hypertension with cardiovascular disease. There was no sex difference in hypertension. After adjustment for other risk factors, the risks of developing hypertension among subgroups in each characterized group were as follows: prehypertensive versus normotensive, 3.21 times; macroalbuminuria and microalbuminuria versus normal, 3.47 and 1.72; diabetic versus nondiabetic, 1.56; overweight and obese versus normal weight, 1.30 and 1.51; and current alcohol drinking versus not, 1.22. Moreover, systolic blood pressure was significantly and positively associated with age, obesity, and albuminuria and negatively with smoking. After adjusting all other risk factors, those pretreated, untreated, controlled, and uncontrolled hypertensive participants had &1.74, 1.81, 2.19, and 2.77 times higher risks of developing cardiovascular disease compared with normotensive participants, respectively. In 45- to 74-year-old American Indians, the risk of developing hypertension was rising. Prehypertensive participants had 3.2/1.74 times higher risk of developing hypertension/cardiovascular disease than normotensive participants. Age, diabetes, and macro/microalbuminuria were independently significant risk factors of both hypertension and cardiovascular disease.

Combined analysis of women's health initiative observational and clinical trial data on postmenopausal hormone treatment and cardiovascular disease

Abstract: Circumstances in which both randomized controlled trial and observational study data are available provide an important opportunity to identify biases and improve study design and analysis procedures. In addition, joint analyses of data from the two sources can extend clinical trial findings. The US Women's Health Initiative includes randomized controlled trials of use of estrogen by posthysterectomy women and of estrogen plus progestin by women with a uterus, along with corresponding observational study components. In this paper, for coronary heart disease, stroke, and venous thromboembolism, results are first presented from joint analysis of estrogen clinical trial and observational study data to show that residual bias patterns are similar to those previously reported for estrogen plus progestin. These findings support certain combined analyses of the observational data on estrogen and the estrogen plus progestin clinical trial and observational study data to give adjusted observational study estimates of estrogen treatment effects. The resulting treatment effect estimates are compared with corresponding clinical trial estimates, and parallel analyses are also presented for estrogen plus progestin. An application to postmenopausal hormone treatment effects on coronary heart disease among younger women is also provided.

Low-fat dietary pattern and risk of colorectal cancer: The women's health initiative randomized controlled dietary modification trial

Abstract: Previous studies have failed to document positive effects of a low-fat diet on the risk of colorectal cancer. The risk was examined in relation to the dietary pattern in the Women's Health Initiative Dietary Modification Trial. This randomized, controlled trial enrolled 48,835 postmenopausal women 50 to 79 years of age seen at 40 clinical centers throughout the United States in the years 1993-1998. The interventional diet called for at least 5 daily servings of vegetables and fruits and at least 6 servings of grains with the goal of lowering total fat to 20% of energy intake. An intensive behavioral intervention entailed 18 group sessions in the first year and, subsequently, quarterly sessions led by specially trained and certified nutritionists. Dietary goals were individualized on the basis of height. Motivational interviewing was part of the program. Forty percent of participants were assigned to the intervention and 60% to a comparison group of women who were given dietary guidelines but were not asked to change their diets. The 2 groups had similar risk profiles for colorectal cancer. During a mean follow-up interval of 8.1 years, the reduction in percentage of energy from fat was approximately 70% of that planned. Fewer than one third of women met the goal after 12 months and only 14%' at year 6. Consumption of saturated fat did decline, and women in the intervention group did eat more fruits, vegetables, and grains. Dietary intake of folate and plasma carotenoid levels increased significantly, whereas serum cholesterol levels declined. Rates of invasive colorectal cancer were 0.13% per year in the intervention group and 0.12% in the comparison group. The hazard ratio (HR) was 1.08, with a 95% confidence interval (CI) of 0.90-1.29. The cumulative hazard of colorectal cancer was very similar in the 2 management groups, and no time trend for invasive colorectal cancer was evident. Outcomes were similar in the 2 groups, and there were no significant differences in total cancer incidence, total cancer mortality, or total mortality. Tumor characteristics were similar in the 2 groups. Annualized incidence rates of self-reported colonic polyps or adenomas were lower in the intervention group (HR, 0.91; 95% CI, 0.87-0.95). The risk of colon cancer increased with advancing age, but intervention did not interact with age at baseline. This large trial gave no evidence that, when taken by midlife to late-life postmenopausal women, a low-fat diet decreases the risk of colorectal cancer over 8 years of observation.

Coronary Heart Disease Risk Equivalence in Diabetes Depends on Concomitant Risk Factors

Abstract: OBJECTIVE —Diabetes has been defined as a coronary heart disease (CHD) risk equivalent, and more aggressive treatment goals have been proposed for diabetic patients. RESEARCH DESIGN AND METHODS —We studied the influence of single and multiple risk factors on the 10-year cumulative incidence of fatal and nonfatal CHD and cardiovascular disease (CVD) in diabetic and nondiabetic men and women, with and without baseline CHD or CVD, in a population ( n = 4,549) with a high prevalence of diabetes. RESULTS —In both sexes, diabetes increased the risk for CHD (hazard ratio 1.99 and 2.93 for men and women, respectively). Diabetic men and women had a 10-year cumulative incidence of CHD of 25.9 and 19.1%, respectively, compared with 57.4 and 58.4% for nondiabetic men and women with previous CHD. The pattern was similar when only fatal events were considered. Diabetic individuals with one or two risk factors had a 10-year cumulative incidence of CHD that was only 1.4 times higher than that of nondiabetic individuals (14%). However, the 10-year incidence of CHD in diabetic subjects with multiple risk factors was >40%, and the incidence of fatal CHD was higher in these subjects than in nondiabetic subjects with previous CHD. Data for CVD showed similar patterns, as did separate analyses by sex. CONCLUSIONS —Our results and comparisons with other available data show wide variation in the rate of CHD in diabetes, depending on the population and existing risk factors. Most individuals had a 10-year cumulative incidence >20%, but only those with multiple risk factors had a 10-year cumulative incidence that was equivalent to that of patients with CHD. Until more data are available, it may be prudent to consider targets based on the entire risk factor profile rather than just the presence of diabetes.

Risk Factors for Arterial Hypertension in Adults With Initial Optimal Blood Pressure: The Strong Heart Study

Abstract: Whether metabolic factors and their change over time influence development of arterial hypertension in adults with initially optimal blood pressure (BP) is unknown. We analyzed associations of BP in the optimal range ( P P P P

Cross-Sectional Associations of Resistin, Coronary Heart Disease, and Insulin Resistance

Abstract: Context: Recently, resistin was found to be present in atherosclerotic lesions in apoE−/− mice. Resistin may be associated with inflammation and atherosclerosis in humans; however, the role of resistin in human disease remains controversial. Objective: This study assesses cross-sectional relationships of resistin with coronary heart disease (CHD). Design, Setting, and Participants: Blood samples from the third examination of the Strong Heart Study (SHS)—the largest study of CHD in American Indians—were used. Cases who had suffered previous myocardial infarction (n = 100) were selected randomly from the three SHS sites and matched for study site and sex with controls who had no history of cardiovascular disease (CHD or stroke) (n = 100). Main Outcome Measure: Resistin levels by enzyme-linked immunosorbent assay method in cases and controls was the main outcome measure. Results: Resistin levels were higher in cases than controls [median (interquartile range): 3.4 (2.5–4.7) vs. 2.8 (2.1–4.0) ng/ml; P = 0.003...

Prediction of Coronary Heart Disease in a Population With High Prevalence of Diabetes and Albuminuria The Strong Heart Study

Abstract: Background— The present article presents equations for the prediction of coronary heart disease (CHD) in a population with high rates of diabetes and albuminuria, derived from data collected in the Strong Heart Study, a longitudinal study of cardiovascular disease in 13 American Indian tribes and communities in Arizona, North and South Dakota, and Oklahoma. Methods and Results— Participants of the Strong Heart Study were examined initially in 1989–1991 and were monitored with additional examinations and mortality and morbidity surveillance. CHD outcome data through December 2001 showed that age, gender, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, smoking, diabetes, hypertension, and albuminuria were significant CHD risk factors. Hazard ratios for ages 65 to 75 years, hypertension, LDL cholesterol ≥160 mg/dL, diabetes, and macroalbuminuria were 2.58, 2.01, 2.44, 1.66, and 2.11 in men and 2.03, 1.69, 2.17, 2.26, and 2.69 in women, compared with ages 45...

Low-fat dietary pattern and risk of cardiovascular disease: The women's health initiative randomized controlled dietary modification trial

Abstract: There is not yet sufficient information to determine whether a diet that is low in fat and high in fruits, vegetables, and grains can lower the risk of cardiovascular disease (CVD). This hypothesis was tested in the Women's Health Initiative Dietary Modification Trial, a randomized, controlled study enrolling 48,835 postmenopausal women ranging in age from 50 to 79 years. The major dietary goal was to lower the intake of total fat to 20% of energy intake by eating 5 or more servings per day of fruits and vegetables and at least 6 servings of grains. Women assigned to the intervention were asked to attend 18 group sessions in the first year and then quarterly sessions conducted by specially trained, certified nutritionists. The group activities were supplemented by individual interviews. Forty percent of women were assigned to the intervention, whereas 60% in a comparison group were given written dietary guidelines and other health-related materials. The participants, seen at 40 U.S. clinical centers in the years 1993-1998 were followed up for 8.1 years on average. The demographic characteristics of this ethnically diverse study population were comparable in the intervention and comparison groups. After 6 years, the intervention group had an 8.2% lower mean total fat intake and a 2.9% lower mean saturated fat intake than at baseline. They ate less trans, monounsaturated, and polyunsaturated fat and cholesterol, but the ratio of polyunsaturated to saturated fat did not change. The dietary intervention was associated with small but significant reductions in body weight, waist circumference, and diastolic blood pressure. Serum levels of low-density lipoprotein cholesterol declined, but there were no significant changes in high-density lipoprotein cholesterol, triglycerides, or lipoprotein(a). The dietary intervention was not associated with significant changes in major coronary heart disease (CHD), which included myocardial infarction and death from CHD; composite CHD (CHD/coronary revascularization); or total, fatal, or nonfatal strokes. After excluding women with a history of CVD at baseline, the hazard ratio for CHD was 0.94 (95% confidence interval, 0.86-1.02), and that for stroke was 1.02 (95% confidence interval, 0.90-1.17). There was a trend toward greater reductions in CHD risk in participants with lower intakes of saturated fat or trans fat, and in those eating more vegetables and fruits. Hazard ratios did not change after considering adherence criteria based on participation in the interventional activities. The low-fat diet given to postmenopausal women in this study for approximately 8 years on average failed to appreciably reduce the risk of CHD or stroke. It may be that a more focused diet with greater changes in multiple macro-and micronutrients, along with alterations in behaviors that influence CVD risk factors, will be needed to achieve a substantial impact on manifestations of CVD.

Gender differences in left ventricular systolic function in American Indians (from the Strong Heart Study).

Abstract: Data from population-based studies indicate that men have a higher incidence and worse prognoses of congestive heart failure than women. Echocardiography was used to compare left ventricular (LV) myocardial and chamber contractility between 490 male and 861 female American Indian participants in the second Strong Heart Study examination. After adjusting for fat-free mass, baseline hypertension, diabetes mellitus, coronary heart disease, and alcohol consumption, LV ejection fractions were higher in women than men (66 +/- 8% vs 63 +/- 9%, p = 0.002), as were stress-corrected mid-wall shortening (106 +/- 13% vs 104+/-15%, p = 0.006) and the circumferential end-systolic stress/end-systolic volume index (7.1 x 10(4) +/- 1.9 x 10(4) vs 6.5 x 10(4) +/- 2.1 x 10(4) kdyne/cm3, all p values <0.001). LV ejection fractions were less than the predefined partition value in 4.7% of women and in 16.7% of men (odds ratio 0.25, 95% confidence interval 0.18 to 0.34, p <0.001). Stress-corrected mid-wall shortening was less than the predetermined lower limit of normal in 2.9% of women and in 6.2% of men (odds ratio 0.45, 95% confidence interval 0.29 to 0.70, p <0.001). There was no significant gender difference in supranormal function by either measure of LV systolic function. Estimated mean independent effects of female gender were a 3% greater ejection fraction, 2.7% greater stress-corrected mid-wall shortening, and a 0.4 x 10(4) kdyne/cm3 greater circumferential end-systolic stress/end-systolic volume index. In conclusion, in a population-based sample aged 45 to 74 years, women had greater LV myocardial and chamber function than men. Gender-specific partition values for measures of LV systolic function may be necessary to detect abnormal contractility in clinical and epidemiologic studies.

Diabetes mellitus and impaired fasting glucose in Alaska Eskimos: the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) study

Abstract: Aims/hypothesis We aimed to: (1) define the prevalence of type 2 diabetes and IFG in Eskimos in Norton Sound, Alaska; (2) determine correlates of prevalent diabetes in this population; and (3) compare the prevalence of diabetes in the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study with other samples of Eskimos, Inuit, American Indians and US blacks, whites and Mexican Americans.

Recruitment and community interactions in the GOCADAN study.

Abstract: Objectives. To study heart and vascular disease in Alaskan Eskimos. To identify risk factors for CVD in Norton Sound Eskimos. Study Design. Participatory research. In this paper, procedures for selection and enrollment and providing feedback and referrals are described. Our working relationships with the Norton Sound Health Corporation (NSHC) Board, the village councils, individuals, and communities are also described. Methods. This study was conducted in the Norton Sound region of Alaska. The participants were members of Alaskan Eskimo families. Results. Procedures were formed for selecting and enrolling extended families into the study and for working with the NSHC Board, the village councils, and individual participants. The average participation was 82.6% of the age-eligible villagers in seven villages. A four-level referral system was designed. Test results were provided to participants in the form of letters, with duplicates sent to health care providers and medical records. A senior researcher returned to the village to explain the results to the participants. Conclusions. Principles of participatory research applied and developed in this study led to successful screening of 1214 Eskimos in nine villages between October 2000 and June 2004. This partnership developed into a relationship with the community, in which researchers and the communities mutually participated in the study, from the initiation of the design to the return of the data to the individuals, communities, and health care providers. (Int J Circumpolar Health 2006; 65(1):55-64.) Keywords: participatory research, CVD risk factors, Alaska Natives, Inuit, Eskimos

A Quantitative Trait Loci-Specific Gene-by-Sex Interaction on Systolic Blood Pressure Among American Indians The Strong Heart Family Study

Abstract: Age-adjusted systolic blood pressure is higher in males than females. Genetic factors may account for this sex-specific variation. To localize sex-specific quantitative trait loci (QTL) influencing blood pressure, we conducted a genome scan of systolic blood pressure, in males and females, separately and combined, and tested for aggregate and QTL-specific genotype-by-sex interaction in American Indian participants of the Strong Heart Family Study. Blood pressure was measured 3 times and the average of the last 2 measures was used for analyses. Systolic blood pressure was adjusted for age and antihypertensive treatment within study center. We performed variance component linkage analysis in the full sample and stratified by sex among 1168 females and 726 males. Marker allele frequencies were derived using maximum likelihood estimates based on all individuals, and multipoint identity-by-descent sharing was estimated using Loki. We detected suggestive evidence of a QTL influencing systolic blood pressure on chromosome 17 at 129 cM between markers D17S784 and D17S928 (logarithm of odds [LOD]=2.4). This signal substantially improved when accounting for QTL-specific genotype-by-sex interaction ( P =0.04), because we observed an LOD score of 3.3 for systolic blood pressure in women on chromosome 17 at 136 cM. The magnitude of the linkage signal on chromosome 17q25.3 was slightly attenuated when participants taking antihypertensive medications were excluded, although suggestive evidence for linkage was still identified (LOD=2.8 in women). Accounting for interaction with sex improved our ability to detect QTLs and demonstrated the importance of considering genotype-by-sex interaction in our search for blood pressure genes.

Common set of genes regulates low‐density lipoprotein size and obesity‐related factors in Alaskan Eskimos: Results from the GOCADAN Study

Abstract: Increasing incidence of cardiovascular disease in traditionally low-risk Alaskan Eskimos is a cause for concern. The purpose of this study was to examine the genetic and environ- mental correlations of low-density lipoprotein (LDL) subfractions with obesity-related factors in Alaskan Eskimos, using data from the first 954 participants of the Genetics of Coronary Artery Disease in Alaska Natives Study. Estimates of genetic and environmental influence were calcu- lated using a maximum likelihood variance component method implemented in SOLAR. Mean values of weight, body mass index (BMI), and waist were 73.4 6 0.5 kg, 27.6 6 0.2 kg/m 2 , and 88.0 6 0.4 cm, respectively. LDL, and its small (LDL1), medium (LDL2), and large (LDL3) sub- fractions, had mean values of 115.8 6 1.2 mg/dl, 8.3 6 0.4 mg/dl, 19.6 6 0.8 mg/dl, and 71.5 6 1.5 mg/dl, respectively. Bivariate analysis displayed significant genetic correlations between LDL subfractions and obesity-related factors: LDL1 with BMI (rhoG ¼ 0.67, P < 0.05), waist (rhoG ¼ 0.80, P < 0.001), and subscapular and tricep skinfolds (rhoG ¼ 0.93, P < 0.005, and rhoG ¼ 0.78, P < 0.05, respectively); LDL2 with BMI (rhoG ¼ 0.52, P < 0.05), waist (rhoG ¼ 0.46, P < 0.05), and tricep skinfold (rhoG ¼ 0.60, P < 0.05); and mean LDL size with BMI (rhoG ¼� 0.36), waist (rhoG ¼� 0.42,), and subscapular and tricep skinfolds (rhoG ¼� 0.44 and � 0.43, respec- tively) (P < 0.005). These results show that a common set of genes is influencing LDL size and obe- sity-related factors in Alaskan Eskimos. Am. J. Hum. Biol. 18:525-531, 2006. ' 2006 Wiley-Liss, Inc.

Fasting Insulin and Obesity-Related Phenotypes Are Linked to Chromosome 2p: The Strong Heart Family Study

Abstract: To localize quantitative trait loci for insulin metabolism and obesity, genome scans/linkage analyses were performed on >900 members of 32 extended families participating in phase 3 of the Strong Heart Study, an investigation of the genetic and environmental determinants of cardiovascular disease in American-Indian populations from Arizona, Oklahoma, and North and South Dakota. Linkage analyses of fasting insulin and two obesity-related phenotypes, BMI and percent fat mass, were performed independently in each of the three populations. For log fasting insulin, we found a genome-wide maximum, robust logarithm of odds (LOD) score of 3.42 at 51 cM on chromosome 2p in the Dakotas. Bivariate linkage analyses of log fasting insulin with both BMI and fat mass indicate a situation of incomplete pleiotropy, as well as several significant bivariate LOD scores in the Dakotas.

Dietary fat as a risk factor for type 2 diabetes.

Abstract: Too much information is missing for a definitive recommendation to be made concerning the role of diet in the development of diabetes. Although studies in certain population subgroups show a positive correlation between amount of dietary fat intake and occurrence of type 2 diabetes, these cannot be considered definitive, in part because they are confounded by many other variables that might relate to the development of diabetes. Furthermore, dietary fat intake has not been correlated with certainty to diabetes risk factors. With regard to diabetes risk, type of dietary fat consumed may be more important than total dietary fat intake. Several studies suggest that diets higher in saturated fat may pose a higher diabetes risk than those higher in unsaturated fat. Although there is a general consensus that reduced consumption of saturated fat and cholesterol reduces CVD risk, there are no definite nutrition recommendations to prevent diabetes. The most important recommendation may be for health-care providers to carefully assess diabetes risk in their patients and institute dietary changes on an individual basis as needed to achieve and maintain body weight.

Lipids and insulin resistance: what we've learned at the Fourth International Smolenice Symposium.

Abstract: A summary of the Fourth International Smolenice Symposium on Lipids and Insulin Resistance focusing on “The Role of Fatty Acid Metabolism and Fuel Partitioning” is provided. Highlights and issues of the conference are mentioned, as well as strategies for the future.

Research with Arctic peoples: Unique research opportunities in heart, lung, blood and sleep disorders

Abstract: Arctic peoples are spread over eight countries and comprise 3.74 million residents, of whom 9% are indigenous. The Arctic countries include Canada, Finland, Greenland (Denmark), Iceland, Norway, Russia, Sweden and the United States. Although Arctic peoples are very diverse, there are a variety of environmental and health issues that are unique to the Arctic regions, and research exploring these issues offers significant opportunities, as well as challenges. On July 28-29, 2004, the National Heart, Lung, and Blood Institute and the Canadian Institutes of Health Research co-sponsored a working group entitled “Research with Arctic Peoples: Unique Research Opportunities in Heart, Lung, Blood and Sleep Disorders”. The meeting was international in scope with investigators from Greenland, Iceland and Russia, as well as Canada and the United States. Multiple health agencies from Canada and the United States sent representatives. Also attending were representatives from the International Union for Circumpolar Health (IUCH) and the National Indian Health Board. The working group developed a set of ten recommendations related to research opportunities in heart, lung, blood and sleep disorders; obstacles and solutions to research implementation; and ways to facilitate international comparisons. These recommendations are expected to serve as an agenda for future research. (Int J Circumpolar Health 2006;65(1):79-90.) Keywords: Arctic Peoples, Indigenous, research, heart disease, international collaboration

Calcium plus vitamin D supplementation and the risk of fractures: Commentary

Abstract: Randomized trials have indicated that calcium or vitamin D supplements—or both—may slow bone loss in postmenopausal women, but whether the risk of bone fracture is reduced remains uncertain. This study randomly assigned 36,282 postmenopausal women 50 to 79 years of age, who were enrolled in the Women’s Health Initiative clinical trial, to receive either 1000 mg calcium in carbonate form plus 400 IU vitamin D3 daily or placebo and followed them for an average of 7 years. Women on active treatment had levels of 25-hydroxyvitamin D 28% higher than those in placebo recipients. Bone mineral density (BMD) at the hip remained higher than in women assigned to receive placebo. The mean group difference at the ninth annual visit was 1.06%. Annualized rates of fracture per 10,000 person-years in the supplement and placebo groups were 14 and 16, respectively, for hip fracture; 44 and 44 for lower arm/wrist fractures; 14 and 15 for clinical vertebral fractures; and 164 and 170 for all fractures combined. Women assigned to supplements had a 12% lower risk of hip fracture than placebo recipients, but this was not a statistically significant effect. There were no significant group differences in rates of major diseases, including cardiovascular disease and cancer. The hazard ratio for kidney stones in women receiving supplements was 1.17 (95% confidence interval, 1.02–1.34). This finding was not related to a high baseline calcium intake. Gastrointestinal symptoms occurred in approximately 9% to 10% of both groups. In generally healthy postmenopausal women, daily supplements of calcium and vitamin D were associated with modest improvement in bone density at the hip, but did not substantially lower the risk of hip fracture in this large-scale study. Compared with placebo, supplementation did appear to increase the risk of kidney stones.